Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like B*

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

objectid	provider_source	provider_number	npi	owner_number	service_location_number	legal_name	enroll_status_eff_dt	provider_taxonomy	nemt_nmt_provider_type	anc_provider_type	fi_provider_type_cd	fi_provider_type	provider_license	fi_provider_specialty_cd	fi_provider_specialty	out_of_state_indicator	in_out_state	address_attention	address	address2	city	state	zip	zip_4	dhcs_county_cd	fips_county_cd	latitude	longitude	countyname
7	Fee-for-Service	1043330970	1043330970	1	1	BURKY, CHRISTOPHER S MD	7/8/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	178202	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
21	Fee-for-Service	1851563159	1851563159	1	1	BI-BETT	8/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	604 BROADWAY STREET	None	VALLEJO	CA	94590	3323	48	06095	38.11231984	-122.2485199	Solano County
33	Fee-for-Service	1356724967	1356724967	1	1	BAIG, ADIL M MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
45	Fee-for-Service	1851672950	1851672950	1	1	BARBOSA, VANESSA PSYD	5/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2211 POST ST	SUITE 300	SAN FRANCISCO	CA	94115	3464	38	06075	37.78446663	-122.4382772	San Francisco County
52	Fee-for-Service	1972090884	1972090884	1	1	BRASCHI, CAITLYN D MD	7/21/2021	208600000X	NA	General Surgery	026	PHYSICIANS	165051	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
56	Fee-for-Service	1528645710	1528645710	1	1	BEAN, TYLER	10/15/2024	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
90	Fee-for-Service	1386799930	1386799930	1	1	BASSLER, DAVID J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68551	66	Emergency Medicine (Urgent Care)	0	In state provider	None	185 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0000	26	06051	37.643877	-118.963932	Mono County
134	Fee-for-Service	1407111206	1407111206	1	1	BROMAGE, KEVIN S MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126286	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
162	Fee-for-Service	1245301274	1245301274	1	1	BROWN, DORIS MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39691	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
167	Fee-for-Service	1336236488	1336236488	1	1	BARNES, DERRICK J MD	9/12/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	133289	None	None	0	In state provider	None	5176 HILL ROAD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
185	Fee-for-Service	1871604314	1871604314	1	1	BAIK, CHARLES DPM	8/12/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	17400 IRVINE BLVD	STE H	TUSTIN	CA	92780	0000	30	06059	33.74814651	-117.828558	Orange County
212	Fee-for-Service	1194801167	1194801167	1	1	BEHMANESH, BEHZAD MD	4/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52472	40	Pediatrics	0	In state provider	None	2031 W ALAMEDA AVE	SUITE 214	BURBANK	CA	91506	2959	19	06037	34.15972797	-118.3237055	Los Angeles County
274	Fee-for-Service	1770628125	1770628125	1	1	BURCH, BRYAN R RPT	2/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	BURCH PHYSICAL THERAPY	320 HARTNELL AVE	None	REDDING	CA	96002	1846	45	06089	40.56651696	-122.3688485	Shasta County
295	Fee-for-Service	1336898337	1336898337	1	1	BENJAMIN HEALTHCARE	10/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	127 HOSPITAL DRIVE	SUITE 202A	VALLEJO	CA	94589	2500	48	06095	38.13103371	-122.2387342	Solano County
342	Fee-for-Service	1063020329	1063020329	1	3	BROOKE & SIMM INC	11/8/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7462 COBBLE CREEK ROAD	None	EASTVALE	CA	92880	3183	33	06065	33.95253927	-117.5801773	Riverside County
344	Fee-for-Service	1528645710	1528645710	1	1	BEAN, TYLER	10/15/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
362	Fee-for-Service	1114196508	1114196508	1	1	BENDER, JEFFREY M MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112994	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
386	Fee-for-Service	1760566830	1760566830	1	1	BURLESON, B. PAMELA	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	54119	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
392	Fee-for-Service	1235304551	1235304551	1	1	BENDIX, PETER G MD	10/14/2021	208600000X	NA	General Surgery	026	PHYSICIANS	175079	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
396	Fee-for-Service	1215917752	1215917752	1	1	BRARA, PRABHTEJ S MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62470	41	Internal Medicine	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
403	Fee-for-Service	1043221781	1043221781	1	1	BARBA, RIGOBERTO MD	2/1/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	608 COTTONWOOD ST	None	WOODLAND	CA	95695	3615	57	06113	38.67351395	-121.7933438	Yolo County
418	Fee-for-Service	1720098114	1720098114	1	1	BASS, JEFFREY H MD	1/1/1991	207P00000X	NA	Other	026	PHYSICIANS	49074	41	Internal Medicine	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
420	Fee-for-Service	1104357474	1104357474	1	1	BOVEE, KRISTIE MD	10/3/2022	207L00000X	NA	Other	026	PHYSICIANS	157029	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
440	Fee-for-Service	1457825788	1457825788	1	1	BARAJAS, ANGEL R	6/10/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND ST	STE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
490	Fee-for-Service	1255645032	1255645032	1	1	BREGMAN, THEA E MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127793	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
544	Fee-for-Service	1740595024	1740595024	1	1	BHATIA, NISHA S MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130239	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
547	Fee-for-Service	1326210246	1326210246	1	1	BHANOT, PRIYANKA S MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113155	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
570	Fee-for-Service	1417160250	1417160250	1	1	BHAKTA, ARPAN M MD	6/3/2019	207L00000X	NA	Other	026	PHYSICIANS	162087	05	Anesthesiology	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
583	Fee-for-Service	1336898337	1336898337	1	1	BENJAMIN HEALTHCARE	10/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	127 HOSPITAL DRIVE	SUITE 202A	VALLEJO	CA	94589	2500	48	06095	38.13103371	-122.2387342	Solano County
596	Fee-for-Service	1629325402	1629325402	1	1	BAUTISTA, CYNTHIA PSYD	5/4/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
616	Fee-for-Service	1659576452	1659576452	1	1	BARIL, DONALD T MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138458	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 526	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
619	Fee-for-Service	1306426986	1306426986	1	1	BHARWANI, RACHEL H MD	10/17/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
643	Fee-for-Service	1174557847	1174557847	1	1	BRIGGS, SUSAN M LMFT	10/15/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	576 B ST	STE 1A	SANTA ROSA	CA	95401	5269	49	06097	38.44377	-122.718393	Sonoma County
648	Fee-for-Service	1174735773	1174735773	1	1	BARK, KIL B CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2227 JAMES M WOOD BLVD	None	LOS ANGELES	CA	90006	2105	19	06037	34.05429163	-118.280786	Los Angeles County
650	Fee-for-Service	1114196508	1114196508	1	1	BENDER, JEFFREY M MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112994	40	Pediatrics	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
660	Fee-for-Service	1265508576	1265508576	1	1	BROWN, AMY M OD	9/9/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	421 PIONEER AVE	STE B	WOODLAND	CA	95776	4948	57	06113	38.6759259	-121.7468988	Yolo County
671	Fee-for-Service	1972527687	1972527687	1	1	BERNSTEIN, DANIEL MD	1/31/1985	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50857	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
685	Fee-for-Service	1265607584	1265607584	1	1	BRIGHT EXPECTATIONS	2/28/2000	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	10466 GRAMERCY PL	None	RIVERSIDE	CA	92505	1300	33	06065	33.93021303	-117.4824426	Riverside County
722	Fee-for-Service	1114026846	1114026846	1	1	BADIE, BEHNAM	11/30/1992	207T00000X	NA	General Surgery	026	PHYSICIANS	70593	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
739	Fee-for-Service	1982230975	1982230975	1	1	BELLO ADEJUGBA, OLUWATOMISIN	10/4/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181724	09	Gynecology (D.O. only)	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
784	Fee-for-Service	1700938925	1700938925	1	1	BLOCK, ROBERT D MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77871	30	Radiology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
823	Fee-for-Service	1932288479	1932288479	1	1	BALFOUR, MORRIS A MD	11/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	36774	04	Otology, Laryngology, Rhinology	0	In state provider	None	999 S FAIRMONT AVE	STE 215	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
838	Fee-for-Service	1861834996	1861834996	1	1	BAPAT, MANASI A MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153787	45	Nephrology (Renal-Kidney)	0	In state provider	None	2905 TELEGRAPH AVE	None	BERKELEY	CA	94705	2017	01	06001	37.85736641	-122.2594952	Alameda County
867	Fee-for-Service	1730356353	1730356353	1	1	BORAZJANI, BORIS H MD	6/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	90161	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
903	Fee-for-Service	1962497073	1962497073	1	1	BROWN, SARA A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2200 RANDALLIA DR	None	FORT WAYNE	IN	46805	4638	00	None	41.09614623	-85.11152248	Allen County
946	Fee-for-Service	1750315297	1750315297	1	1	BEYGUI, RAMIN E MD	1/1/1994	2086S0129X	NA	General Surgery	026	PHYSICIANS	73011	02	General Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
955	Fee-for-Service	1346218294	1346218294	1	1	BOSTON MEDICAL CENTER	10/17/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	85 E CONCORD STREET	SURGICAL 3	BOSTON	MA	02118	2335	00	None	42.335325	-71.072505	Suffolk County
965	Fee-for-Service	1568447456	1568447456	1	1	BAGINSKI, JOANNA MD	9/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73191	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
970	Fee-for-Service	1801008917	1801008917	1	1	BOYD, CHRISTINE R MD	1/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73013	40	Pediatrics	0	In state provider	LEHRER, CHRISTINE B MD	1119 E STANLEY BLVD	None	LIVERMORE	CA	94550	4115	01	06001	37.67890842	-121.7819392	Alameda County
1027	Fee-for-Service	1982230975	1982230975	1	1	BELLO ADEJUGBA, OLUWATOMISIN	10/4/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181724	15	Obstetrics (D.O. only)	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
1067	Fee-for-Service	1255355251	1255355251	1	1	BOWLES, HARRY F MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	61794	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
1068	Fee-for-Service	1669855664	1669855664	1	1	BEGELFER, JENNIFER L MFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23236 LYONS AVE	STE 212	SANTA CLARITA	CA	91321	5014	19	06037	34.37979236	-118.5390969	Los Angeles County
1070	Fee-for-Service	1043356751	1043356751	1	1	BARKER, BRUCE W MD INC	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	35443	40	Pediatrics	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
1075	Fee-for-Service	1548381890	1548381890	1	1	BRUZONI, MATIAS MD	6/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105639	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
1088	Fee-for-Service	1205367059	1205367059	1	1	BARUNI, JALAL K MD	5/10/2021	207L00000X	NA	Other	026	PHYSICIANS	156936	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1107	Fee-for-Service	1386627081	1386627081	1	1	BOYERS, STEPHEN P MD	12/4/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	23725	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	79 SCRIPPS DR	STE 203	SACRAMENTO	CA	95825	6208	34	06067	38.572911	-121.4105085	Sacramento County
1118	Fee-for-Service	1861834996	1861834996	1	1	BAPAT, MANASI A MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153787	41	Internal Medicine	0	In state provider	None	2905 TELEGRAPH AVE	None	BERKELEY	CA	94705	2017	01	06001	37.85736641	-122.2594952	Alameda County
1173	Fee-for-Service	1023368990	1023368990	1	1	BAUMEISTER, ELIZABETH LCSW	10/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
1191	Fee-for-Service	1689652935	1689652935	1	1	BALAA, MARWAN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42734	10	Gastroenterology (M.D. only)	0	In state provider	None	2520 SAMARITAN DR	STE 201	SAN JOSE	CA	95124	4106	43	06085	37.25213274	-121.9501476	Santa Clara County
1203	Fee-for-Service	1255665642	1255665642	1	1	BOISOT, SASKIA MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93010	01	General Practice	0	In state provider	None	555 EAST VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
1210	Fee-for-Service	1083640536	1083640536	1	1	BRAUNFELD, MICHELE Y MD	11/30/1984	207L00000X	NA	Other	026	PHYSICIANS	51050	01	General Practice	0	In state provider	None	805 W 57TH ST	None	LOS ANGELES	CA	90037	3627	19	06037	33.99054878	-118.2873305	Los Angeles County
1230	Fee-for-Service	1326579863	1326579863	1	1	BONDRE, IOANA L MD	7/7/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171540	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
1234	Fee-for-Service	1750315297	1750315297	1	1	BEYGUI, RAMIN E MD	1/1/1994	2086S0129X	NA	General Surgery	026	PHYSICIANS	73011	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
1240	Fee-for-Service	1346218294	1346218294	1	1	BOSTON MEDICAL CENTER	10/17/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	85 E CONCORD STREET	SURGICAL 3	BOSTON	MA	02118	2335	00	None	42.335325	-71.072505	Suffolk County
1252	Fee-for-Service	1629281662	1629281662	1	1	BALUYUT, IRENE D MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87105	40	Pediatrics	0	In state provider	None	1510 FLORIDA AVE	None	MODESTO	CA	95350	4439	50	06099	37.666053	-120.996222	Stanislaus County
1253	Fee-for-Service	1528066685	1528066685	1	2	BHC SIERRA VISTA HOSPITAL	8/15/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	520 PLAZA DR	None	FOLSOM	CA	95630	4791	34	06067	38.65707	-121.1733585	Sacramento County
1255	Fee-for-Service	1801008917	1801008917	1	1	BOYD, CHRISTINE R MD	1/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73013	25	Physical Medicine and Rehabilitation	0	In state provider	LEHRER, CHRISTINE B MD	1119 E STANLEY BLVD	None	LIVERMORE	CA	94550	4115	01	06001	37.67890842	-121.7819392	Alameda County
1282	Fee-for-Service	1639521602	1639521602	1	1	BARBOZA, CHRISTIE	4/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
1316	Fee-for-Service	1457075855	1457075855	1	1	BRIAN HWANG MD, INC	1/10/2024	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
1350	Fee-for-Service	1982616116	1982616116	1	1	BARONE, JOHN A DO	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	4935	01	General Practice	0	In state provider	None	434 S SAN VICENTE BLVD	None	LOS ANGELES	CA	90048	4108	19	06037	34.07053591	-118.375828	Los Angeles County
1356	Fee-for-Service	1740218064	1740218064	1	1	BEVAN, ALISON MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66187	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
1376	Fee-for-Service	1952351280	1952351280	1	1	BUCKLEY, ROBERT A MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73194	20	Orthopedic Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
1383	Fee-for-Service	1477601540	1477601540	1	1	BROWN, DANIEL R	11/2/2005	231HA2500X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	PREMIER HEARING AID CTR	5520 SANTA MONICA BLVD	STE 112	LOS ANGELES	CA	90038	2392	19	06037	34.09074149	-118.310229	Los Angeles County
1398	Fee-for-Service	1982747572	1982747572	1	2	BIER, TIFFANY LYNN RN	9/8/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1733 N ENOS CT	None	VISALIA	CA	93292	2397	54	06107	36.344592	-119.2773645	Tulare County
1479	Fee-for-Service	1982649448	1982649448	1	1	BESHARA, MARIAN N MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91972	41	Internal Medicine	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
1485	Fee-for-Service	1023185048	1023185048	1	1	BROWNING, WILLIAM H MD	6/30/1982	204D00000X	NA	Other	026	PHYSICIANS	14797	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
1498	Fee-for-Service	1932211836	1932211836	1	1	BIO-MED APPS OF CA INC	10/9/1997	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIALYSIS	737 WEST HOBSON WAY	None	BLYTHE	CA	92225	1514	33	06065	33.61029388	-114.6041861	Riverside County
1542	Fee-for-Service	1346347184	1346347184	1	1	BOTROSONS PHARMACEUTICAL	6/9/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TOWER PHARMACY	26732 CROWN VALLEY PKWY	STE 101	MISSION VIEJO	CA	92691	8531	30	06059	33.56347704	-117.66546	Orange County
1543	Fee-for-Service	1801008917	1801008917	1	1	BOYD, CHRISTINE R MD	1/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73013	01	General Practice	0	In state provider	LEHRER, CHRISTINE B MD	1119 E STANLEY BLVD	None	LIVERMORE	CA	94550	4115	01	06001	37.67890842	-121.7819392	Alameda County
1584	Fee-for-Service	1700289501	1700289501	1	1	BRYELS-NECHANICKY, RHONDA L	1/18/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	1726 TEHAMA ST	None	REDDING	CA	96001	1615	45	06089	40.58442016	-122.3951688	Shasta County
1590	Fee-for-Service	1649498403	1649498403	1	1	BRETT C HILL	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
1592	Fee-for-Service	1881987386	1881987386	2	1	BARNES, EDNA I LMFT	7/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 W OLYMPIC BLVD	1034	LOS ANGELES	CA	90015	3808	19	06037	34.04937663	-118.2745348	Los Angeles County
1620	Fee-for-Service	1215263751	1215263751	1	1	BOERMANS, NICKOLET A OD	11/24/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3939 3RD AVE	None	SAN DIEGO	CA	92103	3002	37	06073	32.74905668	-117.16268	San Diego County
1632	Fee-for-Service	1013044361	1013044361	1	1	BROOK, NANCY S NP	11/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1636	Fee-for-Service	1225293095	1225293095	1	1	BADDAY, HASAN MD	12/11/2019	208VP0014X	NA	Other	026	PHYSICIANS	122407	70	Clinic (mixed specialty)	0	In state provider	None	16405 SAND CANYON AVE	SUITE 215	IRVINE	CA	92618	3785	30	06059	33.66098519	-117.7747816	Orange County
1644	Fee-for-Service	1740218064	1740218064	1	1	BEVAN, ALISON MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66187	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
1674	Fee-for-Service	1225183221	1225183221	1	1	BOPARAI, NANAK S MD	12/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98034	40	Pediatrics	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
1675	Fee-for-Service	1386206803	1386206803	1	1	BUCKLE, KAITLIN E CNP	8/31/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
1702	Fee-for-Service	1518155357	1518155357	1	1	BEHLER, CAROLINE M MD	12/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82830	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	FL 3	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
1719	Fee-for-Service	1952920613	1952920613	1	1	BILLINGS, TAYLOR DO	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1325 N LITCHFIELD RD	110	GOODYEAR	AZ	85395	1228	00	None	33.461118	-112.355739	Maricopa County
1720	Fee-for-Service	1225175664	1225175664	1	3	BAART BEHAVIORAL HEALTH SERV	6/14/2021	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1111 MARKET STREET	FIRST AND SECOND FLOORS	SAN FRANCISCO	CA	94103	1513	38	06075	37.78018987	-122.4128297	San Francisco County
1792	Fee-for-Service	1669688552	1669688552	1	1	BRAUN, RYAN E MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103226	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
1802	Fee-for-Service	1700406014	1700406014	1	1	BHINDER, IMRIN MD	9/21/2023	207R00000X	NA	Other	026	PHYSICIANS	188767	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
1911	Fee-for-Service	1063020600	1063020600	1	1	BARCELOS, MARISSA LMFT	5/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
1913	Fee-for-Service	1730250705	1730250705	1	1	BUCHSCHACHER, GARY JR MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62544	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
1918	Fee-for-Service	1790104305	1790104305	1	1	BRUBAKER, ALEAH L MD	7/22/2019	208600000X	NA	General Surgery	026	PHYSICIANS	137609	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1921	Fee-for-Service	1881814549	1881814549	1	1	BRIAN J LEVINE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1712 W ANKLAM RD	STE 103	TUCSON	AZ	85745	0000	00	None	32.226075	-111.0023865	Pima County
1932	Fee-for-Service	1760465967	1760465967	1	1	BRADSHAW, SUSAN E MD	9/30/1986	207P00000X	NA	Other	026	PHYSICIANS	43439	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1625 HILL RD	None	NOVATO	CA	94947	4316	21	06041	38.09815363	-122.5798889	Marin County
1942	Fee-for-Service	1861625956	1861625956	1	1	BAILEY, HELEN L MD	6/8/2010	207ZP0102X	NA	Other	026	PHYSICIANS	99852	22	Pathology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
1960	Fee-for-Service	1386729721	1386729721	1	1	BERGER, GARY DAVID OD	8/14/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1861 S SAN JACINTO AVE	None	SAN JACINTO	CA	92583	5605	33	06065	33.76695754	-116.9587348	Riverside County
2004	Fee-for-Service	1891035267	1891035267	1	1	BARKLEY-BRACKETT, MONIQUE O	11/13/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	T	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
2084	Fee-for-Service	1730632944	1730632944	1	1	BHARGAVA, SURBHI MD	6/24/2023	207R00000X	NA	Other	026	PHYSICIANS	187065	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
2096	Fee-for-Service	1396877932	1396877932	1	2	BURNS, TERRI LMFT	4/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	750 TERRADO PLZ	#248	COVINA	CA	91723	3419	19	06037	34.07598226	-117.8892839	Los Angeles County
2129	Fee-for-Service	1720283393	1720283393	1	1	BASRAON, JASWANT S DO	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11348	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1313 E HERNDON AVE	STE 203	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
2134	Fee-for-Service	1972149045	1972149045	1	1	BRADFORD, LAURA B CNP	2/27/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
2141	Fee-for-Service	1487966735	1487966735	1	1	BASAK, TINA MD	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119265	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	M335	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
2174	Fee-for-Service	1346665247	1346665247	1	1	BAE, HEASUK LMFT	10/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20955 PATHFINDER RD	STE 100	DIAMOND BAR	CA	91765	4005	19	06037	33.98404595	-117.8470211	Los Angeles County
2184	Fee-for-Service	1710596663	1710596663	1	1	BARELA, SHARI A NP	1/4/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
2192	Fee-for-Service	1821595380	1821595380	1	1	BOYD, VINCENT R DO	7/26/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
2200	Fee-for-Service	1730250705	1730250705	1	1	BUCHSCHACHER, GARY JR MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62544	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
2237	Fee-for-Service	1851472088	1851472088	1	1	BOKULIC, RONALD E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
2238	Fee-for-Service	1922190693	1922190693	1	1	BAR-COHEN, YANIV MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70191	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
2243	Fee-for-Service	1558898825	1558898825	1	1	BAK, JOHN S MD	1/27/2022	390200000X	NA	Other	026	PHYSICIANS	174278	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
2264	Fee-for-Service	1205449279	1205449279	1	1	BRUER, LORYN E PT	10/30/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	79440 CORPORATE CENTER D	None	LA QUINTA	CA	92253	7243	33	06065	33.70937862	-116.2788139	Riverside County
2276	Fee-for-Service	1174670350	1174670350	1	1	BURKHAM, JENNIFER MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85894	83	Rheumatology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
2279	Fee-for-Service	1366852865	1366852865	1	1	BUCH, PREEMA M MD	8/17/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168154	None	None	0	In state provider	None	15051 HESPERIAN BLVD	SUITE A	SAN LEANDRO	CA	94578	3536	01	06001	37.703457	-122.130096	Alameda County
2288	Fee-for-Service	1306891759	1306891759	1	1	BARBER, AARON H MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68787	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
2302	Fee-for-Service	1063809218	1063809218	1	1	BARTON-GRIMLEY, JESSICA LCS	2/24/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
2307	Fee-for-Service	1699707935	1699707935	1	1	BRANDSTATER, CHERRY MD	9/30/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	33366	08	Family Practice	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
2372	Fee-for-Service	1083247514	1083247514	1	1	BROUSSEAU, ERICA F LCSW	2/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
2386	Fee-for-Service	1568478402	1568478402	1	1	BURNSTINE, MICHAEL A MD	7/10/1997	174400000X	NA	Other	026	PHYSICIANS	83967	18	Ophthalmology	0	In state provider	None	2121 WILSHIRE BLVD	STE 301	SANTA MONICA	CA	90403	5743	19	06037	34.03262306	-118.4817131	Los Angeles County
2394	Fee-for-Service	1083749212	1083749212	1	1	BENOWITZ, IRVIN S DO	6/27/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	4228	01	General Practice	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
2401	Fee-for-Service	1164497855	1164497855	1	1	BANERJEE, PUSHPENDU MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69490	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
2406	Fee-for-Service	1053386565	1053386565	1	1	BETRE, ABRAHAM DO	6/2/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10290	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	925 MERRITT AVE	None	TULARE	CA	93274	2247	54	06107	36.22198548	-119.3338395	Tulare County
2420	Fee-for-Service	1346668019	1346668019	1	1	BENCK, LILLIAN R MD	12/31/2019	207R00000X	NA	Other	026	PHYSICIANS	148263	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
2422	Fee-for-Service	1013916733	1013916733	1	1	BUCKLEY, DANIEL J MD	2/28/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	62652	18	Ophthalmology	0	In state provider	None	1800 SULLIVAN AVE	STE 410	DALY CITY	CA	94015	2224	41	06081	37.68077723	-122.4728941	San Mateo County
2448	Fee-for-Service	1033297940	1033297940	1	1	BIGELOW, BRIAN R MD	2/3/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	27731	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
2454	Fee-for-Service	1801046867	1801046867	1	1	BOONCHALERMVICHIAN,	3/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	112439	78	Neoplastic Diseases/Oncology	0	In state provider	CHAIYAPORN, MD	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
2463	Fee-for-Service	1912993155	1912993155	1	1	BRON, IGOR M MD INC	2/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	64227	05	Anesthesiology	0	In state provider	None	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
2468	Fee-for-Service	1831152750	1831152750	1	1	BOLIN, REX W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	413 LILLY RD NE	None	OLYMPIA	WA	98506	5133	00	None	47.052801	-122.847462	Thurston County
2477	Fee-for-Service	1528100112	1528100112	1	1	BAUMGARDNER, JENNIFER L LCSW	10/2/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.09817553	-118.293237	Los Angeles County
2488	Fee-for-Service	1730250705	1730250705	1	1	BUCHSCHACHER, GARY JR MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62544	68	Hematology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
2510	Fee-for-Service	1093177131	1093177131	1	1	BLOCK, JASON MD	2/10/2020	207P00000X	NA	Other	026	PHYSICIANS	161108	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
2521	Fee-for-Service	1982673406	1982673406	1	1	BORAN, KEVIN J	3/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56843	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
2522	Fee-for-Service	1578850806	1578850806	1	2	BEHSHAD, SOROOSH MD	10/9/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	135935	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
2539	Fee-for-Service	1225197833	1225197833	1	1	BLOOM, CHRISTINE A MD	12/4/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	45505	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
2551	Fee-for-Service	1508442542	1508442542	1	1	BASMADJYAN, MELISSA LCSW	3/9/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	811 W. 7TH ST.	12TH FLOOR	LOS ANGELES	CA	90017	3403	19	06037	34.0489635	-118.2591312	Los Angeles County
2564	Fee-for-Service	1174670350	1174670350	1	1	BURKHAM, JENNIFER MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85894	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
2582	Fee-for-Service	1053567644	1053567644	1	1	BASHEER, SAAD B K MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142767	38	Geriatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
2624	Fee-for-Service	1588839500	1588839500	1	1	BHAT, JYOTI MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110293	None	None	0	In state provider	None	1450 TREAT BLVD	SUITE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
2640	Fee-for-Service	1063520690	1063520690	1	1	BIRNBAUM, NINA R MD	1/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81570	08	Family Practice	0	In state provider	None	500 SAN PABLO AVE	STE 200	ALBANY	CA	94706	1127	01	06001	37.89781848	-122.3014067	Alameda County
2642	Fee-for-Service	1003946500	1003946500	1	1	BROUSSARD, SUSAN A LMFT	3/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	THERAPY	26323 JEFFERSON AVE	E111	MURRIETA	CA	92562	9514	33	06065	33.53455308	-117.1789876	Riverside County
2658	Fee-for-Service	1033135736	1033135736	1	1	BEGOVIC, SNEZANA MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85838	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
2685	Fee-for-Service	1184817850	1184817850	1	1	BECERRA, ROSALINA	8/30/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18031 US HWY 18	STE E	APPLE VALLEY	CA	92307	1221	36	06071	34.54008717	-117.2706344	San Bernardino County
2694	Fee-for-Service	1053386565	1053386565	1	1	BETRE, ABRAHAM DO	6/2/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10290	09	Gynecology (D.O. only)	0	In state provider	None	925 MERRITT AVE	None	TULARE	CA	93274	2247	54	06107	36.22198548	-119.3338395	Tulare County
2701	Fee-for-Service	1780412544	1780412544	1	1	BEACH PROFESSIONAL PHARMACY,	8/23/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17742 BEACH BLVD #100	None	HUNTINGTON BEACH	CA	92647	6818	30	06059	33.704487	-117.989061	Orange County
2707	Fee-for-Service	1043252489	1043252489	1	1	BUHAIN, ABIGAIL R MD	9/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91792	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
2743	Fee-for-Service	1801046867	1801046867	1	1	BOONCHALERMVICHIAN,	3/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	112439	68	Hematology	0	In state provider	CHAIYAPORN, MD	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
2749	Fee-for-Service	1386226611	1386226611	1	1	BAESA, RAYMAR DO	4/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20792	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
2754	Fee-for-Service	1184665911	1184665911	1	1	BUTLER, PHILIP A MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47129	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
2774	Fee-for-Service	1841614179	1841614179	1	1	BADIEFARD, HAMIDEH PT	11/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1125 E 17TH ST	STE W237	SANTA ANA	CA	92701	2205	30	06059	33.76004145	-117.854838	Orange County
2794	Fee-for-Service	1679919773	1679919773	1	1	BERGER, VICTORIA MD	7/29/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	122129	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2848	Fee-for-Service	1811962913	1811962913	1	1	BURMAN, MICHAEL H MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39377	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5301 F ST	STE 314	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
2854	Fee-for-Service	1750479002	1750479002	1	1	BAHAR, RON J MD APC	7/1/2000	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	52195	40	Pediatrics	0	In state provider	None	5363 BALBOA BLVD	STE 540	ENCINO	CA	91316	2850	19	06037	34.169058	-118.5011265	Los Angeles County
2880	Fee-for-Service	1215981535	1215981535	1	1	BROWN, DANIEL B DO	7/9/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6402	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
2965	Fee-for-Service	1356876718	1356876718	1	1	BRENNAN, JOHN L CRNA	2/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
2989	Fee-for-Service	1962455246	1962455246	1	1	BOYLE, PAUL A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	847 5TH ST	APT 103	SANTA MONICA	CA	90403	1335	19	06037	34.0243392	-118.5025771	Los Angeles County
2997	Fee-for-Service	1841686334	1841686334	1	1	BARUA, ANTARA MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154164	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
3003	Fee-for-Service	1033882824	1033882824	1	1	BEST NON-EMERGENCY MEDICAL T	8/17/2021	172A00000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5001 CALIFORNIA AVE	107	BAKERSFIELD	CA	93309	1690	15	06029	35.36332371	-119.0577919	Kern County
3112	Fee-for-Service	1528083474	1528083474	1	1	BANAIE MEDICAL CORP	9/14/2004	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	87308	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8860 CENTER DR	STE 420	LA MESA	CA	91942	7001	37	06073	32.78189749	-117.0075062	San Diego County
3140	Fee-for-Service	1750479002	1750479002	1	1	BAHAR, RON J MD APC	7/1/2000	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	52195	10	Gastroenterology (M.D. only)	0	In state provider	None	5363 BALBOA BLVD	STE 540	ENCINO	CA	91316	2850	19	06037	34.169058	-118.5011265	Los Angeles County
3141	Fee-for-Service	1538259486	1538259486	1	1	BORN, DONALD E MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89370	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3202	Fee-for-Service	1477524320	1477524320	1	1	BEMBI, ATUL DO	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	7865	08	Family Practice	0	In state provider	None	7798 CHERRY AVE	None	FONTANA	CA	92336	4014	36	06071	34.112232	-117.4887195	San Bernardino County
3222	Fee-for-Service	1144545930	1144545930	1	1	BENN, BRYAN S MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125406	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
3224	Fee-for-Service	1003351560	1003351560	1	1	BULL, SHELLEY A NP	10/12/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
3236	Fee-for-Service	1154139046	1154139046	1	1	BERKMAN, MAYA	1/15/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5807 UNIVERSITY AVE	SUITE 6	SAN DIEGO	CA	92115	6295	37	06073	32.74918877	-117.0721384	San Diego County
3274	Fee-for-Service	1275980492	1275980492	1	1	BECKER, NEISHA D CNP	5/7/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3306	Fee-for-Service	1629307533	1629307533	1	1	BANNING, CLINTON	8/22/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
3313	Fee-for-Service	1740228709	1740228709	1	1	BOISTON, CLYDE F	12/6/2010	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
3332	Fee-for-Service	1639340417	1639340417	1	1	BAMBER, SAMANTHA S MD	10/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158235	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
3341	Fee-for-Service	1609974294	1609974294	1	1	BIRDWELL, TRICIA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89563	08	Family Practice	0	In state provider	None	1133 P ST	None	FIREBAUGH	CA	93622	2230	10	06019	36.85940124	-120.4550963	Fresno County
3370	Fee-for-Service	1801023122	1801023122	1	1	BIXEL, KRISTIN L MD	10/28/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3379	Fee-for-Service	1285096594	1285096594	1	1	BAEHR, AVIGILE MD	8/13/2019	390200000X	NA	Other	026	PHYSICIANS	162858	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
3400	Fee-for-Service	1528083474	1528083474	1	1	BANAIE MEDICAL CORP	9/14/2004	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	87308	10	Gastroenterology (M.D. only)	0	In state provider	None	8860 CENTER DR	STE 420	LA MESA	CA	91942	7001	37	06073	32.78189749	-117.0075062	San Diego County
3406	Fee-for-Service	1104403591	1104403591	1	1	BONAGIRI, PRANAY DO	6/20/2024	207R00000X	NA	Other	026	PHYSICIANS	21252	41	Internal Medicine	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
3411	Fee-for-Service	1639304389	1639304389	1	1	BERNARDO, REN MD	12/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168638	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
3451	Fee-for-Service	1932387727	1932387727	1	1	BURKE, CHARLOTTE V S MD	10/14/2008	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	105056	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
3453	Fee-for-Service	1871721639	1871721639	1	1	BENJAMIN J WATTERS M.D.	11/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 WESTWOOD DR	None	HAMILTON	MT	59840	2345	00	None	46.248102	-114.1718175	Ravalli County
3546	Fee-for-Service	1871571083	1871571083	1	1	BARKMEIER, JEFFREY M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	WOODWINDS HOSPITAL	DBA ST PAUL RADIOLOGY	1925 WOODWINDS DR	WOODBURY	MN	55125	0000	00	None	0	0	None
3587	Fee-for-Service	1831108950	1831108950	1	1	BARKLEY, MARYLYNN MD	11/1/1995	207P00000X	NA	Other	026	PHYSICIANS	81763	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
3644	Fee-for-Service	1578631933	1578631933	1	1	BRAHMBHATT, NALINI S MD	1/1/2016	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	30780	40	Pediatrics	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
3658	Fee-for-Service	1801023122	1801023122	1	1	BIXEL, KRISTIN L MD	10/28/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3667	Fee-for-Service	1881753523	1881753523	1	1	BARTLETT, JEFF T CRNA	6/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
3668	Fee-for-Service	1134671571	1134671571	1	1	BENNETT, ROBERT J	10/17/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	11723 FAIR OAKS BLVD	None	FAIR OAKS	CA	95628	2816	34	06067	38.664945	-121.263111	Sacramento County
3693	Fee-for-Service	1154567857	1154567857	1	1	BURKENBINE-YAMAGUCHI, CANDY	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	100797	None	None	0	In state provider	L MD	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
3700	Fee-for-Service	1285974931	1285974931	1	1	BEST HOME CARE, LLC	6/30/2014	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	410 BEATRICE COURT	SUITE C	BRENTWOOD	CA	94513	7366	07	06013	37.95591147	-121.688217	Contra Costa County
3746	Fee-for-Service	1174822696	1174822696	1	1	BROMLEY, ERICA G MD	2/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125484	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3777	Fee-for-Service	1457909616	1457909616	1	1	BALANCIO, KATELYN A OD	9/26/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	255 E WEBER AVE	None	STOCKTON	CA	95202	2706	39	06077	37.95422434	-121.2877163	San Joaquin County
3781	Fee-for-Service	1164809463	1164809463	1	1	BASRAVI, SUNNIYA K DO	10/24/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	14608	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
3782	Fee-for-Service	1619388972	1619388972	1	1	BARSOUM, MAREEN MD	8/28/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152024	08	Family Practice	0	In state provider	None	7774 CHERRY AVE	None	FONTANA	CA	92336	4014	36	06071	34.11281482	-117.488717	San Bernardino County
3818	Fee-for-Service	1215501606	1215501606	1	1	BRIERLEY, JAKE M MD	9/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
3845	Fee-for-Service	1558921106	1558921106	1	1	BAIG, MALIKA Q MD	9/15/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178800	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
3855	Fee-for-Service	1932389277	1932389277	1	1	BRAR, RONDEEP S MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105055	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3859	Fee-for-Service	1023513983	1023513983	1	1	BAKAL, DAVID R MD	5/6/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	164553	-	NOT APPLICABLE	0	In state provider	None	1820 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87536985	-122.2622489	Alameda County
3873	Fee-for-Service	1841014255	1841014255	1	1	BENEFICIAL PHARMACY, INC.	11/26/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7220 WOODMAN AVE	STE 102	VAN NUYS	CA	91405	2665	19	06037	34.20189	-118.431221	Los Angeles County
3900	Fee-for-Service	1023750114	1023750114	1	1	BAKER, MELISSA L MD	2/26/2025	2279E0002X	NA	Other	026	PHYSICIANS	190397	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
3918	Fee-for-Service	1811962087	1811962087	1	1	BAUMAN, IRENA MD	3/9/2022	207L00000X	NA	Other	026	PHYSICIANS	54440	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
3922	Fee-for-Service	1134390222	1134390222	1	1	BERNSTEIN, IRIT PHD	7/3/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4700 SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
3936	Fee-for-Service	1386958148	1386958148	1	1	BAY AREA HOSPITALIST	11/16/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
3971	Fee-for-Service	1457463374	1457463374	1	1	BASCOM PHARMACY LLC	1/4/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	105 N BASCOM AVE	STE 101	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
4004	Fee-for-Service	1841617115	1841617115	1	1	BRANCHCOMB, JASMINE C	7/22/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	141762	30	Radiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
4043	Fee-for-Service	1407233869	1407233869	1	1	BOORTZ, KASSANDRA D LMFT	12/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
4057	Fee-for-Service	1447915830	1447915830	1	1	BIRD, JANELLE NP	6/30/2023	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
4067	Fee-for-Service	1386083228	1386083228	1	1	BASCHE, ALEX J LMFT	8/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 N MARKET	STE 950	SAN JOSE	CA	95113	1112	43	06085	37.33791617	-121.8939388	Santa Clara County
4119	Fee-for-Service	1932548682	1932548682	1	1	BAJWA, SHERRY MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152110	01	General Practice	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
4129	Fee-for-Service	1023513983	1023513983	1	2	BAKAL, DAVID R MD	8/29/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	164553	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
4134	Fee-for-Service	1568005742	1568005742	1	1	BAYO, ALEXANDRA LMFT	3/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E DAILY DR	210	CAMARILLO	CA	93010	5806	56	06111	34.21906637	-119.0621709	Ventura County
4139	Fee-for-Service	1114903523	1114903523	1	1	BRIM HEALTHCARE OF TEXAS LLC	3/27/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1000 PINE ST	None	TEXARKANA	TX	75505	5100	00	None	33.4279615	-94.04693292	Bowie County
4143	Fee-for-Service	1932389277	1932389277	1	1	BRAR, RONDEEP S MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105055	68	Hematology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
4152	Fee-for-Service	1386662377	1386662377	1	1	BAILEY, JOHN S MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81491	05	Anesthesiology	0	In state provider	None	16300 SAND CANYON AVE	STE 506	IRVINE	CA	92618	3705	30	06059	33.66115075	-117.7742405	Orange County
4163	Fee-for-Service	1922140706	1922140706	1	1	BUCHANAN, KEITH C MD	8/12/2022	207P00000X	NA	Other	026	PHYSICIANS	175367	None	None	0	In state provider	None	3800 JANES RD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
4167	Fee-for-Service	1982866877	1982866877	1	1	BATH, SHELLEY S MD	10/9/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	105524	30	Radiology	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
4208	Fee-for-Service	1699970632	1699970632	1	1	BUI, AU H MD	12/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92745	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
4224	Fee-for-Service	1386958148	1386958148	1	1	BAY AREA HOSPITALIST	11/16/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	ASSOCIATES	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
4290	Fee-for-Service	1306890827	1306890827	1	1	BILAL, BASSAM R MD	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150299	41	Internal Medicine	0	In state provider	None	710 N EUCLID ST	101	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
4294	Fee-for-Service	1710295464	1710295464	1	1	BHAT, PRASHANTH M N MD	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142712	01	General Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
4325	Fee-for-Service	1962656058	1962656058	1	1	BUHAY, CAROLINE M MD	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135806	05	Anesthesiology	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
4353	Fee-for-Service	1912159674	1912159674	1	1	BERGGREN, ERICA K	7/9/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158543	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12264 EL CAMINO REAL	STE 204	SAN DIEGO	CA	92130	3061	37	06073	32.93959909	-117.2401598	San Diego County
4416	Fee-for-Service	1609935287	1609935287	1	1	BALICA, MIHAELA R MD	7/1/1998	207R00000X	NA	Other	026	PHYSICIANS	63010	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
4427	Fee-for-Service	1114903523	1114903523	1	1	BRIM HEALTHCARE OF TEXAS LLC	3/27/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1000 PINE ST	None	TEXARKANA	TX	75505	5100	00	None	33.4279615	-94.04693292	Bowie County
4430	Fee-for-Service	1932389277	1932389277	1	1	BRAR, RONDEEP S MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105055	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
4435	Fee-for-Service	1932235256	1932235256	1	1	BOGGS, AUDREY E	4/28/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30423 CANWOOD ST	SUITE 138	AGOURA HILLS	CA	91301	4315	19	06037	34.14710182	-118.7842501	Los Angeles County
4512	Fee-for-Service	1801861547	1801861547	1	1	BISHARAT, KATHERINE B MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	48709	41	Internal Medicine	0	In state provider	INTERNAL MED & WELLNESS	5931 STANLEY AVE	STE 8	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
4573	Fee-for-Service	1366676165	1366676165	1	1	BALGUMA, BERENISE L LCSW	7/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
4578	Fee-for-Service	1134719875	1134719875	1	1	BREAST PUMP GENIE LLC.	11/24/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1804 CABLE	#A #3	SAN DIEGO	CA	92107	3141	37	06073	32.74425582	-117.2507122	San Diego County
4588	Fee-for-Service	1215609946	1215609946	1	1	BISHWAKARMA, SUBASH MD	4/22/2024	207R00000X	NA	Other	026	PHYSICIANS	191158	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
4600	Fee-for-Service	1912550336	1912550336	1	1	BHOPAL, NAMITA MD	8/29/2023	207L00000X	NA	Other	026	PHYSICIANS	181670	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
4643	Fee-for-Service	1306958897	1306958897	1	1	BUNDY, LOGAN K MD	10/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30561	66	Emergency Medicine (Urgent Care)	0	In state provider	None	533 SESPE AVE	STE B	FILLMORE	CA	93015	1942	56	06111	34.4005357	-118.9150097	Ventura County
4714	Fee-for-Service	1316283534	1316283534	1	1	BEST GOLDEN CARE HOSPICE	4/10/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	11745 EDINGER AVE	None	FOUNTAIN VALLEY	CA	92708	1208	30	06059	33.72922911	-117.9241365	Orange County
4740	Fee-for-Service	1174848444	1174848444	1	1	BENGIAMIN, DEENA I MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119444	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
4776	Fee-for-Service	1710924584	1710924584	1	1	BROWN,JOHN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CASA GRANDE REGIONAL	1800 E FLORENCE BLVD	None	CASA GRAND	AZ	85222	5303	00	None	32.881311	-111.7096155	Pinal County
4797	Fee-for-Service	1720110315	1720110315	1	1	BARONE, JULIE L DO	9/6/2007	208600000X	NA	General Surgery	026	PHYSICIANS	9864	02	General Surgery	0	In state provider	None	1325 E CHURCH ST	STE 202	SANTA MARIA	CA	93454	5909	42	06083	34.95209265	-120.4147348	Santa Barbara County
4799	Fee-for-Service	1801861547	1801861547	1	1	BISHARAT, KATHERINE B MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	48709	66	Emergency Medicine (Urgent Care)	0	In state provider	INTERNAL MED & WELLNESS	5931 STANLEY AVE	STE 8	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
4843	Fee-for-Service	1215955596	1215955596	1	1	BLUMKIN, DANIEL M MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88501	08	Family Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94901	3308	21	06041	38.00450116	-122.5540001	Marin County
4868	Fee-for-Service	1477552941	1477552941	1	1	BARRETTO, ROBERTO L MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81316	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	STE 604	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
4875	Fee-for-Service	1184772022	1184772022	1	1	BYRNES, MATTHEW T DPM	5/19/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
4929	Fee-for-Service	1932555356	1932555356	1	1	BUTLER, DAVID S MD	7/9/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168610	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
4932	Fee-for-Service	1306958897	1306958897	1	1	BUNDY, LOGAN K MD	10/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30561	08	Family Practice	0	In state provider	None	533 SESPE AVE	STE B	FILLMORE	CA	93015	1942	56	06111	34.4005357	-118.9150097	Ventura County
4938	Fee-for-Service	1730570326	1730570326	1	1	BAN, DAVID M MD	4/26/2022	207R00000X	NA	Other	026	PHYSICIANS	158319	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
5000	Fee-for-Service	1194818484	1194818484	1	1	BRENNAN, GARY B MD	11/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171840	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
5002	Fee-for-Service	1316283534	1316283534	1	1	BEST GOLDEN CARE HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	11745 EDINGER AVE	None	FOUNTAIN VALLEY	CA	92708	1208	30	06059	33.72922911	-117.9241365	Orange County
5010	Fee-for-Service	1265886220	1265886220	1	1	BALOG, SARAH E DO	7/29/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
5035	Fee-for-Service	1669652533	1669652533	1	2	BROWN, DAVID D DO	5/22/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	9542	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	990 SONOMA AVENUE	SUITE 17	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
5115	Fee-for-Service	1558657106	1558657106	1	2	BATTAGLIA, CHRISTINE L DO	2/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	12492	08	Family Practice	0	In state provider	O	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
5130	Fee-for-Service	1588715288	1588715288	1	1	BANKS, LARRY OD	9/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
5131	Fee-for-Service	1073522884	1073522884	1	1	BASTA, ONSY	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48938	40	Pediatrics	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
5132	Fee-for-Service	1356359830	1356359830	1	1	BECKER, JOHN C MD	7/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	17632	20	Orthopedic Surgery	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
5138	Fee-for-Service	1215940283	1215940283	1	1	BREUNER, LISA DPM	1/31/2025	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
5155	Fee-for-Service	1861570467	1861570467	1	1	BURRI, ROBERT A MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64408	20	Orthopedic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
5157	Fee-for-Service	1477552941	1477552941	1	1	BARRETTO, ROBERTO L MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81316	04	Otology, Laryngology, Rhinology	0	In state provider	None	1201 W LA VETA AVE	STE 604	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
5192	Fee-for-Service	1932345105	1932345105	1	1	BARJAKTAREVIC, IGOR MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121964	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
5220	Fee-for-Service	1013294727	1013294727	1	1	BOWERS, OWEN J MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118814	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
5249	Fee-for-Service	1982161949	1982161949	1	1	BOGAN, DANIELLE LMFT	1/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
5251	Fee-for-Service	1679632269	1679632269	1	1	BEDRI, JONATHAN M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29996	13	Neurology (M.D. only)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
5295	Fee-for-Service	1336595776	1336595776	1	1	BANIHASHEMI, ASHKON S MD	10/18/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157733	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
5305	Fee-for-Service	1881786390	1881786390	1	1	BRAID, CHRISTINE	9/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8955	08	Family Practice	0	In state provider	None	8001 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7901	34	06067	38.664486	-121.266099	Sacramento County
5384	Fee-for-Service	1851745228	1851745228	1	1	BENSON, DARIK S MD	4/14/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
5401	Fee-for-Service	1881882157	1881882157	1	1	BEHBAHANI, SOHRAB MD INC	5/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	32669	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2626 EDITH AVE	STE B	REDDING	CA	96001	3056	45	06089	40.57103976	-122.3974622	Shasta County
5442	Fee-for-Service	1730166208	1730166208	1	1	BAUMEL, ABRAHAM S MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84821	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
5457	Fee-for-Service	1639136922	1639136922	1	1	BRYAN C. DRYER M.D.	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
5479	Fee-for-Service	1932345105	1932345105	1	1	BARJAKTAREVIC, IGOR MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121964	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
5485	Fee-for-Service	1801184973	1801184973	1	1	BORDIN-WOSK, TALYA S MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123772	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
5494	Fee-for-Service	1932354321	1932354321	1	1	BAJADA, DIANE E NP	4/15/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	17	06033	39.03772106	-122.9223338	Lake County
5512	Fee-for-Service	1184797326	1184797326	1	1	BOBBALA, MANJULA MD	4/7/2020	207R00000X	NA	Other	026	PHYSICIANS	87444	41	Internal Medicine	0	In state provider	None	3400 BELL RD	None	AUBURN	CA	95603	9241	31	06061	38.94188162	-121.1099369	Placer County
5514	Fee-for-Service	1588322721	1588322721	1	1	BONGIOVANNI, JOSHUA M PT	2/9/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1700 KEYSTONE PACIFIC PK	STE C2	PATTERSON	CA	95363	8874	50	06099	37.47600952	-121.160718	Stanislaus County
5534	Fee-for-Service	1780680967	1780680967	1	1	BV GENERAL INCORPORATED	12/1/1988	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1016 S RECORD AVE	None	LOS ANGELES	CA	90023	2533	19	06037	34.02163549	-118.182629	Los Angeles County
5553	Fee-for-Service	1710300447	1710300447	1	1	BOROVSKY, VICTORIA MD INC	2/28/2014	261QP2300X	NA	Other	026	PHYSICIANS	82605	41	Internal Medicine	0	In state provider	None	17777 VENTURA BLVD	SUITE 209	ENCINO	CA	91316	3736	19	06037	34.16286556	-118.5200521	Los Angeles County
5575	Fee-for-Service	1760026298	1760026298	1	1	BLISS HEALTH CARE SERVICES	6/15/2022	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1501 W WASHINGTON BLVD	None	LOS ANGELES	CA	90007	1258	19	06037	34.04003748	-118.2899295	Los Angeles County
5586	Fee-for-Service	1205091329	1205091329	1	1	BALDANDAPANI, PARAMESHWARI	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56171	30	Radiology	0	In state provider	MD	1817 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	5008	15	06029	35.37326659	-119.0227581	Kern County
5591	Fee-for-Service	1720541238	1720541238	1	1	BOROWY, CHRISTOPHER	1/6/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
5596	Fee-for-Service	1093788507	1093788507	1	1	BUTLER, MARILYN W MD	7/24/2000	208600000X	NA	General Surgery	026	PHYSICIANS	83354	02	General Surgery	0	In state provider	None	744 52ND ST	STE 4100	OAKLAND	CA	94609	1810	01	06001	37.83734299	-122.2677613	Alameda County
5612	Fee-for-Service	1295293629	1295293629	1	1	BEST PALLIATIVE HOSPICE CARE	5/8/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	21220 DEVONSHIRE ST	SUITE 201	CHATSWORTH	CA	91311	8275	19	06037	34.25721448	-118.594494	Los Angeles County
5620	Fee-for-Service	1881673713	1881673713	1	1	BRASHEAR, ALLISON MD	11/25/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	164732	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
5675	Fee-for-Service	1801431036	1801431036	1	1	BANDONELL, OLIVER T CRNA	6/18/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
5681	Fee-for-Service	1255919346	1255919346	1	1	BAEK, MICHELLE DO	7/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
5686	Fee-for-Service	1427569037	1427569037	1	1	BRIGHT HEART HEALTH MEDICAL	8/3/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
5752	Fee-for-Service	1396467155	1396467155	1	1	BARAJAS, ANNABEL LCSW	4/26/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	109958	-	NOT APPLICABLE	0	In state provider	None	510 EAST MAGNOLIA ST	100	STOCKTON	CA	95202	1812	39	06077	37.96446348	-121.2872245	San Joaquin County
5758	Fee-for-Service	1932345105	1932345105	1	1	BARJAKTAREVIC, IGOR MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
5764	Fee-for-Service	1033102074	1033102074	1	1	BARRY, CHARISH L MD	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72798	40	Pediatrics	0	In state provider	None	PO BOX 689	None	SANTA BARBARA	CA	93102	0689	42	06083	0	0	None
5803	Fee-for-Service	1801843743	1801843743	1	1	BHAGAT, BIPINCHANDRA MD	11/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55207	77	Infectious Disease	0	In state provider	None	12677 HESPERIA RD	STE 150	VICTORVILLE	CA	92395	7735	36	06071	34.48148078	-117.2906175	San Bernardino County
5806	Fee-for-Service	1326110354	1326110354	1	1	BOOMER, GREG OD	1/31/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	607 COTTAGE ST	STE A	SUSANVILLE	CA	96130	4379	18	06035	40.41779983	-120.6629432	Lassen County
5813	Fee-for-Service	1801851670	1801851670	1	1	BRYAN, THOMAS O MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	49736	20	Orthopedic Surgery	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
5867	Fee-for-Service	1336761519	1336761519	1	1	BOCK, ALEXANDRA M CRNA	6/24/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
5881	Fee-for-Service	1548222961	1548222961	1	1	BARBA, CELINA M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68136	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
5887	Fee-for-Service	1093788507	1093788507	1	1	BUTLER, MARILYN W MD	7/24/2000	208600000X	NA	General Surgery	026	PHYSICIANS	83354	40	Pediatrics	0	In state provider	None	744 52ND ST	STE 4100	OAKLAND	CA	94609	1810	01	06001	37.83734299	-122.2677613	Alameda County
5899	Fee-for-Service	1295293629	1295293629	1	1	BEST PALLIATIVE HOSPICE CARE	5/8/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	21220 DEVONSHIRE ST	SUITE 201	CHATSWORTH	CA	91311	8275	19	06037	34.25721448	-118.594494	Los Angeles County
5921	Fee-for-Service	1356746192	1356746192	1	1	BADE, KRISTINE J G	3/3/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
5945	Fee-for-Service	1477180404	1477180404	1	1	BUI, HOAI T MD	7/31/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
5975	Fee-for-Service	1427569037	1427569037	1	1	BRIGHT HEART HEALTH MEDICAL	8/13/2020	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
6030	Fee-for-Service	1144426875	1144426875	1	1	BAUER, BETH J	6/14/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
6047	Fee-for-Service	1720020464	1720020464	1	1	BOULDOUKIAN, KEVORK A MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55931	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
6057	Fee-for-Service	1437337789	1437337789	1	1	BLEWS III, EDWARD O MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105699	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
6084	Fee-for-Service	1316913833	1316913833	1	1	BELOTT, PETER H MD INC	6/29/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	35571	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1625 E MAIN ST	STE 202	EL CAJON	CA	92021	5245	37	06073	32.80969963	-116.9203429	San Diego County
6087	Fee-for-Service	1942761689	1942761689	1	1	BHARDWAJ, KANIKA MD	5/8/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	180309	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
6091	Fee-for-Service	1801843743	1801843743	1	1	BHAGAT, BIPINCHANDRA MD	11/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55207	41	Internal Medicine	0	In state provider	None	12677 HESPERIA RD	STE 150	VICTORVILLE	CA	92395	7735	36	06071	34.48148078	-117.2906175	San Bernardino County
6107	Fee-for-Service	1013116748	1013116748	1	1	BAY SPINE SURGERY CENTER LLC	3/10/2016	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3065 RICHMOND PKWY	SUITE 100	RICHMOND	CA	94806	5718	07	06013	37.99005286	-122.3297916	Contra Costa County
6108	Fee-for-Service	1538633367	1538633367	1	1	BASBAS, MANUEL E RCP	9/27/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
6142	Fee-for-Service	1073018966	1073018966	1	1	BAQAI, ZANE A MD	5/28/2020	207R00000X	NA	Other	026	PHYSICIANS	17938	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
6145	Fee-for-Service	1336179852	1336179852	1	1	BENAK, JONATHAN J PA	4/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15143	-	NOT APPLICABLE	0	In state provider	None	1028 RENO AVE	None	MODESTO	CA	95351	1127	50	06099	37.648989	-121.0279415	Stanislaus County
6148	Fee-for-Service	1578945663	1578945663	1	1	BOPARAI, RAJNI MD	8/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154666	41	Internal Medicine	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
6158	Fee-for-Service	1134689474	1134689474	1	1	BRUMLEY, BEATRICE A MD	8/7/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	177622	41	Internal Medicine	0	In state provider	None	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
6162	Fee-for-Service	1881993632	1881993632	1	1	BRIAN J YUM, M.D.	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	55 FRUIT ST	BUL-2	BOSTON	MA	02114	2621	00	None	42.363216	-71.0687745	Suffolk County
6174	Fee-for-Service	1093788507	1093788507	1	1	BUTLER, MARILYN W MD	7/24/2000	208600000X	NA	General Surgery	026	PHYSICIANS	83354	85	Surgery-Pediatric	0	In state provider	None	744 52ND ST	STE 4100	OAKLAND	CA	94609	1810	01	06001	37.83734299	-122.2677613	Alameda County
6182	Fee-for-Service	1427113034	1427113034	1	1	BALDWIN, MARI KRISA MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77658	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
6193	Fee-for-Service	1659578698	1659578698	1	1	BARBARINO, SHEILA C MD	6/24/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	107345	18	Ophthalmology	0	In state provider	None	420 E THIRD ST	STE 603	LOS ANGELES	CA	90013	1645	19	06037	34.04702011	-118.241912	Los Angeles County
6208	Fee-for-Service	1033582796	1033582796	1	1	BLANK, ERIC W LMFT	2/4/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	110647	-	NOT APPLICABLE	0	In state provider	None	2219 ODESSA CT	None	LEMON GROVE	CA	91945	3609	37	06073	32.72894008	-117.0384673	San Diego County
6217	Fee-for-Service	1396183703	1396183703	1	1	BUCKLEY, BRIAN J MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134294	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
6248	Fee-for-Service	1932458825	1932458825	1	1	BARNES, SHAWN MD	5/26/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	127179	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
6262	Fee-for-Service	1427569037	1427569037	1	1	BRIGHT HEART HEALTH MEDICAL	12/18/2017	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
6302	Fee-for-Service	1720367352	1720367352	1	1	BOKOCH, MICHAEL P MD	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123771	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
6312	Fee-for-Service	1699819086	1699819086	1	1	BAHIRAEI, FROHAR MD	1/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	123573	02	General Surgery	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0000	26	06051	37.64575895	-118.9638914	Mono County
6322	Fee-for-Service	1164871133	1164871133	1	1	BUI, KIM H MD	7/10/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168848	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
6327	Fee-for-Service	1447314828	1447314828	1	1	BAHUGUNA, CHARU NP	7/6/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
6373	Fee-for-Service	1316913833	1316913833	1	1	BELOTT, PETER H MD INC	6/29/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	35571	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1625 E MAIN ST	STE 202	EL CAJON	CA	92021	5245	37	06073	32.80969963	-116.9203429	San Diego County
6387	Fee-for-Service	1487737573	1487737573	1	1	BERNARD, LEAH S MD	8/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	2911 SISKIYOU BLVD	None	MEDFORD	OR	97504	8179	00	None	42.31964683	-122.8279156	Jackson County
6406	Fee-for-Service	1043507668	1043507668	1	1	BARROWS, BRAD D DO	1/23/2020	207ZP0101X	NA	Other	026	PHYSICIANS	13863	22	Pathology (M.D. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
6421	Fee-for-Service	1164696035	1164696035	1	1	BRODT, CHAD R MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130241	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
6434	Fee-for-Service	1679998827	1679998827	1	2	BENSON, AKEELA NP	9/9/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95011471	-	NOT APPLICABLE	0	In state provider	None	5190 ATLANTIC AVE	None	LONG BEACH	CA	90805	6510	19	06037	33.850449	-118.1848215	Los Angeles County
6446	Fee-for-Service	1134689474	1134689474	1	1	BRUMLEY, BEATRICE A MD	8/7/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	177622	67	Endocrinology	0	In state provider	None	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
6466	Fee-for-Service	1134784168	1134784168	1	1	BUETHE, MARIA G MD	8/16/2024	207NP0225X	NA	Dermatology	026	PHYSICIANS	187371	07	Dermatology	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
6467	Fee-for-Service	1720215866	1720215866	1	1	BOLOUR, ADAM R MD	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101929	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
6470	Fee-for-Service	1871761809	1871761809	1	1	BEHSERESHT, DARIAN J MD	12/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92963	02	General Surgery	0	In state provider	None	11370 ANDERSON STREET	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
6471	Fee-for-Service	1316261266	1316261266	1	1	BAGOT, KARA S MD	10/17/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144536	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
6487	Fee-for-Service	1063255735	1063255735	1	1	BROWN AND PIPKINS CORPORATIO	6/28/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10924 S VERMONT AVE	None	LOS ANGELES	CA	90044	3016	19	06037	33.93659323	-118.2915675	Los Angeles County
6490	Fee-for-Service	1386653178	1386653178	1	1	BARLOW, SEAN A MD	12/17/2018	2084P0802X	NA	Psychiatry	026	PHYSICIANS	78296	36	Psychiatry	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
6492	Fee-for-Service	1356502207	1356502207	1	1	BUCHAN, SUSAN PHD	5/12/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	838 W 19TH ST	None	MERCED	CA	95340	4609	24	06047	37.30539882	-120.4875986	Merced County
6498	Fee-for-Service	1124525340	1124525340	1	1	BACALSO, APRYL PT	9/8/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
6509	Fee-for-Service	1124115431	1124115431	1	1	BLYTHE HEALTH CLINIC	10/1/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1415 W HOBSONWAY	None	BLYTHE	CA	92225	1651	33	06065	33.611922	-114.613272	Riverside County
6550	Fee-for-Service	1427569037	1427569037	1	1	BRIGHT HEART HEALTH MEDICAL	11/16/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
6558	Fee-for-Service	1265922538	1265922538	1	1	BANDURA, JULIAN DO	11/26/2021	390200000X	NA	Other	026	PHYSICIANS	17882	None	None	0	In state provider	None	345 S. HALCYON RD.	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
6559	Fee-for-Service	1306823679	1306823679	1	1	BARTON, KEVIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2160 S 1ST AVE	None	MAYWOOD	IL	60153	3328	00	None	41.86025379	-87.83381752	Cook County
6568	Fee-for-Service	1780690610	1780690610	1	1	BRITT,ALLAN R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MARICOPA MEDICAL CENTER	2601 ROOSEVELT ST	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
6573	Fee-for-Service	1770681488	1770681488	1	1	BABBITT, JILL LCSW	11/19/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	415 HIGHWAY 101 S	SUITE 1	CRESCENT CITY	CA	95531	4378	08	06015	41.75204002	-124.1847846	Del Norte County
6588	Fee-for-Service	1174823363	1174823363	1	1	BADALIAN, VAHE MD INC	8/22/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45222	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1530 E CHEVY CHASE DR	SUITE 201	GLENDALE	CA	91206	4139	19	06037	34.150689	-118.2303855	Los Angeles County
6589	Fee-for-Service	1689671976	1689671976	1	1	BOEHM, KARIN N OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2655 CLEVELAND AVENUE	SUITE A	SANTA ROSA	CA	95403	2779	49	06097	38.463354	-122.7288645	Sonoma County
6594	Fee-for-Service	1467658062	1467658062	1	1	BARTE, FELISE MAY G MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121145	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
6596	Fee-for-Service	1295357416	1295357416	1	1	BREWINGTON, JOHN B MD	9/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186349	None	None	0	In state provider	None	1901 W LUGONIA AVE	STE 120	REDLANDS	CA	92374	9704	36	06071	34.07027851	-117.218421	San Bernardino County
6607	Fee-for-Service	1902944648	1902944648	2	1	BEACH MEDICAL RX INC	6/2/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BEACH MEDICAL PHARMACY	5230 BEACH BLVD	None	BUENA PARK	CA	90621	1230	30	06059	33.88543513	-117.994644	Orange County
6611	Fee-for-Service	1740570944	1740570944	1	1	BUTRYMOWICZ, ANNA MD	6/11/2018	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	155938	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
6615	Fee-for-Service	1285770115	1285770115	1	1	BASTA, MERVAT M MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55540	None	None	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
6633	Fee-for-Service	1609803048	1609803048	1	1	BAZRON, HERBERT MD	10/22/2020	207R00000X	NA	Other	026	PHYSICIANS	159334	41	Internal Medicine	0	In state provider	None	1100 TRANCAS ST	SUITE 201	NAPA	CA	94558	2904	28	06055	38.32316569	-122.2981938	Napa County
6656	Fee-for-Service	1992958847	1992958847	1	1	BAY IMAGING CONSULTANTS	2/28/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	2001 DWIGHT WAY	STE A	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
6690	Fee-for-Service	1386738367	1386738367	1	1	BARRON, JOHN G OD	10/31/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2020 HIGH ST	STE I	SELMA	CA	93662	3518	10	06019	36.56926799	-119.612517	Fresno County
6696	Fee-for-Service	1598723058	1598723058	1	1	BHOGILL, ARCHANA P MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54134	08	Family Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
6709	Fee-for-Service	1164696035	1164696035	1	1	BRODT, CHAD R MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130241	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
6714	Fee-for-Service	1285836403	1285836403	1	1	BORAU, NICOLE C MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107439	67	Endocrinology	0	In state provider	None	751 S BASCOM AVENUE	ATTN DR. A BANUELOS	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
6752	Fee-for-Service	1134784168	1134784168	1	1	BUETHE, MARIA G MD	8/16/2024	207NP0225X	NA	Dermatology	026	PHYSICIANS	187371	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
6758	Fee-for-Service	1497245815	1497245815	1	1	BATHAM, DIANE E NP	10/10/2018	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
6798	Fee-for-Service	1124115431	1124115431	1	1	BLYTHE HEALTH CLINIC	2/12/1996	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1415 W HOBSONWAY	None	BLYTHE	CA	92225	1651	33	06065	33.611922	-114.613272	Riverside County
6838	Fee-for-Service	1427569037	1427569037	1	1	BRIGHT HEART HEALTH MEDICAL	10/27/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
6881	Fee-for-Service	1639556608	1639556608	1	1	BECKETT, JULIE L NP	11/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
6900	Fee-for-Service	1326076019	1326076019	1	1	BINDER, SCOTT W MD	2/28/1991	207ZP0101X	NA	Other	026	PHYSICIANS	59803	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B-186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
6906	Fee-for-Service	1780926352	1780926352	1	1	BEKAREV, MIKHAIL MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152010	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
6929	Fee-for-Service	1992862106	1992862106	1	1	BIGGS, JUDE A PT	2/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
6944	Fee-for-Service	1609258284	1609258284	1	1	BIO-MEDICAL APPLICATIONS OF	2/22/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, INC	27420 IRIS AVE	None	MORENO VALLEY	CA	92555	5700	33	06065	33.89551764	-117.1846606	Riverside County
7008	Fee-for-Service	1174797948	1174797948	1	1	BROWN, RICA B MD	1/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136995	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
7017	Fee-for-Service	1881611457	1881611457	1	1	BAKONDY, SHARON L CRNA	1/1/2002	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
7027	Fee-for-Service	1932392057	1932392057	1	1	BURGAMY, KIRK P MD	6/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97787	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
7030	Fee-for-Service	1861652679	1861652679	1	1	BRUSCA, TERALYN RIGGS	6/19/2008	163WP0200X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5140 HALLWOOD AVE	None	RIVERSIDE	CA	92506	1412	33	06065	33.95836088	-117.3737913	Riverside County
7045	Fee-for-Service	1881790426	1881790426	1	1	BERGERT, LORA J MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
7077	Fee-for-Service	1609123504	1609123504	1	2	BROWN, CHRISTOPHER O MD	9/25/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	126975	-	NOT APPLICABLE	0	In state provider	None	1000 W CARSON ST	PCDC MODULE B & C	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
7087	Fee-for-Service	1124115431	1124115431	1	1	BLYTHE HEALTH CLINIC	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1415 W HOBSONWAY	None	BLYTHE	CA	92225	1651	33	06065	33.611922	-114.613272	Riverside County
7093	Fee-for-Service	1932195765	1932195765	1	1	BAYER, CATHERINE A PHD	1/1/1995	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3220 MATANZAS CREEK LN	None	SANTA ROSA	CA	95404	9851	49	06097	38.381787	-122.593923	Sonoma County
7098	Fee-for-Service	1023154358	1023154358	1	1	BREWER, MARK C LMFT	11/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
7103	Fee-for-Service	1487210373	1487210373	1	1	BAER, MICHELLE	1/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176816	None	None	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
7109	Fee-for-Service	1285722157	1285722157	1	1	BUZI, NADAV A MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54233	40	Pediatrics	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
7113	Fee-for-Service	1942575022	1942575022	1	1	BOSHRA, HEBA A MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120531	01	General Practice	0	In state provider	None	8110 MANGO AVE	STE 104	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
7119	Fee-for-Service	1124559356	1124559356	1	1	BURKY, ROBERT E MD	9/5/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	156874	None	None	0	In state provider	None	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	31	06061	38.74953449	-121.2601832	Placer County
7138	Fee-for-Service	1285255265	1285255265	1	1	BIHM, DUSTIN MD	1/24/2025	390200000X	NA	Other	026	PHYSICIANS	184463	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
7146	Fee-for-Service	1588081954	1588081954	1	1	BUSH, AMANDA R CRNA	8/17/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
7147	Fee-for-Service	1619961497	1619961497	1	1	BENJAMIN S PARAS M.D.	12/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
7154	Fee-for-Service	1437387321	1437387321	1	1	BARKLEY, CLAIRE A LMFT	7/28/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
7157	Fee-for-Service	1033475199	1033475199	1	1	BROWN, STEPHEN E MD INC	11/12/2015	193400000X	NA	Other	026	PHYSICIANS	28692	41	Internal Medicine	0	In state provider	None	4300 LONG BEACH BLVD	SUITE 405	LONG BEACH	CA	90807	2008	19	06037	33.83662572	-118.1900605	Los Angeles County
7165	Fee-for-Service	1699775072	1699775072	1	1	BROWN, JOHN LEROY MD	3/16/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43493	01	General Practice	0	In state provider	None	341 PAULIN AVE	None	CALEXICO	CA	92231	2639	13	06025	32.66819197	-115.4975676	Imperial County
7169	Fee-for-Service	1346673001	1346673001	1	1	BLANCO, JAVIER MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136368	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
7188	Fee-for-Service	1730138876	1730138876	1	1	BOURGON, DOUGLAS R MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85247	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
7200	Fee-for-Service	1649305475	1649305475	1	1	BHUTA, MAHESH V MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29467	41	Internal Medicine	0	In state provider	None	9711 VENICE BLVD	None	LOS ANGELES	CA	90034	5109	19	06037	34.02443331	-118.3971908	Los Angeles County
7240	Fee-for-Service	1427068105	1427068105	1	1	BOWEN-WILLIAMS, JANNE E	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	46586	66	Emergency Medicine (Urgent Care)	0	In state provider	None	460 N GREEN ST	# 5	HANFORD	CA	93230	4059	16	06031	36.32954922	-119.6412075	Kings County
7248	Fee-for-Service	1275785875	1275785875	1	1	BOWMAN, SARAH L MD	6/10/2010	207L00000X	NA	Other	026	PHYSICIANS	102478	05	Anesthesiology	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94039	7025	43	06085	37.36893518	-122.0779448	Santa Clara County
7278	Fee-for-Service	1497322309	1497322309	1	1	BEYOND THERAPY HEALING CENTE	4/4/2023	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	R	4193 FLAT ROCK DR	STE 200	RIVERSIDE	CA	92505	7113	33	06065	33.90361212	-117.4930456	Riverside County
7290	Fee-for-Service	1003824699	1003824699	1	1	BHATT, KOMAL J MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106059	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
7293	Fee-for-Service	1588680508	1588680508	1	1	BISCHOFF, THOMAS W CRNA	7/31/1987	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1347 NORTHCREST DR	STE 300	CRESCENT CITY	CA	95531	2322	08	06015	41.77034521	-124.1995682	Del Norte County
7294	Fee-for-Service	1508046376	1508046376	2	1	BULLOCH, EDGAR M MD	3/11/2020	174400000X	NA	Other	026	PHYSICIANS	113241	15	Obstetrics (D.O. only)	0	In state provider	None	133 W MAIN ST	None	EL CAJON	CA	92020	3315	37	06073	32.79492453	-116.9627861	San Diego County
7301	Fee-for-Service	1174557805	1174557805	1	2	BAY AREA RETINA ASSOCIATES,	6/1/1988	207WX0107X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	365 LENNON LN	250	WALNUT CREEK	CA	94598	5910	07	06013	37.92784983	-122.0301444	Contra Costa County
7303	Fee-for-Service	1245618909	1245618909	1	1	BABY, LINDA MD	11/29/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167610	None	None	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
7343	Fee-for-Service	1154852242	1154852242	1	1	BARTOLOME, BRITTANY A MD	7/10/2020	390200000X	NA	Other	026	PHYSICIANS	157944	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
7355	Fee-for-Service	1437203189	1437203189	1	1	BARTELS, LYNNE M DPM	4/9/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
7373	Fee-for-Service	1124115431	1124115431	1	1	BLYTHE HEALTH CLINIC	10/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1415 W HOBSONWAY	None	BLYTHE	CA	92225	1651	33	06065	33.611922	-114.613272	Riverside County
7375	Fee-for-Service	1033499215	1033499215	1	1	BOITANO, APRIL M CNM	10/14/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
7380	Fee-for-Service	1316075211	1316075211	1	1	BLAND, FARZANA PSYD	3/11/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
7397	Fee-for-Service	1821063298	1821063298	1	1	BROWN, SONYA G MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	97903	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
7398	Fee-for-Service	1346513058	1346513058	2	1	BECK RX PHARMACY, INC.	7/26/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3100 STOCKTON	None	SACRAMENTO	CA	95820	1417	34	06067	38.545704	-121.453596	Sacramento County
7404	Fee-for-Service	1912921164	1912921164	1	1	BUI, UYEN DANG THY MD	9/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66270	40	Pediatrics	0	In state provider	ORANGE COUNTY PEDIATRICS	714 S HARBOR BLVD	None	SANTA ANA	CA	92704	2337	30	06059	33.73777075	-117.9201704	Orange County
7454	Fee-for-Service	1508077306	1508077306	1	1	BOSLEY, JACOB R MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156377	20	Orthopedic Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
7467	Fee-for-Service	1548758006	1548758006	1	1	BENIN, ANDREW MD	10/14/2021	390200000X	NA	Other	026	PHYSICIANS	173715	None	None	0	In state provider	None	790 E FOOTHILL BLVD # D	None	RIALTO	CA	92376	5269	36	06071	34.10679349	-117.3556395	San Bernardino County
7487	Fee-for-Service	1841303849	1841303849	1	1	BOGHOSSIAN, FREDERICK A	6/23/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	64878	41	Internal Medicine	0	In state provider	MD INC	1560 E CHEVY CHASE DR	STE 320	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
7490	Fee-for-Service	1467401216	1467401216	1	1	BESS, OLEG E MD	10/10/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	50863	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5901 W OLYMPIC BLVD	STE 503	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
7522	Fee-for-Service	1427493998	1427493998	1	1	BAIRD, JOHN MD	7/22/2021	207RH0000X	NA	Hematology	026	PHYSICIANS	141758	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
7531	Fee-for-Service	1245323088	1245323088	1	1	BARTLETT CARE CENTER	4/7/1998	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	600 E WASHINGTON AVE	None	SANTA ANA	CA	92701	3843	30	06059	33.75560444	-117.8619535	Orange County
7537	Fee-for-Service	1659499333	1659499333	1	1	BRYAN, SUSAN LMFT	1/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28494 WESTINGHOUSE PL	SUITE 213	VALENCIA	CA	91355	0930	19	06037	34.44221561	-118.5989564	Los Angeles County
7568	Fee-for-Service	1497322309	1497322309	1	1	BEYOND THERAPY HEALING CENTE	6/28/2021	261QM0801X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	R	4193 FLAT ROCK DR	STE 200	RIVERSIDE	CA	92505	7113	33	06065	33.90361212	-117.4930456	Riverside County
7591	Fee-for-Service	1720076755	1720076755	1	1	BARLOW,LYNN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3460 S PIONEER PRKWY	None	W VALLEY CITY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
7604	Fee-for-Service	1194576405	1194576405	1	1	BE FINALLY FREE, INC.	8/15/2024	163WC0400X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	225 CHESTER AVENUE	SUITE A	BAKERSFIELD	CA	93301	5464	15	06029	35.357697	-119.0189465	Kern County
7639	Fee-for-Service	1295888527	1295888527	1	1	BUCKINGHAM, ELLEN RN	7/17/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	95	Registered nurse	0	In state provider	None	4005 GRANITE CREEK RD	None	SCOTTS VALLEY	CA	95066	3742	44	06087	37.05990411	-122.0013725	Santa Cruz County
7647	Fee-for-Service	1427287077	1427287077	1	1	BILLETT, COURTNIE G MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122805	08	Family Practice	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
7649	Fee-for-Service	1235169145	1235169145	1	1	BUTCHART,DENNIS DC	5/1/2001	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	34563 ALVARADO NILES RD	None	UNION CITY	CA	94587	4575	01	06001	37.58685114	-122.0205782	Alameda County
7651	Fee-for-Service	1588724108	1588724108	1	1	BHATTI, RIZWAN A MD	4/28/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	90589	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	SUITE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
7671	Fee-for-Service	1629533690	1629533690	1	1	BANASH, SHAWN MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	176489	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
7684	Fee-for-Service	1710054622	1710054622	1	1	BENSON, VICTOR M MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	33420	01	General Practice	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
7692	Fee-for-Service	1912921164	1912921164	1	1	BUI, UYEN DANG THY MD	9/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66270	66	Emergency Medicine (Urgent Care)	0	In state provider	ORANGE COUNTY PEDIATRICS	714 S HARBOR BLVD	None	SANTA ANA	CA	92704	2337	30	06059	33.73777075	-117.9201704	Orange County
7701	Fee-for-Service	1548533003	1548533003	1	1	BAQLEH, TAMARA Z PT	6/22/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
7707	Fee-for-Service	1255373965	1255373965	1	1	BRAVO, RENE H MD INC	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	52562	40	Pediatrics	0	In state provider	None	3241 SOUTH HIGUERA ST	None	SAN LUIS OBISPO	CA	93401	2598	40	06079	35.25675126	-120.6685906	San Luis Obispo County
7710	Fee-for-Service	1629492939	1629492939	1	1	BUTCHERT, DAVID J OD	1/27/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	11847 SOUTH ST	None	CERRITOS	CA	90703	6825	19	06037	33.85850849	-118.080567	Los Angeles County
7716	Fee-for-Service	1831224369	1831224369	1	1	BENOIT, MICHELLE F MD	6/2/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	192007	09	Gynecology (D.O. only)	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
7731	Fee-for-Service	1326538588	1326538588	1	1	BARNES-FOX, DIANA K LMFT	5/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24526 WAGON WHEEL LN	None	WILDOMAR	CA	92595	9165	33	06065	33.63638934	-117.2317146	Riverside County
7738	Fee-for-Service	1457702383	1457702383	1	1	BARTHOLOMEW, FREDERICK B MD	8/9/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	172548	None	None	0	In state provider	None	1720 EL CAMINO REAL	SUITE 116, 118	BURLINGAME	CA	94010	3224	41	06081	37.59341466	-122.381361	San Mateo County
7778	Fee-for-Service	1932361011	1932361011	1	1	BHAKTA, DIPESH R MD	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111625	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
7813	Fee-for-Service	1194755066	1194755066	1	1	BERGMAN, WAYNE P MD	11/30/1995	207P00000X	NA	Other	026	PHYSICIANS	27786	01	General Practice	0	In state provider	None	492 3RD AVE	STE 105	CHULA VISTA	CA	91910	4614	37	06073	32.63490965	-117.0774465	San Diego County
7857	Fee-for-Service	1497322309	1497322309	1	1	BEYOND THERAPY HEALING CENTE	4/4/2023	261QM0801X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	R	4193 FLAT ROCK DR	STE 200	RIVERSIDE	CA	92505	7113	33	06065	33.90361212	-117.4930456	Riverside County
7863	Fee-for-Service	1851661276	1851661276	1	1	BUSTILLO, MARY VIC AMOR M NP	12/21/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	07	06013	37.90582392	-122.0613697	Contra Costa County
7868	Fee-for-Service	1396576401	1396576401	1	1	BACH, THANH PT	1/21/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
7883	Fee-for-Service	1386613206	1386613206	1	1	BANAIE, ALI	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87308	10	Gastroenterology (M.D. only)	0	In state provider	None	5565 GROSSMONT CENTER	STE 1	LA MESA	CA	91942	3000	37	06073	32.77978322	-117.0094766	San Diego County
7927	Fee-for-Service	1750421483	1750421483	1	1	BAKHSHAY, SHAHROUKH A MD	8/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	31339	08	Family Practice	0	In state provider	None	2740 M ST	None	MERCED	CA	95340	2813	24	06047	37.31239905	-120.478839	Merced County
7928	Fee-for-Service	1295888527	1295888527	1	1	BUCKINGHAM, ELLEN RN	7/17/2016	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4005 GRANITE CREEK RD	None	SCOTTS VALLEY	CA	95066	3742	44	06087	37.05990411	-122.0013725	Santa Cruz County
7933	Fee-for-Service	1790075315	1790075315	1	1	BORREGO COMMUNITY HEALTH	6/16/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1970 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	5202	33	06065	33.97555819	-117.3545428	Riverside County
7953	Fee-for-Service	1013095769	1013095769	1	1	BISSELL, JOHN A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23152	13	Neurology (M.D. only)	0	In state provider	None	PO BOX 696	None	DAVIS	CA	95617	0696	57	06113	0	0	None
7984	Fee-for-Service	1750413365	1750413365	1	1	BOWDEN, TOMIA J LMFT	12/4/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	81803	-	NOT APPLICABLE	0	In state provider	None	44447 N 10TH ST W	None	LANCASTER	CA	93534	3324	19	06037	34.69104127	-118.1480655	Los Angeles County
7992	Fee-for-Service	1154495083	1154495083	1	1	BENARD, JAY K DPM	10/31/1992	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1580 VALENCIA ST	# 804	SAN FRANCISCO	CA	94110	4412	38	06075	37.74746923	-122.4202583	San Francisco County
8004	Fee-for-Service	1831224369	1831224369	1	1	BENOIT, MICHELLE F MD	6/2/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	192007	15	Obstetrics (D.O. only)	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
8031	Fee-for-Service	1689765372	1689765372	1	1	BROWN, TYSON C MD	2/12/2021	207KA0200X	NA	Other	026	PHYSICIANS	166151	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
8067	Fee-for-Service	1326314329	1326314329	1	1	BURNS, PATRICK B MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143772	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
8112	Fee-for-Service	1811088891	1811088891	1	1	BANKSTON, JENNIFER PT	7/28/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	815 TUCKER RD	B	TEHACHAPI	CA	93561	2513	15	06029	35.123004	-118.4678255	Kern County
8160	Fee-for-Service	1851533574	1851533574	1	1	BAUMGARDNER, JEFFREY M MD	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125949	10	Gastroenterology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
8176	Fee-for-Service	1386613206	1386613206	1	1	BANAIE, ALI	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87308	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5565 GROSSMONT CENTER	STE 1	LA MESA	CA	91942	3000	37	06073	32.77978322	-117.0094766	San Diego County
8225	Fee-for-Service	1255320438	1255320438	1	1	BURTON, ALISON L MD	8/21/2003	207R00000X	NA	Other	026	PHYSICIANS	83911	08	Family Practice	0	In state provider	None	2350 BUHNE ST	STE A	EUREKA	CA	95501	3205	12	06023	40.78592523	-124.1422103	Humboldt County
8232	Fee-for-Service	1912291329	1912291329	1	1	BROSSEIT, MATTHEW MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131085	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 FOURTH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
8235	Fee-for-Service	1922137041	1922137041	1	1	BEYOND THE PHARMACY INC	6/1/2002	305S00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3730 W SUNSET BLVD	None	LOS ANGELES	CA	90026	1528	19	06037	34.09077213	-118.2786305	Los Angeles County
8285	Fee-for-Service	1003256280	1003256280	1	1	BROWN, KAITLYN W LCSW	8/12/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	101 CIRBY HILLS DRIVE	None	ROSEVILLE	CA	95678	4360	31	06061	38.7303989	-121.2872592	Placer County
8315	Fee-for-Service	1417903949	1417903949	1	1	BRYSON, YVONNE MD	1/1/1995	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	23660	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	# 22404	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
8322	Fee-for-Service	1063570653	1063570653	1	1	BAY REHABILITATION INC	10/20/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY	1520 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2379	19	06037	34.01926577	-118.1154058	Los Angeles County
8329	Fee-for-Service	1528528072	1528528072	1	1	BOWERS, KATHERINE D NP	9/17/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8170 LAGUNA BLVD	STE 304	ELK GROVE	CA	95758	7903	34	06067	38.421054	-121.405365	Sacramento County
8366	Fee-for-Service	1902950538	1902950538	1	1	BUTLER, JENIFER I MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92881	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
8392	Fee-for-Service	1235587064	1235587064	1	1	BROWN, LAUREN A MD	7/12/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173459	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
8393	Fee-for-Service	1518912799	1518912799	1	1	BARNES, PATRICIA A MD	2/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52645	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
8394	Fee-for-Service	1689134348	1689134348	1	1	BOHRER, NICHOLAS MD	2/20/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	182042	07	Dermatology	0	In state provider	None	655 EUCLID AVE	SUITE 304	NATIONAL CITY	CA	91950	2978	37	06073	32.68353398	-117.082625	San Diego County
8406	Fee-for-Service	1871963603	1871963603	1	1	BURGOS, ADRIAN MD	3/4/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	142380	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
8417	Fee-for-Service	1972600260	1972600260	1	1	BARBOSA, ELISABETH M MD	6/13/2013	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	94789	04	Otology, Laryngology, Rhinology	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
8428	Fee-for-Service	1629344767	1629344767	1	1	BRIDGES, NAIMA D MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130776	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
8496	Fee-for-Service	1740417260	1740417260	1	1	BLECHARCZYK, ELIZABETH M MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113209	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
8499	Fee-for-Service	1104601715	1104601715	1	1	BRIONES, CLARISSA M PT	9/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23100 EUCALYPTUS AVE	SUITE C	MORENO VALLEY	CA	92553	5439	33	06065	33.93157977	-117.2598359	Riverside County
8517	Fee-for-Service	1396271029	1396271029	1	1	BLUMEYER, DAVID H MD	11/3/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	157634	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
8522	Fee-for-Service	1396815270	1396815270	1	1	BELL, DEBORAH	12/31/1987	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	326 ALTA AVE	None	SANTA CRUZ	CA	95060	6442	44	06087	36.95492071	-122.0408614	Santa Cruz County
8532	Fee-for-Service	1801822507	1801822507	1	1	BARMETTLER, BRIAN D MD	4/10/2020	207R00000X	NA	Other	026	PHYSICIANS	55721	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
8536	Fee-for-Service	1134452725	1134452725	1	1	BABAKNIA, ARDALAN MD APC	11/16/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44193	41	Internal Medicine	0	In state provider	None	15775 LAGUNA CANYON ROAD	SUITE 240	IRVINE	CA	92618	3415	30	06059	33.6663745	-117.760682	Orange County
8545	Fee-for-Service	1871522672	1871522672	1	1	BIRCH HOLDINGS, INC	9/1/2000	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	UNIVERSITY CARE CENTER	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	37	06073	32.7481088	-117.0743149	San Diego County
8560	Fee-for-Service	1639904477	1639904477	1	1	BRAIN WAVES INC.	10/15/2024	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	245 SANTA FE AVE	None	PISMO BEACH	CA	93449	1948	40	06079	35.15531752	-120.6722698	San Luis Obispo County
8569	Fee-for-Service	1902127525	1902127525	1	1	BALCH, KARL R MD	12/22/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	149214	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
8575	Fee-for-Service	1154690063	1154690063	1	1	BRENNER, JILL F PT	11/8/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	728 PACIFIC AVE STE 301	None	SAN FRANCISCO	CA	94133	4488	38	06075	37.79687859	-122.4074282	San Francisco County
8586	Fee-for-Service	1073872362	1073872362	1	1	BERMUDEZ ROGERS, EMERALD A L	5/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
8590	Fee-for-Service	1851374623	1851374623	1	1	BRAIN,MACGILLVRAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 MADISON OAK DR	None	SAN ANTONIO	TX	78258	3913	00	None	29.62127927	-98.49119067	Bexar County
8613	Fee-for-Service	1215921028	1215921028	1	1	BRAKIN, MARIO I MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	33396	None	None	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
8618	Fee-for-Service	1134235260	1134235260	1	1	BECKWITH, STEPHEN R MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135829	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
8658	Fee-for-Service	1538117981	1538117981	1	1	BERGER, MITCHEL S	1/31/1996	207T00000X	NA	General Surgery	026	PHYSICIANS	43542	14	Neurological Surgery	0	In state provider	None	505 PARNASSUS AVE	# 787M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
8692	Fee-for-Service	1346416369	1346416369	1	1	BRANDI GARY	5/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	770 KAPIOLANI BLVD	None	HONOLULU	HI	96813	5212	00	None	21.30051254	-157.8538506	Honolulu County
8731	Fee-for-Service	1942225016	1942225016	1	1	BERNAL, SAMUEL D MD	12/2/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75613	41	Internal Medicine	0	In state provider	None	9736 VENICE BLVD	None	CULVER CITY	CA	90232	2717	19	06037	34.02389249	-118.3976555	Los Angeles County
8751	Fee-for-Service	1821011339	1821011339	1	1	BECKLES, DEDRA A MD	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87132	None	None	0	In state provider	None	2600 REDONDO AVENUE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
8771	Fee-for-Service	1720348410	1720348410	1	1	BAUER, STEPHEN J MD	5/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134651	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
8785	Fee-for-Service	1740417260	1740417260	1	1	BLECHARCZYK, ELIZABETH M MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113209	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
8796	Fee-for-Service	1073511762	1073511762	1	1	BAYLOR MEDICAL CENTER AT	3/25/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	GRAPEVINE	1650 W COLLEGE ST	None	GRAPEVINE	TX	76051	3596	00	None	32.93535326	-97.09490339	Tarrant County
8808	Fee-for-Service	1821240342	1821240342	1	1	BURNETT, DEZETTA M LCSW	1/21/2015	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3233 WEST FLORENCE AVE	None	LOS ANGELES	CA	90043	4703	19	06037	33.97456546	-118.329174	Los Angeles County
8812	Fee-for-Service	1336399013	1336399013	1	2	BAZ ALLERGY ASTHMA & SINUS C	9/2/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ENTER, INC.	6643 MILBURN AVE	101	FRESNO	CA	93722	2164	10	06019	36.83380123	-119.8789205	Fresno County
8836	Fee-for-Service	1255655916	1255655916	1	1	BIKUL, LYNDSAY A CRNA	5/9/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	RMC MOB2	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
8883	Fee-for-Service	1326266081	1326266081	1	1	BALLON-LANDA, GONZALO MD	8/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	41894	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4136 BACHMAN PL	None	SAN DIEGO	CA	92103	2028	37	06073	32.75258794	-117.1632586	San Diego County
8897	Fee-for-Service	1114440021	1114440021	1	1	BLEVINS, LORETTA LPCC	5/12/2023	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 W 6TH ST	212C	CORONA	CA	92882	1642	33	06065	33.87790309	-117.589666	Riverside County
8903	Fee-for-Service	1427004415	1427004415	1	1	BHUKET, TAFT P MD	7/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94983	10	Gastroenterology (M.D. only)	0	In state provider	None	2999 REGENT ST	STE 425	BERKELEY	CA	94705	2119	01	06001	37.85592021	-122.2566436	Alameda County
8909	Fee-for-Service	1225000672	1225000672	2	1	BOWNS, GERALD T MD	3/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	24388	18	Ophthalmology	0	In state provider	None	10 CONGRESS ST	#340	PASADENA	CA	91105	3020	19	06037	34.13396893	-118.1528162	Los Angeles County
8980	Fee-for-Service	1427123686	1427123686	1	1	BRANDT, BARBARA E MD	4/1/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64259	08	Family Practice	0	In state provider	None	601 E ROMIE LN	STE 2	SALINAS	CA	93901	4229	27	06053	36.65957467	-121.6443895	Monterey County
9019	Fee-for-Service	1942225016	1942225016	1	1	BERNAL, SAMUEL D MD	12/2/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75613	78	Neoplastic Diseases/Oncology	0	In state provider	None	9736 VENICE BLVD	None	CULVER CITY	CA	90232	2717	19	06037	34.02389249	-118.3976555	Los Angeles County
9036	Fee-for-Service	1558434464	1558434464	1	1	BEBAWY, NAGY MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44080	01	General Practice	0	In state provider	None	1307 W 6TH ST	STE 112	CORONA	CA	92882	3168	33	06065	33.87790309	-117.589666	Riverside County
9042	Fee-for-Service	1750743480	1750743480	1	1	BARVARZ, SHERWIN MD	11/14/2023	207LP2900X	NA	Other	026	PHYSICIANS	167141	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
9047	Fee-for-Service	1306845128	1306845128	1	1	BOWEN, JOHN SCOTT MD	5/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
9048	Fee-for-Service	1063451763	1063451763	1	1	BROOKS WATSON MD	3/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3810 PLAZA WAY	None	KENNEWICK	WA	99338	2722	00	None	46.17644625	-119.1911845	Benton County
9065	Fee-for-Service	1306201751	1306201751	1	1	BERTINO, LAURELL LPCC	8/18/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	798 TRIPLE LODE DR	None	ANGELS CAMP	CA	95222	9447	05	06009	38.06326398	-120.5535428	Calaveras County
9075	Fee-for-Service	1265433254	1265433254	1	1	BIRBECK, DANIEL P	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86952	None	None	0	In state provider	None	1100 TRANCAS ST	STE 250	NAPA	CA	94558	2908	28	06055	38.32316569	-122.2981938	Napa County
9082	Fee-for-Service	1073511762	1073511762	1	1	BAYLOR MEDICAL CENTER AT	11/15/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	GRAPEVINE	1650 W COLLEGE ST	None	GRAPEVINE	TX	76051	3596	00	None	32.93535326	-97.09490339	Tarrant County
9116	Fee-for-Service	1750439253	1750439253	1	1	BORREGO SPRINGS UNIFIED SD	10/25/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1315 PALM CANYON DR	None	BORREGO SPRINGS	CA	92004	5003	37	06073	33.254973	-116.346816	San Diego County
9132	Fee-for-Service	1356438261	1356438261	1	1	BIG VALLEY MEDICAL CTR	5/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PO BOX 277	554-850 MEDICAL CTR DR	None	BIEBER	CA	96009	0000	18	06035	0	0	None
9134	Fee-for-Service	1477624237	1477624237	1	1	BARSHOP, BRUCE A MD	3/3/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	58157	None	None	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
9158	Fee-for-Service	1194256339	1194256339	1	1	BOPARAI, ESHANDEEP MD	9/8/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	157324	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
9164	Fee-for-Service	1790213163	1790213163	1	1	BAILEY, CALEY E LMFT	10/8/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
9174	Fee-for-Service	1326266081	1326266081	1	1	BALLON-LANDA, GONZALO MD	8/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	41894	77	Infectious Disease	0	In state provider	None	4136 BACHMAN PL	None	SAN DIEGO	CA	92103	2028	37	06073	32.75258794	-117.1632586	San Diego County
9182	Fee-for-Service	1265458442	1265458442	1	1	BI COUNTY AMBULANCE SERV	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1700 POOLE BLVD	None	YUBA CITY	CA	95993	2610	51	06101	39.14466629	-121.6480544	Sutter County
9191	Fee-for-Service	1467153098	1467153098	1	1	BOOTH, GENE CRNA	8/30/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
9200	Fee-for-Service	1780767814	1780767814	1	1	BALLOON-REYES, NEDA F MD	4/30/1985	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40762	None	None	0	In state provider	None	18350 ROSCOE BLVD	STE 405	NORTHRIDGE	CA	91325	4173	19	06037	34.22071855	-118.5341175	Los Angeles County
9215	Fee-for-Service	1073661971	1073661971	1	1	BADAWI, SAMMY R MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74162	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
9223	Fee-for-Service	1497117865	1497117865	1	1	BAYLOSIS, BARRY L MD	5/9/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171952	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9257	Fee-for-Service	1043240633	1043240633	1	1	BARBOSA, JEFFREY T MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68075	08	Family Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
9263	Fee-for-Service	1174553994	1174553994	1	1	BAHADUR, GAVIN G MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	83596	18	Ophthalmology	0	In state provider	None	2080 CENTURY PARK E	SUITE 911	LOS ANGELES	CA	90067	2012	19	06037	34.05887194	-118.4122914	Los Angeles County
9264	Fee-for-Service	1184752560	1184752560	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	6838 WEST SUNSET BLVD	None	HOLLYWOOD	CA	90028	7008	19	06037	34.09794248	-118.340001	Los Angeles County
9291	Fee-for-Service	1659541597	1659541597	1	1	BUI, HONG HUU MD INC	9/8/1992	207R00000X	NA	Other	026	PHYSICIANS	51168	41	Internal Medicine	0	In state provider	None	1661 BURDETTE DR	STE I	SAN JOSE	CA	95121	1681	43	06085	37.32012377	-121.8254031	Santa Clara County
9292	Fee-for-Service	1902131790	1902131790	1	1	BURNS, SARAH D CD	2/7/2024	176B00000X	NA	Licensed Midwife	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
9304	Fee-for-Service	1588219786	1588219786	1	1	BERGER, SCOTT LCSW	4/19/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
9307	Fee-for-Service	1942225016	1942225016	1	1	BERNAL, SAMUEL D MD	12/2/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75613	68	Hematology	0	In state provider	None	9736 VENICE BLVD	None	CULVER CITY	CA	90232	2717	19	06037	34.02389249	-118.3976555	Los Angeles County
9318	Fee-for-Service	1326400052	1326400052	1	1	BEARE, MATTHEW B MD	1/19/2021	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	159055	-	NOT APPLICABLE	0	In state provider	None	3117 WILSON ROAD	None	BAKERSFIELD	CA	93304	5319	15	06029	35.33217251	-119.0385045	Kern County
9322	Fee-for-Service	1558434464	1558434464	1	1	BEBAWY, NAGY MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44080	08	Family Practice	0	In state provider	None	1307 W 6TH ST	STE 112	CORONA	CA	92882	3168	33	06065	33.87790309	-117.589666	Riverside County
9341	Fee-for-Service	1376792572	1376792572	1	1	BHASKER, KALA R MD	10/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105201	08	Family Practice	0	In state provider	None	145 THUNDER DRIVE	None	VISTA	CA	92083	6010	37	06073	33.18535652	-117.288201	San Diego County
9381	Fee-for-Service	1295138840	1295138840	1	1	BELDING, JESSICA M CRNA	10/8/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
9407	Fee-for-Service	1851582662	1851582662	1	1	BUTLER, DAVID A A MFT	11/22/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41477	-	NOT APPLICABLE	0	In state provider	None	5600 RICKENBACKER ROAD	2A/B	BELL	CA	90201	6425	19	06037	33.98966197	-118.1648431	Los Angeles County
9419	Fee-for-Service	1356438261	1356438261	1	1	BIG VALLEY MEDICAL CTR	9/1/1997	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	PO BOX 277	554-850 MEDICAL CTR DR	None	BIEBER	CA	96009	0000	18	06035	0	0	None
9431	Fee-for-Service	1295805091	1295805091	1	1	BUSH, ROBERT A	7/1/1969	No Taxonomy Provided	NA	None	026	PHYSICIANS	23336	02	General Surgery	0	In state provider	None	45 CASTRO ST	STE 212	SAN FRANCISCO	CA	94114	1028	38	06075	37.76829732	-122.4357056	San Francisco County
9442	Fee-for-Service	1972878155	1972878155	1	1	BEAMAN, JESSICA MD	5/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130158	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9472	Fee-for-Service	1528048584	1528048584	1	1	BERLIN, MICHAEL S MD	7/1/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	31961	18	Ophthalmology	0	In state provider	GLAUCOMA INSTITUTE	8733 BEVERLY BLVD	STE 301	LOS ANGELES	CA	90048	1843	19	06037	34.07688048	-118.3815765	Los Angeles County
9487	Fee-for-Service	1962426411	1962426411	1	1	BARRACK, FRANK M MD	1/1/1983	207L00000X	NA	Other	026	PHYSICIANS	48187	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
9514	Fee-for-Service	1518208990	1518208990	1	1	BURCIAGA, STEFANIE CCC-SLP	11/10/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5350 OLIVE ST	None	MONTCLAIR	CA	91763	1639	36	06071	34.09054746	-117.6886395	San Bernardino County
9520	Fee-for-Service	1164027173	1164027173	1	1	BARCELON, BRINDA R PT	12/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
9545	Fee-for-Service	1265535199	1265535199	1	1	BOUTROS,RAJA B MD INC	11/5/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	49973	13	Neurology (M.D. only)	0	In state provider	None	25485 MEDICAL CENTER DR	STE 208	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
9551	Fee-for-Service	1225814205	1225814205	1	1	BANKS, CHARLES CRNA	6/6/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
9556	Fee-for-Service	1568862472	1568862472	1	1	BUENROSTRO, FRANCISCA A LCSW	5/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
9570	Fee-for-Service	1396997664	1396997664	1	1	BUSINO, ROWLEY S MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112508	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDRENS WAY	MC:5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
9587	Fee-for-Service	1831114271	1831114271	1	1	BELAFSKY, MELVIN A MD	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	27615	None	None	0	In state provider	None	2121 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1706	19	06037	34.17309265	-118.3314784	Los Angeles County
9623	Fee-for-Service	1922583442	1922583442	1	1	BALL, JULIANA LPCC	12/25/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7170 N FINANCIAL DR.	STE 110	FRESNO	CA	93720	2939	10	06019	36.84000952	-119.7711439	Fresno County
9631	Fee-for-Service	1629257373	1629257373	1	1	BLACK, CASSANDRA LCSW	11/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2555 E. COLORADO BLVD	101	PASADENA	CA	91107	6617	19	06037	34.14612746	-118.0979505	Los Angeles County
9645	Fee-for-Service	1407058423	1407058423	1	1	BURNS, BRIAN J MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121794	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
9648	Fee-for-Service	1639130693	1639130693	1	1	BUCHFUHRER, MARK	7/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	41254	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11480 BROOKSHIRE AVE	STE 108	DOWNEY	CA	90241	5020	19	06037	33.93622932	-118.1311752	Los Angeles County
9655	Fee-for-Service	1538535257	1538535257	1	1	BRITTAIN, KEVIN S PT	3/26/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
9658	Fee-for-Service	1194984708	1194984708	1	1	BROWN, LICHEN D	6/15/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
9659	Fee-for-Service	1346434610	1346434610	1	1	BHATIA, POONAM MD	6/16/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	102581	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
9668	Fee-for-Service	1316500408	1316500408	1	1	BHUTWALA, NEIL	9/23/2023	207P00000X	NA	Other	026	PHYSICIANS	20446	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
9706	Fee-for-Service	1356438261	1356438261	1	1	BIG VALLEY MEDICAL CTR	5/1/1997	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PO BOX 277	554-850 MEDICAL CTR DR	None	BIEBER	CA	96009	0000	18	06035	0	0	None
9742	Fee-for-Service	1508971946	1508971946	1	1	BIBBINS DOMINGO, KIRSTEN	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74969	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
9761	Fee-for-Service	1548769516	1548769516	1	1	BANKS, SHIRLEY C NP	11/21/2024	171M00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
9806	Fee-for-Service	1992945885	1992945885	1	1	BANKS, LISA L DPM	9/14/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9390 HESPERIA RD	SUITE # 7	HESPERIA	CA	92345	3602	36	06071	34.4212584	-117.3021441	San Bernardino County
9827	Fee-for-Service	1154856391	1154856391	1	1	BHARDWAJ, NIKHILL S MD	7/24/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157384	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
9829	Fee-for-Service	1265535199	1265535199	1	1	BOUTROS,RAJA B MD INC	11/5/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	49973	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25485 MEDICAL CENTER DR	STE 208	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
9835	Fee-for-Service	1528730686	1528730686	1	1	BASTOU, CHANEL	12/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
9853	Fee-for-Service	1336108919	1336108919	1	1	BU, XIANGDONG MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64084	22	Pathology (M.D. only)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
9858	Fee-for-Service	1437456589	1437456589	1	1	BENJAMIN COLEMAN	2/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6200 N LA CHOLLA BLVD	None	TUCSON	AZ	85741	3529	00	None	32.320323	-111.009951	Pima County
9896	Fee-for-Service	1801159314	1801159314	1	1	BHAROLIA, ASHISH V MD	9/26/2019	207R00000X	NA	Other	026	PHYSICIANS	159982	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
9902	Fee-for-Service	1780674523	1780674523	1	1	BROWN, ADAM B DO	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9224	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
9947	Fee-for-Service	1538422290	1538422290	1	1	BROADBENT, NATHAN R CRNA	9/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	500 SW RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
9993	Fee-for-Service	1164490090	1164490090	1	1	BELLAPRAVALU,BELLAPRAVALU MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10401 W THUNDERBIRD BLVD	None	SUN CITY	AZ	85351	3004	00	None	33.603885	-112.2831765	Maricopa County
9998	Fee-for-Service	1992966592	1992966592	1	1	BHAKTA, KUNJAN S MD	5/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99192	02	General Surgery	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2214	10	06019	36.74643429	-119.7837416	Fresno County
10014	Fee-for-Service	1982660387	1982660387	1	1	BELLER, MARK J MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61611	30	Radiology	0	In state provider	None	44105 15TH ST W	None	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
10015	Fee-for-Service	1093076747	1093076747	1	1	BRADLEY, ERIN K MD	4/19/2023	2080P0203X	NA	Other	026	PHYSICIANS	183573	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
10052	Fee-for-Service	1578543682	1578543682	1	1	BRADY, PETER A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE	STE #500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
10057	Fee-for-Service	1508982646	1508982646	1	1	BOUBEL,THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	415 6TH ST	None	LEWISTON	ID	83501	2431	00	None	46.416294	-117.024981	Nez Perce County
10097	Fee-for-Service	1982836078	1982836078	1	1	BEIN, SHELLI Y MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108078	40	Pediatrics	0	In state provider	None	4000 CIVIC CENTER DR	SUITE 205	SAN RAFAEL	CA	94903	5233	21	06041	38.0041783	-122.538861	Marin County
10104	Fee-for-Service	1093846792	1093846792	1	1	BADHWAR, GAGAN DO	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9630	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
10111	Fee-for-Service	1104887827	1104887827	2	1	BOARDMAN, KRISTIN M MD	11/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55667	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5900 STATE FARM DRIVE	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
10130	Fee-for-Service	1215217419	1215217419	1	1	BOWMAN, DAVID Z MD	1/24/2019	207P00000X	NA	Other	026	PHYSICIANS	156709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
10151	Fee-for-Service	1124288147	1124288147	1	1	BARKODAR, LINDA MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107742	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
10207	Fee-for-Service	1295252427	1295252427	1	1	BENDER, CRYSTAL LMFT	10/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
10217	Fee-for-Service	1689741175	1689741175	1	2	BORREGO COMMUNITY HEALTH FOU	2/23/2021	3336C0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	NDATION PHARMACY	590 PALM CANYON DRIVE	SUITES 203-204	BORREGO SPRINGS	CA	92004	2369	37	06073	33.25655753	-116.380188	San Diego County
10242	Fee-for-Service	1760792253	1760792253	1	1	BOYLE, ADRIANE M MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115595	07	Dermatology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
10247	Fee-for-Service	1982857363	1982857363	1	1	BUDNICK, ELIOT A DO	4/19/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	13801	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
10263	Fee-for-Service	1437312980	1437312980	1	1	BEAZLIE-WALKER, SALLY DO	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12453	01	General Practice	0	In state provider	None	20101 LAKE CHABOT ROAD	FL 3	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
10272	Fee-for-Service	1780657973	1780657973	1	1	BARNCORD, STEVEN W PSYD	2/14/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
10293	Fee-for-Service	1063594059	1063594059	1	1	BLANEY, JOHN C MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54710	02	General Surgery	0	In state provider	None	292 POSADA LANE	STE C	TEMPLETON	CA	93465	4054	40	06079	35.5531447	-120.7214979	San Luis Obispo County
10295	Fee-for-Service	1689249443	1689249443	1	1	BOWLES, WALTER LCSW	3/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
10297	Fee-for-Service	1639169113	1639169113	1	1	BARKIN,ADAM Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT PC	3033 S PARKER RD # 808	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
10309	Fee-for-Service	1871519272	1871519272	1	1	BICKMORE, DANFORD C MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	73290	30	Radiology	0	In state provider	None	2020 COURT ST	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
10311	Fee-for-Service	1740433945	1740433945	1	1	BRUBAKER, JACOB W MD	8/23/2013	207WX0009X	NA	Ophthalmology	026	PHYSICIANS	124655	None	None	0	In state provider	None	1515 RIVER PARK DRIVE	STE 100	SACRAMENTO	CA	95815	4603	34	06067	38.599947	-121.437279	Sacramento County
10314	Fee-for-Service	1922012632	1922012632	1	1	BROCKMAN, BRUCE	12/27/2001	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	115 PIRIE RD	STE E	OJAI	CA	93023	3100	56	06111	34.44311416	-119.2657233	Ventura County
10328	Fee-for-Service	1780252494	1780252494	1	1	BRUMFIELD, CAREN E PT	1/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2895 LOMA VISTA ROAD	SUITE H	VENTURA	CA	93003	1542	56	06111	34.27543868	-119.2574459	Ventura County
10341	Fee-for-Service	1689693087	1689693087	1	1	BAST, BRIAN T MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77023	02	General Surgery	0	In state provider	None	513 PARNASSUS AVE	# S738	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
10350	Fee-for-Service	1104902568	1104902568	1	1	BERKE, RAYMOND A MD	10/1/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	14196	30	Radiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
10362	Fee-for-Service	1871672907	1871672907	1	1	BOBROWSKY, KEVIN MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62469	41	Internal Medicine	0	In state provider	None	1301 20TH ST	STE 590	SANTA MONICA	CA	90404	2054	19	06037	34.02976782	-118.4812493	Los Angeles County
10416	Fee-for-Service	1801437389	1801437389	1	1	BEHROUZI, ANI NP	4/12/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
10430	Fee-for-Service	1114952264	1114952264	1	2	BALINGIT, PETER PANES MD	11/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69847	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365, 420, 120	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
10449	Fee-for-Service	1447338041	1447338041	1	1	BERTOLLI, SUSAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37778	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
10460	Fee-for-Service	1679985618	1679985618	1	1	BRAUER, DAVID MD	10/28/2019	207K00000X	NA	Other	026	PHYSICIANS	139850	03	Allergy	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
10483	Fee-for-Service	1265480412	1265480412	1	1	BARZI, AFSANEH MD	12/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117268	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	NOR 8302E	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
10493	Fee-for-Service	1528164100	1528164100	1	1	BURLINGAME PACIFICA MED	7/1/1981	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	1828 EL CAMINO REAL	STE 507	BURLINGAME	CA	94010	3118	41	06081	37.59552262	-122.3838771	San Mateo County
10525	Fee-for-Service	1477639789	1477639789	1	1	BAO, WILLIAM MD INC	4/1/2000	207R00000X	NA	Other	026	PHYSICIANS	66842	41	Internal Medicine	0	In state provider	None	17595 ALMAHURST ST	STE 202	CITY OF INDUSTRY	CA	91748	1799	19	06037	33.99174345	-117.9215033	Los Angeles County
10552	Fee-for-Service	1699125195	1699125195	1	1	BACK PAIN HOME SUPPLIES LLC	12/2/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	116 S SKINNER AVE STE B	None	DRUMRIGHT	OK	74030	3642	00	None	35.98795976	-96.61062694	Creek County
10592	Fee-for-Service	1336153741	1336153741	1	1	BUCHANAN, CAROL S OD FAAO	10/18/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ATES	8440 BRENTWOOD BLVD.	# D	BRENTWOOD	CA	94513	1300	07	06013	37.93109403	-121.6951844	Contra Costa County
10596	Fee-for-Service	1588846570	1588846570	1	1	BRAUN, RICHARD M MD	7/31/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	770 WASHINGTON ST	STE 301	SAN DIEGO	CA	92103	2209	37	06073	32.75014189	-117.1579654	San Diego County
10615	Fee-for-Service	1952360539	1952360539	1	2	BASA, JESSICA V MD	2/13/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	53608	08	Family Practice	0	In state provider	None	705 E VIRGINIA WAY	SUITE F	BARSTOW	CA	92311	3978	36	06071	34.88815781	-117.018543	San Bernardino County
10617	Fee-for-Service	1346539509	1346539509	1	1	BAUTISTA, CHRISTOPHER A MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123383	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
10652	Fee-for-Service	1174551378	1174551378	1	1	BOTZ, GREGORY H MD	2/28/1993	207L00000X	NA	Other	026	PHYSICIANS	72910	05	Anesthesiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
10664	Fee-for-Service	1689679458	1689679458	1	1	BOCCARDO, HUMBERTO J MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	35747	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24953 PASEO DE VALENCIA	STE 14B	LAGUNA HILLS	CA	92653	4339	30	06059	33.60028568	-117.7010887	Orange County
10675	Fee-for-Service	1568482081	1568482081	1	1	BRUSCHWEIN, DEAN A MD	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
10695	Fee-for-Service	1346478591	1346478591	1	1	BELLOMY, LINDA L OD	2/24/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND STREET	SUITE 2	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
10696	Fee-for-Service	1801946785	1801946785	1	1	BONTRAGER, MARK W LCSW	11/29/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
10710	Fee-for-Service	1730498981	1730498981	1	1	BAUMBERGER, RIMA Z	2/21/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 ALAMEDA ST	None	POMONA	CA	91768	1727	19	06037	34.07825822	-117.7555489	Los Angeles County
10716	Fee-for-Service	1659461457	1659461457	1	1	BERQUIST, WILLIAM E MD	4/28/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32783	10	Gastroenterology (M.D. only)	0	In state provider	DEPARTMENT OF PEDIATRICS	2340 CLAY ST	# 305	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
10721	Fee-for-Service	1578702163	1578702163	1	1	BANSALE, WINSTON CRNA	3/10/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
10733	Fee-for-Service	1417514902	1417514902	1	1	BARGER, KURT M DO	11/3/2022	390200000X	NA	Other	026	PHYSICIANS	20184	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
10771	Fee-for-Service	1265480412	1265480412	1	1	BARZI, AFSANEH MD	12/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117268	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	NOR 8302E	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
10782	Fee-for-Service	1669979696	1669979696	1	1	BYRNES-FINGER, IRIS MD	2/11/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163567	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
10787	Fee-for-Service	1649274929	1649274929	1	1	BERMUDEZ, ARMAND J MD	1/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	31663	41	Internal Medicine	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
10816	Fee-for-Service	1477639789	1477639789	1	1	BAO, WILLIAM MD INC	4/1/2000	207R00000X	NA	Other	026	PHYSICIANS	66842	02	General Surgery	0	In state provider	None	17595 ALMAHURST ST	STE 202	CITY OF INDUSTRY	CA	91748	1799	19	06037	33.99174345	-117.9215033	Los Angeles County
10857	Fee-for-Service	1629495643	1629495643	1	1	BEST, JENNIFER MD	10/28/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	160588	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
10876	Fee-for-Service	1285671016	1285671016	1	1	BUCH, ERIC F MD	6/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86398	41	Internal Medicine	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
10891	Fee-for-Service	1578906186	1578906186	1	1	BUI, KEVIN T MD	1/18/2020	2085R0204X	NA	Other	026	PHYSICIANS	134576	30	Radiology	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
10936	Fee-for-Service	1124414651	1124414651	1	1	BERMUDEZ, XAVIER MD	9/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151226	01	General Practice	0	In state provider	None	351 N MT VIEW AVE	None	SAN BERNARDINO	CA	92415	0010	36	06071	34.10557802	-117.2873448	San Bernardino County
10951	Fee-for-Service	1689679458	1689679458	1	1	BOCCARDO, HUMBERTO J MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	35747	41	Internal Medicine	0	In state provider	None	24953 PASEO DE VALENCIA	STE 14B	LAGUNA HILLS	CA	92653	4339	30	06059	33.60028568	-117.7010887	Orange County
11001	Fee-for-Service	1922004480	1922004480	1	1	BATINI, ANGELA MS	4/12/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2510 AIRPARK DR	STE 101	REDDING	CA	96001	2461	45	06089	40.57119566	-122.4016582	Shasta County
11003	Fee-for-Service	1659461457	1659461457	1	1	BERQUIST, WILLIAM E MD	4/28/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32783	40	Pediatrics	0	In state provider	DEPARTMENT OF PEDIATRICS	2340 CLAY ST	# 305	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
11027	Fee-for-Service	1861688061	1861688061	1	1	BRAR, AMARPREET S MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77993	18	Ophthalmology	0	In state provider	INC	4455 W 117TH ST	STE 502	HAWTHORNE	CA	90250	2261	19	06037	33.92825048	-118.3539285	Los Angeles County
11030	Fee-for-Service	1497186829	1497186829	1	1	BURNETT, KIMBERLY MSW LCSW	2/3/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	900 LOS OSOS VALLEY	STE C	LOS OSOS	CA	93402	3268	40	06079	35.31159615	-120.8347375	San Luis Obispo County
11058	Fee-for-Service	1427203991	1427203991	1	1	BARNETZER, IRIT PSY	3/7/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21128	-	NOT APPLICABLE	0	In state provider	None	10603 DOWNEY AVE	None	DOWNEY	CA	90241	3426	19	06037	33.94617788	-118.1295872	Los Angeles County
11061	Fee-for-Service	1770826869	1770826869	1	1	BATTLE, LAURA A MD	6/21/2020	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	134836	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
11085	Fee-for-Service	1629075247	1629075247	1	1	BOSS, DONALD J MD	3/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	83220	30	Radiology	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
11108	Fee-for-Service	1801944723	1801944723	1	1	BEBAK, KIMBERLEE G NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18040 SHERMAN WAY	None	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
11109	Fee-for-Service	1285076240	1285076240	1	1	BAHMANI, AFSANEH MD	1/28/2014	207L00000X	NA	Other	026	PHYSICIANS	61989	05	Anesthesiology	0	In state provider	PROFESSIONAL CORP	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
11116	Fee-for-Service	1487848115	1487848115	1	1	BLAIR PYLE MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1311 N MILDRED RD	None	CORTEZ	CO	81321	2231	00	None	37.36196474	-108.5727346	Montezuma County
11120	Fee-for-Service	1083935878	1083935878	1	1	BAGHIAN, ALI MD	6/25/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	160469	68	Hematology	0	In state provider	None	900 S MAIN ST	STE 204	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
11126	Fee-for-Service	1366436073	1366436073	1	1	BEAUFORT MEMORIAL HOSPITAL	11/16/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	955 RIBAUT ROAD	None	BEAUFORT	SC	29902	5441	00	None	32.416929	-80.68852154	Beaufort County
11130	Fee-for-Service	1598832503	1598832503	1	1	BALLESTEROS, JULIAN P MD	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78111	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11144	Fee-for-Service	1912208836	1912208836	1	1	BRYDON, PAUL D DO	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11340	08	Family Practice	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
11182	Fee-for-Service	1841269461	1841269461	1	1	BROWN, JOY L MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77662	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
11235	Fee-for-Service	1598981698	1598981698	2	1	BALLAN, WASSIM MD	4/5/2024	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
11253	Fee-for-Service	1740355643	1740355643	1	1	BODDULA, MADHAV R MD	3/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96091	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
11294	Fee-for-Service	1013958867	1013958867	1	1	BHAVSAR, MADHUMALTI D MD	7/16/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	146376	36	Psychiatry	0	In state provider	None	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	36	06071	34.09544496	-117.5747968	San Bernardino County
11348	Fee-for-Service	1023159365	1023159365	1	1	BERMAN, CYNTHIA PHD	1/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
11375	Fee-for-Service	1871960328	1871960328	1	1	BOBADILLA, VERONICA LMFT	3/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
11409	Fee-for-Service	1609893437	1609893437	1	1	BARAZANGI, NOBL MD	1/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85581	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
11412	Fee-for-Service	1366436073	1366436073	1	1	BEAUFORT MEMORIAL HOSPITAL	11/16/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	955 RIBAUT ROAD	None	BEAUFORT	SC	29902	5441	00	None	32.416929	-80.68852154	Beaufort County
11434	Fee-for-Service	1154401941	1154401941	1	49	BASS MEDICAL GROUP	12/17/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	19845 LAKE CHABOT RD	STE 200	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
11443	Fee-for-Service	1740235985	1740235985	1	1	BARTON, NICOLAS B	4/29/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
11449	Fee-for-Service	1184730855	1184730855	1	1	BOYD, JAMES B MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	24018	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
11478	Fee-for-Service	1588800668	1588800668	1	1	BOURGUIGNON, CARRIE D PSYD	12/23/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	908 E ST	SUITE C	SAN RAFAEL	CA	94901	2851	21	06041	37.97283098	-122.5332815	Marin County
11496	Fee-for-Service	1609422799	1609422799	1	1	BROSOF, LEIGH PSYD	12/3/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
11500	Fee-for-Service	1619748639	1619748639	1	1	BLUME MATERNITY SUPPORT SERV	6/20/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
11551	Fee-for-Service	1356484323	1356484323	1	1	BROWN, JONEL L III PHD	8/4/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
11576	Fee-for-Service	1386744266	1386744266	1	1	BADERY, AHMAD F MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	235 W 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
11599	Fee-for-Service	1548428113	1548428113	1	1	BAY, PATRICIA L LMFT	9/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1352 OREGON ST	None	REDDING	CA	96001	1621	45	06089	40.58468628	-122.3949533	Shasta County
11609	Fee-for-Service	1992749105	1992749105	1	1	BERNSTEIN, HAROLD S MD	10/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72794	40	Pediatrics	0	In state provider	PERMANENTE MED GROUP	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
11636	Fee-for-Service	1154401941	1154401941	1	40	BASS MEDICAL GROUP	3/4/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2339 ALMOND AVE	None	CONCORD	CA	94520	2027	07	06013	37.98130916	-122.0340489	Contra Costa County
11651	Fee-for-Service	1063441897	1063441897	1	1	BASYE, STACYE L PT	11/30/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14011 PARK AVE	None	VICTORVILLE	CA	92392	2413	36	06071	34.505647	-117.3265457	San Bernardino County
11656	Fee-for-Service	1366407934	1366407934	1	1	BUCCINO, KENNETH R MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	280 MAPLE	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
11674	Fee-for-Service	1841275955	1841275955	1	1	BOHRINGER, CHRISTIAN H	11/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80865	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
11691	Fee-for-Service	1336991082	1336991082	1	1	BREEN, CAITLIN	9/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	41	06081	0	0	None
11720	Fee-for-Service	1154401941	1154401941	1	49	BASS MEDICAL GROUP	12/17/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	19845 LAKE CHABOT RD	STE 200	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
11722	Fee-for-Service	1457531378	1457531378	1	1	BROWN, FELICIA A LCSW	8/9/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	537 CAJON ST	None	REDLANDS	CA	92373	5903	36	06071	34.04796302	-117.1769203	San Bernardino County
11736	Fee-for-Service	1184730855	1184730855	1	1	BOYD, JAMES B MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	24018	08	Family Practice	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
11744	Fee-for-Service	1689658270	1689658270	1	1	BOSCOVICH, BROCK MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
11792	Fee-for-Service	1518965771	1518965771	1	1	BETTS, JENNIFER L MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72470	08	Family Practice	0	In state provider	None	501 N INDIAN RD	None	SMITH RIVER	CA	95567	9509	08	06015	41.95702601	-124.2045614	Del Norte County
11794	Fee-for-Service	1053890079	1053890079	1	1	BANGTHAMAI, TARA RCP	8/21/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
11795	Fee-for-Service	1710438825	1710438825	1	1	BOCCIO, HEATHER D M NP	11/28/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
11802	Fee-for-Service	1275630204	1275630204	1	1	BARILE, VERA A MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44778	01	General Practice	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
11803	Fee-for-Service	1275693681	1275693681	1	1	BELL, CAROLYN P CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
11806	Fee-for-Service	1265019756	1265019756	1	1	BASSAL, ANGELA MD	9/19/2024	390200000X	NA	Other	026	PHYSICIANS	183522	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
11823	Fee-for-Service	1982780094	1982780094	1	1	BELOIT MEMORIAL HOSPITAL	8/14/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1969 W HART RD	None	BELOIT	WI	53511	2230	00	None	42.548616	-89.00829	Rock County
11848	Fee-for-Service	1104192038	1104192038	1	1	BEYLIN, MARIE E MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128243	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
11854	Fee-for-Service	1780657122	1780657122	2	1	BERG, MARC D MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146366	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
11866	Fee-for-Service	1902531403	1902531403	1	1	BELLFLOWER SKILLED LLC	8/16/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16910 WOODRUFF AVE	None	BELLFLOWER	CA	90706	6036	19	06037	33.880707	-118.117294	Los Angeles County
11875	Fee-for-Service	1548229206	1548229206	1	1	BROOKS MIRRER	4/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	5317	00	None	40.700349	-73.9416015	Kings County
11885	Fee-for-Service	1871153809	1871153809	1	1	BINA, ROYA MD	7/1/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179120	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
11896	Fee-for-Service	1780356790	1780356790	1	1	BGM MEDICAL SERVICES INC	11/16/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	44	Public Health	0	In state provider	CARE	524 W 4TH ST	SUITE B	PERRIS	CA	92570	2016	33	06065	33.78236446	-117.237456	Riverside County
11901	Fee-for-Service	1467795237	1467795237	1	1	BECKERT, RACHAEL H MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135567	40	Pediatrics	0	In state provider	None	2200 OFARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
11907	Fee-for-Service	1922453513	1922453513	1	1	BARNES, CLAYTON A MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150795	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
11915	Fee-for-Service	1619342607	1619342607	1	1	BANTA ELEMENTARY SCHOOL	7/1/2015	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	22375 EL RANCHO ROAD	None	TRACY	CA	95304	9413	39	06077	37.75542609	-121.3729499	San Joaquin County
11919	Fee-for-Service	1265187272	1265187272	1	1	BAY AREA MOBILE MEDICAL GROU	10/2/2024	208D00000X	NA	Adult Primary Care	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	P, INC.	121 PAUL DR	STE A	SAN RAFAEL	CA	94903	2047	21	06041	38.01742481	-122.5371986	Marin County
11925	Fee-for-Service	1154401941	1154401941	1	40	BASS MEDICAL GROUP	3/4/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2339 ALMOND AVE	None	CONCORD	CA	94520	2027	07	06013	37.98130916	-122.0340489	Contra Costa County
11932	Fee-for-Service	1861652679	1861652679	1	2	BRUSCA, TERALYN RIGGS	7/29/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5140 HALLWOOD AVE	None	RIVERSIDE	CA	92506	1412	33	06065	33.95836088	-117.3737913	Riverside County
11945	Fee-for-Service	1780644682	1780644682	1	1	BARRON, JOEL D MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71235	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
11953	Fee-for-Service	1124158159	1124158159	1	1	BELTRAN, ALMA LMFT	8/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1274 CENTER COURT DR	#112	COVINA	CA	91724	3668	19	06037	34.07278979	-117.8637519	Los Angeles County
11956	Fee-for-Service	1609805225	1609805225	1	1	BARBARA M CHAVEZ D.O.	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2340 E TRINITY MILLS RD	STE 250	CARROLLTON	TX	75006	1946	00	None	32.98506851	-96.8736825	Dallas County
11982	Fee-for-Service	1730349572	1730349572	1	1	BETTESWORTH, JACOB G DO	9/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12256	40	Pediatrics	0	In state provider	None	6235 N FRESNO	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
12003	Fee-for-Service	1518941343	1518941343	1	1	BYRON R SPENCER, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	499 E HAMPDEN AVE	STE 360	ENGLEWOOD	CO	80113	3877	00	None	39.65319046	-104.982129	Arapahoe County
12009	Fee-for-Service	1154401941	1154401941	1	49	BASS MEDICAL GROUP	12/17/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	19845 LAKE CHABOT RD	STE 200	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
12012	Fee-for-Service	1982108262	1982108262	1	1	BUI, BRIAN M MD	8/16/2021	207R00000X	NA	Other	026	PHYSICIANS	173386	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
12017	Fee-for-Service	1407360563	1407360563	1	1	BELFORD, EMILY R LCSW	11/5/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96009	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
12037	Fee-for-Service	1518994854	1518994854	1	1	BAZZANO, ALICIA T F MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70658	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
12047	Fee-for-Service	1346218054	1346218054	1	1	BARR, KEIRA L MD	9/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103500	07	Dermatology	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
12050	Fee-for-Service	1134752694	1134752694	1	1	BARAJAS, CRYSTAL NP	10/21/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
12068	Fee-for-Service	1174919971	1174919971	1	1	BAUM, PETER M DO	8/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14949	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
12083	Fee-for-Service	1609061811	1609061811	1	1	BETTER CARE MEDICAL GROUP	4/21/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1153 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4714	19	06037	34.08087826	-118.1230792	Los Angeles County
12108	Fee-for-Service	1982780094	1982780094	1	1	BELOIT MEMORIAL HOSPITAL	8/14/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1969 W HART RD	None	BELOIT	WI	53511	2230	00	None	42.548616	-89.00829	Rock County
12109	Fee-for-Service	1184736159	1184736159	1	1	BEGERT, DAVID L MD	1/17/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64920	08	Family Practice	0	In state provider	None	500 DOYLE PARK DR	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
12140	Fee-for-Service	1427577659	1427577659	1	1	BEAUTIFUL LIFE SERVICES	5/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LICENSED CLINICAL SOCIAL	9700 RESEDA BLVD	SUITE 203B	NORTHRIDGE	CA	91324	6903	19	06037	34.246647	-118.5360505	Los Angeles County
12173	Fee-for-Service	1285614529	1285614529	1	1	BUCAY, MOISE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4411 MEDICAL DR	STE 300	SAN ANTONIO	TX	78229	3824	00	None	29.51000304	-98.57210273	Bexar County
12211	Fee-for-Service	1578561502	1578561502	1	1	BERLIOZ, DEANA CRNA	5/17/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
12213	Fee-for-Service	1154401941	1154401941	1	40	BASS MEDICAL GROUP	3/4/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2339 ALMOND AVE	None	CONCORD	CA	94520	2027	07	06013	37.98130916	-122.0340489	Contra Costa County
12239	Fee-for-Service	1821349622	1821349622	1	1	BISSELL, MARY B MD	10/21/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	132363	None	None	0	In state provider	None	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
12247	Fee-for-Service	1932365939	1932365939	1	1	BECKER, ROSANNE LCSW	6/4/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21243 VENTURA BLVD	STE 205	WOODLAND HILLS	CA	91364	2109	19	06037	34.16736368	-118.5947825	Los Angeles County
12249	Fee-for-Service	1144583782	1144583782	1	1	BALLI, ALYSSA N LMFT	8/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
12251	Fee-for-Service	1528590031	1528590031	1	1	BLACK, SHANNON L CCC-SLP	10/8/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
12261	Fee-for-Service	1629206453	1629206453	1	1	BAWA, AMIT MD	4/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127953	01	General Practice	0	In state provider	None	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
12272	Fee-for-Service	1730349572	1730349572	1	1	BETTESWORTH, JACOB G DO	9/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12256	05	Anesthesiology	0	In state provider	None	6235 N FRESNO	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
12289	Fee-for-Service	1851811624	1851811624	1	1	BANGALAN, CHRISTINE JOY P CN	11/29/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
12292	Fee-for-Service	1225061591	1225061591	1	1	BEHBOODIKHAH, MAHNAZ MD	11/25/2012	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	62261	01	General Practice	0	In state provider	None	320 SUPERIOR AVE	STE 150	NEWPORT BEACH	CA	92663	6139	30	06059	33.62657138	-117.9330754	Orange County
12293	Fee-for-Service	1659670214	1659670214	1	1	BRITTON, JUSTIN D MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135107	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
12325	Fee-for-Service	1518994854	1518994854	1	1	BAZZANO, ALICIA T F MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70658	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
12327	Fee-for-Service	1942402631	1942402631	1	1	BUDAY, ERICA S	1/10/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
12343	Fee-for-Service	1649722760	1649722760	1	1	BASCO, CLAIRE T NP	2/28/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
12352	Fee-for-Service	1467488262	1467488262	1	1	BROOK, MICHAEL M MD	10/31/1990	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	66635	None	None	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
12356	Fee-for-Service	1992898910	1992898910	1	2	BUSHARD PHARMACY INC	3/1/2020	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	244 FOREST AVE	None	LAGUNA BEACH	CA	92651	2114	30	06059	33.54276715	-117.7829098	Orange County
12398	Fee-for-Service	1669774857	1669774857	1	1	BURKI, BROOKE V PT	4/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22995 MILL CREEK DR	SUITE A	LAGUNA HILLS	CA	92653	1215	30	06059	33.62819651	-117.7351762	Orange County
12402	Fee-for-Service	1508327479	1508327479	1	1	BALACHANDRAN, SMITHA NP	3/9/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
12410	Fee-for-Service	1285182162	1285182162	1	1	BEDFORD, MARISA J CRNA	10/12/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
12415	Fee-for-Service	1760739049	1760739049	1	1	BAILIS, JESSICA R PSYD	9/27/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12437	Fee-for-Service	1497834964	1497834964	1	1	BETSON, LANCE H DO	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7341	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
12448	Fee-for-Service	1043070667	1043070667	1	1	BLOSSER, HAYLIE C DOULA	3/20/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	58	06115	0	0	None
12455	Fee-for-Service	1699728832	1699728832	1	1	BACHMAN, MICHAEL C MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
12466	Fee-for-Service	1326545690	1326545690	1	1	BROWN, KIMBERLEY N MD	6/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183749	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
12486	Fee-for-Service	1720179310	1720179310	1	1	BALLI, MEAGHAN A MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71835	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
12492	Fee-for-Service	1780974709	1780974709	1	1	BHARDWAJ, AMRIT MD	10/27/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
12504	Fee-for-Service	1780764225	1780764225	1	1	BARRAM, ROBERT D PHD	12/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5800 ACORN RIDGE DR	None	PARADISE	CA	95969	3754	04	06007	39.7530588	-121.6410043	Butte County
12521	Fee-for-Service	1184617524	1184617524	1	1	BOGARD, DENISE R MD	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	69673	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
12549	Fee-for-Service	1265537906	1265537906	1	1	BAHARVAR, JAMSHID MD	1/29/1982	207R00000X	NA	Other	026	PHYSICIANS	34541	41	Internal Medicine	0	In state provider	None	2428 SANTA MONICA BLVD	STE 404	SANTA MONICA	CA	90404	2047	19	06037	34.0317559	-118.4762013	Los Angeles County
12553	Fee-for-Service	1588160436	1588160436	1	1	BURK, CHARNEY A MD	8/8/2022	207P00000X	NA	Other	026	PHYSICIANS	165008	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
12570	Fee-for-Service	1780765909	1780765909	1	1	BLAKELY, STEVEN B PHD	9/17/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
12590	Fee-for-Service	1154401941	1154401941	1	20	BASS MEDICAL GROUP	2/25/2019	207YX0007X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2316 DWIGHT WAY	None	BERKELEY	CA	94704	2212	01	06001	37.86460853	-122.2621987	Alameda County
12605	Fee-for-Service	1447258090	1447258090	1	1	BROOKS, STEVEN L MD	12/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	155 HWY 50	None	STATELINE	NV	89449	0000	00	None	38.96860553	-119.9356859	Douglas County
12635	Fee-for-Service	1134270440	1134270440	1	2	BHATIA, VARADA D MD	11/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14602	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	STE 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
12650	Fee-for-Service	1144726811	1144726811	1	1	BARRERA ADAME, OBED DO	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	19510	None	None	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
12685	Fee-for-Service	1366838443	1366838443	1	1	BLAKELY, MORGAN MD	5/10/2019	207ZP0102X	NA	Other	026	PHYSICIANS	155128	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
12686	Fee-for-Service	1437216025	1437216025	1	1	BRESLOW, JONATHAN	7/25/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	350 N LANTANA ST	STE 220	CAMARILLO	CA	93010	9024	56	06111	34.219683	-119.0550525	Ventura County
12691	Fee-for-Service	1912311127	1912311127	1	1	BAUER, ARIELLE A MD	2/7/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	168105	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
12713	Fee-for-Service	1649316399	1649316399	1	1	BASIL R BESH MD INC	10/18/2018	207XS0106X	NA	Orthopedic Surgery	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	01	06001	37.53211262	-121.9981587	Alameda County
12743	Fee-for-Service	1699728832	1699728832	1	1	BACHMAN, MICHAEL C MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
12780	Fee-for-Service	1922032952	1922032952	1	1	BHAVABHUTANON, L DO	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7134	41	Internal Medicine	0	In state provider	LUK BHAVA DO AMC	880 S ATLANTIC BLVD	STE 307	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
12782	Fee-for-Service	1093476921	1093476921	1	1	BENNETT, TYNESHA DOULA	2/5/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	55	06109	0	0	None
12807	Fee-for-Service	1659502680	1659502680	1	1	BERGER, SANDRA M LMFT	6/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
12827	Fee-for-Service	1710977160	1710977160	1	1	BOBILA, RAY T MD	5/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176226	None	None	0	In state provider	None	15237 ELEVENTH ST	STE A	VICTORVILLE	CA	92395	3736	36	06071	34.52804997	-117.2925096	San Bernardino County
12848	Fee-for-Service	1962935775	1962935775	1	1	BURK, MICHELLE DO	10/19/2021	207R00000X	NA	Other	026	PHYSICIANS	17096	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
12871	Fee-for-Service	1043639974	1043639974	1	1	BALINO, THERESE J OT	3/2/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
12876	Fee-for-Service	1255784922	1255784922	1	1	BERGER, TERISA M LCSW	11/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
12881	Fee-for-Service	1154401941	1154401941	1	48	BASS MEDICAL GROUP	10/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2700 GRANT ST	STE 316	CONCORD	CA	94520	2272	07	06013	37.98417931	-122.0361585	Contra Costa County
12908	Fee-for-Service	1720084049	1720084049	2	1	BREES, MARTIN M MD	10/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	24462	41	Internal Medicine	0	In state provider	None	930 SUNNYSLOPE RD	SUITE B1	HOLLISTER	CA	95023	5615	35	06069	36.83909681	-121.3851338	San Benito County
12959	Fee-for-Service	1861581993	1861581993	1	1	BUCARDO, JESUS A MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	62934	36	Psychiatry	0	In state provider	None	835 3RD AVE	STE C	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
12961	Fee-for-Service	1144313040	1144313040	1	1	BERTOZZI, SUSAN J LMFT	9/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2535 FOREST AVE	SUITE 150	CHICO	CA	95928	7691	04	06007	39.71811989	-121.793882	Butte County
12969	Fee-for-Service	1457308793	1457308793	1	1	BITTNER, AVA K OD	11/19/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
12974	Fee-for-Service	1316395791	1316395791	1	1	BRIGHT DAY HOME HEALTH INC	3/19/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13746 VICTORY BLVD	SUITE 207	VAN NUYS	CA	91401	6718	19	06037	34.18664551	-118.432764	Los Angeles County
13000	Fee-for-Service	1225203169	1225203169	1	1	BULL, MARY W MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	13839	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 NORTH LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
13002	Fee-for-Service	1649316399	1649316399	1	1	BASIL R BESH MD INC	10/18/2018	207XS0106X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	46	Hand Surgery	0	In state provider	None	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	01	06001	37.53211262	-121.9981587	Alameda County
13024	Fee-for-Service	1205974482	1205974482	1	1	BAART BEHAVIORAL HEALTH SERV	2/17/2004	261QM0850X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1646 S COURT ST	None	VISALIA	CA	93277	4962	54	06107	36.315774	-119.2913235	Tulare County
13037	Fee-for-Service	1982050704	1982050704	1	1	BECHER, JULIAN MD	5/23/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145139	01	General Practice	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
13045	Fee-for-Service	1639675465	1639675465	1	1	BRZYCKI, RYAN	4/2/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
13070	Fee-for-Service	1891971578	1891971578	1	2	BRAXLEY, NICOLE M MD	10/2/2019	207P00000X	NA	Other	086	MEDICAL DIRECTORS	116841	-	NOT APPLICABLE	0	In state provider	None	8395 JACKSON RD	None	SACRAMENTO	CA	95826	3904	34	06067	38.546001	-121.3947675	Sacramento County
13080	Fee-for-Service	1346773322	1346773322	1	1	BAWEJA, SHILPA LCSW	9/12/2017	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
13117	Fee-for-Service	1487655882	1487655882	1	1	BISIGNANI, MARK MD	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151223	78	Neoplastic Diseases/Oncology	0	In state provider	None	1165 S DORA ST	None	UKIAH	CA	95482	8325	23	06045	39.13602308	-123.2095502	Mendocino County
13147	Fee-for-Service	1083630677	1083630677	1	1	BAEK, HESUK H MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77992	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
13157	Fee-for-Service	1649244534	1649244534	1	1	BANCHEROHASSON, MONICA M MD	4/30/1995	207R00000X	NA	Other	026	PHYSICIANS	52497	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
13166	Fee-for-Service	1154401941	1154401941	1	20	BASS MEDICAL GROUP	2/25/2019	207YX0007X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	2316 DWIGHT WAY	None	BERKELEY	CA	94704	2212	01	06001	37.86460853	-122.2621987	Alameda County
13179	Fee-for-Service	1689609901	1689609901	1	1	BEST, KARIN M PHD	1/28/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
13185	Fee-for-Service	1477970002	1477970002	1	1	BAYHAN, GREGORY F CRNA	4/8/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
13193	Fee-for-Service	1851779847	1851779847	1	1	BEDI, GURRAJ S DO MD	9/20/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15033	08	Family Practice	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
13212	Fee-for-Service	1225269111	1225269111	1	1	BOETHEL, WOODROW M CRNA	12/21/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
13216	Fee-for-Service	1194741629	1194741629	1	1	BESENDORFER,JAMES M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	48 WEST 1500 N	None	NEPHI	UT	84648	0000	00	None	39.7306275	-111.83724	Juab County
13218	Fee-for-Service	1184741985	1184741985	1	1	BISHAI, NABIL F MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	37471	18	Ophthalmology	0	In state provider	None	1850 N RIVERSIDE AVE	STE 110	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
13226	Fee-for-Service	1053559690	1053559690	1	1	BERRY, RANDI L PT	10/20/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	980 ROOSEVELT	STE 100	IRVINE	CA	92620	3670	30	06059	33.69380208	-117.7653165	Orange County
13244	Fee-for-Service	1972685972	1972685972	1	1	BIRNBAUM, GARY MD	10/17/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36641	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	STE 201	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
13270	Fee-for-Service	1720419013	1720419013	1	1	BLANCQ FERNANDEZ, ERIKA Y LP	12/6/2017	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
13287	Fee-for-Service	1154351484	1154351484	1	1	BRUNEL, LAWRENCE E MD	12/16/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	28693	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 GREENLEY RD	STE 920	SONORA	CA	95370	5287	55	06109	37.9777038	-120.3700429	Tuolumne County
13289	Fee-for-Service	1649316399	1649316399	1	1	BASIL R BESH MD INC	10/18/2018	207XS0106X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	01	06001	37.53211262	-121.9981587	Alameda County
13292	Fee-for-Service	1790429090	1790429090	1	1	BEREZA, DEANNA L LCSW	6/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
13299	Fee-for-Service	1932168598	1932168598	1	1	BOBOLIS, KRISTIE MD	8/30/1990	207RH0003X	NA	Oncology	026	PHYSICIANS	58258	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
13302	Fee-for-Service	1871058636	1871058636	1	1	BLAYTON, ASHLEY M	5/25/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
13323	Fee-for-Service	1912372335	1912372335	2	1	BUCHANAN, ILESE LMFT	12/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1410 3RD STREET	12	RIVERSIDE	CA	92507	3422	33	06065	33.98297949	-117.3436605	Riverside County
13332	Fee-for-Service	1154378362	1154378362	1	1	BROTMAN MEDICAL	11/14/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ANESTHESIA GROUP	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
13337	Fee-for-Service	1992287866	1992287866	1	1	BEKIER, JENNA LCSW	10/24/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
13338	Fee-for-Service	1134652266	1134652266	1	1	BHUVANAGIRI, SAI SANTOSH KUM	9/30/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	176527	None	None	0	In state provider	AR MD	1541 FLORIDA AVE	STE 101	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
13384	Fee-for-Service	1790895050	1790895050	1	1	BHUTTO, ZAHIDA R MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	45139	41	Internal Medicine	0	In state provider	None	315 N 3RD AVE	STE 206	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
13385	Fee-for-Service	1073559704	1073559704	1	1	BROWN, MARY K MD	7/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79469	40	Pediatrics	0	In state provider	None	2020 SUTTER PL	# 201	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
13396	Fee-for-Service	1417582586	1417582586	1	1	BRIGHT EXPECTATIONS INC	10/14/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6760 OLYMPIA DR	None	RIVERSIDE	CA	92503	1031	33	06065	33.95279892	-117.4745034	Riverside County
13398	Fee-for-Service	1417910076	1417910076	1	1	BOSEROY, KANCHANA	12/7/2022	2080P0006X	NA	Psychiatry	026	PHYSICIANS	181875	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
13406	Fee-for-Service	1487655882	1487655882	1	1	BISIGNANI, MARK MD	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151223	30	Radiology	0	In state provider	None	1165 S DORA ST	None	UKIAH	CA	95482	8325	23	06045	39.13602308	-123.2095502	Mendocino County
13411	Fee-for-Service	1164783734	1164783734	1	1	BUCCI, ERIN S	7/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	303 POTRERO	STE 45-204	SANTA CRUZ	CA	95060	7600	44	06087	36.98079126	-122.030791	Santa Cruz County
13422	Fee-for-Service	1669941878	1669941878	1	1	BISHOP, LESLIE A NP	12/6/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
13441	Fee-for-Service	1306992284	1306992284	1	1	BARAJAS, LUCIANO MD	10/31/1989	207ZP0101X	NA	Other	026	PHYSICIANS	29473	22	Pathology (M.D. only)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
13445	Fee-for-Service	1194757252	1194757252	1	1	BABU, MUTHIYALIAH MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41533	45	Nephrology (Renal-Kidney)	0	In state provider	HYPERTENSION,NEPHROLOGY	1401 E MAIN ST	None	SANTA MARIA	CA	93454	4801	42	06083	34.95292749	-120.413619	Santa Barbara County
13454	Fee-for-Service	1154401941	1154401941	1	48	BASS MEDICAL GROUP	10/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2700 GRANT ST	STE 316	CONCORD	CA	94520	2272	07	06013	37.98417931	-122.0361585	Contra Costa County
13498	Fee-for-Service	1205331279	1205331279	1	1	BRAVO, STEPHEN A MD	7/7/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162100	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
13502	Fee-for-Service	1598472334	1598472334	1	1	BERTONE, ZACHARY J LPCC	3/6/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
13533	Fee-for-Service	1972685972	1972685972	1	1	BIRNBAUM, GARY MD	10/17/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36641	08	Family Practice	0	In state provider	None	1580 VALENCIA ST	STE 201	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
13577	Fee-for-Service	1649316399	1649316399	1	1	BASIL R BESH MD INC	10/18/2018	207XS0106X	NA	Orthopedic Surgery	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	01	06001	37.53211262	-121.9981587	Alameda County
13580	Fee-for-Service	1003997032	1003997032	1	1	BERGANZA, JOSE D MD	11/30/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45608	40	Pediatrics	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
13583	Fee-for-Service	1558317248	1558317248	1	1	BAILEY, PATRICK V. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
13597	Fee-for-Service	1710985981	1710985981	1	1	BRANDT H WILLIAMSON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 HOSPITAL DR	None	MARTINSBURG	WV	25401	3402	00	None	39.47628781	-77.98077516	Berkeley County
13610	Fee-for-Service	1659513836	1659513836	1	1	BAE, HO S MD INC	11/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83132	10	Gastroenterology (M.D. only)	0	In state provider	None	520 VIRGIL AVE	STE 202	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
13671	Fee-for-Service	1275917627	1275917627	1	1	BELMONT HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1007 E COOLEY DRIVE	SUITE 117	COLTON	CA	92324	3901	36	06071	34.05461152	-117.310599	San Bernardino County
13674	Fee-for-Service	1790895050	1790895050	1	1	BHUTTO, ZAHIDA R MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	45139	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	315 N 3RD AVE	STE 206	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
13690	Fee-for-Service	1295200038	1295200038	1	1	BUDIMAN, KARTIKA NP	4/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
13718	Fee-for-Service	1790852655	1790852655	1	1	BARBA, ALFONSO A MD	8/10/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60949	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
13722	Fee-for-Service	1881040863	1881040863	1	1	BUNGA TERATAI CEMERLANG	5/8/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AMERICA INC	583 E FOOTHILL BLVD	STE 7 & 8	UPLAND	CA	91786	3995	36	06071	34.1070873	-117.6429202	San Bernardino County
13731	Fee-for-Service	1174122832	1174122832	1	1	BRIGHT HOSPICE CARE INC	2/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	505 MONTGOMERY ST	STE 1059	SAN FRANCISCO	CA	94111	6529	38	06075	37.79414597	-122.4030344	San Francisco County
13744	Fee-for-Service	1154401941	1154401941	1	48	BASS MEDICAL GROUP	10/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2700 GRANT ST	STE 316	CONCORD	CA	94520	2272	07	06013	37.98417931	-122.0361585	Contra Costa County
13748	Fee-for-Service	1760402895	1760402895	1	1	BRONSKY, ERIC S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
13804	Fee-for-Service	1992860142	1992860142	1	1	BARCOHANA, MARK DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9103	05	Anesthesiology	0	In state provider	None	5900 W OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
13810	Fee-for-Service	1346052024	1346052024	1	1	BENJAMIN E JONES COMMUNITY R	2/3/2025	251B00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	ESOURCE CENTER	794 W 40TH ST	STE C	SAN BERNARDINO	CA	92407	3545	36	06071	34.16464949	-117.2998665	San Bernardino County
13832	Fee-for-Service	1154389146	1154389146	1	1	BEAR CREEK ANESTHESIA	6/21/2000	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
13849	Fee-for-Service	1508873571	1508873571	2	1	BRUBAKER, NADINE I OD	6/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
13851	Fee-for-Service	1669769832	1669769832	1	1	BAXTER, COREY MD	7/4/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156355	15	Obstetrics (D.O. only)	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
13898	Fee-for-Service	1659513836	1659513836	1	1	BAE, HO S MD INC	11/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83132	41	Internal Medicine	0	In state provider	None	520 VIRGIL AVE	STE 202	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
13899	Fee-for-Service	1285680959	1285680959	1	1	BRANSFORD, KENT J MD	7/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45162	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
13906	Fee-for-Service	1831267400	1831267400	1	1	BOLIN, GARY R	2/8/2015	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	22572 TARANTO	None	LAGUNA HILLS	CA	92653	1919	30	06059	33.61985251	-117.7358085	Orange County
13928	Fee-for-Service	1538114004	1538114004	1	1	BRACKIN, REID F MD	5/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87762	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
13957	Fee-for-Service	1275917627	1275917627	1	1	BELMONT HOSPICE INC	7/21/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1007 E COOLEY DRIVE	SUITE 117	COLTON	CA	92324	3901	36	06071	34.05461152	-117.310599	San Bernardino County
13961	Fee-for-Service	1841338845	1841338845	1	1	BORIRAKCHANYAVAT, SID MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84115	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
13965	Fee-for-Service	1083496723	1083496723	1	1	BOND, MEGAN	1/23/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
13973	Fee-for-Service	1063414258	1063414258	1	2	BOSTON SCIENTIFIC CARDIAC DI	4/12/2024	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	AGNOSTIC SERVICES, LLC	400 OYSTER POINT BLVD	100	SOUTH SAN FRANCIS	CA	94080	1904	41	06081	37.66637638	-122.3833791	San Mateo County
13981	Fee-for-Service	1538787221	1538787221	1	1	BARTE, LEX HERWEN DPM	11/4/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
13991	Fee-for-Service	1386696573	1386696573	1	1	BHANVER, INDER	5/26/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	76645	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
13997	Fee-for-Service	1881820371	1881820371	1	1	BAUER, KAREN L MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113226	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	92128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
14001	Fee-for-Service	1275821936	1275821936	1	1	BALLOW, SHANA L DO	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10299	02	General Surgery	0	In state provider	None	7415 NORTH CEDAR AVENUE	SUITE 102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
14020	Fee-for-Service	1174122832	1174122832	1	1	BRIGHT HOSPICE CARE INC	2/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	505 MONTGOMERY ST	STE 1059	SAN FRANCISCO	CA	94111	6529	38	06075	37.79414597	-122.4030344	San Francisco County
14068	Fee-for-Service	1417010380	1417010380	1	1	BANAAG, ERNESTO B MD INC	1/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36730	01	General Practice	0	In state provider	A PROF MED CORP	4034 VERDUGO RD	None	LOS ANGELES	CA	90065	3727	19	06037	34.12382686	-118.2314453	Los Angeles County
14070	Fee-for-Service	1528235660	1528235660	1	1	BUCKNER, LEANNE R MD	8/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100254	None	None	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
14077	Fee-for-Service	1588188262	1588188262	1	1	BASSI PSYCHOLOGICAL SERVICES	2/25/2021	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	2200 PACIFIC COAST HWY	STE 302	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
14079	Fee-for-Service	1861448995	1861448995	1	1	BALAYAN, MARI M	4/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24258 EL TORO RD	None	LAGUNA WOODS	CA	92637	3488	30	06059	33.61088364	-117.7236433	Orange County
14102	Fee-for-Service	1154525475	1154525475	1	1	BISCOE, KERI MD	8/29/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	79182	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
14125	Fee-for-Service	1790245363	1790245363	1	1	BROOKS, JOSHUA MD	11/10/2023	207R00000X	NA	Other	026	PHYSICIANS	179079	None	None	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
14129	Fee-for-Service	1033178785	1033178785	1	1	BREZNICK, DAVID A MD	11/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	86255	05	Anesthesiology	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
14150	Fee-for-Service	1588195994	1588195994	1	1	BALSARA, MILIN DO	5/11/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18977	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
14187	Fee-for-Service	1285680959	1285680959	1	1	BRANSFORD, KENT J MD	7/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45162	41	Internal Medicine	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
14207	Fee-for-Service	1164742813	1164742813	1	1	BACON, LANCE T DO	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
14247	Fee-for-Service	1205412947	1205412947	1	1	BASKIN, ALISON MD	5/31/2024	208600000X	NA	General Surgery	026	PHYSICIANS	183666	02	General Surgery	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
14264	Fee-for-Service	1528409604	1528409604	1	1	BROWN, JOHN LCSW	12/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
14268	Fee-for-Service	1700028537	1700028537	1	1	BOSWELL, STEPHANIE B MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114913	30	Radiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
14305	Fee-for-Service	1427008606	1427008606	1	1	BLANCHARD INC	7/1/1999	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	DIRECT DIABETIC SUPPLY	13402 N SCOTTSDALE RD	STE A125	SCOTTSDALE	AZ	85254	4055	00	None	33.608241	-111.9273885	Maricopa County
14331	Fee-for-Service	1508021502	1508021502	1	1	BAIR, ZACHARY C DO	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
14356	Fee-for-Service	1417010380	1417010380	1	1	BANAAG, ERNESTO B MD INC	1/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36730	47	Miscellaneous	0	In state provider	A PROF MED CORP	4034 VERDUGO RD	None	LOS ANGELES	CA	90065	3727	19	06037	34.12382686	-118.2314453	Los Angeles County
14358	Fee-for-Service	1487060166	1487060166	1	1	BODHIT, AAKASH N MD	5/17/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	174204	None	None	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
14361	Fee-for-Service	1457691388	1457691388	1	1	BORDEN, MORGAN N DO	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14065	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2601 W ALAMEDA AVE	STE 212	BURBANK	CA	91505	4814	19	06037	34.15783817	-118.3293969	Los Angeles County
14366	Fee-for-Service	1588188262	1588188262	1	1	BASSI PSYCHOLOGICAL SERVICES	8/16/2024	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	2200 PACIFIC COAST HWY	STE 302	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
14369	Fee-for-Service	1477515948	1477515948	1	1	BEAN, JR. DAVID W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1417 S MINNESOTA AVE	None	SIOUX FALLS	SD	57105	1715	00	None	43.532343	-96.731658	Minnehaha County
14377	Fee-for-Service	1386821569	1386821569	1	1	BELLI-MOJICA, ANGELO R MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120630	08	Family Practice	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1332	42	06083	34.4458497	-119.779596	Santa Barbara County
14378	Fee-for-Service	1154479814	1154479814	1	1	BERRYESSA UNION SCHOOL DIST	12/5/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1376 PIEDMONT RD	None	SAN JOSE	CA	95132	2427	43	06085	37.40196851	-121.8479901	Santa Clara County
14384	Fee-for-Service	1710131834	1710131834	1	1	BENDZINSKI, JOY K	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
14391	Fee-for-Service	1669498630	1669498630	1	1	BOULAND, DANIEL L MD	5/12/1995	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	50358	41	Internal Medicine	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
14394	Fee-for-Service	1790982130	1790982130	1	1	BANKS, LONNIE JR LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
14423	Fee-for-Service	1457395352	1457395352	1	1	BOLGER, ANN F MD	3/31/1984	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49323	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
14445	Fee-for-Service	1306223896	1306223896	1	1	BIZIMUNGU, REMY MD	8/2/2019	207PE0004X	NA	Other	026	PHYSICIANS	147255	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
14452	Fee-for-Service	1407285356	1407285356	1	1	BENADERET, DEBRA R LCSW	6/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
14463	Fee-for-Service	1033392584	1033392584	1	1	BODLE, ETHAN E MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100979	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
14464	Fee-for-Service	1740264191	1740264191	2	1	BNHA HEALTH GROUP INC	3/24/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 20TH ST	# 120	SANTA MONICA	CA	90404	2094	19	06037	34.02976782	-118.4812493	Los Angeles County
14471	Fee-for-Service	1285680959	1285680959	1	1	BRANSFORD, KENT J MD	7/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45162	78	Neoplastic Diseases/Oncology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
14472	Fee-for-Service	1134196256	1134196256	1	1	BARGAR, WILLIAM L MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	34044	20	Orthopedic Surgery	0	In state provider	None	1020 29TH ST	STE 450	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
14479	Fee-for-Service	1104109883	1104109883	1	1	BROMBERG, ERIK LCSW	5/14/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
14510	Fee-for-Service	1467107144	1467107144	1	1	BARTH, ALEXANDRA M PHD	12/11/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
14535	Fee-for-Service	1821386517	1821386517	1	1	BHOPAL, NAVIN S MD	12/23/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
14557	Fee-for-Service	1528078193	1528078193	1	1	BERRY, LYN E MD	10/31/1995	207R00000X	NA	Other	026	PHYSICIANS	50678	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
14569	Fee-for-Service	1972990067	1972990067	1	1	BOBO, MICHELLE LCSW	10/29/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	855 3RD AVENUE	SUITE 2230	CHULA VISTA	CA	91911	1350	37	06073	32.62197574	-117.0723222	San Diego County
14583	Fee-for-Service	1831286822	1831286822	2	1	BALI, AMBIKA MD INC	4/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51761	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 505	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
14593	Fee-for-Service	1003108531	1003108531	1	1	BOECK, MARISSA A MD	5/8/2019	390200000X	NA	Other	026	PHYSICIANS	154281	02	General Surgery	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
14597	Fee-for-Service	1154401941	1154401941	1	27	BASS MEDICAL GROUP	7/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	45 CASTRO ST	210	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
14607	Fee-for-Service	1619189388	1619189388	1	1	BERNARD-PEARL, DEIRDRE J MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56201	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
14645	Fee-for-Service	1972123941	1972123941	1	1	BECHTOLD, ELLEN K MD	8/25/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
14652	Fee-for-Service	1588188262	1588188262	1	1	BASSI PSYCHOLOGICAL SERVICES	2/25/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	2200 PACIFIC COAST HWY	STE 302	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
14655	Fee-for-Service	1497705099	1497705099	1	1	BLESA, EMRIQUE S MD	7/12/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	31529	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	185 S EUCLID AVE	STE 14	PASADENA	CA	91101	2420	19	06037	34.14233627	-118.1429909	Los Angeles County
14666	Fee-for-Service	1265603997	1265603997	1	1	BLANCETT, MELISSA S CCC-SP	4/13/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
14676	Fee-for-Service	1952342636	1952342636	1	1	BROOKE T HALL, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 NE NEFF RD	None	BEND	OR	97701	6015	00	None	44.067735	-121.268187	Deschutes County
14688	Fee-for-Service	1558667485	1558667485	1	2	BLIZE HEALTHCARE CALIFORNIA	5/17/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1762 TECHNOLOGY DR	STE 202	SAN JOSE	CA	95110	1885	43	06085	37.36945439	-121.9201262	Santa Clara County
14694	Fee-for-Service	1881772606	1881772606	1	1	BROWN, STEPHANIE K MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78022	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
14702	Fee-for-Service	1942374269	1942374269	1	1	BEDDOW, ISABELL H MD	3/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69848	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
14710	Fee-for-Service	1700998507	1700998507	1	1	BIO MEDICAL APPLICATIONS	2/24/2009	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	636 E BRIER DRIVE	STE 150	SAN BERNARDINO	CA	92408	2809	36	06071	34.07051831	-117.2715298	San Bernardino County
14742	Fee-for-Service	1467434225	1467434225	1	1	BOONE COUNTY HOSPITAL	11/7/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1015 UNION STREET	None	BOONE	IA	50036	4619	00	None	42.05557486	-93.87695748	Boone County
14769	Fee-for-Service	1376518662	1376518662	1	1	BOYD, ANNE S MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50851	01	General Practice	0	In state provider	None	202 W WILLOW AVE	STE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
14803	Fee-for-Service	1588907596	1588907596	1	1	BALACHANDRAN, JACQUELINE NP	8/17/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
14817	Fee-for-Service	1447621321	1447621321	1	1	BRETL, CARLY ROSE LMFT	4/24/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 WATER ST.	L2	SANTA CRUZ	CA	95060	0000	44	06087	36.98046158	-122.018718	Santa Cruz County
14818	Fee-for-Service	1124552641	1124552641	1	1	BULLOCK, ANDREW MD	8/15/2024	207R00000X	NA	Other	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
14822	Fee-for-Service	1568889921	1568889921	1	1	BALDASSARRE, RANDALL L MD	7/16/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	138073	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
14828	Fee-for-Service	1013291103	1013291103	1	1	BENDER, DAVID I MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117874	40	Pediatrics	0	In state provider	None	191 S BUENA VISTA ST	STE 240	BURBANK	CA	91505	4559	19	06037	34.15872557	-118.3283863	Los Angeles County
14864	Fee-for-Service	1295790582	1295790582	1	1	BRYAN,HALL K MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3801 S NATIONAL COX	MED CTR SOUTH	SPRINGFIELD	MO	65807	5210	00	None	37.1451107	-93.27863681	Greene County
14866	Fee-for-Service	1710399530	1710399530	1	1	BURNS, DEIRDRE MD	12/8/2017	390200000X	NA	Other	026	PHYSICIANS	149735	40	Pediatrics	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
14871	Fee-for-Service	1407921737	1407921737	1	1	BURNS, JOHN MD	10/14/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41985	None	None	0	In state provider	None	2252 BEVERLY BLVD	STE 102	LOS ANGELES	CA	90057	2246	19	06037	34.06771646	-118.2728448	Los Angeles County
14873	Fee-for-Service	1831286822	1831286822	2	1	BALI, AMBIKA MD INC	4/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51761	10	Gastroenterology (M.D. only)	0	In state provider	None	1801 W ROMNEYA DR	STE 505	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
14886	Fee-for-Service	1154401941	1154401941	1	27	BASS MEDICAL GROUP	7/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	45 CASTRO ST	210	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
14932	Fee-for-Service	1972123941	1972123941	1	1	BECHTOLD, ELLEN K MD	8/25/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
14942	Fee-for-Service	1497705099	1497705099	1	1	BLESA, EMRIQUE S MD	7/12/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	31529	66	Emergency Medicine (Urgent Care)	0	In state provider	None	185 S EUCLID AVE	STE 14	PASADENA	CA	91101	2420	19	06037	34.14233627	-118.1429909	Los Angeles County
14943	Fee-for-Service	1952771370	1952771370	1	1	BROCK, WHITNEY W	9/12/2019	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
14965	Fee-for-Service	1225718877	1225718877	1	1	BRYANT, WILSON	7/16/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	19196 PINE WAY	None	APPLE VALLEY	CA	92308	4914	36	06071	34.46198745	-117.245088	San Bernardino County
14981	Fee-for-Service	1851449763	1851449763	1	1	BEAR, CLAUDIA A OD	2/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
14997	Fee-for-Service	1184038895	1184038895	1	1	BITOW, NAOMI MD	9/28/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150788	08	Family Practice	0	In state provider	None	2999 REGENT STREET	301	BERKELEY	CA	94705	2118	01	06001	37.85592021	-122.2566436	Alameda County
15024	Fee-for-Service	1497315725	1497315725	1	1	BINSTOCK, MAXWELL L MD	8/31/2022	208M00000X	NA	Other	026	PHYSICIANS	180408	None	None	0	In state provider	None	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
15025	Fee-for-Service	1194183087	1194183087	1	1	BALL, BENJAMIN Z MD	5/4/2023	363AS0400X	NA	Physician Assistant	026	PHYSICIANS	147883	None	None	0	In state provider	None	255 E BONITA AVE	BLDG 9	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
15029	Fee-for-Service	1467434225	1467434225	1	1	BOONE COUNTY HOSPITAL	11/7/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1015 UNION STREET	None	BOONE	IA	50036	4619	00	None	42.05557486	-93.87695748	Boone County
15045	Fee-for-Service	1740415454	1740415454	1	1	BRUNELLE, AUDRA K MD	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129883	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15046	Fee-for-Service	1417529033	1417529033	1	1	BABCOCK, LAUREN LMFT	3/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD.	400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
15056	Fee-for-Service	1447796453	1447796453	2	1	BIFANO, ALYSON J LCSW	10/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
15122	Fee-for-Service	1336535921	1336535921	1	1	BERG, ANDREW MD	6/14/2024	207P00000X	NA	Other	026	PHYSICIANS	185571	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
15140	Fee-for-Service	1780976977	1780976977	1	1	BONAR, KYLE A MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122364	None	None	0	In state provider	None	27200 CALAROGA AVENUE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
15142	Fee-for-Service	1548690035	1548690035	1	4	BIENESTAR HUMAN SERVICES	12/2/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	5326 E BEVERLY BLVD	None	LOS ANGELES	CA	90022	2104	19	06037	34.03021115	-118.1505459	Los Angeles County
15174	Fee-for-Service	1154401941	1154401941	1	27	BASS MEDICAL GROUP	7/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	45 CASTRO ST	210	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
15177	Fee-for-Service	1073655072	1073655072	1	1	BRODZINSKY, LAURA MD	1/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	81091	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
15180	Fee-for-Service	1750712410	1750712410	1	1	BEAR VALLEY HOSPICE LLC	8/25/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	909 W BIG BEAR BLVD	None	BIG BEAR CITY	CA	92314	0140	36	06071	34.26048489	-116.8612498	San Bernardino County
15196	Fee-for-Service	1285824011	1285824011	1	1	BALASUBRAMANYA KOLAR M.D.	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3015 3RD AVE SE	None	ABERDEEN	SD	57401	5418	00	None	45.46218051	-98.444655	Brown County
15197	Fee-for-Service	1952315640	1952315640	1	1	BROOKS, MAI N MD	11/30/1994	2086X0206X	NA	General Surgery	026	PHYSICIANS	81443	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDIAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
15207	Fee-for-Service	1194927855	1194927855	1	1	BEIDELMAN, MARK R PHD	7/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
15220	Fee-for-Service	1255887295	1255887295	1	1	BOARD, JASMINE B LMFT	3/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
15225	Fee-for-Service	1710249180	1710249180	1	1	BUTLER, SHANNA E PHD	12/10/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7765 HEALDSBURG AVE	STE. 14	SEBASTOPOL	CA	95472	3309	49	06097	38.40525805	-122.8342649	Sonoma County
15238	Fee-for-Service	1912146721	1912146721	1	1	BRAVEMAN, MELISSA W MD	9/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106753	40	Pediatrics	0	In state provider	None	910 MARSHALL STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.4876781	-122.2249265	San Mateo County
15260	Fee-for-Service	1891308425	1891308425	1	1	BEVERLY HILLS TERRACE LLC	3/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1470 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3402	19	06037	34.05277159	-118.3840336	Los Angeles County
15299	Fee-for-Service	1598723223	1598723223	1	1	BMS PHYSICIAN MED GRP	7/22/2008	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1010 WEST LA VENTA AVE	STE 250	ORANGE	CA	92868	4304	30	06059	33.78028244	-117.8635552	Orange County
15313	Fee-for-Service	1982794855	1982794855	1	1	BRENNAN, ELIZABETH MD	9/21/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79874	41	Internal Medicine	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
15315	Fee-for-Service	1548468796	1548468796	1	1	BIZEK, GUY M MD	4/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102028	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
15338	Fee-for-Service	1861924391	1861924391	1	1	BENZAR, TARAS MD	7/24/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	175470	41	Internal Medicine	0	In state provider	None	9808 VENICE BLVD	SUITE 603	CULVER CITY	CA	90232	6819	19	06037	34.0236396	-118.3980847	Los Angeles County
15355	Fee-for-Service	1659627115	1659627115	1	1	BIERMAN, DINA F MD	12/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124111	07	Dermatology	0	In state provider	None	200 MED PLAZA	365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
15370	Fee-for-Service	1982078564	1982078564	1	1	BROADLEY, STEPHANIE A	5/23/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
15382	Fee-for-Service	1396141008	1396141008	1	1	BEDELIAN, TALINE NP	11/25/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
15392	Fee-for-Service	1790727188	1790727188	1	1	BRUGMAN, JOSEPH J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	21552	None	None	0	In state provider	None	1100 N TUSTIN AVE	None	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
15400	Fee-for-Service	1275812323	1275812323	1	1	BROWN, MACKENZIE E DO	6/24/2020	2081P0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14180	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
15402	Fee-for-Service	1710099510	1710099510	1	1	BIO-MEDICAL APPLICATIONS OF	9/1/2009	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, INC	10532 ACACIA ST	B2/B3	RANCHO CUCAMONGA	CA	91730	5446	36	06071	34.09002059	-117.575185	San Bernardino County
15405	Fee-for-Service	1417247677	1417247677	1	1	BEAU BAILEY MD	11/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 WEST	None	PROVO	UT	84604	3380	00	None	40.248072	-111.6673905	Utah County
15411	Fee-for-Service	1215374418	1215374418	1	1	BECERRA-LICHA, IGNACIO MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132849	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
15418	Fee-for-Service	1528630316	1528630316	1	1	BELL, NASTASSJA MD	10/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
15447	Fee-for-Service	1114013026	1114013026	1	1	BLACK-WILLIAMS, MARY NP	3/22/2023	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	855 E HOSPITALITY LANE	None	SAN BERNARDINO	CA	92408	3596	36	06071	34.06878193	-117.2675193	San Bernardino County
15448	Fee-for-Service	1558569533	1558569533	1	1	BENNETT, DONALD R MD	4/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104991	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
15456	Fee-for-Service	1154401941	1154401941	1	19	BASS MEDICAL GROUP	2/25/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2242 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1363	07	06013	37.77676087	-121.9672603	Contra Costa County
15467	Fee-for-Service	1154401941	1154401941	1	36	BASS MEDICAL GROUP	10/31/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	929 CLAY ST	SUITE 201	SAN FRANCISCO	CA	94108	1556	38	06075	37.79398652	-122.4083496	San Francisco County
15468	Fee-for-Service	1750712410	1750712410	1	1	BEAR VALLEY HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	909 W BIG BEAR BLVD	None	BIG BEAR CITY	CA	92314	0140	36	06071	34.26048489	-116.8612498	San Bernardino County
15486	Fee-for-Service	1194194514	1194194514	1	1	BUI, CUC K LCSW	7/12/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
15488	Fee-for-Service	1952315640	1952315640	1	1	BROOKS, MAI N MD	11/30/1994	2086X0206X	NA	General Surgery	026	PHYSICIANS	81443	02	General Surgery	0	In state provider	None	200 MEDIAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
15537	Fee-for-Service	1124460506	1124460506	1	1	BORAZJANI, BORIS H M D INC	8/19/2013	2086S0127X	NA	General Surgery	026	PHYSICIANS	90161	02	General Surgery	0	In state provider	None	15031 RINALDI STREET	None	MISSON HILLS	CA	91346	1207	19	06037	34.27904453	-118.459944	Los Angeles County
15550	Fee-for-Service	1003247545	1003247545	2	1	BARON, ERIC S CPO	1/13/2014	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2345 S BROADWAY	#E	SANTA MARIA	CA	93454	7840	42	06083	34.91787028	-120.4361185	Santa Barbara County
15585	Fee-for-Service	1598723223	1598723223	1	1	BMS PHYSICIAN MED GRP	4/13/1993	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1010 WEST LA VENTA AVE	STE 250	ORANGE	CA	92868	4304	30	06059	33.78028244	-117.8635552	Orange County
15614	Fee-for-Service	1134117955	1134117955	1	1	BAASEN, CHAD M MD	5/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	64062	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
15619	Fee-for-Service	1164876140	1164876140	1	2	BILBREY, ARTHUR LMFT	10/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 N PALM CANYON DR	215	PALM SPRINGS	CA	92262	5658	33	06065	33.827652	-116.5468485	Riverside County
15635	Fee-for-Service	1417169491	1417169491	1	1	BROWN, LIDIA K MD	2/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	97089	13	Neurology (M.D. only)	0	In state provider	None	695 OAK GROVE AVE	STE 310	MENLO PARK	CA	94025	4370	41	06081	37.45316606	-122.185299	San Mateo County
15657	Fee-for-Service	1427311034	1427311034	1	1	BROTHERS, JOEL M MD	7/1/2019	207R00000X	NA	Other	026	PHYSICIANS	141503	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
15669	Fee-for-Service	1154401941	1154401941	1	4	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	820 S AKERS ST	STE 120	VISALIA	CA	93277	8306	54	06107	36.323757	-119.3491755	Tulare County
15686	Fee-for-Service	1669130753	1669130753	1	1	BURRI, SABRINA D PT	1/21/2022	2251N0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
15688	Fee-for-Service	1275812323	1275812323	1	1	BROWN, MACKENZIE E DO	6/24/2020	2081P0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14180	25	Physical Medicine and Rehabilitation	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
15719	Fee-for-Service	1689886921	1689886921	1	1	BEHNAWA, WALID MD	7/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175578	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
15743	Fee-for-Service	1306307202	1306307202	1	1	BUI, TIMOTHY	11/22/2023	207L00000X	NA	Other	026	PHYSICIANS	181890	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
15749	Fee-for-Service	1992749790	1992749790	1	1	BAUM, DAVID W MD	11/29/1984	207P00000X	NA	Other	026	PHYSICIANS	54001	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
15756	Fee-for-Service	1154401941	1154401941	1	36	BASS MEDICAL GROUP	10/31/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	929 CLAY ST	SUITE 201	SAN FRANCISCO	CA	94108	1556	38	06075	37.79398652	-122.4083496	San Francisco County
15766	Fee-for-Service	1770881906	1770881906	1	1	BERBER, MARIEL S MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116187	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
15771	Fee-for-Service	1336675313	1336675313	1	1	BUENROSTRO, SILVIA MD	11/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163320	None	None	0	In state provider	None	10000 LAKEWOOD BLVD	None	DOWNEY	CA	90240	4020	19	06037	33.94833058	-118.1166411	Los Angeles County
15785	Fee-for-Service	1093812836	1093812836	1	1	BOSTROS, NABIL	9/1/2003	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2246 NEWPORT BLVD	None	COSTA MESA	CA	92627	1752	30	06059	33.65289256	-117.9069081	Orange County
15797	Fee-for-Service	1124129218	1124129218	1	1	BEHMAND, RAMIN A MD	4/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79315	24	Plastic Surgery	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
15850	Fee-for-Service	1396721932	1396721932	1	1	BRIER OAK ON SUNSET	10/20/2017	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5154 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5708	19	06037	34.09809647	-118.302417	Los Angeles County
15865	Fee-for-Service	1427811694	1427811694	1	1	BASCH, ALLYSON OT	10/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
15868	Fee-for-Service	1568521292	1568521292	1	1	BOZINSKI, KATHY L CNM	12/26/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10900 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.90543111	-117.4724668	Riverside County
15886	Fee-for-Service	1417027392	1417027392	1	1	BERG, MARION E LMFT	7/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	500 S. SEPULVEDA	STE 204	MANHATTAN BEACH	CA	90266	0000	19	06037	33.875154	-118.3958905	Los Angeles County
15938	Fee-for-Service	1992883672	1992883672	1	1	BORCHERS, STEPHEN L MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	42763	07	Dermatology	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
15945	Fee-for-Service	1255445334	1255445334	1	1	BRADEN PARTNERS, LP	3/15/2013	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3108 SPENGLER WAY	None	TURLOCK	CA	95380	8504	50	06099	37.48450048	-120.8835695	Stanislaus County
15956	Fee-for-Service	1154401941	1154401941	1	4	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	820 S AKERS ST	STE 120	VISALIA	CA	93277	8306	54	06107	36.323757	-119.3491755	Tulare County
15973	Fee-for-Service	1427203355	1427203355	1	1	BUNKER, STEPHEN R MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	36647	42	Nuclear Medicine	0	In state provider	A PROFESSIONAL CORP	1700 CALIFORNIA ST	STE 260	SAN FRANCISCO	CA	94109	4588	38	06075	37.79030099	-122.4230289	San Francisco County
15985	Fee-for-Service	1992886618	1992886618	1	1	BRENT, DALE J MD	3/13/2006	207R00000X	NA	Other	026	PHYSICIANS	43070	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	STE 411	SHERMAN OAKS	CA	91403	1824	19	06037	34.160805	-118.4487295	Los Angeles County
15990	Fee-for-Service	1447532809	1447532809	1	1	BOYCE, JOHN LMFT	9/25/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106653	-	NOT APPLICABLE	0	In state provider	None	736, 737, 745 E GRAND AV	None	ESCONDIDO	CA	92025	4044	37	06073	33.12520683	-117.0718117	San Diego County
16009	Fee-for-Service	1649366345	1649366345	1	1	BIAMA, RICHARD A MD	1/1/1982	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	39905	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
16031	Fee-for-Service	1497595367	1497595367	1	1	BERTA, ARIANA M LCSW	6/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1835 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
16041	Fee-for-Service	1396741005	1396741005	1	1	BELLER, RICHARD A MD	3/10/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40056	18	Ophthalmology	0	In state provider	None	895 TRANCAS ST	None	NAPA	CA	94558	3040	28	06055	38.32406807	-122.2928218	Napa County
16044	Fee-for-Service	1154401941	1154401941	1	36	BASS MEDICAL GROUP	10/31/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	929 CLAY ST	SUITE 201	SAN FRANCISCO	CA	94108	1556	38	06075	37.79398652	-122.4083496	San Francisco County
16120	Fee-for-Service	1760963466	1760963466	1	1	BELLA MENTE MONTESSORI	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ACADEMY	1737 WEST VISTA WAY	None	VISTA	CA	92083	2112	37	06073	33.18932856	-117.2783831	San Diego County
16134	Fee-for-Service	1124242490	1124242490	1	1	BERKEMER, LORI L NP	4/21/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	8798	-	NOT APPLICABLE	0	In state provider	None	600 W SANTA ANA BLVD	SUITE 107 108 109 110	SANTA ANA	CA	92701	4558	30	06059	33.74804119	-117.874111	Orange County
16139	Fee-for-Service	1831756535	1831756535	1	1	BRIDGES HOME HEALTH CARE INC	12/22/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9795 CABRINI DR	STE 201	BURBANK	CA	91504	1739	19	06037	34.20957984	-118.3438935	Los Angeles County
16193	Fee-for-Service	1447308473	1447308473	1	1	BELL, JEFFREY M CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
16224	Fee-for-Service	1558885541	1558885541	1	1	BEVERLY HILLS MULTISPECIALTY	3/18/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGICAL CENTER, LLC	50 N LA CIENEGA BLVD	201	BEVERLY HILLS	CA	90211	2246	19	06037	34.06689439	-118.3762514	Los Angeles County
16227	Fee-for-Service	1831617851	1831617851	1	1	BREEN, COLLEEN M LMFT	12/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
16234	Fee-for-Service	1619251881	1619251881	1	1	BARAJAS, DANA E LCSW	11/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
16247	Fee-for-Service	1730250622	1730250622	1	1	BUI, THANH DUC MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69908	08	Family Practice	0	In state provider	None	800 DOUGLAS RD	None	STOCKTON	CA	95207	3607	39	06077	38.00786919	-121.3210892	San Joaquin County
16255	Fee-for-Service	1154401941	1154401941	1	28	BASS MEDICAL GROUP	7/23/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3838 CALIFORNIA ST	505	SAN FRANCISCO	CA	94118	1502	38	06075	37.78591809	-122.4575439	San Francisco County
16263	Fee-for-Service	1427203355	1427203355	1	1	BUNKER, STEPHEN R MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	36647	30	Radiology	0	In state provider	A PROFESSIONAL CORP	1700 CALIFORNIA ST	STE 260	SAN FRANCISCO	CA	94109	4588	38	06075	37.79030099	-122.4230289	San Francisco County
16273	Fee-for-Service	1992886618	1992886618	1	1	BRENT, DALE J MD	3/13/2006	207R00000X	NA	Other	026	PHYSICIANS	43070	01	General Practice	0	In state provider	None	4955 VAN NUYS BLVD	STE 411	SHERMAN OAKS	CA	91403	1824	19	06037	34.160805	-118.4487295	Los Angeles County
16275	Fee-for-Service	1174606610	1174606610	1	1	BROWNS, MONIQUE M MD	12/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94360	08	Family Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
16281	Fee-for-Service	1467895144	1467895144	1	1	BASSETT, HANNAH K MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131985	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
16338	Fee-for-Service	1972554301	1972554301	1	1	BAIRD, DONALD I MD	6/7/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32307	08	Family Practice	0	In state provider	None	3306 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58239845	-124.1360414	Humboldt County
16378	Fee-for-Service	1932444239	1932444239	1	1	BLAIR, CALLIE R DO	4/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12240	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 OLD RIVER RD	None	BAKERSFIELD	CA	93311	8823	15	06029	35.35253312	-119.1144456	Kern County
16396	Fee-for-Service	1265490890	1265490890	1	1	BRUCE, WILLIAM H JR MD	10/14/2013	207R00000X	NA	Other	026	PHYSICIANS	12358	41	Internal Medicine	0	In state provider	None	520 SUPERIOR AVENUE	SUITE 255	NEWPORT BEACH	CA	92663	3668	30	06059	33.628914	-117.9276525	Orange County
16407	Fee-for-Service	1497092159	1497092159	1	1	BESS, DANIEL W MD	10/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170551	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
16412	Fee-for-Service	1063450286	1063450286	1	1	BRAUSER, STEVEN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50086	05	Anesthesiology	0	In state provider	None	20998 REDWOOD RD	None	CASTRO VALLEY	CA	94546	5918	01	06001	37.69338464	-122.0737355	Alameda County
16427	Fee-for-Service	1003307679	1003307679	1	1	BASI, JASPREET S OT	3/20/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
16428	Fee-for-Service	1003017906	1003017906	1	1	BURZELL, LINDEN J MD	3/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	112617	01	General Practice	0	In state provider	None	3142 VISTA WAY	SUITE 100	OCEANSIDE	CA	92056	3627	37	06073	33.18253858	-117.3252818	San Diego County
16467	Fee-for-Service	1316442296	1316442296	1	1	BAKER, DAVID DO	4/7/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	20607	None	None	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
16482	Fee-for-Service	1730642745	1730642745	1	1	BONOMO, SARAH NP	9/16/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
16486	Fee-for-Service	1245337609	1245337609	1	1	BENOIT, ROCKY J MD	10/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93817	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
16506	Fee-for-Service	1851307581	1851307581	1	1	BERNARD, REBECCA S PHD	6/2/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
16546	Fee-for-Service	1154401941	1154401941	1	51	BASS MEDICAL GROUP	9/27/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6061 N 1ST ST	STE 103	FRESNO	CA	93710	5470	10	06019	36.824157	-119.774304	Fresno County
16581	Fee-for-Service	1366527491	1366527491	2	1	BABAKNIA, ARDALAN MD PHD	4/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	44193	41	Internal Medicine	0	In state provider	None	15775 LAGUNA CANYON ROAD	SUITE 240	IRVINE	CA	92618	3415	30	06059	33.6663745	-117.760682	Orange County
16596	Fee-for-Service	1619060456	1619060456	1	1	BROUKHIM, KAMRAN MD	6/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38857	None	None	0	In state provider	None	3200 SANTA MONICA BLVD	STE 100	SANTA MONICA	CA	90404	2638	19	06037	34.03800936	-118.46844	Los Angeles County
16604	Fee-for-Service	1427634963	1427634963	1	1	BLOYD, COOPER	8/2/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183168	40	Pediatrics	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
16626	Fee-for-Service	1578875324	1578875324	1	1	BASTIAN, REBECCA J MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117932	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
16644	Fee-for-Service	1053461681	1053461681	1	1	BARSTOW USD	10/8/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	CAMERON HEALTHY START	551 S AVENUE H	None	BARSTOW	CA	92311	2500	36	06071	34.89042646	-117.0474808	San Bernardino County
16659	Fee-for-Service	1033139225	1033139225	1	1	BERES, KIMBERLY CRNA	11/5/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
16684	Fee-for-Service	1235169327	1235169327	1	1	BURCH, KATIE E PT	1/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
16693	Fee-for-Service	1457310377	1457310377	1	1	BAIER, MARK E MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	68629	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10121 PINE AVENUE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
16741	Fee-for-Service	1235199373	1235199373	1	1	BOTELHO, RONALD J MD	7/23/1991	208600000X	NA	General Surgery	026	PHYSICIANS	53308	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
16742	Fee-for-Service	1407389331	1407389331	1	1	BRODSKY-BROOKS, TREVOR MD	3/10/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158949	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
16832	Fee-for-Service	1982747572	1982747572	1	1	BIER, TIFFANY LYNN RN	2/15/2006	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1733 N. ENOS CT	None	VISALIA	CA	93292	2397	54	06107	36.344592	-119.2773645	Tulare County
16833	Fee-for-Service	1154401941	1154401941	1	28	BASS MEDICAL GROUP	7/23/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3838 CALIFORNIA ST	505	SAN FRANCISCO	CA	94118	1502	38	06075	37.78591809	-122.4575439	San Francisco County
16864	Fee-for-Service	1699705210	1699705210	1	1	BHATNAGAR, MADHUR MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	42480	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
16866	Fee-for-Service	1174755367	1174755367	1	1	BARBOSA, HEATHER L MD	3/22/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	107070	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
16884	Fee-for-Service	1508911892	1508911892	1	28	BAY AREA FOOT CARE, INC	8/17/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	400 EVELYN AVE	STE 215	ALBANY	CA	94706	1372	01	06001	37.89873243	-122.2971602	Alameda County
16896	Fee-for-Service	1245391242	1245391242	1	1	BOLES, SARAH G MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82562	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
16898	Fee-for-Service	1679593727	1679593727	1	1	BOLDING, DAWN R RN	2/1/2003	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
16902	Fee-for-Service	1144877952	1144877952	1	2	BEST PACIFIC MD GROUP INC	1/19/2020	207ZP0102X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	319 S BRAND BLVD	None	GLENDALE	CA	91204	1701	19	06037	34.14172735	-118.2550689	Los Angeles County
16930	Fee-for-Service	1689800088	1689800088	1	1	BROWN, MARY K LMFT	5/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	344 FLUME ST	STE H	CHICO	CA	95928	5429	04	06007	39.73035452	-121.8370815	Butte County
16932	Fee-for-Service	1215988399	1215988399	1	1	BEDIKIAN,VICKEN A DC	8/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4719 TORRANCE BLVD	None	TORRANCE	CA	90503	4173	19	06037	33.83759548	-118.364301	Los Angeles County
16992	Fee-for-Service	1588790893	1588790893	1	1	BUECHNER, JOHN DC	7/19/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1775 HARRISON AVE	None	EUREKA	CA	95501	1338	12	06023	40.79191911	-124.1395817	Humboldt County
17000	Fee-for-Service	1124401252	1124401252	1	1	BETTER LIFE CBAS INC	5/5/2016	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1616 W BEVERLY BLVD	None	LOS ANGELES	CA	90026	5711	19	06037	34.06365993	-118.2637107	Los Angeles County
17015	Fee-for-Service	1679998827	1679998827	1	1	BENSON, AKEELA NP	8/5/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
17017	Fee-for-Service	1154360071	1154360071	1	1	BRIAN T HOYT	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHNS MEDICAL CENTER	1615 DELAWARE	None	LONGVIEW	WA	98632	0000	00	None	46.1309207	-122.9408931	Cowlitz County
17040	Fee-for-Service	1639790744	1639790744	1	1	BEIT SHALOM	12/8/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3121 CASTLE HEIGHTS AVE	None	LOS ANGELES	CA	90034	2706	19	06037	34.03395026	-118.3988321	Los Angeles County
17098	Fee-for-Service	1669976825	1669976825	1	1	BUCHANAN, JOANNA J DO	1/31/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18335	None	None	0	In state provider	None	1370 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9554	34	06067	38.65493608	-121.1686756	Sacramento County
17120	Fee-for-Service	1154401941	1154401941	1	51	BASS MEDICAL GROUP	12/21/2020	174400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6061 N 1ST ST	STE 103	FRESNO	CA	93710	5470	10	06019	36.824157	-119.774304	Fresno County
17153	Fee-for-Service	1306465125	1306465125	1	1	BURKE, RENNIE M MD	11/30/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179616	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
17187	Fee-for-Service	1144877952	1144877952	1	2	BEST PACIFIC MD GROUP INC	1/19/2020	207ZP0102X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	319 S BRAND BLVD	None	GLENDALE	CA	91204	1701	19	06037	34.14172735	-118.2550689	Los Angeles County
17191	Fee-for-Service	1023108503	1023108503	1	1	BELAND,SUSAN S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM STREET	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
17217	Fee-for-Service	1518966340	1518966340	1	1	BOUCHER, DAVID A PHD	3/1/1995	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3633 CAMINO DEL RIO S	SUITE 102	SAN DIEGO	CA	92108	4012	37	06073	32.77798059	-117.1163142	San Diego County
17240	Fee-for-Service	1639487457	1639487457	1	1	BUSTILLOS, JULIANA	5/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
17280	Fee-for-Service	1821529959	1821529959	1	1	BANERJEE, AMIT MD	3/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165446	None	None	0	In state provider	None	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	36	06071	34.54034956	-117.2645069	San Bernardino County
17282	Fee-for-Service	1306277132	1306277132	1	1	BUCHHOLZ, MICHELLE E NP	6/25/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
17286	Fee-for-Service	1326202458	1326202458	1	1	BRAUNSTEIN, LAURA S PSYD	6/27/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
17294	Fee-for-Service	1174557805	1174557805	1	9	BAY AREA RETINA ASSOCIATES,	11/3/2023	207WX0107X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	2160 GRANT LINE RD	STE 240	TRACY	CA	95377	7335	39	06077	37.75399922	-121.455877	San Joaquin County
17328	Fee-for-Service	1275093056	1275093056	1	1	BILLAH, ZAEEM M	4/25/2023	2085B0100X	NA	MRI Provider	026	PHYSICIANS	182295	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
17337	Fee-for-Service	1336163450	1336163450	1	1	BAILS, RICHARD P MD	6/29/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	23592	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2510 WEBER ST	# 200	BERKELEY	CA	94705	0000	01	06001	0	0	None
17341	Fee-for-Service	1306076716	1306076716	1	1	BINDER, NICHOLAS R MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124698	18	Ophthalmology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
17369	Fee-for-Service	1699287995	1699287995	1	1	BRUHNKE, STEPHANIE E CNP	3/11/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
17379	Fee-for-Service	1679629257	1679629257	1	1	BAUMGARTNER, JOEL M MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121105	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
17387	Fee-for-Service	1174783989	1174783989	1	1	BIG BEAR LAKE MEDICAL GROUP	4/27/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	6319	41	Internal Medicine	0	In state provider	BIG BEAR LAKE MEDICAL GR	41930 GARSTIN ROAD	None	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24596994	-116.8872868	San Bernardino County
17404	Fee-for-Service	1407295702	1407295702	1	1	BIDDY, EDNA E MD	7/20/2018	390200000X	NA	Other	026	PHYSICIANS	140194	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
17408	Fee-for-Service	1154401941	1154401941	1	51	BASS MEDICAL GROUP	8/15/2022	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6061 N 1ST ST	STE 103	FRESNO	CA	93710	5470	10	06019	36.824157	-119.774304	Fresno County
17415	Fee-for-Service	1154401941	1154401941	1	25	BASS MEDICAL GROUP	2/25/2019	207XX0005X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2255 YGNACIO VALLEY RD	STE V	WALNUT CREEK	CA	94598	3343	07	06013	37.92242643	-122.0301696	Contra Costa County
17434	Fee-for-Service	1497251185	1497251185	1	1	BHATTER, MEGHNA MD	1/10/2023	208M00000X	NA	Other	026	PHYSICIANS	163601	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
17467	Fee-for-Service	1386179612	1386179612	1	1	BUSTOS, FRANCIS MD	8/12/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	184708	20	Orthopedic Surgery	0	In state provider	None	16311 VENTURA BLVD	SUITE #1150	ENCINO	CA	91436	4386	19	06037	34.15706864	-118.4885978	Los Angeles County
17472	Fee-for-Service	1386074763	1386074763	1	1	BAY, MEGAN	9/27/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
17478	Fee-for-Service	1720602113	1720602113	1	1	BOUCHE, VICKY A PHD	10/5/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
17527	Fee-for-Service	1649531088	1649531088	1	1	BILDERBECK, EVA C CNM	6/12/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
17578	Fee-for-Service	1124338116	1124338116	1	1	BURKHOLDER, LISANNE R MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84136	41	Internal Medicine	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
17585	Fee-for-Service	1093723595	1093723595	1	1	BUTTELMAN, CHRISTOPHER	7/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47864	41	Internal Medicine	0	In state provider	BUTTELMAN MEDICAL CORP	17075 DEVONSHIRE ST	STE 209	NORTHRIDGE	CA	91325	5411	19	06037	34.25755945	-118.50471	Los Angeles County
17586	Fee-for-Service	1982900783	1982900783	1	1	BALLARD, MICHELLE L	2/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 E GUASTI RD	STE 178B	ONTARIO	CA	91761	8660	36	06071	34.06518	-117.5822055	San Bernardino County
17602	Fee-for-Service	1629421839	1629421839	1	1	BANUELOS, KAREN D NP	5/30/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
17623	Fee-for-Service	1093911943	1093911943	2	2	BARCO MEDICAL CLINIC	12/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	38962	01	General Practice	0	In state provider	None	8929 WILSHIRE BLVD	STE 225	BEVERLY HILLS	CA	90211	1837	19	06037	34.06709669	-118.386182	Los Angeles County
17626	Fee-for-Service	1336163450	1336163450	1	1	BAILS, RICHARD P MD	6/29/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	23592	41	Internal Medicine	0	In state provider	None	2510 WEBER ST	# 200	BERKELEY	CA	94705	0000	01	06001	0	0	None
17635	Fee-for-Service	1659820025	1659820025	1	1	BROWN, EMMA K CRNA	11/22/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
17637	Fee-for-Service	1063525426	1063525426	1	1	BELL, BRIDGIT	7/15/2023	207RC0200X	NA	Other	026	PHYSICIANS	137417	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
17640	Fee-for-Service	1407218167	1407218167	1	1	BELANI, SANJAY MD	9/14/2020	390200000X	NA	Other	026	PHYSICIANS	154930	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
17655	Fee-for-Service	1629391123	1629391123	1	1	BYRNE, KATIE PSYD	8/16/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4909 MURPHY CANYON RD	300	SAN DIEGO	CA	92123	4349	37	06073	32.8287682	-117.1197549	San Diego County
17666	Fee-for-Service	1679629257	1679629257	1	1	BAUMGARTNER, JOEL M MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121105	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
17668	Fee-for-Service	1194246967	1194246967	1	1	BADE, BRITTANY N MD	5/14/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18691	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
17675	Fee-for-Service	1114254430	1114254430	1	1	BANSAL, SHELJA	5/15/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
17690	Fee-for-Service	1154775906	1154775906	1	1	BARRIOS, ERICA N MD	7/14/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153891	None	None	0	In state provider	None	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	19	06037	33.96800305	-118.0956362	Los Angeles County
17696	Fee-for-Service	1154401941	1154401941	1	28	BASS MEDICAL GROUP	7/23/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	3838 CALIFORNIA ST	505	SAN FRANCISCO	CA	94118	1502	38	06075	37.78591809	-122.4575439	San Francisco County
17697	Fee-for-Service	1215004064	1215004064	1	1	BERDUGO, MAYRA L OD	12/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7825 ATLANTIC AVE	None	CUDAHY	CA	90201	5022	19	06037	33.96396181	-118.1866866	Los Angeles County
17703	Fee-for-Service	1154401941	1154401941	1	25	BASS MEDICAL GROUP	2/25/2019	207XX0005X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2255 YGNACIO VALLEY RD	STE V	WALNUT CREEK	CA	94598	3343	07	06013	37.92242643	-122.0301696	Contra Costa County
17708	Fee-for-Service	1841940251	1841940251	1	1	BLESSED SACRAMENT SISTERS	7/10/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OF CHARITY INC	248 S MARIPOSA AVE	None	LOS ANGELES	CA	90004	5408	19	06037	34.06966756	-118.2991005	Los Angeles County
17716	Fee-for-Service	1558819193	1558819193	1	1	BARBA, FELIPE D PHD	6/13/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
17718	Fee-for-Service	1902233422	1902233422	1	1	BRIE, MELISSA S PSYD	9/4/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
17730	Fee-for-Service	1104183896	1104183896	1	1	BECHLER, KEVIN A MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127400	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
17738	Fee-for-Service	1558724286	1558724286	1	1	BRAH, TARA K MD	8/25/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151543	None	None	0	In state provider	None	7050 N RECREATION AVE	SUITE 105	FRESNO	CA	93720	8001	10	06019	36.83835219	-119.7404373	Fresno County
17745	Fee-for-Service	1366025496	1366025496	1	1	BEIT SHALOM GROUP LLC	5/26/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1620 S SHERBOURNE DR	None	LOS ANGELES	CA	90035	4415	19	06037	34.04906999	-118.3801984	Los Angeles County
17782	Fee-for-Service	1326029950	1326029950	1	1	BAUER, JASON R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
17793	Fee-for-Service	1811194426	1811194426	1	1	BERNAL, NICOLE P MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113740	89	Surgery-Traumatic	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
17798	Fee-for-Service	1467500413	1467500413	1	1	BEGER, PAULO MD	11/30/1995	207P00000X	NA	Other	026	PHYSICIANS	80562	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
17807	Fee-for-Service	1942656590	1942656590	1	1	BHATT, SHRILKUMAR MD	1/1/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1325 N LITCHFIELD RD	110	GOODYEAR	AZ	85395	1228	00	None	33.461118	-112.355739	Maricopa County
17834	Fee-for-Service	1265698450	1265698450	1	1	BERTRAND, KYLE M MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112313	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
17836	Fee-for-Service	1992396881	1992396881	1	1	BIRRING, SATINDER K CRNA	5/7/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
17842	Fee-for-Service	1992800452	1992800452	1	1	BROWN, DAVID M MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88545	13	Neurology (M.D. only)	0	In state provider	None	1 HOAG DR	# 2	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
17860	Fee-for-Service	1497978761	1497978761	1	1	BLUMBERG, MARC A MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99113	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
17863	Fee-for-Service	1194893040	1194893040	1	1	BECK, SAMUEL MD	4/22/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
17864	Fee-for-Service	1588790893	1588790893	1	2	BUECHNER, JOHN DC	7/16/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	TIC	310 3RD ST	SUITE A	EUREKA	CA	95501	0587	12	06023	40.8033152	-124.1683129	Humboldt County
17867	Fee-for-Service	1396059440	1396059440	1	1	BLAKER, KRISTEN M MD	9/11/2020	208600000X	NA	General Surgery	026	PHYSICIANS	141260	02	General Surgery	0	In state provider	None	3601 VISTA WAY	STE 203	OCEANSIDE	CA	92056	4559	37	06073	33.18140858	-117.3093221	San Diego County
17912	Fee-for-Service	1235173394	1235173394	1	1	BINDER, RENEE MD	6/15/2022	2084F0202X	NA	Psychiatry	026	PHYSICIANS	27505	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
17937	Fee-for-Service	1245737188	1245737188	1	1	BRODERS, SAMUEL F MD	10/8/2022	207P00000X	NA	Other	026	PHYSICIANS	179942	None	None	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
17942	Fee-for-Service	1306826029	1306826029	1	1	BOARD OF GOV OF DALLAS CNTY	10/4/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 N CLIFTON ST	None	FORDYCE	AR	71742	3026	00	None	33.811002	-92.425347	Dallas County
17968	Fee-for-Service	1710912068	1710912068	1	1	BARATHAN, SHRINATH MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83691	45	Nephrology (Renal-Kidney)	0	In state provider	None	8635 W THIRD ST	STE 485W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
18006	Fee-for-Service	1841667847	1841667847	1	1	BUNN-RUBIO, LUCRECIA LMFT	10/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20212 REDWOOD ROAD	103C	CASTRO VALLEY	CA	94546	4324	01	06001	37.698066	-122.073924	Alameda County
18020	Fee-for-Service	1164725255	1164725255	1	1	BRAID, ROY L MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129335	None	None	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
18054	Fee-for-Service	1346320645	1346320645	1	1	BONDS, PAUL M MD	5/22/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41001	18	Ophthalmology	0	In state provider	None	2095 WEST VISTA WAY	#216	VISTA	CA	92083	6095	37	06073	33.18438885	-117.2876725	San Diego County
18056	Fee-for-Service	1932113107	1932113107	1	1	BERVEL, DEBBIE DENISE	10/31/1988	207P00000X	NA	Other	026	PHYSICIANS	60547	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
18074	Fee-for-Service	1942343975	1942343975	1	1	BUSCH, DAVID F MD	8/15/1986	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	19205	41	Internal Medicine	0	In state provider	None	3838 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1522	38	06075	37.78591809	-122.4575439	San Francisco County
18089	Fee-for-Service	1619060332	1619060332	1	1	BILLYS, MEDA M MD	5/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	65714	07	Dermatology	0	In state provider	None	2820 W MAIN ST	None	VISALIA	CA	93291	4331	54	06107	36.329778	-119.322099	Tulare County
18090	Fee-for-Service	1861802720	1861802720	1	1	BUTTAR, MUHAMMAD M MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150045	01	General Practice	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
18093	Fee-for-Service	1497911929	1497911929	1	1	BROWN, LORENA NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11911 CENTRAL AVE	None	CHINO	CA	91710	1906	36	06071	34.03704117	-117.6893971	San Bernardino County
18098	Fee-for-Service	1285015271	1285015271	1	1	BLAKE, ADARA	7/20/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
18103	Fee-for-Service	1043406937	1043406937	1	1	BAUTISTA, CHRISTINE A MFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52430	-	NOT APPLICABLE	0	In state provider	None	2400 MOORPARK AVE	SUITE 300	SAN JOSE	CA	95128	2631	43	06085	37.3160785	-121.937121	Santa Clara County
18118	Fee-for-Service	1588820880	1588820880	1	1	BINDAL, ANKUR MD	2/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132533	36	Psychiatry	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
18122	Fee-for-Service	1417261785	1417261785	1	1	BLOOM, DAVID A MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139300	02	General Surgery	0	In state provider	None	200 MISSION BLVD	None	JACKSON	CA	95642	2564	03	06005	38.35007723	-120.7659932	Amador County
18128	Fee-for-Service	1992800452	1992800452	1	1	BROWN, DAVID M MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88545	14	Neurological Surgery	0	In state provider	None	1 HOAG DR	# 2	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
18130	Fee-for-Service	1740679315	1740679315	1	2	BRAMBLE, MANUEL	3/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147887	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
18144	Fee-for-Service	1558775403	1558775403	1	1	BUTKA, KIMBERLY OD	1/29/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
18149	Fee-for-Service	1285860478	1285860478	1	1	BIAS, TRAVIS G DO MD	7/5/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15740	08	Family Practice	0	In state provider	None	4053 LONE TREE WAY	101	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
18174	Fee-for-Service	1487022539	1487022539	1	1	BOSWORTH, LAURA INC	4/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12881 KNOTT ST	SUITE 106	GARDEN GROVE	CA	92841	3939	30	06059	33.77542911	-118.0080111	Orange County
18215	Fee-for-Service	1467590901	1467590901	1	3	BEACH CITIES MIDWIFERY	5/12/2021	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	AND WOMEN'S HEALTH CARE	1224 E WARDLOW ROAD	None	LONG BEACH	CA	92881	7262	19	06037	33.8189015	-118.1756925	Los Angeles County
18224	Fee-for-Service	1306000922	1306000922	1	1	BAJWA, JASWINDER P MD	12/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118049	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
18232	Fee-for-Service	1891750121	1891750121	1	1	BUI, KARL T DPM	5/30/2003	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3612 DALE RD	None	MODESTO	CA	95356	0500	50	06099	37.69097901	-121.0498748	Stanislaus County
18239	Fee-for-Service	1699199612	1699199612	1	1	BRASWELL, NICOLE A LMFT	4/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 WOODRUFF AVE	STE 209	LONG BEACH	CA	90808	2149	19	06037	33.828786	-118.1165535	Los Angeles County
18268	Fee-for-Service	1073538278	1073538278	1	1	BELLAMY, PAUL E MD	1/1/1995	207RC0200X	NA	Other	026	PHYSICIANS	36684	29	Pulmonary Diseases (M.D. only)	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
18270	Fee-for-Service	1427366210	1427366210	1	1	BROENNIMANN, ALLISON L PHD	3/7/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
18296	Fee-for-Service	1942771555	1942771555	1	1	BARTHE, CARL RCP	12/30/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
18301	Fee-for-Service	1942914387	1942914387	1	1	BAK, JOHNSAM	8/23/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1045 W REDONDO BEACH BLV	130	GARDENA	CA	90247	4129	19	06037	33.89247044	-118.2931941	Los Angeles County
18319	Fee-for-Service	1750302378	1750302378	1	1	BASHANDY, HANY G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	96051	41	Internal Medicine	0	In state provider	None	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
18358	Fee-for-Service	1083147300	1083147300	1	1	BEST, BENJAMIN J MD	7/1/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
18377	Fee-for-Service	1659494318	1659494318	2	1	BENICIA UNIFIED SCHOOL	1/1/2008	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	350 EAST K STREET	None	BENICIA	CA	94510	3437	48	06095	38.05073543	-122.1514108	Solano County
18389	Fee-for-Service	1871816694	1871816694	1	1	BERVEN, MICHAEL D MD	1/26/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
18415	Fee-for-Service	1023211778	1023211778	1	1	BATIN, RONALD S MD INC	10/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77080	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6480 PENTZ ROAD	SUITE C	PARADISE	CA	95969	3673	04	06007	39.771162	-121.5795825	Butte County
18420	Fee-for-Service	1013134113	1013134113	3	2	BIOMED CALIFORNIA, INC	10/28/2021	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	721 S. GLASGOW	STE C	INGLEWOOD	CA	90301	3016	19	06037	33.954093	-118.3718595	Los Angeles County
18421	Fee-for-Service	1871882035	1871882035	1	1	BUGAILISKIS, CHERYL LYNN M	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130557	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
18422	Fee-for-Service	1164958120	1164958120	1	1	BAINS, GURVIJAY MD	10/19/2021	207P00000X	NA	Other	026	PHYSICIANS	165417	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
18437	Fee-for-Service	1225153737	1225153737	1	1	BITAR, ROGER A MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	28274	77	Infectious Disease	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18440	Fee-for-Service	1316997497	1316997497	1	1	BRACEWELL, GREGORY MD	1/2/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52464	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
18444	Fee-for-Service	1487158671	1487158671	1	1	BRANDT, EMILY A	1/11/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17800	None	None	0	In state provider	None	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	19	06037	34.137603	-118.101464	Los Angeles County
18456	Fee-for-Service	1386037372	1386037372	1	1	BELTON, KARENCE L LMFT	11/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
18493	Fee-for-Service	1154845584	1154845584	1	1	BURNS MEDICAL CORPORATION PC	5/15/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
18497	Fee-for-Service	1619287364	1619287364	1	1	BANERJEE, SANJOY MD INC	11/10/2010	193400000X	NA	Other	026	PHYSICIANS	90939	05	Anesthesiology	0	In state provider	None	1561 EAST ONTARIO AVE	STE 103A	CORONA	CA	92881	6665	33	06065	33.84257433	-117.5332788	Riverside County
18501	Fee-for-Service	1437460359	1437460359	1	1	BREITHAUPT, ANDREW D MD	2/22/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	118094	None	None	0	In state provider	None	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	30	06059	33.61321911	-117.8722084	Orange County
18507	Fee-for-Service	1467590901	1467590901	1	3	BEACH CITIES MIDWIFERY	5/12/2021	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	AND WOMEN'S HEALTH CARE	1224 E WARDLOW ROAD	None	LONG BEACH	CA	92881	7262	19	06037	33.8189015	-118.1756925	Los Angeles County
18524	Fee-for-Service	1255621397	1255621397	1	1	BARDES, JAMES M MD	7/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141775	02	General Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
18525	Fee-for-Service	1891896320	1891896320	1	1	BHAT, YASSER M MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104393	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
18556	Fee-for-Service	1629157417	1629157417	1	1	BURNS, MICHAEL D DPM	5/7/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
18559	Fee-for-Service	1699850362	1699850362	1	1	BONACICH, JANE MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74496	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
18565	Fee-for-Service	1538248612	1538248612	1	1	BRUGUERA, LAWRENCE J MD	8/4/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45032	08	Family Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
18600	Fee-for-Service	1285701003	1285701003	1	1	BACH, LONG TOAN MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66596	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
18610	Fee-for-Service	1023389293	1023389293	2	1	BENNETT MEDICAL SERVICES	8/23/2019	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1164 NATIONAL DR	10	SACRAMENTO	CA	95834	1978	34	06067	38.645199	-121.4862975	Sacramento County
18634	Fee-for-Service	1275720682	1275720682	1	1	BALES, ELIZABETH A MD	3/2/2011	207L00000X	NA	Other	026	PHYSICIANS	91889	None	None	0	In state provider	None	1301 N ROSE DRIVE	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
18639	Fee-for-Service	1083735203	1083735203	1	1	BATRES, ERIC R MD	3/9/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44726	None	None	0	In state provider	MEDICAL CORP	5101 FLORENCE AVE	STE 4	BELL	CA	90201	3801	19	06037	33.96904913	-118.1757922	Los Angeles County
18640	Fee-for-Service	1669688560	1669688560	1	1	BORGHESE, ROBYN A MD	6/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107676	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
18671	Fee-for-Service	1811544422	1811544422	1	1	BOTILL, KALEIGH PT	10/30/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1870 CENTRAL ST	None	VISALIA	CA	93277	4418	54	06107	36.314541	-119.310201	Tulare County
18676	Fee-for-Service	1003206228	1003206228	1	2	BUCKELEW PROGRAMS	12/14/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	291 SMITH RANCH RD.	None	SAN RAFAEL	CA	94903	2093	21	06041	38.02243532	-122.5239302	Marin County
18679	Fee-for-Service	1467719278	1467719278	1	1	BLACK, JESSICA R MD	12/4/2017	207L00000X	NA	Other	026	PHYSICIANS	148448	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
18686	Fee-for-Service	1124318530	1124318530	1	1	BERBERYAN, MARIAM M LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
18699	Fee-for-Service	1023211778	1023211778	1	1	BATIN, RONALD S MD INC	10/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77080	01	General Practice	0	In state provider	None	6480 PENTZ ROAD	SUITE C	PARADISE	CA	95969	3673	04	06007	39.771162	-121.5795825	Butte County
18717	Fee-for-Service	1003377615	1003377615	1	1	BEAUDOIN, JARETT MD	12/4/2023	390200000X	NA	Other	026	PHYSICIANS	191533	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
18721	Fee-for-Service	1811916992	1811916992	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	2311 W CLEVELAND AVE	101	MADERA	CA	93637	8766	20	06039	36.9746635	-120.085245	Madera County
18726	Fee-for-Service	1225153737	1225153737	1	1	BITAR, ROGER A MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	28274	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18751	Fee-for-Service	1851498224	1851498224	1	1	BURROUGHS, GLORIA J MD	7/12/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	76781	30	Radiology	0	In state provider	None	44274 GEORGE CUSHMAN CT	108	TEMECULA	CA	92592	5945	33	06065	33.48313254	-117.0888293	Riverside County
18771	Fee-for-Service	1093828758	1093828758	1	1	BLAND, GERARD VINCENT MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	79746	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
18772	Fee-for-Service	1174744833	1174744833	1	1	BURBANK ADHC	9/1/2004	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	2609 W BURBANK BLVD	None	BURBANK	CA	91505	2304	19	06037	34.17811421	-118.340069	Los Angeles County
18784	Fee-for-Service	1255782090	1255782090	1	1	BURKEY, EILEEN T LCSW	12/9/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
18799	Fee-for-Service	1477546414	1477546414	1	1	BARRUGA, MENARD D MD	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	66243	40	Pediatrics	0	In state provider	None	9581 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3605	33	06065	33.91967885	-117.4479887	Riverside County
18821	Fee-for-Service	1417985847	1417985847	1	1	BOURNE, ROBERT MD	6/21/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31522	08	Family Practice	0	In state provider	None	1300 E COOLEY DR	None	COLTON	CA	92324	3905	36	06071	34.0544745	-117.306315	San Bernardino County
18830	Fee-for-Service	1699815274	1699815274	1	1	BRANDT GROUP HOMES INC	4/3/2000	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3653 CENTINELLA DR	None	NORTH HIGHLANDS	CA	95660	3735	34	06067	38.688183	-121.3796925	Sacramento County
18841	Fee-for-Service	1932110160	1932110160	1	1	BEATTY, PAUL R MD	6/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	35987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
18854	Fee-for-Service	1538248612	1538248612	1	1	BRUGUERA, LAWRENCE J MD	8/4/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45032	01	General Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
18866	Fee-for-Service	1245255595	1245255595	1	1	BRIEL, ROBERT CRNA	4/6/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
18910	Fee-for-Service	1104178193	1104178193	1	1	BRAND, LISA E MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126474	02	General Surgery	0	In state provider	None	2438 PONDEROSA DR N	STE C-207	CAMARILLO	CA	93010	2374	56	06111	34.24219545	-119.0227012	Ventura County
18920	Fee-for-Service	1942319199	1942319199	1	1	BANNER BEHAVIORAL HEALTH	8/3/2010	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	7575 E EARLL DR	None	SCOTTSDALE	AZ	85251	6915	00	None	33.482538	-111.9185955	Maricopa County
18951	Fee-for-Service	1174880496	1174880496	1	1	BHATT, JAY M MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126898	04	Otology, Laryngology, Rhinology	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
18952	Fee-for-Service	1033101639	1033101639	1	1	BRYAN, RICHARD H MD	4/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83382	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
18982	Fee-for-Service	1477380160	1477380160	1	1	BLAKEY, CLAIRE LMFT	11/4/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	922 STATE STREET	STE A, OFFICE #2	SANTA BARBARA	CA	93101	6795	42	06083	34.42108289	-119.7013175	Santa Barbara County
18994	Fee-for-Service	1821008913	1821008913	1	1	BANGASH, ISHTIAQUE A MD	9/20/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50964	03	Allergy	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
19013	Fee-for-Service	1225153737	1225153737	1	1	BITAR, ROGER A MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	28274	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
19020	Fee-for-Service	1649505611	1649505611	1	1	BUDNERO, MARIA J 0D	11/2/2009	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
19025	Fee-for-Service	1205925864	1205925864	1	1	BOE, JUSTIN J MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	97272	30	Radiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
19071	Fee-for-Service	1669679148	1669679148	1	1	BRAESCU, OTILIA MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145221	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
19118	Fee-for-Service	1992877716	1992877716	1	1	BRYANT, JASON W MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80083	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
19126	Fee-for-Service	1992392930	1992392930	1	1	BUXTON, WILLIAM P MD	1/14/2021	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
19131	Fee-for-Service	1356795249	1356795249	1	1	BANKS, MAURICE	2/22/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1178 MATTOS DRIVE	None	VALLEJO	CA	94591	4723	48	06095	38.10870751	-122.2159833	Solano County
19157	Fee-for-Service	1477084655	1477084655	1	1	BELLOR-YEH, PEI CHUAN MD	10/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169538	08	Family Practice	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
19164	Fee-for-Service	1841550340	1841550340	1	1	BRESS, MARTIN M MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	24462	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	930 SUNNYSLOPE RD	SUITE B1	HOLLISTER	CA	95023	5615	35	06069	36.83909681	-121.3851338	San Benito County
19198	Fee-for-Service	1750439626	1750439626	1	1	BRUTSCHER, RUSSELL L MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77378	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
19210	Fee-for-Service	1942319199	1942319199	1	1	BANNER BEHAVIORAL HEALTH	8/3/2010	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	7575 E EARLL DR	None	SCOTTSDALE	AZ	85251	6915	00	None	33.482538	-111.9185955	Maricopa County
19224	Fee-for-Service	1235884503	1235884503	1	1	BAIN, SOPHIE H	2/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
19234	Fee-for-Service	1053532580	1053532580	1	1	BOUTROS, GHASSAN K MD INC	12/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	2750 E WASHINGTON BLVD	STE 260	PASADENA	CA	91107	6202	19	06037	34.1680038	-118.0943955	Los Angeles County
19276	Fee-for-Service	1184961716	1184961716	1	1	BRAVO ONE INC	8/4/2014	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	9700 FAIRWAY DR	STE 120	ROSEVILLE	CA	95678	3604	31	06061	38.78406283	-121.272797	Placer County
19280	Fee-for-Service	1649382052	1649382052	1	1	BYRNE, CHRIS M DPM INC	2/20/2014	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1551 BISHOP ST	STE 210B	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
19284	Fee-for-Service	1679696728	1679696728	1	1	BATCHELOR, BRET K MD APC	11/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53375	20	Orthopedic Surgery	0	In state provider	None	11160 WARNER AVE	STE 311	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
19305	Fee-for-Service	1093081788	1093081788	1	1	BLUE BUTTERFLY HOSPICE INC	8/8/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21049 DEVONSHIRE STREET	SUITE 103A	CHATSWORTH	CA	91311	2366	19	06037	34.25727553	-118.592343	Los Angeles County
19387	Fee-for-Service	1598715823	1598715823	1	1	BAILEY, CHRISTINA B MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67263	08	Family Practice	0	In state provider	None	41715 WINCHESTER RD	STE 101	TEMECULA	CA	92590	4853	33	06065	33.51843041	-117.1680022	Riverside County
19397	Fee-for-Service	1992266688	1992266688	1	1	BARBICA, CORTNEY L	6/29/2023	207L00000X	NA	Other	026	PHYSICIANS	185075	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
19419	Fee-for-Service	1356795249	1356795249	1	1	BANKS, MAURICE	2/22/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1178 MATTOS DRIVE	None	VALLEJO	CA	94591	4723	48	06095	38.10870751	-122.2159833	Solano County
19437	Fee-for-Service	1154401941	1154401941	1	21	BASS MEDICAL GROUP	2/25/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2400 BALFOUR RD	STE 302	BRENTWOOD	CA	94513	4955	07	06013	37.92519383	-121.734461	Contra Costa County
19450	Fee-for-Service	1417625484	1417625484	1	1	BALUMYAN, ARMINE CNP	2/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	19	06037	34.18659936	-118.5552114	Los Angeles County
19460	Fee-for-Service	1477948115	1477948115	1	1	BARNEY, ANGELA M MD	8/17/2022	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	161687	40	Pediatrics	0	In state provider	None	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
19461	Fee-for-Service	1871582833	1871582833	1	1	BELCASTER,GARY M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
19470	Fee-for-Service	1851369649	1851369649	1	1	BARRIE, GENE M MD INC	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	26722	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2299 MOWRY AVE	STE 3A	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
19483	Fee-for-Service	1063590867	1063590867	1	1	BOLINGER, BEVERLY L MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80970	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
19520	Fee-for-Service	1053532580	1053532580	1	1	BOUTROS, GHASSAN K MD INC	12/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2750 E WASHINGTON BLVD	STE 260	PASADENA	CA	91107	6202	19	06037	34.1680038	-118.0943955	Los Angeles County
19530	Fee-for-Service	1508891052	1508891052	1	1	BUSQUE, STEPHAN	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76050	02	General Surgery	0	In state provider	None	2340 CLAY ST	FL 4	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
19545	Fee-for-Service	1073610226	1073610226	1	1	BROOKS, BARRY S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24899	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
19564	Fee-for-Service	1487742979	1487742979	1	1	BENNY J. GUZMAN, M.D., CORPO	11/20/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RATION	8253 SIERRA AVE	SUITE 200	FONTANA	CA	92335	3578	36	06071	34.10379	-117.4357525	San Bernardino County
19570	Fee-for-Service	1689662447	1689662447	1	1	BAILEY, ROLLIN C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34443	41	Internal Medicine	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
19572	Fee-for-Service	1831389089	1831389089	1	1	BADGER, AMY N MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111399	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
19589	Fee-for-Service	1093081788	1093081788	1	1	BLUE BUTTERFLY HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21049 DEVONSHIRE STREET	SUITE 103A	CHATSWORTH	CA	91311	2366	19	06037	34.25727553	-118.592343	Los Angeles County
19590	Fee-for-Service	1154620789	1154620789	1	1	BERKOVITS, ADAM S DO	7/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89128	0436	00	None	36.072729	-115.295094	Clark County
19614	Fee-for-Service	1588751952	1588751952	1	1	BANERJEE, DEBASHREE MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	41645	66	Emergency Medicine (Urgent Care)	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
19619	Fee-for-Service	1760450340	1760450340	1	1	BELLEZZO, JOSPEH M MD	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
19642	Fee-for-Service	1457321903	1457321903	1	1	BHAVAN, SATHY V MD	3/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98352	18	Ophthalmology	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91913	1800	37	06073	32.62382113	-116.9960539	San Diego County
19660	Fee-for-Service	1114197019	1114197019	1	1	BURGIS, JENNIFER C MD	5/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102929	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
19675	Fee-for-Service	1053388637	1053388637	1	1	BODZIN, GORDON A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88984	02	General Surgery	0	In state provider	DELANO SURGICAL GROUP	1205 GARCES HWY	STE 303	DELANO	CA	93215	3659	15	06029	35.76144147	-119.2400687	Kern County
19694	Fee-for-Service	1437548526	1437548526	1	1	BUI, HOANG DIEM LMFT	11/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
19706	Fee-for-Service	1851479315	1851479315	1	1	BERGER, HOWARD G MD	9/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	19870	None	None	0	In state provider	None	44725 10TH ST W	# 105	LANCASTER	CA	93534	3033	19	06037	34.695693	-118.1480965	Los Angeles County
19720	Fee-for-Service	1306824222	1306824222	1	1	BRIAN D DOROTIK	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT PC	3033 SOUTH PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
19724	Fee-for-Service	1154401941	1154401941	1	43	BASS MEDICAL GROUP	6/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2260 GLADSTONE DR	STE 5	PITTSBURG	CA	94565	5125	07	06013	38.00615824	-121.8668668	Contra Costa County
19728	Fee-for-Service	1982635835	1982635835	1	1	BUI, VAN-KHOI T CRNA	10/18/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
19731	Fee-for-Service	1023446739	1023446739	1	1	BURGARA, MONICA N LCSW	5/18/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
19737	Fee-for-Service	1306250527	1306250527	1	1	BRYANT, TARA K MD	8/29/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168895	18	Ophthalmology	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
19742	Fee-for-Service	1184856593	1184856593	1	1	BURNS, KIRSTEN L PSYD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
19751	Fee-for-Service	1871835389	1871835389	1	1	BUTTERFIELD, MICHAEL C MD	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156222	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH STREET	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
19754	Fee-for-Service	1780295519	1780295519	2	1	BIOACCESS HEALTH SERVICES, I	8/22/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	120 N FAIRWAY LN	STE A	WEST COVINA	CA	91791	1729	19	06037	34.07342691	-117.8733597	Los Angeles County
19783	Fee-for-Service	1154376762	1154376762	1	1	BARTE, LORNA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50707	36	Psychiatry	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
19794	Fee-for-Service	1801094131	1801094131	1	1	BEHARIE, CARLOS S MD	11/4/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	46446	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1433 W MERCED AVE	STE 103	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
19823	Fee-for-Service	1003952276	1003952276	1	1	BLOYER, MARY A CNM	10/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
19829	Fee-for-Service	1407839632	1407839632	1	1	BARRY, MICHELE MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88539	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19830	Fee-for-Service	1396926754	1396926754	1	3	BEIT T'SHUVAH	8/29/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8847 VENICE BLVD	SUITE B	LOS ANGELES	CA	90034	3223	19	06037	34.03056062	-118.3863512	Los Angeles County
19841	Fee-for-Service	1760560569	1760560569	1	1	BARBER, THOMAS C MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71463	None	None	0	In state provider	None	280 W MACARTHUR BLVD	-	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
19868	Fee-for-Service	1467403238	1467403238	1	1	BOGLE, LAWRENCE P MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	22889	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
19872	Fee-for-Service	1295700235	1295700235	1	1	BARME, GREGORY MD	8/24/2023	208800000X	NA	Other	026	PHYSICIANS	79030	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
19874	Fee-for-Service	1437432218	1437432218	1	1	BOMBARDINI, MORELLA E PSYD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVENUE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
19879	Fee-for-Service	1528167723	1528167723	1	1	BAUTISTA, MARIA C MD	7/31/1988	207R00000X	NA	Other	026	PHYSICIANS	41768	41	Internal Medicine	0	In state provider	None	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
19901	Fee-for-Service	1134370372	1134370372	1	1	BAXTER, CARMEN C MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137472	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
19909	Fee-for-Service	1588751952	1588751952	1	1	BANERJEE, DEBASHREE MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	41645	40	Pediatrics	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
19938	Fee-for-Service	1528135498	1528135498	1	1	BARDOLPH, EILEEN L MD	8/31/1993	2084N0400X	NA	Neurology	026	PHYSICIANS	43006	13	Neurology (M.D. only)	0	In state provider	None	25825 S VERMONT ST	None	HARBOR CITY	CA	90710	0000	19	06037	33.7892965	-118.2937327	Los Angeles County
19973	Fee-for-Service	1376740068	1376740068	1	1	BISHOP, CYNTHIA M LMFT	2/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
19994	Fee-for-Service	1710954649	1710954649	1	1	BILLINGS, WILLIAM E	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13050	20	Orthopedic Surgery	0	In state provider	JR MD	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
20000	Fee-for-Service	1003260480	1003260480	1	1	BBH BMC, LLC	4/8/2020	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2010 BROOKWOOD MEDICAL C	None	BIRMINGHAM	AL	35209	6804	00	None	33.46310667	-86.77645664	Jefferson County
20013	Fee-for-Service	1154401941	1154401941	1	43	BASS MEDICAL GROUP	6/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2260 GLADSTONE DR	STE 5	PITTSBURG	CA	94565	5125	07	06013	38.00615824	-121.8668668	Contra Costa County
20034	Fee-for-Service	1558421768	1558421768	1	1	BIANCO, YLAYALY K MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88919	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20036	Fee-for-Service	1629003256	1629003256	1	1	BROTMAN, PATRICIA MD APC	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69097	66	Emergency Medicine (Urgent Care)	0	In state provider	CHINO VALLEY DERMATOLOGY	15944 LOS SERRANOS CNTRY	SUITE 180	CHINO HILLS	CA	91709	3129	36	06071	33.9635227	-117.695881	San Bernardino County
20050	Fee-for-Service	1235679234	1235679234	1	1	BOSWELL, SARA L PHD	5/1/2017	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
20112	Fee-for-Service	1487126942	1487126942	1	1	BUI-NGUYEN, SONG-TOAN WINSTO	9/22/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	N PT	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
20121	Fee-for-Service	1962512624	1962512624	1	1	BEL AIR MARKET INC	1/3/2000	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8425 ELK GROVE FLORIN RD	None	ELK GROVE	CA	95624	9518	34	06067	38.451492	-121.3703775	Sacramento County
20128	Fee-for-Service	1346337904	1346337904	1	1	BRODSKY, MARK E MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53623	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
20138	Fee-for-Service	1861424988	1861424988	1	1	BITTKER, THOMAS E MD	5/24/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	30013	-	NOT APPLICABLE	0	In state provider	None	704 MILL ST	None	LOYALTON	CA	96118	0265	46	06091	39.67395553	-120.241026	Sierra County
20144	Fee-for-Service	1740252204	1740252204	2	1	BUADU, ANNEMARIE MD	4/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152105	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
20151	Fee-for-Service	1376663831	1376663831	1	1	BUECHNER, CHARLENE A MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68463	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2196	37	06073	32.70162897	-117.1465065	San Diego County
20153	Fee-for-Service	1194787507	1194787507	1	1	BEATY, CRAIG L DO	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9905	36	Psychiatry	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
20154	Fee-for-Service	1750114559	1750114559	1	1	BRIDGER, ALLISON OT	2/14/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
20169	Fee-for-Service	1619448271	1619448271	1	1	BANAAG, MONICA	12/17/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
20176	Fee-for-Service	1851320451	1851320451	1	1	BROWN, IAN P MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97870	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20187	Fee-for-Service	1083639710	1083639710	1	1	BANZUELA, CRESENCIA D MD	2/5/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53873	40	Pediatrics	0	In state provider	INC	260 E ONTARIO AVE	STE 204	CORONA	CA	92879	3507	33	06065	33.8560157	-117.5678999	Riverside County
20193	Fee-for-Service	1568752012	1568752012	1	1	BHAKTA, SAMIT J MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
20195	Fee-for-Service	1851552657	1851552657	1	1	BLANCO, MICHELLE R MD	10/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107346	08	Family Practice	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
20197	Fee-for-Service	1427350180	1427350180	1	1	BANCROFT, GEORGE R MD	7/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146241	05	Anesthesiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
20212	Fee-for-Service	1376033043	1376033043	1	1	BEAULIEU, DEREK MD	9/26/2024	163WM0705X	NA	Other	026	PHYSICIANS	163746	07	Dermatology	0	In state provider	None	2921 DE LA VINA ST	None	SANTA BARBARA	CA	93105	3309	42	06083	34.43816014	-119.7277541	Santa Barbara County
20217	Fee-for-Service	1518999374	1518999374	1	1	BACH, THUC T	3/31/1981	246ZC0007X	NA	Other	026	PHYSICIANS	31717	None	None	0	In state provider	None	960 E GREEN ST	STE 201	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
20234	Fee-for-Service	1992748479	1992748479	1	1	BROWN, BRIAN M MD INC	7/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	52712	18	Ophthalmology	0	In state provider	None	10933 LAKEWOOD BLVD	None	DOWNEY	CA	90241	3808	19	06037	33.93756015	-118.1230982	Los Angeles County
20238	Fee-for-Service	1841330800	1841330800	1	1	BASS, TSILYA MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	63630	36	Psychiatry	0	In state provider	None	11631 VICTORY BLVD	STE 103	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
20269	Fee-for-Service	1366673311	1366673311	1	1	BARTCZAK, THOMAS CO	6/3/2014	174400000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4013 BROCKTON AVENUE	None	RIVERSIDE	CA	92501	3440	33	06065	33.98177617	-117.3807605	Riverside County
20273	Fee-for-Service	1518041359	1518041359	1	1	BAQUIRAN, PAULINA M MD	6/30/1989	193400000X	NA	Other	026	PHYSICIANS	37167	40	Pediatrics	0	In state provider	None	1321 N VERMONT AVE	STE C	LOS ANGELES	CA	90027	6307	19	06037	34.096149	-118.291788	Los Angeles County
20275	Fee-for-Service	1710954649	1710954649	1	1	BILLINGS, WILLIAM E	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13050	46	Hand Surgery	0	In state provider	JR MD	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
20277	Fee-for-Service	1821353541	1821353541	1	1	BROOKER, SARA B PSYD	11/2/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
20287	Fee-for-Service	1114923307	1114923307	1	1	BAZ, MALIK M MD	3/31/1980	207KA0200X	NA	Other	026	PHYSICIANS	35393	03	Allergy	0	In state provider	None	500 E ALMOND AVE	STE 1	MADERA	CA	93637	5600	20	06039	36.94548547	-120.0518941	Madera County
20292	Fee-for-Service	1003260480	1003260480	1	1	BBH BMC, LLC	4/8/2020	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2010 BROOKWOOD MEDICAL C	None	BIRMINGHAM	AL	35209	6804	00	None	33.46310667	-86.77645664	Jefferson County
20296	Fee-for-Service	1316204654	1316204654	1	1	BUTANI, VIRIT D DPM	7/10/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
20302	Fee-for-Service	1154401941	1154401941	1	21	BASS MEDICAL GROUP	2/25/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2400 BALFOUR RD	STE 302	BRENTWOOD	CA	94513	4955	07	06013	37.92519383	-121.734461	Contra Costa County
20322	Fee-for-Service	1558421768	1558421768	1	1	BIANCO, YLAYALY K MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88919	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20376	Fee-for-Service	1427399476	1427399476	1	1	BOERE, MARIANKA A CRNA	1/15/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	SUITE 1	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
20402	Fee-for-Service	1861009920	1861009920	1	1	BRIDGE HOSPICE FRESNO LLC	6/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	155 E SHAW AVE	SUITE 202	FRESNO	CA	93710	7619	10	06019	36.8084105	-119.7867195	Fresno County
20406	Fee-for-Service	1356764534	1356764534	1	1	BRANDI, ABIGAIL	7/13/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1827 KNOLL DR	None	VENTURA	CA	93003	7321	56	06111	34.25641704	-119.2199387	Ventura County
20484	Fee-for-Service	1881623932	1881623932	1	1	BILAL, LOUAI A MD	8/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87443	36	Psychiatry	0	In state provider	None	3840 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
20488	Fee-for-Service	1538453790	1538453790	1	1	BOYADJIAN, SHANT H LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3655 ALAMO ST	STE 202	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
20525	Fee-for-Service	1841330800	1841330800	1	1	BASS, TSILYA MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	63630	01	General Practice	0	In state provider	None	11631 VICTORY BLVD	STE 103	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
20535	Fee-for-Service	1063414258	1063414258	1	1	BOSTON SCIENTIFIC CARDIAC DI	5/19/2015	293D00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	1717 N SAM HOUSTON PKW W	STE 100	HOUSTON	TX	77038	1324	00	None	29.93763081	-95.44337591	Harris County
20557	Fee-for-Service	1053469924	1053469924	1	1	BHAKTA, SANJAY C MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54782	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
20561	Fee-for-Service	1750395042	1750395042	1	1	BUSIC, JANET R LMFT	11/22/2022	103T00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7248 GOLD RUN DR	None	OAKDALE	CA	95361	7877	50	06099	37.74476292	-120.9026548	Stanislaus County
20563	Fee-for-Service	1710954649	1710954649	1	1	BILLINGS, WILLIAM E	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13050	02	General Surgery	0	In state provider	JR MD	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
20575	Fee-for-Service	1366400657	1366400657	1	1	BENARON, STEVE MD	9/30/1982	207PE0004X	NA	Other	026	PHYSICIANS	45273	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 S SUSANA RD	None	COMPTON	CA	90221	5418	19	06037	33.87386619	-118.2070981	Los Angeles County
20576	Fee-for-Service	1114923307	1114923307	1	1	BAZ, MALIK M MD	3/31/1980	207KA0200X	NA	Other	026	PHYSICIANS	35393	47	Miscellaneous	0	In state provider	None	500 E ALMOND AVE	STE 1	MADERA	CA	93637	5600	20	06039	36.94548547	-120.0518941	Madera County
20578	Fee-for-Service	1407063357	1407063357	1	1	BROWN, YING W MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99529	08	Family Practice	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
20588	Fee-for-Service	1154401941	1154401941	1	43	BASS MEDICAL GROUP	6/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2260 GLADSTONE DR	STE 5	PITTSBURG	CA	94565	5125	07	06013	38.00615824	-121.8668668	Contra Costa County
20592	Fee-for-Service	1912193947	1912193947	1	1	BROWNRIGG, JESSICA E NP	11/18/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
20593	Fee-for-Service	1184739872	1184739872	1	1	BUSH, SEAN P MD	7/1/1993	207P00000X	NA	Other	026	PHYSICIANS	52112	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
20610	Fee-for-Service	1194912550	1194912550	1	1	BOWEN, SERENITY LCSW	5/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	655 F STREET	STE A	ARCATA	CA	95521	6366	12	06023	40.8666166	-124.0855684	Humboldt County
20615	Fee-for-Service	1508992470	1508992470	1	1	BOLEK, LUKE MD	3/15/2022	207U00000X	NA	Other	026	PHYSICIANS	111584	None	None	0	In state provider	None	12602 AMARGOSA RD	STE F	VICTORVILLE	CA	92392	7640	36	06071	34.47936072	-117.3397257	San Bernardino County
20622	Fee-for-Service	1154099414	1154099414	1	1	BRYANS, BRIANNA L PT	10/27/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29645 RANCHO CALIFORNIA	SUITE 234	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
20653	Fee-for-Service	1235796848	1235796848	1	1	BARNES, KIRSTEN MD	10/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182818	None	None	0	In state provider	None	1301 MISSION STREET	None	SANTA CRUZ	CA	95030	3528	44	06087	36.96817615	-122.0381947	Santa Cruz County
20673	Fee-for-Service	1861648560	1861648560	1	1	BANKO, LESANEMARIAM T MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104321	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
20692	Fee-for-Service	1861009920	1861009920	1	1	BRIDGE HOSPICE FRESNO LLC	6/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	155 E SHAW AVE	SUITE 202	FRESNO	CA	93710	7619	10	06019	36.8084105	-119.7867195	Fresno County
20714	Fee-for-Service	1518200393	1518200393	1	1	BEGGS, ABIGAIL E MD	3/12/2019	207R00000X	NA	Other	026	PHYSICIANS	140285	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
20746	Fee-for-Service	1669561858	1669561858	1	1	BARTLETT, CONNIE P DO	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	6599	40	Pediatrics	0	In state provider	None	19341 WEYMOUTH LN	None	HUNTINGTON BEACH	CA	92646	2040	30	06059	33.681546	-117.985798	Orange County
20772	Fee-for-Service	1154337152	1154337152	1	1	BROWN, JERRELL S MD	7/31/1991	207L00000X	NA	Other	026	PHYSICIANS	63511	05	Anesthesiology	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
20804	Fee-for-Service	1174601249	1174601249	1	1	BANERJEE, SUJAY MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72941	08	Family Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
20819	Fee-for-Service	1558453258	1558453258	1	1	BATRA, ANJAN S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61838	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
20824	Fee-for-Service	1033202478	1033202478	1	1	BRISTOL MEDICAL PH INC	11/1/2001	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BRISTOL MEDICAL PHARMACY	2720 S BRISTOL ST	#102	SANTA ANA	CA	92704	6209	30	06059	33.710463	-117.8854565	Orange County
20832	Fee-for-Service	1598362238	1598362238	1	1	BEST CARE UNLIMITED HOME	10/20/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH	13425 VENTURA BLVD	STE 303	SHERMAN OAKS	CA	91423	3974	19	06037	34.14714439	-118.4258194	Los Angeles County
20845	Fee-for-Service	1144701392	1144701392	1	1	BRERETON, KAILA A S NP	1/11/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
20862	Fee-for-Service	1114923307	1114923307	1	1	BAZ, MALIK M MD	3/31/1980	207KA0200X	NA	Other	026	PHYSICIANS	35393	40	Pediatrics	0	In state provider	None	500 E ALMOND AVE	STE 1	MADERA	CA	93637	5600	20	06039	36.94548547	-120.0518941	Madera County
20863	Fee-for-Service	1154401941	1154401941	1	18	BASS MEDICAL GROUP	8/15/2022	2086S0129X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3443 VILLA LN	STE 5	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
20868	Fee-for-Service	1275857377	1275857377	1	1	BEVERLY HILLS TRANSPORTATION	4/19/2011	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	9025 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1808	19	06037	34.06708809	-118.3884174	Los Angeles County
20871	Fee-for-Service	1366529315	1366529315	1	1	BOWEN, MARFIYA V. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE S	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95652346	-93.26250787	Hennepin County
20877	Fee-for-Service	1154401941	1154401941	1	21	BASS MEDICAL GROUP	2/25/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	2400 BALFOUR RD	STE 302	BRENTWOOD	CA	94513	4955	07	06013	37.92519383	-121.734461	Contra Costa County
20937	Fee-for-Service	1245646736	1245646736	1	1	BARBER, JOSHUA A MD	8/23/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	164845	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
20992	Fee-for-Service	1306058805	1306058805	1	1	BRADLEY, RYAN J MD	5/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99446	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
21022	Fee-for-Service	1083124937	1083124937	1	1	BEARBOWER, JEROME	5/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1085 I ST	SUITE 107	ARCATA	CA	95521	5586	12	06023	40.8707065	-124.0873395	Humboldt County
21033	Fee-for-Service	1700446176	1700446176	1	1	BEUNES SOLER, HANSER MD	11/10/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	179426	None	None	0	In state provider	None	16455 MAIN ST	STE 1	HESPERIA	CA	92345	3500	36	06071	34.42186386	-117.3038021	San Bernardino County
21042	Fee-for-Service	1447267505	1447267505	1	1	BERTOLUCCI, GEORGE A MD	6/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	60951	18	Ophthalmology	0	In state provider	None	1122 S ST	None	FRESNO	CA	93721	1430	10	06019	36.74185388	-119.7823667	Fresno County
21058	Fee-for-Service	1154337152	1154337152	1	1	BROWN, JERRELL S MD	7/31/1991	207L00000X	NA	Other	026	PHYSICIANS	63511	02	General Surgery	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
21072	Fee-for-Service	1639565096	1639565096	1	1	BEYER, CHRISTOPHER D MD	5/16/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161619	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
21078	Fee-for-Service	1003902610	1003902610	1	2	BRISTOL MCFADDEN MEDICAL GRO	1/3/2024	2251P0200X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP, INC.	1212 SOUTH BRISTOL STREE	UNIT 16	SANTA ANA	CA	92704	3476	30	06059	33.731874	-117.8852195	Orange County
21100	Fee-for-Service	1376361956	1376361956	1	1	BULUTYAN, ARAM NP	4/4/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4855 SANTA MONICA BLVD	102	LOS ANGELES	CA	90029	2654	19	06037	34.09087851	-118.2953115	Los Angeles County
21106	Fee-for-Service	1629075478	1629075478	1	1	BUTTERS, KENNETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	55 COBURG RD	None	EUGENE	OR	97401	2433	00	None	44.06095991	-123.0812169	Lane County
21132	Fee-for-Service	1518026111	1518026111	1	1	BLAIR, BRANT V MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83736	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	0000	19	06037	34.040502	-118.191954	Los Angeles County
21144	Fee-for-Service	1811029036	1811029036	1	1	BOFILL, LORA L MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106333	01	General Practice	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
21152	Fee-for-Service	1154401941	1154401941	1	18	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	3443 VILLA LN	STE 5	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
21168	Fee-for-Service	1972152692	1972152692	1	1	BURNETT, HALEY LCSW	2/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
21191	Fee-for-Service	1457388944	1457388944	1	1	BEVERLY, ROSALIE B MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152877	41	Internal Medicine	0	In state provider	None	271 TURN PIKE DRIVE	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
21216	Fee-for-Service	1508911892	1508911892	1	24	BAY AREA FOOT CARE, INC	6/27/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6620 COYLE AVE	STE202	CARMICHAEL	CA	95608	6333	34	06067	38.66751	-121.310028	Sacramento County
21233	Fee-for-Service	1972899839	1972899839	1	1	BARVE, PRANAV R MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129731	41	Internal Medicine	0	In state provider	None	341 E MAIN STREET	SUITE 100	SAN JACINTO	CA	92583	4206	33	06065	33.78391437	-116.9562698	Riverside County
21248	Fee-for-Service	1396707717	1396707717	1	1	BOARD, DAVID MD	9/29/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	88516	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
21252	Fee-for-Service	1619902764	1619902764	1	1	BULPITT, KEN J MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	59166	83	Rheumatology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
21256	Fee-for-Service	1568484855	1568484855	1	1	BUCKMAN, KEVIN J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33983	41	Internal Medicine	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
21258	Fee-for-Service	1114155082	1114155082	1	1	BAZICK, JESSICA G MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121356	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
21273	Fee-for-Service	1316102080	1316102080	1	1	BHAT, AMBARISH MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120744	30	Radiology	0	In state provider	None	44725 TENTH ST W	STE 150	LANCASTER	CA	93534	3000	19	06037	34.695693	-118.1480965	Los Angeles County
21275	Fee-for-Service	1336108372	1336108372	1	1	BAI, FENG MD	5/13/2008	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	83645	25	Physical Medicine and Rehabilitation	0	In state provider	None	2160 W GRANT LINE RD	STE 110	TRACY	CA	95377	7331	39	06077	37.75399922	-121.455877	San Joaquin County
21287	Fee-for-Service	1619944246	1619944246	1	1	BALL, DAVID L LMFT	6/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
21288	Fee-for-Service	1841517943	1841517943	1	1	BEDDOW, ISABELL MD AMC	9/1/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	69848	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 BAYWOOD AVENUE	STE 5	SAN MATEO	CA	94402	1537	41	06081	37.56513159	-122.3284067	San Mateo County
21289	Fee-for-Service	1710481445	1710481445	1	1	BUITRAGO, CARLOS A MD	3/17/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	164374	10	Gastroenterology (M.D. only)	0	In state provider	None	375 TERRACINA BLVD	None	REDLANDS	CA	92373	3801	36	06071	34.03691371	-117.2040917	San Bernardino County
21359	Fee-for-Service	1114112372	1114112372	1	1	BEVERLY RADIOLOGY MED GR	2/13/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IMAGING	18523 CORWIN	STE J	APPLE VALLEY	CA	92307	2338	36	06071	34.54095703	-117.2601143	San Bernardino County
21382	Fee-for-Service	1164494696	1164494696	1	1	BURSTEN, STUART L MD	9/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86125	41	Internal Medicine	0	In state provider	None	3443 VILLA LN	STE 6	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
21407	Fee-for-Service	1801826839	1801826839	2	1	BAYLOR SCOTT & WHITE MEDICAL	7/29/2018	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER-CENTENNIAL	12505 LEBANON ROAD	None	FRISCO	TX	75035	8298	00	None	33.11585211	-96.77068374	Collin County
21417	Fee-for-Service	1558643569	1558643569	1	1	BERTA, SCOTT C MD, INC	10/24/2011	207T00000X	NA	General Surgery	026	PHYSICIANS	91971	14	Neurological Surgery	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
21433	Fee-for-Service	1881854990	1881854990	1	1	BLEAKLY, NICOLE T MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109795	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
21435	Fee-for-Service	1174682942	1174682942	1	1	BOYD, MARGARET S LCSW	1/27/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	438 CAMINO DEL RIO S	STE 112	SAN DIEGO	CA	92108	3509	37	06073	32.76144507	-117.1604009	San Diego County
21438	Fee-for-Service	1154401941	1154401941	1	18	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3443 VILLA LN	STE 5	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
21445	Fee-for-Service	1265642268	1265642268	1	1	BERNHOFT, FRANKLIN O PHD	5/6/2024	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1300 W. LODI AVENUE	SUITE A6	LODI	CA	95242	4334	39	06077	38.13001447	-121.289931	San Joaquin County
21504	Fee-for-Service	1508911892	1508911892	1	24	BAY AREA FOOT CARE, INC	8/27/2024	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	6620 COYLE AVE	STE202	CARMICHAEL	CA	95608	6333	34	06067	38.66751	-121.310028	Sacramento County
21546	Fee-for-Service	1568484855	1568484855	1	1	BUCKMAN, KEVIN J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33983	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
21550	Fee-for-Service	1225186265	1225186265	1	1	BRITTON, CAROL L NP	7/21/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
21555	Fee-for-Service	1134320732	1134320732	1	1	BJ'S EYE SPECS OPTICAL	10/16/1989	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	SERVICES & BOUTIQUE	322 HARBOUR WAY	STE 2	RICHMOND	CA	94801	3142	07	06013	37.9362474	-122.3599855	Contra Costa County
21566	Fee-for-Service	1407888191	1407888191	1	1	BOGART, TRINA L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
21583	Fee-for-Service	1174605224	1174605224	1	1	BRIZUELA, RICARDO M MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96753	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
21585	Fee-for-Service	1053328856	1053328856	1	1	BERNAL, JONAS L MD	4/27/2006	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	64082	40	Pediatrics	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
21661	Fee-for-Service	1295883262	1295883262	1	1	BEECHER, MICHAEL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29624	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
21663	Fee-for-Service	1215518030	1215518030	1	1	BEHYMER, SARAH A MD	11/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
21669	Fee-for-Service	1164494696	1164494696	1	1	BURSTEN, STUART L MD	9/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86125	45	Nephrology (Renal-Kidney)	0	In state provider	None	3443 VILLA LN	STE 6	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
21671	Fee-for-Service	1164740460	1164740460	1	1	BEI, LING Y MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129618	18	Ophthalmology	0	In state provider	None	2240 NORTH HARBOR BLVD	SUITE 210	FULLERTON	CA	92835	3517	30	06059	33.89764434	-117.929218	Orange County
21675	Fee-for-Service	1861940165	1861940165	1	1	BUCHANAN, AMY LCSW	4/6/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	BUCHANAN	3183 SPANISH RAVINE RAVI	None	PLACERVILLE	CA	95667	8984	09	06017	38.72663199	-120.7856861	El Dorado County
21700	Fee-for-Service	1801826839	1801826839	2	1	BAYLOR SCOTT & WHITE MEDICAL	7/29/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER-CENTENNIAL	12505 LEBANON ROAD	None	FRISCO	TX	75035	8298	00	None	33.11585211	-96.77068374	Collin County
21727	Fee-for-Service	1154401941	1154401941	1	18	BASS MEDICAL GROUP	2/25/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3443 VILLA LN	STE 5	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
21738	Fee-for-Service	1518231331	1518231331	1	1	BACAL, LIANE R MD	3/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103264	08	Family Practice	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
21743	Fee-for-Service	1760591713	1760591713	1	1	BARBARA SINATRA CHILDREN'S C	10/23/2018	283Q00000X	NA	Hospitals	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ENTER	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
21764	Fee-for-Service	1043345952	1043345952	1	1	B & B PHARMACY	3/28/1983	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1727 A FILLMORE ST	None	SAN FRANCISCO	CA	94115	3167	38	06075	37.78547944	-122.4331765	San Francisco County
21810	Fee-for-Service	1316309511	1316309511	1	1	BETENIA, NICOLE MD	8/11/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179467	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21830	Fee-for-Service	1801645817	1801645817	1	1	BABY DOULA CO LLC	5/14/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
21849	Fee-for-Service	1104908292	1104908292	1	1	BOOKSPAN, MARK A MD	6/11/2013	207R00000X	NA	Other	026	PHYSICIANS	36429	41	Internal Medicine	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
21856	Fee-for-Service	1174375257	1174375257	1	1	BERGADO, JASMIN NICOLE NP	5/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
21885	Fee-for-Service	1780841197	1780841197	1	1	BELEK, ANN M MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103125	83	Rheumatology	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
21903	Fee-for-Service	1689643884	1689643884	1	1	BERG, ROBERTA G MD	3/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	18770	08	Family Practice	0	In state provider	None	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	49	06097	38.440494	-122.74353	Sonoma County
21951	Fee-for-Service	1245557875	1245557875	1	1	BREGMAN, ANDREW R MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126901	36	Psychiatry	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
21988	Fee-for-Service	1699887497	1699887497	1	1	BIO MEDICAL APPLICATIONS	3/2/2010	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	145 W VICTORIA ST	None	LONG BEACH	CA	90805	2162	19	06037	33.86489618	-118.2026866	Los Angeles County
22001	Fee-for-Service	1154401941	1154401941	1	65	BASS MEDICAL GROUP	7/21/2023	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	15965 LOS GATOS BLVD	STE 201	LOS GATOS	CA	95032	3415	43	06085	37.23642819	-121.962839	Santa Clara County
22016	Fee-for-Service	1154401941	1154401941	1	18	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3443 VILLA LN	STE 5	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
22030	Fee-for-Service	1760591713	1760591713	1	1	BARBARA SINATRA CHILDREN'S C	10/23/2018	283Q00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ENTER	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
22044	Fee-for-Service	1174557805	1174557805	1	6	BAY AREA RETINA ASSOCIATES,	9/27/2021	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	39055 HASTINGS ST	SUITE #105	FREMONT	CA	94538	1518	01	06001	37.55249404	-121.983385	Alameda County
22089	Fee-for-Service	1205860335	1205860335	1	1	BLOOMINGTON HOSPITAL	12/13/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 W 2ND ST	None	BLOOMINGTON	IN	47403	2317	00	None	39.16137332	-86.54012395	Monroe County
22109	Fee-for-Service	1083683056	1083683056	1	1	BUNUELL-JORDANA, LEO R DO	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
22110	Fee-for-Service	1508290917	1508290917	1	1	BARNAJIAN, MOSHE MD INC	12/16/2013	208C00000X	NA	General Surgery	026	PHYSICIANS	107431	28	Proctology (colon and rectal)	0	In state provider	None	222 W EULALIA ST	STE 100A	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
22124	Fee-for-Service	1366602088	1366602088	1	1	BAILEY, JAMES R MD	11/1/2023	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	182613	None	None	0	In state provider	None	2936 DE LA VINA ST	None	SANTA BARBARA	CA	93105	3354	42	06083	34.4383104	-119.7278207	Santa Barbara County
22137	Fee-for-Service	1104908292	1104908292	1	1	BOOKSPAN, MARK A MD	6/11/2013	207R00000X	NA	Other	026	PHYSICIANS	36429	83	Rheumatology	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
22177	Fee-for-Service	1134518129	1134518129	1	1	BRULAND-GLIMCHER, LORI A MD	3/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141729	None	None	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
22183	Fee-for-Service	1093474306	1093474306	1	1	BTC SENIOR CARE LLC	11/8/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16803 MAPLE ST	None	FOUNTAIN VALLEY	CA	92708	2226	30	06059	33.71891844	-117.9678197	Orange County
22184	Fee-for-Service	1538788203	1538788203	1	1	BORMAND, MAHDIS H LMFT	4/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
22256	Fee-for-Service	1346261393	1346261393	2	1	BURBANK COMPOUNDING PHCY	2/4/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BURBANK COMPOUNDING PHCY	201 S BUENA VISTA ST	#110	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
22274	Fee-for-Service	1922357003	1922357003	1	1	BREEN, ETHAN J DO	12/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13057	01	General Practice	0	In state provider	None	901 OAK PARK BLVD	SUITE 101	PISMO BEACH	CA	93449	3409	40	06079	35.13460775	-120.6050814	San Luis Obispo County
22280	Fee-for-Service	1477658680	1477658680	1	1	BROWN, WALTER PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5701 W SLAUSON AVE	STE 108	CULVER CITY	CA	90230	3423	19	06037	33.98900269	-118.3811279	Los Angeles County
22295	Fee-for-Service	1518924737	1518924737	1	1	BERNS, DAVID H MD	4/30/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89079	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
22320	Fee-for-Service	1760591713	1760591713	1	1	BARBARA SINATRA CHILDREN'S C	10/23/2018	283Q00000X	NA	Hospitals	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ENTER	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
22369	Fee-for-Service	1225221245	1225221245	1	1	BARNHORST, AMY V MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101677	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
22372	Fee-for-Service	1689904443	1689904443	1	1	BEST HOME HEALTH CARE INC	10/10/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1175 S GROVE AVE	SUITE 102	ONTARIO	CA	91761	3470	36	06071	34.05078	-117.6280695	San Bernardino County
22380	Fee-for-Service	1205860335	1205860335	1	1	BLOOMINGTON HOSPITAL	4/1/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 W 2ND ST	None	BLOOMINGTON	IN	47403	2317	00	None	39.16137332	-86.54012395	Monroe County
22397	Fee-for-Service	1508290917	1508290917	1	1	BARNAJIAN, MOSHE MD INC	12/16/2013	208C00000X	NA	General Surgery	026	PHYSICIANS	107431	02	General Surgery	0	In state provider	None	222 W EULALIA ST	STE 100A	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
22400	Fee-for-Service	1043451461	1043451461	1	1	BOOYA, FARGOL MD	7/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119184	30	Radiology	0	In state provider	None	455 HICKEY BLVD	STE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
22401	Fee-for-Service	1215349030	1215349030	1	1	BERCOVICI, NICHOLAS DO	7/9/2020	207ZP0102X	NA	Other	026	PHYSICIANS	18147	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
22403	Fee-for-Service	1649939935	1649939935	1	1	BAGSBY, ANDREA NP	1/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	77 ROLLING OAKS DR	#201	THOUSAND OAKS	CA	91361	1018	56	06111	34.17577423	-118.8748925	Ventura County
22432	Fee-for-Service	1639241458	1639241458	1	1	BURG, TAMARA L MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93705	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
22504	Fee-for-Service	1629267422	1629267422	1	1	BILGI, TEJASI	12/10/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52714	-	NOT APPLICABLE	0	In state provider	None	33440 ALVARADO NILES RD	None	UNION CITY	CA	94587	3110	01	06001	37.59181933	-122.0376576	Alameda County
22556	Fee-for-Service	1366487225	1366487225	1	1	BUTLER, DERRICK L MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67268	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
22564	Fee-for-Service	1982808846	1982808846	1	1	BANH, NICOLE T MD	10/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93159	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
22574	Fee-for-Service	1912191628	1912191628	1	1	BURGE, JASON F DO	8/5/2009	207R00000X	NA	Other	026	PHYSICIANS	10126	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
22576	Fee-for-Service	1205442373	1205442373	1	1	BUELOW, KOURTNEY N PT	7/20/2023	2081S0010X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	588 NORTH SUNRISE AVENUE	SUITE 100	ROSEVILLE	CA	95661	2843	31	06061	38.7585915	-121.2527015	Placer County
22592	Fee-for-Service	1992522833	1992522833	1	1	BASS, CELESTE A BIRTH DOULA	1/16/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
22604	Fee-for-Service	1396528477	1396528477	1	1	BELL, VANESSA NP	7/26/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	33	06065	33.95782448	-117.3904065	Riverside County
22615	Fee-for-Service	1992701080	1992701080	1	1	BOGGELN, LAURENCE H MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	49322	01	General Practice	0	In state provider	None	500 LA TERRAZA BLVD	SUITE 130	ESCONDIDO	CA	92025	3875	37	06073	33.11238641	-117.096444	San Diego County
22618	Fee-for-Service	1548348287	1548348287	1	1	BURRALL, STEVEN F MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45274	22	Pathology (M.D. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
22642	Fee-for-Service	1740744705	1740744705	1	1	BOCKSER, JACOB T RCP	2/5/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
22649	Fee-for-Service	1447742812	1447742812	1	1	BROWN, HALLIE S MD	7/21/2023	207P00000X	NA	Other	026	PHYSICIANS	174029	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
22719	Fee-for-Service	1366685273	1366685273	1	1	BANSAL, ANSHUMAN K MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118184	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
22724	Fee-for-Service	1427345503	1427345503	1	1	BHOLA, NEETU MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128093	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
22726	Fee-for-Service	1316190085	1316190085	1	1	BEDERMAN, STACEY S MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105779	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
22728	Fee-for-Service	1154401941	1154401941	1	30	BASS MEDICAL GROUP	7/25/2019	2251N0400X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	130 LA CASA VIA	2-210	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
22743	Fee-for-Service	1821197864	1821197864	1	1	BEGGS, LELAND K MD INC	6/30/1994	207RC0200X	NA	Other	026	PHYSICIANS	42406	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
22762	Fee-for-Service	1457630154	1457630154	1	1	BOYCHUK, TAMANTHA LCSW	5/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
22786	Fee-for-Service	1982660122	1982660122	1	1	BROUARD, YVONNE J MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74079	40	Pediatrics	0	In state provider	None	2219 SANTA CLARA AVE	None	ALAMEDA	CA	94501	4416	01	06001	37.76691588	-122.2454249	Alameda County
22831	Fee-for-Service	1003846379	1003846379	1	1	BEN-AVI, DORON D MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	41751	30	Radiology	0	In state provider	None	157 EAST COOLIDGE AVENUE	None	MODESTO	CA	95350	4504	50	06099	37.66550138	-120.991345	Stanislaus County
22883	Fee-for-Service	1639826530	1639826530	1	1	BURRILL DIALYSIS LLC	4/19/2023	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1700 N ROSE AVENUE	STE 370	OXNARD	CA	93030	7652	56	06111	34.21746	-119.155545	Ventura County
22886	Fee-for-Service	1336205756	1336205756	1	1	BAKER, MICHELANNE PSY	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18433	-	NOT APPLICABLE	0	In state provider	None	1930 MARKET ST	None	SAN FRANCISCO	CA	94102	6228	38	06075	37.77037155	-122.4255051	San Francisco County
22892	Fee-for-Service	1649957374	1649957374	1	1	BAN PHARMACY LLC	10/1/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	43839 15TH ST W	SUITE P	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
22910	Fee-for-Service	1396093811	1396093811	1	1	BESIMANTO, TINA	6/28/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2034 COTNER AVE	200	LOS ANGELES	CA	90025	5664	19	06037	34.0413463	-118.441113	Los Angeles County
22915	Fee-for-Service	1356442412	1356442412	1	1	BAKER, KIMBERLY S	5/20/2002	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9910 HORN RD	STE 3	SACRAMENTO	CA	95827	1959	34	06067	38.575323	-121.3247205	Sacramento County
22964	Fee-for-Service	1538174206	1538174206	1	1	BELLA MIA PLASTIC AND RECONS	1/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85329	24	Plastic Surgery	0	In state provider	TRUCTIVE SURGERY CENTER	1000 E LATHAM AVE	STE A	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
23004	Fee-for-Service	1659558492	1659558492	1	1	BAKHCHI, FREDERIC E MD	5/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141416	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
23015	Fee-for-Service	1154332807	1154332807	1	1	BUDNICK, PAUL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5656 S POWER RD	None	GILBERT	AZ	85295	8487	00	None	33.31386	-111.6877185	Maricopa County
23033	Fee-for-Service	1225615248	1225615248	1	1	BRAVO, MOISES MD	7/12/2024	207P00000X	NA	Other	026	PHYSICIANS	182652	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
23057	Fee-for-Service	1508884388	1508884388	1	1	BANSAL, RAMESH MD	1/31/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30850	41	Internal Medicine	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
23061	Fee-for-Service	1861137481	1861137481	1	1	BIOGROUP LABORATORY CORP	10/24/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2769 E ATLANTIC BLVD	None	POMPANO BEACH	FL	33062	4941	00	None	26.23194548	-80.095239	Broward County
23080	Fee-for-Service	1538197231	1538197231	1	1	BANNER LASSEN MEDICAL CENTER	1/1/1999	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	BANNER LASSEN MEDICAL CT	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
23100	Fee-for-Service	1043476468	1043476468	1	1	BARKIN, JENNIFER J PSYD	9/4/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
23107	Fee-for-Service	1932802055	1932802055	1	1	BARNITT, ANNE E CNP	4/17/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23156	Fee-for-Service	1760634315	1760634315	1	1	BOKHOOR, POOYA I MD	5/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111524	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
23159	Fee-for-Service	1689621849	1689621849	1	1	BHASKARABHATLA, KRISHNA MD	3/14/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	350 JOHN MUIR PKWY	105	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
23220	Fee-for-Service	1992778948	1992778948	1	1	BASRI, WILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1945 CORLIES AVE	None	NEPTUNE	NJ	07753	4859	00	None	40.20750349	-74.0406949	Monmouth County
23228	Fee-for-Service	1679839468	1679839468	1	1	BLUM, RYAN W MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143627	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
23236	Fee-for-Service	1700146347	1700146347	1	1	BASKA, MATTHEW DO	7/1/2024	208M00000X	NA	Other	026	PHYSICIANS	22719	41	Internal Medicine	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
23271	Fee-for-Service	1831579689	1831579689	1	1	BACH, CLARK T MD	4/23/2019	207R00000X	NA	Other	026	PHYSICIANS	155470	41	Internal Medicine	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
23287	Fee-for-Service	1902640840	1902640840	1	1	BOWEN, JESSICA PT	7/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 41ST AVE	SUITE H	CAPITOLA	CA	95010	3900	44	06087	36.969003	-121.964871	Santa Cruz County
23291	Fee-for-Service	1528066685	1528066685	1	3	BHC SIERRA VISTA HOSPITAL	7/10/2023	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2840 5TH STREET	None	DAVIS	CA	95618	7759	57	06113	38.55275379	-121.7152579	Yolo County
23295	Fee-for-Service	1508859182	1508859182	1	1	BENEVENTO, DAVID A	1/1/1983	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2545 E BIDWELL ST	STE 130	FOLSOM	CA	95630	6443	34	06067	38.659932	-121.1314185	Sacramento County
23303	Fee-for-Service	1407903636	1407903636	1	1	BOYD, JAMES I III MD	8/2/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	80891	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
23306	Fee-for-Service	1215173497	1215173497	1	1	BASU, REEMA MD	9/15/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	106276	40	Pediatrics	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
23318	Fee-for-Service	1174557805	1174557805	1	5	BAY AREA RETINA ASSOCIATES,	9/27/2021	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	1460 N CAMINO ALTO	206	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
23321	Fee-for-Service	1417956921	1417956921	2	1	BBT HEALTH, LLC	6/30/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5105 E DAKOTA AVE	STE 101	FRESNO	CA	93727	7443	10	06019	36.7867513	-119.7230403	Fresno County
23330	Fee-for-Service	1063648343	1063648343	1	1	BENNER, ERIC O MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107675	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PRKWY	STE 315	MISSION VIEJO	CA	92691	8039	30	06059	33.56286021	-117.6673449	Orange County
23334	Fee-for-Service	1871922567	1871922567	1	1	BERROCAL, AGUSTINA LMFT	5/21/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
23335	Fee-for-Service	1174557805	1174557805	1	8	BAY AREA RETINA ASSOCIATES,	9/27/2021	207WX0107X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	4049 LONE TREE WAY	SUITE I/J	ANTIOCH	CA	94531	6203	07	06013	37.97553261	-121.800537	Contra Costa County
23336	Fee-for-Service	1356030639	1356030639	1	1	BELL, ALLISON L NP	5/19/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
23362	Fee-for-Service	1871263145	1871263145	1	1	BOPARAI, DENNIS MD	6/22/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147142	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
23364	Fee-for-Service	1467423483	1467423483	1	1	BULL, DALE MD	1/1/1994	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	63155	40	Pediatrics	0	In state provider	None	533 PARNASSUS AVE	# U503	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
23365	Fee-for-Service	1538197231	1538197231	1	1	BANNER LASSEN MEDICAL CENTER	1/1/1999	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	BANNER LASSEN MEDICAL CT	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
23376	Fee-for-Service	1760574123	1760574123	2	1	BRADSHAW, TONDA D DO	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	6282	41	Internal Medicine	0	In state provider	None	35237 YUCAIPA BLVD	None	YUCAIPA	CA	92399	4340	36	06071	34.03383351	-117.0358111	San Bernardino County
23413	Fee-for-Service	1447225446	1447225446	1	1	BRUFFEY, JAMES D MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60176	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
23440	Fee-for-Service	1174083984	1174083984	1	1	BROMLEY, WINDY L NP	9/17/2024	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
23441	Fee-for-Service	1174966154	1174966154	1	1	BRANT ZAWADZKI, GRAHAM M MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133389	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
23447	Fee-for-Service	1477515435	1477515435	1	1	BECKLUND, HOPE A MD	6/12/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60274	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
23454	Fee-for-Service	1861961682	1861961682	1	1	BILLINGSLEY, DARIUS MD	8/1/2023	390200000X	NA	Other	026	PHYSICIANS	184277	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
23487	Fee-for-Service	1386043370	1386043370	1	1	BACA LEANOS, KATHLEEN J LCSW	3/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
23500	Fee-for-Service	1205031887	1205031887	1	1	BASRAON, SANMAAN K MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118257	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
23555	Fee-for-Service	1962023143	1962023143	1	1	BUI, MARIA CRISELDA M CRNA	7/16/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
23599	Fee-for-Service	1588784029	1588784029	1	2	BERRY MORONY, MICHELE LCSW	7/6/2020	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	322 E THOUSAND OAKS BLVD	100	THOUSAND OAKS	CA	91360	5804	56	06111	34.17896875	-118.8712017	Ventura County
23621	Fee-for-Service	1699394627	1699394627	1	1	BATH, HARJOT MD	8/4/2023	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	184173	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
23624	Fee-for-Service	1225102825	1225102825	1	1	BILLER, JASON A MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81268	84	Surgery-Head and Neck	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
23626	Fee-for-Service	1003254186	1003254186	1	1	BRAVO CARRILLO, CLAUDIO A MD	2/25/2025	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
23655	Fee-for-Service	1538197231	1538197231	1	1	BANNER LASSEN MEDICAL CENTER	6/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	BANNER LASSEN MEDICAL CT	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
23712	Fee-for-Service	1407835978	1407835978	1	1	BARBA, LILLY M MD	4/1/1985	207RN0300X	NA	Nephrology	026	PHYSICIANS	41616	13	Neurology (M.D. only)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
23715	Fee-for-Service	1164607164	1164607164	1	1	BATISTE, CHARMAN C LMFT	5/18/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
23731	Fee-for-Service	1417921792	1417921792	1	1	BUNNELL, DANIEL H MD	4/30/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53598	30	Radiology	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
23757	Fee-for-Service	1336138791	1336138791	1	1	BRYAN, DAVID C MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	17464	30	Radiology	0	In state provider	None	100 CONGRESS STREET	None	PASADENA	CA	91105	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
23780	Fee-for-Service	1679581656	1679581656	1	1	BERNARDI, MARCUS R DC	7/13/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVENUE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
23791	Fee-for-Service	1871812537	1871812537	1	1	BEAS, VIRGINIA	5/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
23832	Fee-for-Service	1659466969	1659466969	1	1	BLASKI, MINDY L MD	2/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36982	08	Family Practice	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
23846	Fee-for-Service	1487644282	1487644282	1	1	BRENT ELWOOD JONES, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 E 100 N	None	PAYSON	UT	84651	1600	00	None	40.04472385	-111.7145663	Utah County
23850	Fee-for-Service	1053417303	1053417303	1	1	BAGHDIKIAN, BAGHDASSAR	4/28/1999	207LP2900X	NA	Other	026	PHYSICIANS	54505	05	Anesthesiology	0	In state provider	None	1310 W STEWART DR	STE 310	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
23857	Fee-for-Service	1891812962	1891812962	1	1	BUNKE, NISHA J MD	9/8/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101022	None	None	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
23875	Fee-for-Service	1801893201	1801893201	1	2	BROWN, ELISE S MD	12/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	85861	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6719 ALVARADO RD	STE 302	SAN DIEGO	CA	92120	5263	37	06073	32.77684978	-117.055137	San Diego County
23924	Fee-for-Service	1932764081	1932764081	1	1	BHATIA, KARISHMA	7/8/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
23932	Fee-for-Service	1598020455	1598020455	1	1	BUSCH, KRISTEN L	2/14/2017	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
23947	Fee-for-Service	1629119334	1629119334	1	1	BROCKINGTON, NANCY MD	6/17/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	69128	-	NOT APPLICABLE	0	In state provider	None	125 WEST F ST	SUITE 101	ONTARIO	CA	91762	3201	36	06071	34.069302	-117.652158	San Bernardino County
23960	Fee-for-Service	1558408328	1558408328	1	1	BRADSHAW, BARTON G G MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83638	02	General Surgery	0	In state provider	None	3257 PROFESSIONAL DR	STE E	AUBURN	CA	95602	2460	31	06061	38.943405	-121.1008195	Placer County
23987	Fee-for-Service	1063807105	1063807105	1	1	BATRA, KANCHI MD	8/7/2020	207R00000X	NA	Other	026	PHYSICIANS	144165	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
24001	Fee-for-Service	1407835978	1407835978	1	1	BARBA, LILLY M MD	4/1/1985	207RN0300X	NA	Nephrology	026	PHYSICIANS	41616	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
24002	Fee-for-Service	1720444680	1720444680	1	1	BERG, NAN H A CRNA	11/21/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
24025	Fee-for-Service	1588671267	1588671267	1	1	BINDMAN, ANDREW B MD	1/31/1989	207R00000X	NA	Other	026	PHYSICIANS	57568	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
24034	Fee-for-Service	1275607582	1275607582	1	1	BARKHORDAR, SOHRAB MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81302	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
24036	Fee-for-Service	1508120429	1508120429	1	1	BRITTON, ATISA B MD	8/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127954	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
24053	Fee-for-Service	1649406778	1649406778	1	1	BORNA, REZA M MD	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138643	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
24058	Fee-for-Service	1184854622	1184854622	1	1	BELLO, CHINONYERE K PHD	10/23/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
24068	Fee-for-Service	1154401941	1154401941	1	17	BASS MEDICAL GROUP	2/25/2019	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
24076	Fee-for-Service	1053315887	1053315887	1	1	BAKER, BRADLEY S MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2650 N TENAYA WAY	STE 301	LAS VEGAS	NV	89128	1112	00	None	36.20804839	-115.2501292	Clark County
24109	Fee-for-Service	1740458801	1740458801	1	1	BIRDSALL, BENJAMIN S MD	3/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100194	01	General Practice	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
24110	Fee-for-Service	1235243155	1235243155	1	1	BARBOSA, JOILO C MD	9/1/2009	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
24120	Fee-for-Service	1508911892	1508911892	1	23	BAY AREA FOOT CARE, INC	1/25/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1580 CREEKSIDE DR	STE 100	FOLSOM	CA	95630	3886	34	06067	38.668914	-121.148028	Sacramento County
24121	Fee-for-Service	1659466969	1659466969	1	1	BLASKI, MINDY L MD	2/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36982	38	Geriatrics	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
24137	Fee-for-Service	1598127284	1598127284	1	1	BRACKEN, RICHARD H DO	9/1/2019	207P00000X	NA	Other	026	PHYSICIANS	15847	66	Emergency Medicine (Urgent Care)	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
24145	Fee-for-Service	1972747798	1972747798	1	1	BOTROS, JACQUELINE MD	6/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114200	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
24220	Fee-for-Service	1073522769	1073522769	1	1	BANIGO, M L MD INC	7/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66185	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
24237	Fee-for-Service	1619537446	1619537446	1	1	BROCKMANN, DANA M MD	4/4/2023	390200000X	NA	Other	026	PHYSICIANS	177034	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
24245	Fee-for-Service	1063485167	1063485167	1	1	BLENKO, KATHERINE A MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73776	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
24248	Fee-for-Service	1902960867	1902960867	1	1	BUCHANAN, BETH A LMFT	6/21/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
24277	Fee-for-Service	1881898401	1881898401	1	1	BOLARIS, MICHAEL A MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	98301	41	Internal Medicine	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90509	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
24278	Fee-for-Service	1457870685	1457870685	1	1	BATTEN, KIMBERLY R PT	11/14/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
24309	Fee-for-Service	1023133972	1023133972	1	1	BREWER, MICHAEL B MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119134	02	General Surgery	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
24316	Fee-for-Service	1023008422	1023008422	1	1	BIVIJI, AYAZ A MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67794	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
24345	Fee-for-Service	1952363038	1952363038	1	1	BAWA, MANEESH MD	8/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	75837	20	Orthopedic Surgery	0	In state provider	None	4060 4TH AVE	STE 700	SAN DIEGO	CA	92103	2121	37	06073	32.75053673	-117.1616539	San Diego County
24361	Fee-for-Service	1275907115	1275907115	1	2	BEAUREGARD, JONATHAN G	3/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1325 E COOLEY DR	106 & 107	COLTON	CA	92324	3947	36	06071	34.05468148	-117.306261	San Bernardino County
24374	Fee-for-Service	1962937177	1962937177	1	1	BRAVO, CHERRIE J MD	6/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158914	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
24381	Fee-for-Service	1992732192	1992732192	1	1	BOLSA MEDICAL GROUP	7/8/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10362 BOLSA AVE	STE 110	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
24382	Fee-for-Service	1770656704	1770656704	1	1	BAY AREA COMMUNITY RESOURCES	7/31/2015	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	171 CARLOS DR	None	SAN RAFAEL	CA	94903	2005	21	06041	38.01757315	-122.5347337	Marin County
24394	Fee-for-Service	1952483554	1952483554	1	1	BAKODY PHILIP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY MEDICAL CENTE	1501 N CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
24405	Fee-for-Service	1497081566	1497081566	1	1	BHAJU, JESHMIN PHD	4/20/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
24407	Fee-for-Service	1508911892	1508911892	1	23	BAY AREA FOOT CARE, INC	8/19/2024	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1580 CREEKSIDE DR	STE 100	FOLSOM	CA	95630	3886	34	06067	38.668914	-121.148028	Sacramento County
24429	Fee-for-Service	1528066685	1528066685	1	1	BHC SIERRA VISTA HOSPITAL	12/1/1996	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	8001 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2329	34	06067	38.4669	-121.417101	Sacramento County
24448	Fee-for-Service	1790245868	1790245868	1	1	BHAT, PRADHAN U MD	8/13/2024	207L00000X	NA	Other	026	PHYSICIANS	186210	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
24455	Fee-for-Service	1588639181	1588639181	1	1	BHATIA, GULSHAN MD	2/1/1996	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	47977	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
24462	Fee-for-Service	1871038547	1871038547	1	1	BREAKFIELD, IRMA LMFT	10/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
24477	Fee-for-Service	1649248360	1649248360	1	1	BROWN, STEVEN E MD	3/5/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
24500	Fee-for-Service	1306979042	1306979042	1	1	BROWN, TYEAST M LMFT	7/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
24506	Fee-for-Service	1316113376	1316113376	1	1	BATTERTON, SARAH E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
24542	Fee-for-Service	1093353112	1093353112	1	1	BLUM, JENS	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
24556	Fee-for-Service	1841297959	1841297959	1	1	BANKER, FRANKLIN L MD	2/24/1982	2085R0001X	NA	Other	026	PHYSICIANS	26302	30	Radiology	0	In state provider	None	1025 19TH ST	STE 3	SACRAMENTO	CA	95814	4137	34	06067	38.576376	-121.481226	Sacramento County
24566	Fee-for-Service	1881898401	1881898401	1	1	BOLARIS, MICHAEL A MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	98301	40	Pediatrics	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90509	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
24571	Fee-for-Service	1881026672	1881026672	1	1	BARTOS, GABRIELLA MD	5/4/2022	207R00000X	NA	Other	026	PHYSICIANS	138801	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
24611	Fee-for-Service	1124639943	1124639943	1	1	BIELEFELD, JOSEPH F NP	9/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
24632	Fee-for-Service	1811382328	1811382328	1	1	BONNINGTON, ADAM J MD	5/15/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147178	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
24648	Fee-for-Service	1851412340	1851412340	1	1	BATTAH, SHADI I M MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145962	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	411 30TH ST	STE 314	OAKLAND	CA	94609	3312	01	06001	37.81903474	-122.2649444	Alameda County
24650	Fee-for-Service	1265438451	1265438451	1	1	BLUM, NANCY A PHD	3/2/1995	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5535 BALBOA BLVD	STE 104	ENCINO	CA	91316	1522	19	06037	34.171632	-118.5011955	Los Angeles County
24659	Fee-for-Service	1518147404	1518147404	1	1	BRENING, RORY K MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65523	18	Ophthalmology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
24662	Fee-for-Service	1689753717	1689753717	1	1	BAKER, BRIAN L MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	71648	30	Radiology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
24678	Fee-for-Service	1841636321	1841636321	1	1	BROWN, JEFFREY A MD	1/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159363	30	Radiology	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
24681	Fee-for-Service	1912055930	1912055930	1	1	BOROWY, DONNA M CNM	10/21/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	400 CRAVEN RD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
24702	Fee-for-Service	1144304213	1144304213	1	1	BRIERLY, SHAUN C	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73850	18	Ophthalmology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
24708	Fee-for-Service	1962418806	1962418806	1	1	BARKDULL, GREGORY C MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	93160	01	General Practice	0	In state provider	None	3307 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239431	-124.1358906	Humboldt County
24713	Fee-for-Service	1255479044	1255479044	1	1	BOGHOSIAN, GHASSAN E DO	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11166	20	Orthopedic Surgery	0	In state provider	None	45-280 SEELEY DR	2ND FL	LA QUINTA	CA	92253	6834	33	06065	33.72276914	-116.291709	Riverside County
24715	Fee-for-Service	1528066685	1528066685	1	1	BHC SIERRA VISTA HOSPITAL	12/1/1996	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	8001 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2329	34	06067	38.4669	-121.417101	Sacramento County
24734	Fee-for-Service	1639533870	1639533870	1	1	BELL, JEREMIAH MD	9/10/2024	2084A2900X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
24742	Fee-for-Service	1588639181	1588639181	1	1	BHATIA, GULSHAN MD	2/1/1996	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	47977	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
24750	Fee-for-Service	1174523831	1174523831	1	1	BARLOW PULMONARY MED GRP	8/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
24752	Fee-for-Service	1154401941	1154401941	1	55	BASS MEDICAL GROUP	6/14/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	110 TAMPICO DRIVE	SUITE 210	WALNUT CREEK	CA	94598	2512	07	06013	37.91113845	-122.0458263	Contra Costa County
24757	Fee-for-Service	1689655730	1689655730	1	1	BOKELMAN, JOHN F MD	4/30/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52998	None	None	0	In state provider	None	1 S FOREST RD	None	SONORA	CA	95370	4816	55	06109	37.98218745	-120.3911521	Tuolumne County
24772	Fee-for-Service	1043590151	1043590151	1	1	BHUIYAN, IFFAT MD	9/27/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155544	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
24797	Fee-for-Service	1710963673	1710963673	1	1	BREWSTER, ELAINE M MD	11/1/1994	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
24841	Fee-for-Service	1356831317	1356831317	1	1	BRAUN, ADAM P MD	2/24/2021	207R00000X	NA	Other	026	PHYSICIANS	167183	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
24850	Fee-for-Service	1881898401	1881898401	1	1	BOLARIS, MICHAEL A MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	98301	77	Infectious Disease	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90509	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
24895	Fee-for-Service	1982891669	1982891669	1	1	BECKER, DANIEL M C LCSW	8/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	71973	-	NOT APPLICABLE	0	In state provider	None	1931 CENTER ST	None	BERKELEY	CA	94704	1105	01	06001	37.86983853	-122.2717273	Alameda County
24897	Fee-for-Service	1538371679	1538371679	1	1	BAXTER, ZACHERY C MD	8/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103187	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
24903	Fee-for-Service	1730482118	1730482118	1	1	BUNCH-LIPSCOMB, SHIRELL	12/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18484 HIGHWAY 18	#210	APPLE VALLEY	CA	92307	1331	36	06071	34.53970843	-117.2611301	San Bernardino County
24908	Fee-for-Service	1831494079	1831494079	1	1	BOATMAN, COURTNEY J LMFT	9/17/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3288 EL CAJON BLVD	SUITE 1A, 1B, 3, 5, 6, 8	SAN DIEGO	CA	92104	1430	37	06073	32.75537145	-117.1228095	San Diego County
24937	Fee-for-Service	1851412340	1851412340	1	1	BATTAH, SHADI I M MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145962	66	Emergency Medicine (Urgent Care)	0	In state provider	None	411 30TH ST	STE 314	OAKLAND	CA	94609	3312	01	06001	37.81903474	-122.2649444	Alameda County
24942	Fee-for-Service	1033117189	1033117189	1	1	BOCCI, JERROLD C MD INC	11/30/1985	207W00000X	NA	Ophthalmology	026	PHYSICIANS	20794	18	Ophthalmology	0	In state provider	None	2001 UNION ST	STE 480	SAN FRANCISCO	CA	94123	4128	38	06075	37.7974427	-122.432532	San Francisco County
24951	Fee-for-Service	1275545329	1275545329	1	1	BENEKE, MICHAEL A MD	7/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	62335	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
24961	Fee-for-Service	1104956556	1104956556	1	1	BERENSON, LAURIE E PSY D	8/3/2007	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	450 S.MELROSE DRIVE	STE 113	VISTA	CA	92081	6674	37	06073	33.18961915	-117.2537894	San Diego County
24969	Fee-for-Service	1811990633	1811990633	1	1	BRUDNER, PETER N OD	3/7/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 N H ST	None	LOMPOC	CA	93436	4521	42	06083	34.64936471	-120.4577269	Santa Barbara County
24992	Fee-for-Service	1538766886	1538766886	1	1	BAKER, J'NYSSIENNE M PT	3/19/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
25006	Fee-for-Service	1528066685	1528066685	1	1	BHC SIERRA VISTA HOSPITAL	12/1/1996	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	8001 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2329	34	06067	38.4669	-121.417101	Sacramento County
25007	Fee-for-Service	1073541876	1073541876	2	6	BROOKS, JEFFREY L MD	7/17/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	51713	None	None	0	In state provider	None	5120 MANZANITA AVENUE	STE 105	CARMICHAEL	CA	95608	0590	34	06067	38.659392	-121.327155	Sacramento County
25019	Fee-for-Service	1255510376	1255510376	1	1	BIDWELL PHARMACY AND	2/20/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL SUPPLY INC	1200 MANGROVE AVE	#A	CHICO	CA	95926	3528	04	06007	39.74235637	-121.8385941	Butte County
25029	Fee-for-Service	1699487108	1699487108	1	1	BARTON, LAUREN A CNM	12/13/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
25040	Fee-for-Service	1154401941	1154401941	1	55	BASS MEDICAL GROUP	6/14/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	110 TAMPICO DRIVE	SUITE 210	WALNUT CREEK	CA	94598	2512	07	06013	37.91113845	-122.0458263	Contra Costa County
25045	Fee-for-Service	1548346075	1548346075	1	1	BENNER, DOUGLAS A MD	8/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	35266	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
25065	Fee-for-Service	1538246335	1538246335	1	1	BURKE, JEROME A OD	9/6/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	445 W POPLAR ST	None	STOCKTON	CA	95203	2426	39	06077	37.96038489	-121.2996945	San Joaquin County
25095	Fee-for-Service	1871198705	1871198705	1	1	BERNSTEIN, JESSICA PT	6/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	224 INDIAN HILL BLVD	None	CLAREMONT	CA	91711	4609	19	06037	34.09607063	-117.7192866	Los Angeles County
25135	Fee-for-Service	1083697874	1083697874	1	1	BAUER, PAUL M MD	9/20/2022	2086S0127X	NA	General Surgery	026	PHYSICIANS	139323	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
25145	Fee-for-Service	1710186440	1710186440	1	1	BUI, ANH L MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98900	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
25148	Fee-for-Service	1134201643	1134201643	1	1	BABIN, TOM D CRNA	10/18/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
25189	Fee-for-Service	1164876140	1164876140	1	1	BILBREY, ARTHUR LMFT	10/7/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	134935	-	NOT APPLICABLE	0	In state provider	None	3148 MIDWAY DRIVE	SUITE 113	SAN DIEGO	CA	92110	5439	37	06073	32.75039352	-117.208269	San Diego County
25200	Fee-for-Service	1710179791	1710179791	1	1	BUFFORD, TAEKO LCSW	7/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
25204	Fee-for-Service	1942625348	1942625348	1	1	BISQUERA-CACPAL, JOANNA Y MD	8/15/2017	390200000X	NA	Other	026	PHYSICIANS	141091	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
25219	Fee-for-Service	1265724553	1265724553	1	1	BUTLER, WILLIAM J MD	8/18/2022	208600000X	NA	General Surgery	026	PHYSICIANS	122410	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
25232	Fee-for-Service	1083654404	1083654404	2	1	BANSKOTA, NIRMAL K MD	9/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44429	67	Endocrinology	0	In state provider	None	1015 N FIRST AVENUE	SUITE B	ARCADIA	CA	91006	7401	19	06037	34.15065339	-118.0285869	Los Angeles County
25238	Fee-for-Service	1275545329	1275545329	1	1	BENEKE, MICHAEL A MD	7/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	62335	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
25264	Fee-for-Service	1760713713	1760713713	1	1	BELLOSO-CURIEL, JORGE R LCSW	1/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
25288	Fee-for-Service	1679514509	1679514509	1	1	BASIC HOME INFUSION INC	2/24/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	1401 VALLEY ROAD	4TH FLOOR	WAYNE	NJ	07470	2037	00	None	40.95906618	-74.22580787	Passaic County
25293	Fee-for-Service	1063899276	1063899276	1	1	BUCZKO, JENNIFER L LPCC	11/9/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5078 BULLION STREET	SUITE #2	MARIPOSA	CA	95338	2416	22	06043	37.48819922	-119.967001	Mariposa County
25309	Fee-for-Service	1588219067	1588219067	1	1	BRILLIANT SENIOR CARE INC	3/16/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16246 VINTAGE STREET	None	NORTH HILLS	CA	91343	1315	19	06037	34.25187482	-118.4866484	Los Angeles County
25310	Fee-for-Service	1275907115	1275907115	1	1	BEAUREGARD, JONATHAN G	11/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
25328	Fee-for-Service	1154401941	1154401941	1	38	BASS MEDICAL GROUP	9/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	365 LENNON LN	200	WALNUT CREEK	CA	94598	5910	07	06013	37.92784983	-122.0301444	Contra Costa County
25330	Fee-for-Service	1255373924	1255373924	1	1	BALDRIDGE, E BRADFORD MD	1/1/1988	207P00000X	NA	Other	026	PHYSICIANS	61732	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
25333	Fee-for-Service	1154401941	1154401941	1	55	BASS MEDICAL GROUP	6/14/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	110 TAMPICO DRIVE	SUITE 210	WALNUT CREEK	CA	94598	2512	07	06013	37.91113845	-122.0458263	Contra Costa County
25336	Fee-for-Service	1154401941	1154401941	1	60	BASS MEDICAL GROUP	3/1/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	5201 NORRIS CANYON RD	STE 120	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
25337	Fee-for-Service	1194021295	1194021295	1	1	BARSOUMIAN, JANET L	7/28/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 CAMARILLO RANCH ROAD	SUITE 209	CAMARILLO	CA	93012	5903	56	06111	34.220943	-119.0186825	Ventura County
25391	Fee-for-Service	1467483966	1467483966	1	1	BOYLE, THOMAS M MD	7/17/1995	208600000X	NA	General Surgery	026	PHYSICIANS	56911	01	General Practice	0	In state provider	None	123 MARGARET LN	STE B2	GRASS VALLEY	CA	95945	5268	29	06057	39.22839146	-121.0455763	Nevada County
25398	Fee-for-Service	1548439003	1548439003	1	1	BIRCH, JENNIFER S NP	7/28/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND STREET W	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
25404	Fee-for-Service	1831411131	1831411131	1	1	BENNETT, HILARY A MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110027	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
25427	Fee-for-Service	1215294327	1215294327	1	1	BUCKNER, JOHN W MD	9/1/2018	207P00000X	NA	Other	026	PHYSICIANS	157401	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
25428	Fee-for-Service	1750945523	1750945523	1	1	BLANSCET, CASSANDRA D MD	7/18/2022	207P00000X	NA	Other	026	PHYSICIANS	178484	None	None	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
25430	Fee-for-Service	1457489239	1457489239	1	1	BOUTROS, SHADI F MD	4/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126254	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
25474	Fee-for-Service	1366893935	1366893935	1	1	BRUNO, JEHREL A LCSW	2/24/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
25495	Fee-for-Service	1700926698	1700926698	2	1	BELLOMO, THOMAS N MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	69193	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
25503	Fee-for-Service	1841502184	1841502184	1	1	BAE, JUNG MOON MD INC	10/12/2010	193400000X	NA	Other	026	PHYSICIANS	45605	45	Nephrology (Renal-Kidney)	0	In state provider	None	1245 WILSHIRE BLVD	STE 785	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
25507	Fee-for-Service	1407387244	1407387244	1	1	BLAIKIE, ERIKA T MD	8/28/2020	207P00000X	NA	Other	026	PHYSICIANS	166742	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
25520	Fee-for-Service	1083654404	1083654404	2	1	BANSKOTA, NIRMAL K MD	9/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44429	41	Internal Medicine	0	In state provider	None	1015 N FIRST AVENUE	SUITE B	ARCADIA	CA	91006	7401	19	06037	34.15065339	-118.0285869	Los Angeles County
25539	Fee-for-Service	1508911892	1508911892	1	20	BAY AREA FOOT CARE, INC	12/8/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	480 REDWOOD ST	SUITE 10	VALLEJO	CA	94590	2958	48	06095	38.12315545	-122.2597619	Solano County
25561	Fee-for-Service	1780623587	1780623587	1	1	BASEMAN, ADAM G MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104890	34	Urology and Urological Surgery	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
25589	Fee-for-Service	1740941996	1740941996	1	1	BUELL, TRITIA NP	3/16/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
25590	Fee-for-Service	1144374919	1144374919	1	1	BLACKBURN &WHITNEY MD PS	3/19/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	None	2500 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1856	00	None	48.77624644	-122.4753927	Whatcom County
25611	Fee-for-Service	1164609558	1164609558	1	1	BURGAMY, ELIZABETH B MD	5/19/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	99859	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
25615	Fee-for-Service	1881842888	1881842888	1	1	BHAYANI, RITESH R MD	2/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103584	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
25616	Fee-for-Service	1154401941	1154401941	1	38	BASS MEDICAL GROUP	9/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	365 LENNON LN	200	WALNUT CREEK	CA	94598	5910	07	06013	37.92784983	-122.0301444	Contra Costa County
25625	Fee-for-Service	1154401941	1154401941	1	60	BASS MEDICAL GROUP	3/1/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	5201 NORRIS CANYON RD	STE 120	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
25628	Fee-for-Service	1306269535	1306269535	1	1	BHARDWAJ, ASHWANI MD INC	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54408	41	Internal Medicine	0	In state provider	None	15211 VANOWEN STREET	SUITE 205	VAN NUYS	CA	91405	3626	19	06037	34.19395411	-118.4642527	Los Angeles County
25633	Fee-for-Service	1790897593	1790897593	1	1	BIO MEDICAL APPLICATIONS	1/30/2002	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	10116 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2564	19	06037	33.90199052	-118.1179665	Los Angeles County
25638	Fee-for-Service	1700979465	1700979465	1	1	BAPTIST HOSPITAL	7/1/2003	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1000 W MORENO ST	None	PENSACOLA	FL	32501	2316	00	None	30.42868443	-87.23133744	Escambia County
25715	Fee-for-Service	1659450799	1659450799	1	1	BARR, IRWIN R MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	69947	01	General Practice	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
25724	Fee-for-Service	1417489758	1417489758	1	1	BOONE, SEAN L MD	6/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176662	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
25743	Fee-for-Service	1124051560	1124051560	1	1	BERENSON, JAMES R MD	4/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42018	78	Neoplastic Diseases/Oncology	0	In state provider	None	9201 W SUNSET BLVD	STE 310	WEST HOLLYWOOD	CA	90069	3704	19	06037	34.09054375	-118.392295	Los Angeles County
25744	Fee-for-Service	1649362443	1649362443	1	1	BOSE, SHYAMAL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	17800 KEDZIE AVE	None	HAZEL CREST	IL	60429	2029	00	None	41.566383	-87.697116	Cook County
25770	Fee-for-Service	1386166817	1386166817	1	1	BAJAJ, SONALI MD	1/29/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169441	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
25777	Fee-for-Service	1730214222	1730214222	1	1	BACHUSS, AMANDA MD	9/16/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	128558	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
25790	Fee-for-Service	1841502184	1841502184	1	1	BAE, JUNG MOON MD INC	10/12/2010	193400000X	NA	Other	026	PHYSICIANS	45605	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	STE 785	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
25793	Fee-for-Service	1528016235	1528016235	1	1	BOONE, ANDREA B MD	8/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79417	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	202 W WILLOW AVE	None	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
25818	Fee-for-Service	1508163437	1508163437	1	1	BASEHORE, GINA M CRNA	1/6/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25872	Fee-for-Service	1013937200	1013937200	1	1	BERKELEY,BENNETT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	0000	00	None	39.14105892	-84.50040782	Hamilton County
25904	Fee-for-Service	1689252082	1689252082	1	1	BRAR, RAJVIR K MD	11/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188984	08	Family Practice	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
25905	Fee-for-Service	1154401941	1154401941	1	38	BASS MEDICAL GROUP	9/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	365 LENNON LN	200	WALNUT CREEK	CA	94598	5910	07	06013	37.92784983	-122.0301444	Contra Costa County
25909	Fee-for-Service	1306908082	1306908082	1	1	BOWNE, KRISTIN L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
25911	Fee-for-Service	1154401941	1154401941	1	60	BASS MEDICAL GROUP	3/1/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5201 NORRIS CANYON RD	STE 120	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
25915	Fee-for-Service	1669555405	1669555405	1	1	BARKIN, KARIN MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50768	38	Geriatrics	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
25928	Fee-for-Service	1700979465	1700979465	1	1	BAPTIST HOSPITAL	12/1/1998	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1000 W MORENO ST	None	PENSACOLA	FL	32501	2316	00	None	30.42868443	-87.23133744	Escambia County
25940	Fee-for-Service	1346330024	1346330024	1	1	BRANDENBURG,SUZANNE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742182	-104.8408515	Adams County
25947	Fee-for-Service	1831543784	1831543784	1	1	BREYRE, AMELIA MD	9/30/2019	390200000X	NA	Other	026	PHYSICIANS	151993	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
25956	Fee-for-Service	1891910873	1891910873	1	1	BAKER-LEPAIN, JULIE C MD	2/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97452	83	Rheumatology	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
25971	Fee-for-Service	1730613811	1730613811	1	1	BHUSHAN, RAGINI MD	9/23/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	169518	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
25998	Fee-for-Service	1265780597	1265780597	1	1	BARTOLOME, ANGELA LCSW	9/6/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	68950	-	NOT APPLICABLE	0	In state provider	None	2115 N WILMINGTON AVE	None	COMPTON	CA	90222	2030	19	06037	33.91197848	-118.2391821	Los Angeles County
26006	Fee-for-Service	1326083809	1326083809	1	1	BARDELES, RICARDO H MD	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52141	None	None	0	In state provider	None	3301 C ST	STE 103C	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
26017	Fee-for-Service	1821185802	1821185802	1	1	BLOHM, RICHARD R MD	2/28/1993	207P00000X	NA	Other	026	PHYSICIANS	55120	None	None	0	In state provider	None	2270 BELLE AVE	None	YREKA	CA	96097	9528	47	06093	41.69226513	-122.6522929	Siskiyou County
26018	Fee-for-Service	1497704381	1497704381	1	1	BUNO-BRION, IRENE J MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83987	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
26030	Fee-for-Service	1124051560	1124051560	1	1	BERENSON, JAMES R MD	4/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42018	68	Hematology	0	In state provider	None	9201 W SUNSET BLVD	STE 310	WEST HOLLYWOOD	CA	90069	3704	19	06037	34.09054375	-118.392295	Los Angeles County
26040	Fee-for-Service	1780875088	1780875088	1	1	BAN, VU Q MD INC	10/15/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34606	08	Family Practice	0	In state provider	None	14571 MAGNOLIA ST	STE 106	WESTMINSTER	CA	92683	5575	30	06059	33.75097286	-117.9723502	Orange County
26072	Fee-for-Service	1669452801	1669452801	1	2	BENKLE, DAVID J OD	9/15/1982	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	715 LINCOLN CTR	None	STOCKTON	CA	95207	2644	39	06077	38.01170936	-121.3236351	San Joaquin County
26075	Fee-for-Service	1972684249	1972684249	1	1	BECKMANN, ANDREW E MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	10112	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
26076	Fee-for-Service	1275199374	1275199374	1	1	BOODAIE, BENJAMIN D MD	6/29/2023	207P00000X	NA	Other	026	PHYSICIANS	181086	None	None	0	In state provider	None	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
26122	Fee-for-Service	1689606154	1689606154	1	1	BANTLEY, OKSANA MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55384	05	Anesthesiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
26128	Fee-for-Service	1386395499	1386395499	1	1	BRENHAUG, MICHELLE C CD	3/9/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
26147	Fee-for-Service	1922637891	1922637891	1	1	BOLAND, JULIA L MD	9/21/2023	208M00000X	NA	Other	026	PHYSICIANS	190494	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
26148	Fee-for-Service	1124018601	1124018601	1	1	BRODY, CHRISTINE Z MD	8/10/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84300	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2067 W VISTA WAY	STE 225	VISTA	CA	92083	6001	37	06073	33.18505594	-117.285958	San Diego County
26149	Fee-for-Service	1346688371	1346688371	1	1	BENARON, DAVID J MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1678	00	None	39.52483792	-119.7968314	Washoe County
26174	Fee-for-Service	1821035528	1821035528	1	1	BOWKER, DEBRA D MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71837	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH AVENUE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
26199	Fee-for-Service	1669555405	1669555405	1	1	BARKIN, KARIN MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50768	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
26219	Fee-for-Service	1164966073	1164966073	1	1	BUCKNER, LAURA L LMFT	3/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
26267	Fee-for-Service	1487747804	1487747804	1	1	BETTENEL MEDICAL GROUP INC	3/10/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22905	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3113	01	06001	37.819368	-122.263902	Alameda County
26270	Fee-for-Service	1437171089	1437171089	1	1	BARRIOS, BENNETT R MD	5/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77203	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
26279	Fee-for-Service	1093037061	1093037061	1	1	BIRJANDI, NAHID PODIATRIC	3/31/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	27871 MEDICAL CENTER RD	SUITE 130	MISSION VIEJO	CA	92691	6334	30	06059	33.558534	-117.6641255	Orange County
26335	Fee-for-Service	1639477532	1639477532	1	1	BERRY SIMON, MARJORIE LCSW	11/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
26355	Fee-for-Service	1518426345	1518426345	1	1	BELL, JENNIFER A DO	1/18/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176970	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
26357	Fee-for-Service	1922126374	1922126374	1	1	BOLES, JULIE L MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90896	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
26395	Fee-for-Service	1700945417	1700945417	1	1	BAHMAN, OMRANI DO	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9465	41	Internal Medicine	0	In state provider	None	23512 MADERO	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
26401	Fee-for-Service	1740660133	1740660133	1	1	BHASIN, VRINDA S MD	11/16/2021	207R00000X	NA	Other	026	PHYSICIANS	172432	None	None	0	In state provider	None	27799 MEDICAL CENTER RD	STE 460	MISSION VIEJO	CA	92691	6400	30	06059	33.55993179	-117.6654941	Orange County
26406	Fee-for-Service	1023271582	1023271582	1	1	BLIEDEN, LAUREN S MD	11/1/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
26423	Fee-for-Service	1619005170	1619005170	1	1	BUTTE COUNTY HEALTH DEPT	1/31/1991	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY	695 OLEANDER AVE	None	CHICO	CA	95926	3924	04	06007	39.73502442	-121.841522	Butte County
26425	Fee-for-Service	1467116848	1467116848	1	1	BIGGIANI, HEATHER CCC-SLP	10/16/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25467 MEDICAL CENTER DR	100	MURRIETA	CA	92562	1501	33	06065	33.55711632	-117.1860368	Riverside County
26446	Fee-for-Service	1790768026	1790768026	1	1	BELAFSKY, PETER C MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
26462	Fee-for-Service	1073543211	1073543211	1	2	BELTRAN, DANIEL M OD INC	3/5/1985	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	DR DANIEL BELTRAN OD INC	2490 MISSION ST	None	SAN FRANCISCO	CA	94110	2415	38	06075	37.75720117	-122.4189619	San Francisco County
26468	Fee-for-Service	1487742979	1487742979	1	3	BENNY J. GUZMAN, M.D., CORPO	12/6/2018	390200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RATION	5827 PINE AVE	SUITE A	CHINO HILLS	CA	91709	6534	36	06071	33.94745656	-117.6777147	San Bernardino County
26469	Fee-for-Service	1437171063	1437171063	1	1	BAUER, MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
26493	Fee-for-Service	1164472460	1164472460	1	1	BHADAURIA, SUSHMA MD	7/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	63137	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
26497	Fee-for-Service	1427107085	1427107085	1	1	BARRS, ALICIA	6/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
26501	Fee-for-Service	1134186604	1134186604	1	1	BOOTH,TIMOTHY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
26516	Fee-for-Service	1205032752	1205032752	1	1	BAUGHN, MARIAH R MD	4/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106594	22	Pathology (M.D. only)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
26543	Fee-for-Service	1831509520	1831509520	1	1	BEVERLY HOSPITALIST GROUP	8/11/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INCORPORATED	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
26556	Fee-for-Service	1083687776	1083687776	1	1	BEVERLY, ROLAND S MD	4/30/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	65658	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
26600	Fee-for-Service	1912927021	1912927021	1	1	BUYYOUNOUSKI, MARK K MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55796	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
26610	Fee-for-Service	1801099593	1801099593	1	1	BUI, BAO T MD	7/12/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	125690	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
26612	Fee-for-Service	1437237971	1437237971	1	1	BELENISKI, FLORENCIA MD	1/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127051	85	Surgery-Pediatric	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
26621	Fee-for-Service	1801062997	1801062997	1	1	BEAN, MELINDA J AU	12/22/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	205 CLAYDELLE AVE	SUITE 105	EL CAJON	CA	92090	4555	37	06073	32.79381683	-116.9587603	San Diego County
26632	Fee-for-Service	1295210953	1295210953	1	1	BAISA, ASTA I CNP	6/6/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2455 SAN RAMON VALLEY BL	None	SAN RAMON	CA	94583	1601	07	06013	37.77494737	-121.9771019	Contra Costa County
26644	Fee-for-Service	1154407237	1154407237	1	1	BILLECI, BARTON T MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76874	41	Internal Medicine	0	In state provider	None	4050 BARRANCA PKWY	STE 250	IRVINE	CA	92604	1734	30	06059	33.68293726	-117.8067799	Orange County
26648	Fee-for-Service	1982846572	1982846572	1	1	BATHURST, PATRICIA E LMFT	9/3/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1315 25TH ST	None	SAN DIEGO	CA	92102	2107	37	06073	32.71932	-117.1402715	San Diego County
26654	Fee-for-Service	1497978902	1497978902	1	1	BEHDAD, AMIR MD	11/10/2009	207T00000X	NA	General Surgery	026	PHYSICIANS	103833	01	General Practice	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
26684	Fee-for-Service	1437122975	1437122975	1	1	BOTKIN, LEE A MD	12/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80670	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
26691	Fee-for-Service	1679304067	1679304067	1	1	BAPTISTE III, JOHN LMFT	8/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
26728	Fee-for-Service	1437801727	1437801727	1	1	BALDWIN, JOY CRNA	10/12/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
26734	Fee-for-Service	1790768026	1790768026	1	1	BELAFSKY, PETER C MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76009	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
26778	Fee-for-Service	1821000456	1821000456	1	1	BERGSTROM, RECHA S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79519	30	Radiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
26825	Fee-for-Service	1982763637	1982763637	1	1	BLAU, ROD A MD	9/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61405	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
26847	Fee-for-Service	1245812759	1245812759	1	1	BAHAMONDE, AMELIA MD	4/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181853	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
26848	Fee-for-Service	1346328119	1346328119	1	1	BERMAN, ARNOLD MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45513	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
26853	Fee-for-Service	1295712206	1295712206	1	1	BAUTISTA, LUIS G MD	2/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9727	08	Family Practice	0	In state provider	None	427 CENTRAL AVE	None	FILLMORE	CA	93015	1329	56	06111	34.40149146	-118.9139494	Ventura County
26869	Fee-for-Service	1942435433	1942435433	1	1	BIRKHAUSER, JENNIFER L MD	3/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109336	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
26873	Fee-for-Service	1225055932	1225055932	1	1	BASAEZ, KATHERINE L RN	2/1/1995	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
26880	Fee-for-Service	1063752020	1063752020	1	1	BUCHANAN, RAQUEL A LMFT	5/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
26887	Fee-for-Service	1770661431	1770661431	1	1	BOVILL, DAVID MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	41301	20	Orthopedic Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
26889	Fee-for-Service	1912927021	1912927021	1	1	BUYYOUNOUSKI, MARK K MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55796	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
26897	Fee-for-Service	1760506513	1760506513	1	1	BUHARI, SHIRAZ MD INC	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82278	08	Family Practice	0	In state provider	ANCHOR FAMILY MEDICAL	1805 N CALIFORNIA ST	STE 401	STOCKTON	CA	95204	6033	39	06077	37.9711691	-121.2894221	San Joaquin County
26933	Fee-for-Service	1154407237	1154407237	1	1	BILLECI, BARTON T MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76874	40	Pediatrics	0	In state provider	None	4050 BARRANCA PKWY	STE 250	IRVINE	CA	92604	1734	30	06059	33.68293726	-117.8067799	Orange County
26967	Fee-for-Service	1639166291	1639166291	1	1	BRAUN, RICHARD M MD INC	11/6/1993	174400000X	NA	Other	026	PHYSICIANS	6731	66	Emergency Medicine (Urgent Care)	0	In state provider	None	770 WASHINGTON ST	STE 301	SAN DIEGO	CA	92103	2209	37	06073	32.75014189	-117.1579654	San Diego County
27001	Fee-for-Service	1700912466	1700912466	1	1	BOX, ELISABETH C LMFT	8/8/2024	106H00000X	NA	Mental Health Outpatient Services	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
27003	Fee-for-Service	1912962028	1912962028	1	1	BASTASCH, MICHAEL D MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85084	78	Neoplastic Diseases/Oncology	0	In state provider	None	39101 CIVIC CENTER DR	None	FREMONT	CA	94538	5817	01	06001	37.55467054	-121.9770646	Alameda County
27018	Fee-for-Service	1821197864	1821197864	1	2	BEGGS, LELAND K MD INC	1/21/2019	207RC0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1400 E CHURCH STREET	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
27019	Fee-for-Service	1215162045	1215162045	1	1	BRADLEY, NANCY J LMFT	4/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	633 CHERRY ST	None	SANTA ROSA	CA	95404	4202	49	06097	38.44485	-122.7159	Sonoma County
27027	Fee-for-Service	1548205800	1548205800	1	1	BRIAN CLARKOWSKI MD	4/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1455 SAINT FRANCIS AVE	None	SHAKOPEE	MN	55379	3374	00	None	44.771976	-93.502944	Scott County
27045	Fee-for-Service	1972617413	1972617413	1	1	BLAKELY, PATRICIA	6/30/1990	207RN0300X	NA	Nephrology	026	PHYSICIANS	66318	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
27118	Fee-for-Service	1528057569	1528057569	1	1	BRIAN I YUH, MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
27126	Fee-for-Service	1013932847	1013932847	1	1	BELLDEGRUN, ARIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44477	34	Urology and Urological Surgery	0	In state provider	CHS	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
27133	Fee-for-Service	1437165149	1437165149	1	1	BARNETT, PETER B MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
27139	Fee-for-Service	1104276229	1104276229	1	1	BE, STEPHANIE M DO	12/24/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18111	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
27193	Fee-for-Service	1205964384	1205964384	1	1	BENNETT, RHONDA K	9/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST	SUITE 102	FOUNTAIN VALLEY	CA	92708	7301	30	06059	33.68919119	-117.9542204	Orange County
27194	Fee-for-Service	1205027737	1205027737	1	1	BECKETT, CRAIG S LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	770 MAGNOLIA AVE	STE 1F	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
27204	Fee-for-Service	1215971999	1215971999	1	2	BURINGRUD, DUANE M MD	8/1/1981	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	488 E VALLEY PKWY	STE 310	ESCONDIDO	CA	92025	3373	37	06073	33.12523814	-117.0769715	San Diego County
27209	Fee-for-Service	1902811524	1902811524	3	1	BBN PHARMACY, INC	11/14/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6226 E SPRING ST	SUITE 140	LONG BEACH	CA	90815	1441	19	06037	33.81040053	-118.1102715	Los Angeles County
27222	Fee-for-Service	1710968425	1710968425	1	1	BARTE, OPHELIA G MD	3/27/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	43189	01	General Practice	0	In state provider	None	12949 JOLETTE AVE	None	GRANADA HILLS	CA	91344	1069	19	06037	34.30487803	-118.5168056	Los Angeles County
27224	Fee-for-Service	1679569891	1679569891	1	1	BURDUMY, THEODORE MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	42096	05	Anesthesiology	0	In state provider	None	100 CONGRESS STREET	None	PASADENA	CA	91105	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
27227	Fee-for-Service	1760922603	1760922603	1	1	BUTLER, MARISTELA M NP	9/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
27231	Fee-for-Service	1154401941	1154401941	1	34	BASS MEDICAL GROUP	10/10/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	5924 STONERIDGE DR	SUITE 206	PLEASANTON	CA	94588	5400	01	06001	37.69132593	-121.8988844	Alameda County
27250	Fee-for-Service	1164556353	1164556353	1	1	BALCH, DAVID G R MD	12/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55497	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
27253	Fee-for-Service	1144809393	1144809393	1	1	BILOTTA, NATALIE NP	2/14/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
27254	Fee-for-Service	1639166291	1639166291	1	1	BRAUN, RICHARD M MD INC	11/6/1993	174400000X	NA	Other	026	PHYSICIANS	6731	20	Orthopedic Surgery	0	In state provider	None	770 WASHINGTON ST	STE 301	SAN DIEGO	CA	92103	2209	37	06073	32.75014189	-117.1579654	San Diego County
27283	Fee-for-Service	1104311596	1104311596	1	1	BALAKRISHNAN, VIJAY MD	11/11/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	176445	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
27290	Fee-for-Service	1841595832	1841595832	1	1	BACA, MICHELLE M LMFT	5/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
27293	Fee-for-Service	1912962028	1912962028	1	1	BASTASCH, MICHAEL D MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85084	30	Radiology	0	In state provider	None	39101 CIVIC CENTER DR	None	FREMONT	CA	94538	5817	01	06001	37.55467054	-121.9770646	Alameda County
27299	Fee-for-Service	1568473361	1568473361	1	1	BLUMLEIN, STEVEN L MD	6/30/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	39578	None	None	0	In state provider	None	3580 CALIFORNIA ST	STE 304	SAN FRANCISCO	CA	94118	1725	38	06075	37.78648975	-122.452943	San Francisco County
27307	Fee-for-Service	1497839476	1497839476	1	1	BOHRER, PAMELA S MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69280	None	None	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
27320	Fee-for-Service	1225165731	1225165731	1	1	BASIRATMAND, SIAMAK MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	60474	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS ROAD	None	TEMPLETON	CA	93465	0000	40	06079	35.55442648	-120.719754	San Luis Obispo County
27332	Fee-for-Service	1972617413	1972617413	1	1	BLAKELY, PATRICIA	6/30/1990	207RN0300X	NA	Nephrology	026	PHYSICIANS	66318	01	General Practice	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
27360	Fee-for-Service	1881739613	1881739613	1	1	BOULDER CITY HOSPITAL INC	7/10/2018	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	901 ADAMS BOULEVARD	None	BOULDER CITY	NV	89005	2213	00	None	35.96821237	-114.8424842	Clark County
27402	Fee-for-Service	1063707420	1063707420	1	1	BRITA B CHENG ARAMAKI M	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
27447	Fee-for-Service	1821652785	1821652785	1	1	BIRTH CENTER NURSE MIDWIVES,	11/24/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	A NURSING CORPORATION	5440 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3106	34	06067	38.661714	-121.337991	Sacramento County
27464	Fee-for-Service	1447577853	1447577853	1	1	BADALAMENTI, CONO P MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117762	01	General Practice	0	In state provider	None	2 WEST FERN	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
27490	Fee-for-Service	1063462893	1063462893	1	1	BRUNSON, DARIN D MD	4/22/1995	207L00000X	NA	Other	026	PHYSICIANS	79289	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
27507	Fee-for-Service	1083681506	1083681506	1	1	BROWNELL, JOEL D MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64313	None	None	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
27511	Fee-for-Service	1710968425	1710968425	1	1	BARTE, OPHELIA G MD	3/27/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	43189	08	Family Practice	0	In state provider	None	12949 JOLETTE AVE	None	GRANADA HILLS	CA	91344	1069	19	06037	34.30487803	-118.5168056	Los Angeles County
27513	Fee-for-Service	1417929696	1417929696	1	1	BERGLUND, LARS F MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89561	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
27520	Fee-for-Service	1154401941	1154401941	1	34	BASS MEDICAL GROUP	10/10/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5924 STONERIDGE DR	SUITE 206	PLEASANTON	CA	94588	5400	01	06001	37.69132593	-121.8988844	Alameda County
27529	Fee-for-Service	1306421995	1306421995	1	1	BENITES PLATA, KITZIA LMFT	10/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 S. B ST.	None	SAN MATEO	CA	94401	4053	41	06081	37.56539871	-122.3222584	San Mateo County
27540	Fee-for-Service	1306917224	1306917224	1	1	BRANDON, JOHN D MD	5/1/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35394	40	Pediatrics	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
27634	Fee-for-Service	1043296643	1043296643	1	1	BUCHANAN, GARY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 GARTH RD	None	BAYTOWN	TX	77521	2122	00	None	29.76910842	-94.97759843	Harris County
27648	Fee-for-Service	1881739613	1881739613	1	1	BOULDER CITY HOSPITAL INC	7/10/2018	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	901 ADAMS BOULEVARD	None	BOULDER CITY	NV	89005	2213	00	None	35.96821237	-114.8424842	Clark County
27652	Fee-for-Service	1285728758	1285728758	1	1	BOONSURMSUWONGS, BUNGORN	5/10/1991	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37720	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	601 W MURRAY AVE	None	VISALIA	CA	93291	4859	54	06107	36.333612	-119.2986405	Tulare County
27657	Fee-for-Service	1093781189	1093781189	1	1	BHAVANI INC	8/19/2009	193200000X	NA	Other	026	PHYSICIANS	54017	08	Family Practice	0	In state provider	None	1035 PEACH ST	SUITE 301	SAN LUIS OBISPO	CA	93401	2700	40	06079	35.28478505	-120.6627228	San Luis Obispo County
27661	Fee-for-Service	1578186359	1578186359	1	1	BRABSON, LAUREL A PHD	5/8/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
27681	Fee-for-Service	1154684132	1154684132	1	1	BOSWORTH, JANET M LMFT	5/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
27697	Fee-for-Service	1639197577	1639197577	1	1	BRANSTETTER,VANESSA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 WEST 8TH AVE	None	SPOKANE	WA	99205	0000	00	None	47.647989	-117.4112415	Spokane County
27706	Fee-for-Service	1578943478	1578943478	1	1	BECKETTI, PEGGY C DO	2/17/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15072	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
27753	Fee-for-Service	1447577853	1447577853	1	1	BADALAMENTI, CONO P MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117762	08	Family Practice	0	In state provider	None	2 WEST FERN	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
27779	Fee-for-Service	1114084878	1114084878	1	1	BENNETT, ANDREW MD	4/2/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	99787	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
27792	Fee-for-Service	1619920709	1619920709	1	1	BROWN, CHARLES A MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44611	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
27802	Fee-for-Service	1417929696	1417929696	1	1	BERGLUND, LARS F MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89561	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
27803	Fee-for-Service	1154401941	1154401941	1	14	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	384 PEARSON DR	None	PORTERVILLE	CA	93257	3368	54	06107	36.07245277	-119.0275821	Tulare County
27812	Fee-for-Service	1417153081	1417153081	1	1	BLAZEN, JEAN L LCSW	5/31/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
27814	Fee-for-Service	1205954351	1205954351	1	1	BU, DALIA MD	1/1/1983	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40859	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5525 DEWEY DR	STE 108	FAIR OAKS	CA	95628	3130	34	06067	38.666592	-121.309182	Sacramento County
27824	Fee-for-Service	1720677859	1720677859	1	1	BORK, GEOFFREY P LCSW	11/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
27828	Fee-for-Service	1316160211	1316160211	1	1	BREYER, BENJAMIN N MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91487	34	Urology and Urological Surgery	0	In state provider	None	1001 POTRERO AVENUE	RM 3A20	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
27837	Fee-for-Service	1932408390	1932408390	1	1	BARRERA, DANIEL LMFT	4/14/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
27847	Fee-for-Service	1851773717	1851773717	1	1	BAKER, KADRINA LCSW	6/15/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
27860	Fee-for-Service	1164447082	1164447082	1	1	BERTOLDI, ROGER V MD	8/8/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40519	13	Neurology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
27865	Fee-for-Service	1528066685	1528066685	1	4	BHC SIERRA VISTA HOSPITAL	9/1/2023	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	8009 BRUCEVILLE RD	100	SACRAMENTO	CA	95823	2332	34	06067	38.467404	-121.4176455	Sacramento County
27879	Fee-for-Service	1336423516	1336423516	1	1	BAILEY, JENNIFER MD	6/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125644	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95356	9262	39	06077	37.744011	-121.4349725	San Joaquin County
27882	Fee-for-Service	1700126240	1700126240	1	1	BUILDING FOUNDATIONS COUNSEL	9/14/2018	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC, A PROFE	193 BLUE RAVINE RD	SUITE #220	FOLSOM	CA	95630	4756	34	06067	38.653461	-121.17996	Sacramento County
27897	Fee-for-Service	1053896597	1053896597	1	1	BRETON, ALBERT LMFT	2/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	922 STATE STREET	STE A, OFFICE #2	SANTA BARBARA	CA	93101	6795	42	06083	34.42108289	-119.7013175	Santa Barbara County
27906	Fee-for-Service	1649249319	1649249319	1	1	BOZEK, MARK PHILLIP OD	1/31/1980	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1280 S VICTORIA AVE	STE 100	VENTURA	CA	93003	6550	56	06111	34.26344767	-119.2119344	Ventura County
27926	Fee-for-Service	1497329940	1497329940	1	1	BAY AREA ESTHETICS PLASTIC S	12/27/2021	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	URGERY	1111 SONOMA AVE	SUITE 210	SANTA ROSA	CA	95405	4833	49	06097	38.442042	-122.700033	Sonoma County
27940	Fee-for-Service	1417141904	1417141904	1	1	BARTHEL, ERIK R MD	1/7/2019	2086S0120X	NA	General Surgery	026	PHYSICIANS	105113	85	Surgery-Pediatric	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
27988	Fee-for-Service	1417977786	1417977786	1	1	BERMAN, JACK L MD	12/16/1981	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33328	None	None	0	In state provider	None	43713 20TH ST W	None	LANCASTER	CA	93534	4628	19	06037	34.67701317	-118.1657538	Los Angeles County
28016	Fee-for-Service	1639700305	1639700305	1	1	BARNARD, DISHAWNA M	3/18/2023	176B00000X	NA	Licensed Midwife	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
28039	Fee-for-Service	1538382882	1538382882	1	1	BOLIARIS, MARINA A LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
28047	Fee-for-Service	1598150039	1598150039	1	1	BAILEY, JACOB A MD	6/18/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	141518	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
28060	Fee-for-Service	1366803140	1366803140	1	1	BURNHAM, CAROLYN	2/10/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	157 BRENTWOOD DRIVE	None	LAKE ARROWHEAD	CA	92352	9800	36	06071	34.25262918	-117.2218405	San Bernardino County
28067	Fee-for-Service	1326085358	1326085358	1	1	BAILON, MARIA-JESUS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
28081	Fee-for-Service	1205018967	1205018967	1	1	BEAVEN, SIMON W MD	12/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83692	None	None	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
28092	Fee-for-Service	1154401941	1154401941	1	34	BASS MEDICAL GROUP	10/10/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	5924 STONERIDGE DR	SUITE 206	PLEASANTON	CA	94588	5400	01	06001	37.69132593	-121.8988844	Alameda County
28098	Fee-for-Service	1669897187	1669897187	1	1	BARGIONI, GINA M OT	9/11/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
28111	Fee-for-Service	1427121904	1427121904	1	1	BRYNER, URS M MD	12/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	814 N MAIN ST	None	YREKA	CA	96097	2538	47	06093	41.74092055	-122.6331064	Siskiyou County
28117	Fee-for-Service	1306034442	1306034442	1	1	BELLFLOWER UNIFIED SD	1/10/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	16703 S CLARK AVE	None	BELLFLOWER	CA	90706	5203	19	06037	33.88289607	-118.1340285	Los Angeles County
28121	Fee-for-Service	1275738098	1275738098	1	1	BENITEZ, CESAR MD	8/21/2012	2084P0800X	NA	Psychiatry	026	PHYSICIANS	107600	01	General Practice	0	In state provider	None	225 W MADISON AVE	STE 2	EL CAJON	CA	92020	3454	37	06073	32.80066448	-116.9642655	San Diego County
28175	Fee-for-Service	1255413852	1255413852	1	1	BULA, MELANIA L MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	111302	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
28192	Fee-for-Service	1215590989	1215590989	1	1	BRAR, YUVRAJ S MD	12/16/2022	207R00000X	NA	Other	026	PHYSICIANS	177274	None	None	0	In state provider	None	2975 NORTH SYCAMORE DR.	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
28193	Fee-for-Service	1447648605	1447648605	1	1	BUSHMAN, ETHAN P CRNA	10/14/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
28216	Fee-for-Service	1407803687	1407803687	1	1	BALIKIAN, PHILIP MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52136	20	Orthopedic Surgery	0	In state provider	None	17190 BERNARDO CENTER DR	None	SAN DIEGO	CA	92128	7030	37	06073	33.02473938	-117.0778645	San Diego County
28221	Fee-for-Service	1073280632	1073280632	1	1	BARBOSA, CARLENE CNP	10/17/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4829 CLAIREMONT DR	None	SAN DIEGO	CA	92117	2706	37	06073	32.83175462	-117.2052088	San Diego County
28232	Fee-for-Service	1073975702	1073975702	1	1	BESS, RANDALL K MD	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
28255	Fee-for-Service	1235255886	1235255886	2	2	BURT'S PHARMACY LLC	10/23/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2333 BORCHARD RD	None	NEWBURY PARK	CA	91320	3206	56	06111	34.18114461	-118.9283594	Ventura County
28263	Fee-for-Service	1891983748	1891983748	1	1	BULLOCK, CLAYTON M MD	3/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	94641	36	Psychiatry	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
28275	Fee-for-Service	1306803572	1306803572	1	1	BENIPAL, PARAMJIT S MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	64620	10	Gastroenterology (M.D. only)	0	In state provider	None	116 S PALISADE DR	SUITE 210	SANTA MARIA	CA	93454	8904	42	06083	34.9523869	-120.4120717	Santa Barbara County
28287	Fee-for-Service	1811002777	1811002777	2	1	BANOONI, PEYMAN MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	75080	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1919 WEST 7TH STREET	STE 2A	LOS ANGELES	CA	90057	4103	19	06037	34.05575686	-118.2751751	Los Angeles County
28349	Fee-for-Service	1366803140	1366803140	1	1	BURNHAM, CAROLYN	2/10/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	157 BRENTWOOD DRIVE	None	LAKE ARROWHEAD	CA	92352	9800	36	06071	34.25262918	-117.2218405	San Bernardino County
28358	Fee-for-Service	1174561492	1174561492	1	1	BUKATA, W RICHARD	4/1/1998	207P00000X	NA	Other	026	PHYSICIANS	26036	66	Emergency Medicine (Urgent Care)	0	In state provider	None	218 N SANTA ANITA ST	None	SAN GABRIEL	CA	91775	2918	19	06037	34.10510572	-118.1045763	Los Angeles County
28378	Fee-for-Service	1154401941	1154401941	1	14	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	384 PEARSON DR	None	PORTERVILLE	CA	93257	3368	54	06107	36.07245277	-119.0275821	Tulare County
28387	Fee-for-Service	1174900021	1174900021	1	1	BALLAL, MEGANA L MD	7/30/2018	208M00000X	NA	Other	026	PHYSICIANS	145786	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
28389	Fee-for-Service	1528440237	1528440237	1	1	BRICHARD, JULIE M MD	11/29/2018	390200000X	NA	Other	026	PHYSICIANS	152445	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
28392	Fee-for-Service	1669466439	1669466439	1	1	BHANDARI, ANIL K MD	4/3/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	39656	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	STE 703	LOS ANGELES	CA	90017	4807	19	06037	34.05362775	-118.2661889	Los Angeles County
28401	Fee-for-Service	1457189730	1457189730	1	1	BANERJEE, KASTURI PHD	8/15/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
28409	Fee-for-Service	1275738098	1275738098	1	1	BENITEZ, CESAR MD	8/21/2012	2084P0800X	NA	Psychiatry	026	PHYSICIANS	107600	36	Psychiatry	0	In state provider	None	225 W MADISON AVE	STE 2	EL CAJON	CA	92020	3454	37	06073	32.80066448	-116.9642655	San Diego County
28433	Fee-for-Service	1538796255	1538796255	1	1	BANH, ESTHER T MD	10/1/2024	207L00000X	NA	Other	026	PHYSICIANS	190009	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
28440	Fee-for-Service	1568580405	1568580405	1	1	BROWN, THEODORE H MD	6/1/1982	174400000X	NA	Other	026	PHYSICIANS	35114	41	Internal Medicine	0	In state provider	None	1220 E AVENUE S	STE L	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
28444	Fee-for-Service	1770756561	1770756561	1	1	BROOKFIELD, KATHLEEN F MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119755	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
28471	Fee-for-Service	1932734597	1932734597	1	1	BUDDE, LAURA M	10/8/2021	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
28489	Fee-for-Service	1881252427	1881252427	1	1	BEYOND LIFE HOSPICE INC	5/27/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21049 DEVONSHIRE STREET	SUITE 201B	CHATSWORTH	CA	91311	2375	19	06037	34.25727553	-118.592343	Los Angeles County
28520	Fee-for-Service	1518978253	1518978253	1	1	BATZOFIN, JOEL H MD	11/4/2019	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	41646	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
28608	Fee-for-Service	1366519928	1366519928	1	1	BAILEY, BARBARA L LCSW	6/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 S VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.7892965	-118.2937327	Los Angeles County
28619	Fee-for-Service	1760402549	1760402549	1	1	BATTE, EDWIN E MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83275	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
28624	Fee-for-Service	1851478374	1851478374	1	1	BALMES, JOHN R MD	3/31/1986	207RP1001X	NA	Pulmonology	026	PHYSICIANS	48421	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
28639	Fee-for-Service	1639708860	1639708860	1	1	BEST CHOICE HOSPICE SERVICE	1/6/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	8700 RESEDA BLVD	SUITE 216	NORTHRIDGE	CA	91324	6120	19	06037	34.229988	-118.536062	Los Angeles County
28657	Fee-for-Service	1366404428	1366404428	1	1	BON SECOURS RICHMOND COMMU	8/8/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 N 28TH ST	None	RICHMOND	VA	23223	5332	00	None	37.53999406	-77.4064939	Richmond city
28749	Fee-for-Service	1326214693	1326214693	1	1	BOWLING, BENJAMIN D MD	2/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145143	41	Internal Medicine	0	In state provider	None	650 5TH STREET	STE 502	SAN FRANCISCO	CA	94107	1536	38	06075	37.77575268	-122.3977845	San Francisco County
28771	Fee-for-Service	1396834073	1396834073	1	1	BOTROSONS PHARMACEUTICAL	2/24/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LARSON PHARMACY	142 W H ST	None	COLTON	CA	92324	2923	36	06071	34.06799664	-117.3244652	San Bernardino County
28777	Fee-for-Service	1881252427	1881252427	1	1	BEYOND LIFE HOSPICE INC	5/27/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21049 DEVONSHIRE STREET	SUITE 201B	CHATSWORTH	CA	91311	2375	19	06037	34.25727553	-118.592343	Los Angeles County
28778	Fee-for-Service	1235756933	1235756933	1	1	BJELLA, JESSIE D MD	7/24/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	185102	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
28803	Fee-for-Service	1104898774	1104898774	1	1	BERNDT, GEORGE A MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68363	02	General Surgery	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
28812	Fee-for-Service	1780639765	1780639765	1	1	BREA DIAGNOSTIC CARDIAC	1/25/2008	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	IMAGING CORPORATION	379 W CENTRAL AVE	STE C	BREA	CA	92821	3041	30	06059	33.93204049	-117.9011115	Orange County
28814	Fee-for-Service	1386989085	1386989085	1	1	BHANGDA, MARIUM NP	3/11/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 EUCLID ST	203	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
28821	Fee-for-Service	1619408960	1619408960	1	1	BROWN, LINDSAY A	8/19/2022	207L00000X	NA	Other	026	PHYSICIANS	180743	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
28857	Fee-for-Service	1417062852	1417062852	1	1	BAILEY, LINDA LCSW	9/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	852 MANZANITA CT	155	CHICO	CA	95926	2399	04	06007	39.75135869	-121.8426013	Butte County
28860	Fee-for-Service	1922467984	1922467984	1	1	BROWN, DONIKA T LMFT	8/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2716 S VERMONT AVE	UNIT 9	LOS ANGELES	CA	90007	2671	19	06037	34.029891	-118.2915225	Los Angeles County
28919	Fee-for-Service	1821051871	1821051871	1	1	BATSON, HILARY E	4/26/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
28920	Fee-for-Service	1740945146	1740945146	1	1	BLUMEYERMD INCORPORATED	12/15/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
28929	Fee-for-Service	1639708860	1639708860	1	1	BEST CHOICE HOSPICE SERVICE	1/6/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	8700 RESEDA BLVD	SUITE 216	NORTHRIDGE	CA	91324	6120	19	06037	34.229988	-118.536062	Los Angeles County
28931	Fee-for-Service	1942891312	1942891312	1	1	BASIS DIAGNOSTICS INC.	3/27/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	39655 EUREKA DR	None	NEWARK	CA	94560	4806	01	06001	37.51008228	-121.9978441	Alameda County
28933	Fee-for-Service	1407953029	1407953029	1	1	BACCHUS, SOROYA M MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	74246	-	NOT APPLICABLE	0	In state provider	None	1020 PICO BOULEVARD	None	SANTA MONICA	CA	90405	1326	19	06037	34.01325007	-118.4802398	Los Angeles County
28952	Fee-for-Service	1699017475	1699017475	1	1	BAGGA, BIPINJOT S MD	10/22/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171338	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
28998	Fee-for-Service	1982741567	1982741567	1	1	BAART BEHAVIORAL HEALTH SERV	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	2821 S ORANGE AVE	None	FRESNO	CA	93725	1921	10	06019	36.69854175	-119.7636383	Fresno County
29022	Fee-for-Service	1336158732	1336158732	1	1	BERNSTEIN, MICHAEL L MD	1/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	68377	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
29059	Fee-for-Service	1114173937	1114173937	1	1	BROUHA, BROOK L MD	5/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97902	07	Dermatology	0	In state provider	None	7300 GIRARD AVE	STE 104	LA JOLLA	CA	92037	5138	37	06073	32.83772948	-117.2716382	San Diego County
29077	Fee-for-Service	1356493415	1356493415	1	1	BANCE, YADVINDER	9/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
29086	Fee-for-Service	1154401941	1154401941	1	42	BASS MEDICAL GROUP	6/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2485 HIGH SCHOOL AVE	SUITE 222	CONCORD	CA	94520	1819	07	06013	37.98507961	-122.034189	Contra Costa County
29091	Fee-for-Service	1104898774	1104898774	1	1	BERNDT, GEORGE A MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68363	28	Proctology (colon and rectal)	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
29105	Fee-for-Service	1467619122	1467619122	1	1	BIRENBAUM, EMILY K MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70369	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 TARA HILLS DR	None	PINOLE	CA	94564	2581	07	06013	37.99581609	-122.3050212	Contra Costa County
29108	Fee-for-Service	1568088193	1568088193	1	1	BUENA VISTA AL LLC	8/26/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1393 S BUENA VISTA ST	None	HEMET	CA	92543	7660	33	06065	33.724161	-116.967216	Riverside County
29134	Fee-for-Service	1013630995	1013630995	1	1	BIRRING, MANJEET K NP	8/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95022612	-	NOT APPLICABLE	0	In state provider	None	1235 MCHENRY AVENUE	A & B	MODESTO	CA	95350	5370	50	06099	37.66105327	-120.9939108	Stanislaus County
29158	Fee-for-Service	1801816525	1801816525	1	1	BLAIN, ARTHUR A IV MD	1/5/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63511	None	None	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
29164	Fee-for-Service	1295154359	1295154359	1	1	BARRETT, EMILY C MD	7/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138667	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	SUITE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
29176	Fee-for-Service	1699853341	1699853341	1	1	BHATNAGAR, RITU MD	9/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76622	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
29184	Fee-for-Service	1972083574	1972083574	1	1	BARBHAYA, URVASHI PT	7/20/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8550 BALBOA BLVD,	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
29205	Fee-for-Service	1578765699	1578765699	1	1	BORAU, JOSEPH F MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108030	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0000	39	06077	37.97026329	-121.2890849	San Joaquin County
29206	Fee-for-Service	1851604896	1851604896	1	1	BRICE, THOMAS R	8/24/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
29246	Fee-for-Service	1316074792	1316074792	1	1	BARRY, JOHN N MD	3/31/1991	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51895	36	Psychiatry	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
29250	Fee-for-Service	1588784029	1588784029	1	1	BERRY MORONY, MICHELE LCSW	7/25/2007	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	165 E HIGH ST	STE 102	MOORPARK	CA	93021	1151	56	06111	34.28543068	-118.880127	Ventura County
29284	Fee-for-Service	1427271758	1427271758	1	1	BLEDIN, ANTHONY G MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42124	30	Radiology	0	In state provider	DBA OCEAN MED IMAGING	1851 HOLSER WALK	STE 220	OXNARD	CA	93036	2626	56	06111	34.22021697	-119.1556025	Ventura County
29326	Fee-for-Service	1114086717	1114086717	1	1	BERNSTEIN-SINGER, M MD	7/31/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	43875	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
29365	Fee-for-Service	1417036161	1417036161	1	1	BROWNE, SARAH E MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85583	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
29373	Fee-for-Service	1962464057	1962464057	1	1	BLACK, RENAE L CNM	4/22/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
29374	Fee-for-Service	1154401941	1154401941	1	42	BASS MEDICAL GROUP	6/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2485 HIGH SCHOOL AVE	SUITE 222	CONCORD	CA	94520	1819	07	06013	37.98507961	-122.034189	Contra Costa County
29376	Fee-for-Service	1740861541	1740861541	1	1	BUEZIS, GRACE S CNM	7/6/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
29380	Fee-for-Service	1447218805	1447218805	1	1	BUI, JOE N DO	9/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	6600	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
29383	Fee-for-Service	1346652468	1346652468	1	1	BROWN, WENDY LMFT	2/20/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
29386	Fee-for-Service	1265845390	1265845390	1	1	BECK, RYAN MD	5/16/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162415	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
29392	Fee-for-Service	1558997577	1558997577	1	1	BAISIE, KLESHIE MD	7/19/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187831	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
29469	Fee-for-Service	1427212406	1427212406	1	1	BOOKWALTER, RICHARD A OT	3/5/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
29511	Fee-for-Service	1508825795	1508825795	1	1	BAY PATHOLOGY MED GROUP	4/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
29513	Fee-for-Service	1306043609	1306043609	1	1	BAGHBEH, SHEILA LMFT	5/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
29550	Fee-for-Service	1518104892	1518104892	1	1	BALZER, CHRISTIAN A MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112433	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
29553	Fee-for-Service	1003268178	1003268178	1	2	BEST OPTIONS LIMITED	2/14/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LIABILITY CO	2770 COLD PLAINS DR	None	HACIENDA HEIGHTS	CA	91745	5248	19	06037	33.98686701	-117.9717416	Los Angeles County
29561	Fee-for-Service	1457938540	1457938540	1	1	BENSADIGH, MATTHEW LMFT	8/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2121 AVENUE OF THE STARS	STE 800	LOS ANGELES	CA	90067	5080	19	06037	34.05537699	-118.4128434	Los Angeles County
29576	Fee-for-Service	1952462798	1952462798	1	1	BLUMHARDT, MICHAEL MD	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2825 EAST BARNETT ROAD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
29577	Fee-for-Service	1821049388	1821049388	1	1	BROWN, KAREN R CNMW	3/4/2004	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10990 SAN DIEGO MISSION	None	SAN DIEGO	CA	92108	2417	37	06073	32.7850186	-117.1023292	San Diego County
29580	Fee-for-Service	1083091771	1083091771	1	1	BELUR, PRAVEEN K MD	12/4/2020	390200000X	NA	Other	026	PHYSICIANS	146180	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
29600	Fee-for-Service	1215910757	1215910757	1	1	BACON, JEFFREY P MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
29603	Fee-for-Service	1992772784	1992772784	1	1	BONGIOVANNI, MICHAEL S	5/7/2009	174400000X	NA	Other	026	PHYSICIANS	59386	20	Orthopedic Surgery	0	In state provider	MD	4065 3RD AVE	#101	SAN DIEGO	CA	92103	2184	37	06073	32.75123948	-117.1627318	San Diego County
29660	Fee-for-Service	1154401941	1154401941	1	42	BASS MEDICAL GROUP	6/22/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2485 HIGH SCHOOL AVE	SUITE 222	CONCORD	CA	94520	1819	07	06013	37.98507961	-122.034189	Contra Costa County
29666	Fee-for-Service	1669479184	1669479184	1	1	BUCKINGHAM, ROBERT L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	39064	41	Internal Medicine	0	In state provider	None	115 PIRIE RD	STE D	OJAI	CA	93023	3100	56	06111	34.44311416	-119.2657233	Ventura County
29670	Fee-for-Service	1720429319	1720429319	1	1	BAHETI, DEEPTI	5/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
29701	Fee-for-Service	1891734372	1891734372	1	1	BUTELA, SHAWN T MD	3/24/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71143	30	Radiology	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
29721	Fee-for-Service	1639676760	1639676760	1	1	BAKHIT, RYAN H DO	7/18/2022	207L00000X	NA	Other	026	PHYSICIANS	19728	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
29738	Fee-for-Service	1609895150	1609895150	1	1	BERTKEN, RICHARD D MD	12/1/1987	207RR0500X	NA	Other	026	PHYSICIANS	30979	41	Internal Medicine	0	In state provider	None	2615 E CLINTON AVE	None	FRESNO	CA	93703	2223	10	06019	36.77230594	-119.7792767	Fresno County
29787	Fee-for-Service	1649612581	1649612581	1	1	BOUGOUKALOS, AMY M	5/18/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
29836	Fee-for-Service	1477160232	1477160232	1	1	BRALEY, BETSY CRNA	3/26/2021	163WC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
29845	Fee-for-Service	1558328120	1558328120	1	1	BABO, MARK E MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88931	08	Family Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
29856	Fee-for-Service	1992783237	1992783237	1	1	BARTH, GARY P MD	4/30/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	34382	18	Ophthalmology	0	In state provider	None	858 4TH ST	None	SANTA ROSA	CA	95404	4597	49	06097	38.442636	-122.7087765	Sonoma County
29864	Fee-for-Service	1952462798	1952462798	1	1	BLUMHARDT, MICHAEL MD	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	2825 EAST BARNETT ROAD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
29877	Fee-for-Service	1780741546	1780741546	1	1	BESSE, MICHELLE LMFT	5/15/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47914	-	NOT APPLICABLE	0	In state provider	None	1914 22ND ST	None	SACRAMENTO	CA	95816	7109	34	06067	38.565666	-121.482	Sacramento County
29882	Fee-for-Service	1548690035	1548690035	1	1	BIENESTAR HUMAN SERVICES	12/5/2016	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8551 VESPER AVE	None	PANORAMA CITY	CA	91402	2914	19	06037	34.22631303	-118.4503432	Los Angeles County
29888	Fee-for-Service	1215910757	1215910757	1	1	BACON, JEFFREY P MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
29901	Fee-for-Service	1508940081	1508940081	1	1	BALKE, DEBRA L MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78900	13	Neurology (M.D. only)	0	In state provider	CHILD NEUROLOGY OF SLO	1320 LAS TABLAS RD	STE E	TEMPLETON	CA	93465	9711	40	06079	35.5544315	-120.7225935	San Luis Obispo County
29918	Fee-for-Service	1457568362	1457568362	1	1	BENOR, MARK B MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	93572	None	None	0	In state provider	None	5901 GREEN VALLEY CIR	STE 405	CULVER CITY	CA	90230	6971	19	06037	33.98409358	-118.3923715	Los Angeles County
29922	Fee-for-Service	1063854115	1063854115	1	1	BISHOP, KATHLEEN A LCSW	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	68807	-	NOT APPLICABLE	0	In state provider	None	1340 TULLY RD	STE 301 & 304	SAN JOSE	CA	95122	3055	43	06085	37.31710924	-121.8334186	Santa Clara County
29937	Fee-for-Service	1962412536	1962412536	1	1	BAI, EUNG KOO MD	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41124	08	Family Practice	0	In state provider	None	12017 ROSECRANS AVE	None	NORWALK	CA	90650	4120	19	06037	33.9023553	-118.0774579	Los Angeles County
29947	Fee-for-Service	1740820786	1740820786	1	1	BACCAM, BRANDON DPM	9/1/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3031 W MARCH LANE	SUITE 310E	STOCKTON	CA	95219	6525	39	06077	37.9842796	-121.3494311	San Joaquin County
29963	Fee-for-Service	1669650164	1669650164	1	1	BOSMAN, SANDRA J MD	2/9/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	97989	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 WILLOW PLAZA	STE 201	VISALIA	CA	93291	6213	54	06107	36.33012504	-119.2922477	Tulare County
29975	Fee-for-Service	1861752156	1861752156	1	1	BROWN, BLAKE C MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131165	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
29983	Fee-for-Service	1194963991	1194963991	1	1	BREKKA, SUSAN M LMFT	8/25/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11040 SANTA MONICA BLVD	SUITE 208	LOS ANGELES	CA	90025	7515	19	06037	34.04800261	-118.4425929	Los Angeles County
29989	Fee-for-Service	1225201940	1225201940	1	1	BROWN, MICHAELE M LCSW	6/23/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1616 WEST STREET	None	REDDING	CA	96001	1726	45	06089	40.58145964	-122.3966513	Shasta County
30002	Fee-for-Service	1104698679	1104698679	1	1	BLAYLOCK, AMBER M	1/24/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
30004	Fee-for-Service	1750640272	1750640272	1	1	BARRALES, NATZAYETH E LMFT	12/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
30026	Fee-for-Service	1609895150	1609895150	1	1	BERTKEN, RICHARD D MD	12/1/1987	207RR0500X	NA	Other	026	PHYSICIANS	30979	83	Rheumatology	0	In state provider	None	2615 E CLINTON AVE	None	FRESNO	CA	93703	2223	10	06019	36.77230594	-119.7792767	Fresno County
30028	Fee-for-Service	1255356960	1255356960	1	1	BLAKE, SISSELA S MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101062	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
30039	Fee-for-Service	1245536895	1245536895	1	1	BURKE, ANGELINA R MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131633	40	Pediatrics	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
30043	Fee-for-Service	1811954860	1811954860	1	1	BRIAN J ADAMS MD	10/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1819 W CLINCH AVE	STE 108	KNOXVILLE	TN	37916	2435	00	None	35.95759156	-83.93528515	Knox County
30063	Fee-for-Service	1346387131	1346387131	1	1	BERDOULAY, CHRISTINA S	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
30082	Fee-for-Service	1184174518	1184174518	1	1	BOLAND, CYNTHIA LMFT	2/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	37 AUBURN AVE	9	SIERRA MADRE	CA	91024	1844	19	06037	34.1626081	-118.0549869	Los Angeles County
30085	Fee-for-Service	1497246086	1497246086	1	1	BRETT MONROE	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
30091	Fee-for-Service	1194873059	1194873059	1	1	BUTLER, JEREME P MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64796	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
30097	Fee-for-Service	1396702759	1396702759	1	1	BUCHLER, KAREN W MD	2/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60631	40	Pediatrics	0	In state provider	None	900 S FAIRMONT AVE	None	LODI	CA	95240	5119	39	06077	38.122551	-121.285822	San Joaquin County
30105	Fee-for-Service	1215161427	1215161427	1	1	BERTANY, KATHRYN D MD	6/4/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163426	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
30119	Fee-for-Service	1154401941	1154401941	1	56	BASS MEDICAL GROUP	4/30/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	365 HAWTHORNE AVE	STE 101-102	OAKLAND	CA	94609	3107	01	06001	37.82079728	-122.2633226	Alameda County
30190	Fee-for-Service	1669550141	1669550141	1	1	BUBNA, NISHA MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91490	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
30219	Fee-for-Service	1770694267	1770694267	1	1	BUEHNERKEMPER, MARK L	5/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	120 S MAIN ST	None	LAKEPORT	CA	95453	5017	17	06033	39.0419512	-122.9151647	Lake County
30232	Fee-for-Service	1114660305	1114660305	1	1	BERGER, KRISTINA LMFT	1/12/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1428 PHILLIPS LANE	STE 202	SAN LUIS OBISPO	CA	93401	2567	40	06079	35.28794905	-120.6574321	San Luis Obispo County
30250	Fee-for-Service	1407864341	1407864341	3	1	BLYTHE AMBULANCE SERVICE	5/25/2017	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	129 S FIRST ST	None	BLYTHE	CA	92225	2518	33	06065	33.60956903	-114.5954822	Riverside County
30262	Fee-for-Service	1811317357	1811317357	1	1	BRODIE, FRANK MD	7/25/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	137610	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
30264	Fee-for-Service	1285732370	1285732370	1	1	BAIK, SANG H MD	5/18/2022	207R00000X	NA	Other	026	PHYSICIANS	83759	None	None	0	In state provider	None	266 S HARVARD BLVD	SUITE 110	LOS ANGELES	CA	90004	4374	19	06037	34.069221	-118.3041245	Los Angeles County
30277	Fee-for-Service	1619078946	1619078946	1	1	BRAIMAH, FERDINAND E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52196	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
30289	Fee-for-Service	1760782460	1760782460	1	1	BEREAN, MALCOLM A LMFT	1/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1338 S SCHOOL ST	STE A	LODI	CA	95240	5700	39	06077	38.11592571	-121.2749411	San Joaquin County
30290	Fee-for-Service	1396173597	1396173597	1	1	BRIDGE HOSPICE LLC	11/10/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5090 SHOREHAM PL	SUITE 209	SAN DIEGO	CA	92122	5935	37	06073	32.85270901	-117.1853975	San Diego County
30313	Fee-for-Service	1801404850	1801404850	1	1	BARMANN, KELLY CCC-SLP	6/7/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
30317	Fee-for-Service	1568916278	1568916278	1	1	BARIL, DANIELLE N CO	8/15/2016	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	7720 CARDINAL COURT	None	SAN DIEGO	CA	92123	3333	37	06073	32.79149637	-117.1577414	San Diego County
30342	Fee-for-Service	1740325570	1740325570	1	1	BALIAN, HAROUT R MD APC	11/7/1995	193200000X	NA	Other	026	PHYSICIANS	49429	41	Internal Medicine	0	In state provider	None	333 N HILL AVE	STE 101	PASADENA	CA	91106	1574	19	06037	34.15148254	-118.1214123	Los Angeles County
30370	Fee-for-Service	1790770063	1790770063	1	1	BEYER, JILL E OD	2/12/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30407	Fee-for-Service	1154401941	1154401941	1	56	BASS MEDICAL GROUP	4/30/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	365 HAWTHORNE AVE	STE 101-102	OAKLAND	CA	94609	3107	01	06001	37.82079728	-122.2633226	Alameda County
30430	Fee-for-Service	1588286553	1588286553	1	1	BAY AREA MEDICAL SUPPLY	8/14/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	845 CENTRAL AVE	None	ALAMEDA	CA	94501	3403	01	06001	37.7712906	-122.2709757	Alameda County
30433	Fee-for-Service	1407161136	1407161136	1	1	BURDICK, KIM OD	10/6/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
30449	Fee-for-Service	1235286014	1235286014	1	1	BETHENCOURT, DANIEL M MD	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2865 ATLANTIC AVE	STE 205	LONG BEACH	CA	90806	1745	19	06037	33.809418	-118.185058	Los Angeles County
30470	Fee-for-Service	1164927075	1164927075	1	1	BAGHOOLIZADEH, MAHTA Q MD	7/31/2023	174400000X	NA	Other	026	PHYSICIANS	166390	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 53	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
30489	Fee-for-Service	1417719709	1417719709	1	1	BOOGARD, MICHELLE CRNA	4/11/2025	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30493	Fee-for-Service	1902280019	1902280019	1	1	BACH MEDICAL GROUP, INC.	9/13/2017	207ZP0105X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	17672 COWAN	None	IRVINE	CA	92614	6027	30	06059	33.69402698	-117.857103	Orange County
30517	Fee-for-Service	1164513297	1164513297	1	1	BORSES, MARY J MD	2/20/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	79195	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2333 MOWRY AVE	STE 300	FREMONT	CA	94538	1602	01	06001	37.55614438	-121.9822469	Alameda County
30528	Fee-for-Service	1730296526	1730296526	1	1	BRAR, HARMINDER S MD	4/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102611	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
30537	Fee-for-Service	1710282629	1710282629	1	1	BRAND, BORIS Y NP	2/14/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	121 S GLENOAKS BLVD	STE 3	BURBANK	CA	91502	1315	19	06037	34.18291031	-118.3058877	Los Angeles County
30554	Fee-for-Service	1265136295	1265136295	1	1	BURRUEL, KAYLA PT	6/19/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	31515 RANCHO PUEBLO RD	SUITE 101	TEMECULA	CA	92592	0000	33	06065	33.47922478	-117.1107757	Riverside County
30565	Fee-for-Service	1619078946	1619078946	1	1	BRAIMAH, FERDINAND E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52196	08	Family Practice	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
30580	Fee-for-Service	1396173597	1396173597	1	1	BRIDGE HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5090 SHOREHAM PL	SUITE 209	SAN DIEGO	CA	92122	5935	37	06073	32.85270901	-117.1853975	San Diego County
30601	Fee-for-Service	1225175664	1225175664	1	1	BAART BEHAVIORAL HEALTH SERV	12/1/1977	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	75 TOWNSEND ST	None	SAN FRANCISCO	CA	94107	2009	38	06075	37.78078472	-122.3902709	San Francisco County
30631	Fee-for-Service	1740325570	1740325570	1	1	BALIAN, HAROUT R MD APC	11/7/1995	193200000X	NA	Other	026	PHYSICIANS	49429	25	Physical Medicine and Rehabilitation	0	In state provider	None	333 N HILL AVE	STE 101	PASADENA	CA	91106	1574	19	06037	34.15148254	-118.1214123	Los Angeles County
30639	Fee-for-Service	1306196159	1306196159	1	1	BROWNLEE, ANDREW R MD	8/19/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	168783	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
30644	Fee-for-Service	1891729133	1891729133	1	1	BIO MEDICAL APPLICATIONS	5/31/2006	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	751 W LEGION RD	STE 100	BRAWLEY	CA	92227	7754	13	06025	32.95996012	-115.5538196	Imperial County
30647	Fee-for-Service	1881164283	1881164283	1	1	BIG VINE HOME HEALTH	6/30/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	8220 KATELLA AVE	SUITE 218	STANTON	CA	90680	4607	30	06059	33.80292007	-117.9890004	Orange County
30649	Fee-for-Service	1952806671	1952806671	1	1	BOWMAN, SCOTT J MD	10/18/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	191193	None	None	0	In state provider	None	4560 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90022	1117	19	06037	34.04057653	-118.167318	Los Angeles County
30662	Fee-for-Service	1609235423	1609235423	1	1	BEATY, SARAH P DO	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14490	01	General Practice	0	In state provider	None	801 S CHEVY CHASE DR	STE 230	GLENDALE	CA	91205	4436	19	06037	34.136757	-118.2396195	Los Angeles County
30696	Fee-for-Service	1154401941	1154401941	1	56	BASS MEDICAL GROUP	4/30/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	365 HAWTHORNE AVE	STE 101-102	OAKLAND	CA	94609	3107	01	06001	37.82079728	-122.2633226	Alameda County
30735	Fee-for-Service	1235286014	1235286014	1	1	BETHENCOURT, DANIEL M MD	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	2865 ATLANTIC AVE	STE 205	LONG BEACH	CA	90806	1745	19	06037	33.809418	-118.185058	Los Angeles County
30759	Fee-for-Service	1790853083	1790853083	1	1	BASCH, CORINNE V MD	11/22/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51185	08	Family Practice	0	In state provider	None	4641 VALLEY EAST BLVD	STE 2	ARCATA	CA	95521	4630	12	06023	40.90049348	-124.0821518	Humboldt County
30774	Fee-for-Service	1447336953	1447336953	1	1	BLAY, TERRY A MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47094	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
30776	Fee-for-Service	1457836314	1457836314	1	1	BURTON JOSSELYN, ERIN LCSW	4/21/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	125 BETHANY DRIVE	SUITE 203	SCOTTS VALLEY	CA	95066	2803	44	06087	37.06760225	-121.997132	Santa Cruz County
30841	Fee-for-Service	1699731794	1699731794	1	1	BERRIOS, MARGARITA MD	1/1/1994	174400000X	NA	Other	026	PHYSICIANS	52474	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
30853	Fee-for-Service	1710174693	1710174693	1	1	BLOUNT, MARSHA W MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69030	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
30904	Fee-for-Service	1396008199	1396008199	1	1	BARNETT, ANDREW R MD	9/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	EMILE @ 42ND	None	OMAHA	NE	68198	0001	00	None	41.254236	-95.97573	Douglas County
30910	Fee-for-Service	1194085860	1194085860	1	1	BAKER, NANCY A MD	6/30/2020	2081N0008X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	143857	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
30918	Fee-for-Service	1972892057	1972892057	1	1	BECK, KENDALL R MD	7/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122880	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
30923	Fee-for-Service	1841396488	1841396488	1	1	BARTON, MARIA T CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	43563 HWY 299 E	None	FALL RIVER MILLS	CA	96028	0459	45	06089	41.02401196	-121.4246219	Shasta County
30925	Fee-for-Service	1316449507	1316449507	1	1	BAREKET, ILANA CCC-SLP	7/4/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
30936	Fee-for-Service	1679550859	1679550859	1	1	BACHRACH, LAURA K MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36802	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
30940	Fee-for-Service	1376648170	1376648170	1	1	BUCHSBAUM, EDWARD G MD	6/7/1996	207K00000X	NA	Other	026	PHYSICIANS	36432	41	Internal Medicine	0	In state provider	None	20911 EARL ST	STE 301	TORRANCE	CA	90503	4354	19	06037	33.840459	-118.3580985	Los Angeles County
30976	Fee-for-Service	1750827895	1750827895	1	1	BRETTON, ANGELA M CNP	11/27/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	318 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	1925	37	06073	33.14269478	-117.0953874	San Diego County
30997	Fee-for-Service	1073761243	1073761243	1	1	BADAR, RIZWAN MD	4/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105268	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
31016	Fee-for-Service	1003235243	1003235243	1	1	BALASIRE, OLUWASEYI S MD	4/30/2020	208M00000X	NA	Other	026	PHYSICIANS	152926	41	Internal Medicine	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
31025	Fee-for-Service	1558596866	1558596866	1	1	BRAZIO, PHILIP MD	7/8/2019	208200000X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31030	Fee-for-Service	1013917954	1013917954	1	1	BRODRICK, STACY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOSEPH HOSPITAL	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
31040	Fee-for-Service	1336143866	1336143866	1	1	BOCKHORST, PETER R. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 W RAVINE RD	None	KINGSPORT	TN	37660	3837	00	None	36.55331493	-82.55497769	Sullivan County
31043	Fee-for-Service	1720232465	1720232465	1	1	BRIGHT HEALTH PHYSICIANS OF	7/27/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PIH	12522 E LAMBERT RD	STE D	WHITTIER	CA	90606	2758	19	06037	33.96495228	-118.0466484	Los Angeles County
31056	Fee-for-Service	1962580787	1962580787	1	1	BUCKERFIELD, CHARLES MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50019	20	Orthopedic Surgery	0	In state provider	None	510 CYPRESS ST	None	FORT BRAGG	CA	95437	5411	23	06045	39.43260152	-123.798942	Mendocino County
31166	Fee-for-Service	1619234960	1619234960	1	1	BAVISETTY, SUMATI MD	2/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120743	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
31209	Fee-for-Service	1639172448	1639172448	1	1	BELIZARIO, MARCELINO C MD	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	4880 WYNN ROAD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
31226	Fee-for-Service	1679550859	1679550859	1	1	BACHRACH, LAURA K MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36802	67	Endocrinology	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
31235	Fee-for-Service	1306028709	1306028709	1	1	BARNES, LOIS MD INC	11/25/2008	193400000X	NA	Other	026	PHYSICIANS	58467	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3460 LOMA VISTA RD	None	VENTURA	CA	93003	3026	56	06111	34.27656239	-119.2494074	Ventura County
31238	Fee-for-Service	1710689906	1710689906	1	1	BECKETT PROFESSIONAL CORPORA	2/9/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	TION	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
31253	Fee-for-Service	1467830711	1467830711	1	1	BALZANO, FELICIA MD	7/2/2020	208800000X	NA	Other	026	PHYSICIANS	168902	34	Urology and Urological Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
31254	Fee-for-Service	1366512360	1366512360	1	1	BRADLEY, HEATHER A PHD	11/13/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
31276	Fee-for-Service	1154401941	1154401941	1	59	BASS MEDICAL GROUP	7/19/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1210 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87774537	-122.0710148	Contra Costa County
31278	Fee-for-Service	1396822326	1396822326	1	1	BLUE EAGLE ANESTHESIA INC	4/11/2013	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
31280	Fee-for-Service	1154401941	1154401941	1	24	BASS MEDICAL GROUP	2/25/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	5601 NORRIS CANYON RD	STE 240	SAN RAMON	CA	94589	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
31287	Fee-for-Service	1093847998	1093847998	2	1	BAKERSFIELD RECOVERY SERVICE	8/30/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	EN	2000 BAKER STREET	None	BAKERSFIELD	CA	93305	3061	15	06029	35.38964269	-118.9883711	Kern County
31308	Fee-for-Service	1063647865	1063647865	1	1	BADIEI, PEJMAN MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	121014	None	None	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
31316	Fee-for-Service	1558596866	1558596866	1	1	BRAZIO, PHILIP MD	7/8/2019	208200000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31320	Fee-for-Service	1053681932	1053681932	1	1	BADYAL, MONIKA K	5/28/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3535 WEST COMMONWEALTH A	None	FULLERTON	CA	92833	2821	30	06059	33.8700505	-117.9749565	Orange County
31322	Fee-for-Service	1609875434	1609875434	1	1	BALBIR SINGH SIDHU, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2300 OPITZ BLVD	None	WOODBRIDGE	VA	22191	3311	00	None	38.63718	-77.2863255	Prince William County
31335	Fee-for-Service	1598842700	1598842700	1	1	BIESHEUVEL, DEREK L	2/16/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
31347	Fee-for-Service	1003268178	1003268178	1	1	BEST OPTIONS LIMITED	8/28/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LIABILITY CO	18160 MESCAL ST	None	ROWLAND HEIGHTS	CA	91748	4372	19	06037	33.97691595	-117.9106713	Los Angeles County
31350	Fee-for-Service	1699224980	1699224980	1	1	BLACKWELL, CHRISTOPHER LCSW	6/21/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4070 JURAPA AVE	None	RIVERSIDE	CA	92506	2234	33	06065	33.96087652	-117.3960765	Riverside County
31351	Fee-for-Service	1144773904	1144773904	1	1	BELTRAN, CARLOS LCSW	12/16/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
31358	Fee-for-Service	1053766196	1053766196	1	1	BOLANO, MARIELLE C MD	4/14/2021	207R00000X	NA	Other	026	PHYSICIANS	166900	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
31362	Fee-for-Service	1730240029	1730240029	1	1	BECKER, HUBERT J PHD	10/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
31364	Fee-for-Service	1184932949	1184932949	1	1	BAUM, BLAKE LPCC	3/13/2025	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
31409	Fee-for-Service	1902822760	1902822760	1	1	BITTAR, TAREK MD	10/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	71373	20	Orthopedic Surgery	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91345	1285	19	06037	34.27904453	-118.459944	Los Angeles County
31445	Fee-for-Service	1013910983	1013910983	1	1	BARBUTO, DENISE A MD	7/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69404	22	Pathology (M.D. only)	0	In state provider	None	200 N ROBERTSON BLVD	None	LOS ANGELES	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles
31458	Fee-for-Service	1780028522	1780028522	1	1	BOHRER, LISA M CCC-SLP	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
31466	Fee-for-Service	1326246224	1326246224	1	1	BRIONES, MANUEL A LCSW	8/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
31513	Fee-for-Service	1679550859	1679550859	1	1	BACHRACH, LAURA K MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
31524	Fee-for-Service	1760795538	1760795538	1	1	BROWNE, ANDREW O LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
31536	Fee-for-Service	1942261631	1942261631	1	1	BAKER, REGINALD L MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	98182	30	Radiology	0	In state provider	None	3900 GEER ROAD	None	TURLOCK	CA	95382	1147	50	06099	37.52828715	-120.8488829	Stanislaus County
31542	Fee-for-Service	1669855664	1669855664	2	1	BEGELFER, JENNIFER LMFT	11/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25201 AVENUE TIBBITTS	203	VALENCIA	CA	91355	3433	19	06037	34.42872823	-118.5738422	Los Angeles County
31558	Fee-for-Service	1750493557	1750493557	1	1	BIO MEDICAL APPS OF CA	6/8/1995	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1801 HOLSER WALK	STE 310	OXNARD	CA	93036	5061	56	06111	34.220745	-119.1572315	Ventura County
31566	Fee-for-Service	1154401941	1154401941	1	59	BASS MEDICAL GROUP	1/20/2022	174400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1210 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87774537	-122.0710148	Contra Costa County
31567	Fee-for-Service	1528086246	1528086246	1	1	BRATHWAITE, RON K MD	7/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87445	40	Pediatrics	0	In state provider	None	1680 E 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
31568	Fee-for-Service	1396822326	1396822326	1	1	BLUE EAGLE ANESTHESIA INC	4/14/2009	193400000X	NA	Other	026	PHYSICIANS	8819	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
31573	Fee-for-Service	1558517557	1558517557	1	1	BELTRAN, MIA FIDES E	11/1/2010	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
31623	Fee-for-Service	1780181230	1780181230	1	1	BURDICK, BRITTANY VASAE L MD	4/3/2022	174400000X	NA	Other	026	PHYSICIANS	163369	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
31625	Fee-for-Service	1285020487	1285020487	1	1	BROWNELL, NICHOLAS K MD	7/15/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162562	41	Internal Medicine	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
31629	Fee-for-Service	1225131105	1225131105	1	1	BELLUM, VENUGOPAL MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55196	08	Family Practice	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
31656	Fee-for-Service	1730381476	1730381476	1	1	BOADA-DOUTT, CYNTHIA LMFT	1/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
31691	Fee-for-Service	1194744409	1194744409	1	1	BARNETT, NANCY L MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92272	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
31725	Fee-for-Service	1205978806	1205978806	1	1	BERTELSEN, CARL A MD	1/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	44277	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 550	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31739	Fee-for-Service	1750301198	1750301198	1	1	BIJAK, GREGORY JOSEPH MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	78771	05	Anesthesiology	0	In state provider	None	1801 HANOVER DR	STE F	DAVIS	CA	95616	1067	57	06113	38.55895232	-121.7567316	Yolo County
31754	Fee-for-Service	1427262757	1427262757	1	1	BAGGA, DILPRIT MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118256	41	Internal Medicine	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
31757	Fee-for-Service	1154401941	1154401941	1	11	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	4 FINANCIAL PLZ	None	NAPA	CA	94558	3043	28	06055	38.32432544	-122.2896184	Napa County
31766	Fee-for-Service	1013002625	1013002625	1	1	BHALLA, SARBPAUL S MD	8/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	36251	20	Orthopedic Surgery	0	In state provider	None	2690 PACIFIC AVE	STE 380	LONG BEACH	CA	90806	2632	19	06037	33.805854	-118.1936805	Los Angeles County
31778	Fee-for-Service	1518980374	1518980374	1	1	BOCK, CHERYL L NP	1/13/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2295 S VINEYARD AVE	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
31830	Fee-for-Service	1528086246	1528086246	1	1	BRATHWAITE, RON K MD	7/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87445	41	Internal Medicine	0	In state provider	None	1680 E 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
31846	Fee-for-Service	1417094277	1417094277	1	1	BUENAFLOR, GENEVIEVE B DO	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11320	01	General Practice	0	In state provider	None	9089 BASELINE RD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
31850	Fee-for-Service	1255370334	1255370334	1	1	BROUMANDI, DAVID D MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76646	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
31853	Fee-for-Service	1154401941	1154401941	1	59	BASS MEDICAL GROUP	8/15/2022	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1210 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87774537	-122.0710148	Contra Costa County
31858	Fee-for-Service	1164495024	1164495024	1	1	BARRY W MARTIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	52 MEDICAL PARK DR E	SUITE 321	BIRMINGHAM	AL	35235	0000	00	None	33.59628	-86.667903	Jefferson County
31859	Fee-for-Service	1295071876	1295071876	1	1	BERGER, NEAL M MD	6/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	116874	20	Orthopedic Surgery	0	In state provider	None	2900 WHIPPLE AVE	STE 210	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
31865	Fee-for-Service	1255931135	1255931135	1	1	BEST QUALITY HOSPICE AND	4/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	6308 WOODMAN AVE	SUITE 104	VAN NUYS	CA	91401	2307	19	06037	34.185123	-118.4312405	Los Angeles County
31901	Fee-for-Service	1174557805	1174557805	1	7	BAY AREA RETINA ASSOCIATES,	9/27/2021	207WX0107X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	15051 HESPERIAN	SUITE D	SAN LEANDRO	CA	94578	3536	01	06001	37.703457	-122.130096	Alameda County
31913	Fee-for-Service	1285020487	1285020487	1	1	BROWNELL, NICHOLAS K MD	7/15/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162562	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
31914	Fee-for-Service	1356443519	1356443519	1	1	BIO MEDICAL APPLICATIONS AZ	5/11/2010	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	ROUTE 1	AGENCY ROAD	PARKER	AZ	85344	9701	00	None	33.91670484	-114.4369941	La Paz County
31959	Fee-for-Service	1285993634	1285993634	2	1	BERZAK-WOLF, JODI DO	5/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12954	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
31961	Fee-for-Service	1154401941	1154401941	1	70	BASS MEDICAL GROUP	1/21/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2800	07	06013	37.94798358	-122.073455	Contra Costa County
31971	Fee-for-Service	1417242603	1417242603	1	1	BRADY, MEREDITH C MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123606	26	Psychiatry (child)	0	In state provider	None	2001 JUNIPERO SERRA BLVD	SUITE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
32011	Fee-for-Service	1942498928	1942498928	1	1	BALAGTAS, JAY MICHAEL S MD	12/10/2009	2080P0207X	NA	Hematology	026	PHYSICIANS	93450	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
32014	Fee-for-Service	1205978806	1205978806	1	1	BERTELSEN, CARL A MD	1/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	44277	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MC 550	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32044	Fee-for-Service	1427262757	1427262757	1	1	BAGGA, DILPRIT MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118256	68	Hematology	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
32045	Fee-for-Service	1154401941	1154401941	1	11	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4 FINANCIAL PLZ	None	NAPA	CA	94558	3043	28	06055	38.32432544	-122.2896184	Napa County
32072	Fee-for-Service	1093763906	1093763906	1	1	BENJAMIN LUCAS HARPER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	551 HILL COUNTRY DR	None	KERRVILLE	TX	78028	6085	00	None	30.04481871	-99.15170303	Kerr County
32134	Fee-for-Service	1417094277	1417094277	1	1	BUENAFLOR, GENEVIEVE B DO	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11320	08	Family Practice	0	In state provider	None	9089 BASELINE RD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
32155	Fee-for-Service	1255931135	1255931135	1	1	BEST QUALITY HOSPICE AND	4/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	6308 WOODMAN AVE	SUITE 104	VAN NUYS	CA	91401	2307	19	06037	34.185123	-118.4312405	Los Angeles County
32164	Fee-for-Service	1801834601	1801834601	1	1	BELTRAN, MARK A. MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71724	08	Family Practice	0	In state provider	None	50 S SAN MATEO DR	STE 150	SAN MATEO	CA	94401	3832	41	06081	37.56634141	-122.3261145	San Mateo County
32211	Fee-for-Service	1760161863	1760161863	1	1	BURKHART, LYDIA DOULA	11/16/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
32212	Fee-for-Service	1972317980	1972317980	1	1	BRAND, LAUREN PSYD	2/18/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
32237	Fee-for-Service	1275568479	1275568479	1	2	BROWN, CALVANESE, CAMERON	1/24/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	1	Border provider	LTD	10101 DOUBLE R BLVD	None	RENO	NV	89521	5931	00	None	39.43617476	-119.758524	Washoe County
32251	Fee-for-Service	1154401941	1154401941	1	70	BASS MEDICAL GROUP	1/21/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2800	07	06013	37.94798358	-122.073455	Contra Costa County
32302	Fee-for-Service	1164879177	1164879177	1	1	BURR, MATTHEW A MD	5/4/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171621	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
32304	Fee-for-Service	1861434763	1861434763	1	1	BHAT, ARVIND R MD	4/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153201	41	Internal Medicine	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
32332	Fee-for-Service	1154401941	1154401941	1	11	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	4 FINANCIAL PLZ	None	NAPA	CA	94558	3043	28	06055	38.32432544	-122.2896184	Napa County
32384	Fee-for-Service	1215302245	1215302245	1	1	BEECHTREE DIAGNOSTICS LLP	1/15/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	12351 SOUTH GATEWAY PARK	SUITE D-700	DRAPER	UT	84020	9581	00	None	40.52576346	-111.9029955	Salt Lake County
32417	Fee-for-Service	1063042380	1063042380	1	1	BELSKY, LARISSA CNP	11/21/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	738 BANCROFT RD	None	WALNUT CREEK	CA	94598	1531	07	06013	37.92857256	-122.041705	Contra Costa County
32419	Fee-for-Service	1740890755	1740890755	1	1	BLESSED HANDS HOSPICE, INC	7/7/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4045 N FRESNO ST	SUITE 103B	FRESNO	CA	93726	4099	10	06019	36.79117337	-119.7814427	Fresno County
32423	Fee-for-Service	1154377943	1154377943	1	1	BARNUM, MICHAEL DEAN MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76644	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
32424	Fee-for-Service	1154401941	1154401941	1	15	BASS MEDICAL GROUP	2/25/2019	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	2400 BALFOUR DR	STE 300	BRENTWOOD	CA	94513	4950	07	06013	37.92519383	-121.734461	Contra Costa County
32425	Fee-for-Service	1154401941	1154401941	1	23	BASS MEDICAL GROUP	2/25/2019	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	3443 VILLA LN	STE 9	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
32445	Fee-for-Service	1396837290	1396837290	1	1	BAUDONNET, ANTHONY A OD	9/1/1999	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1045 S ST	None	FRESNO	CA	93721	1406	10	06019	36.74077211	-119.7813343	Fresno County
32446	Fee-for-Service	1174557805	1174557805	1	3	BAY AREA RETINA ASSOCIATES,	7/27/2021	207WX0107X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	5980 STONERIDGE	SUITE 117	PLEASANTON	CA	94588	4518	01	06001	37.69135348	-121.90203	Alameda County
32508	Fee-for-Service	1104261296	1104261296	1	1	BUI, CYNTHIA H MD	10/14/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	134222	40	Pediatrics	0	In state provider	None	4968 BOOTH	106	IRVINE	CA	92604	3360	30	06059	33.68590715	-117.7855253	Orange County
32521	Fee-for-Service	1154722031	1154722031	1	1	BETTS, SARAH B CNP	8/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32528	Fee-for-Service	1437607926	1437607926	1	1	BAKERSFIELDIDENCE OPCO LLC	4/16/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5151 KNUDSEN DRIVE	None	BAKERSFIELD	CA	93308	7199	15	06029	35.40625586	-119.0586754	Kern County
32537	Fee-for-Service	1386841039	1386841039	1	1	BREJCHA, CHARLES T AU	9/23/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	623 W DUARTE RD	#8	ARCADIA	CA	91007	7349	19	06037	34.12648672	-118.0522757	Los Angeles County
32550	Fee-for-Service	1932165776	1932165776	1	1	BALTAYIAN, SARKIS MD	12/2/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	33181	05	Anesthesiology	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
32557	Fee-for-Service	1013464205	1013464205	1	1	BAKER, PHILIP LMFT	7/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS RD	600	CONCORD	CA	94520	5292	07	06013	37.96879608	-122.0519798	Contra Costa County
32562	Fee-for-Service	1285896605	1285896605	1	1	BARAZANI, YAGIL MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128369	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
32566	Fee-for-Service	1720351935	1720351935	1	1	BHOSREKAR, KIRANKUMAR MD	1/1/2024	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
32579	Fee-for-Service	1811011406	1811011406	1	1	BELAFSKY, SHERI R MD	3/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76118	01	General Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
32584	Fee-for-Service	1659424240	1659424240	1	1	BROYLES, DAVID DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MEDICAL CENTER BLVD	None	CHESTER	PA	19013	3902	00	None	39.85602959	-75.36863009	Delaware County
32587	Fee-for-Service	1275681355	1275681355	1	1	BUCKNER, DOROTHY JEAN MD	9/1/1973	207N00000X	NA	Dermatology	026	PHYSICIANS	24510	07	Dermatology	0	In state provider	None	340 DARDANELLI LN	STE 21A	LOS GATOS	CA	95032	1418	43	06085	37.262079	-121.9673345	Santa Clara County
32677	Fee-for-Service	1154355063	1154355063	1	1	BERG, HELGE MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COLUMBIA WILLAMETTE VALL	2700 SE STRAIS AVE	None	MCMINNVILLE	OR	97128	0000	00	None	0	0	None
32685	Fee-for-Service	1275516361	1275516361	1	1	BHARGAVA, SUMIT MD	12/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54974	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
32690	Fee-for-Service	1144461427	1144461427	1	1	BHANDARKAR, SUNIL G MD INC	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91354	None	None	0	In state provider	None	321 N LARCHMONT BLVD	STE 700	LOS ANGELES	CA	90004	6407	19	06037	34.0769016	-118.323663	Los Angeles County
32705	Fee-for-Service	1689680654	1689680654	1	1	BIEN, MICHAEL HIEN MD	9/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74264	41	Internal Medicine	0	In state provider	None	315 N 3RD AVE	STE 207	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
32707	Fee-for-Service	1740890755	1740890755	1	1	BLESSED HANDS HOSPICE, INC	7/7/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4045 N FRESNO ST	SUITE 103B	FRESNO	CA	93726	4099	10	06019	36.79117337	-119.7814427	Fresno County
32713	Fee-for-Service	1154401941	1154401941	1	15	BASS MEDICAL GROUP	2/25/2019	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	2400 BALFOUR DR	STE 300	BRENTWOOD	CA	94513	4950	07	06013	37.92519383	-121.734461	Contra Costa County
32722	Fee-for-Service	1457351652	1457351652	1	1	BOYCE, JAMES D MD	4/20/1978	207W00000X	NA	Ophthalmology	026	PHYSICIANS	34050	18	Ophthalmology	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 401	GARDEN GROVE	CA	92843	1918	30	06059	33.77450141	-117.9123364	Orange County
32739	Fee-for-Service	1689040123	1689040123	1	1	BLOOM-WELFORD, JESSICA A LMF	6/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	770 E SHAW AVE	STE 230	FRESNO	CA	93710	7708	10	06019	36.80886739	-119.7731624	Fresno County
32758	Fee-for-Service	1184324097	1184324097	1	1	BARBERO, ROZELY CRNA	9/3/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
32761	Fee-for-Service	1366021800	1366021800	1	1	BAGHCHECHI, MOHSEN B	1/3/2023	390200000X	NA	Other	026	PHYSICIANS	181126	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
32793	Fee-for-Service	1619316783	1619316783	1	1	BAUGHMAN, ETHAN J MD	8/19/2019	208200000X	NA	General Surgery	026	PHYSICIANS	158793	24	Plastic Surgery	0	In state provider	None	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	19	06037	34.20369349	-118.629837	Los Angeles County
32812	Fee-for-Service	1740252204	1740252204	1	1	BUADU,ANNEMARIE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.24069515	-110.9438648	Pima County
32815	Fee-for-Service	1518992585	1518992585	1	1	BAHADORI, AMIR H MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	65627	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5000 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1717	19	06037	34.16148087	-118.4486642	Los Angeles County
32818	Fee-for-Service	1093307936	1093307936	1	1	BESTYLE HOME CARE SERVICES	5/16/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	25350 MAGIC MOUNTAIN PKW	SUITE 300	VALENCIA	CA	91355	1356	19	06037	34.42404153	-118.577664	Los Angeles County
32820	Fee-for-Service	1922133800	1922133800	1	1	BABAIAN, ARA Y MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84481	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
32825	Fee-for-Service	1578349742	1578349742	1	1	BELL, AUDREY NP	10/11/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
32865	Fee-for-Service	1295811867	1295811867	1	1	BARNES, RANDY L MD	12/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89918	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
32887	Fee-for-Service	1194897256	1194897256	1	1	BAYNE, DAVID A MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	28673	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
32930	Fee-for-Service	1992113971	1992113971	1	1	BELGRAVE, MELINDA C MD	4/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148826	40	Pediatrics	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6862	24	06047	37.28825369	-120.4963159	Merced County
32991	Fee-for-Service	1689680654	1689680654	1	1	BIEN, MICHAEL HIEN MD	9/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74264	45	Nephrology (Renal-Kidney)	0	In state provider	None	315 N 3RD AVE	STE 207	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
33003	Fee-for-Service	1396942116	1396942116	1	1	BRINK, ERIK D DO	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13712	02	General Surgery	0	In state provider	None	2800 L ST	STE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
33006	Fee-for-Service	1932289014	1932289014	1	1	BEHRINGER, ELIZABETH C	2/7/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83564	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
33013	Fee-for-Service	1154401941	1154401941	1	15	BASS MEDICAL GROUP	2/25/2019	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2400 BALFOUR DR	STE 300	BRENTWOOD	CA	94513	4950	07	06013	37.92519383	-121.734461	Contra Costa County
33045	Fee-for-Service	1366839466	1366839466	1	1	BENSON, ERICA K DPM	9/1/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13624 HAWTHORNE BLVD	STE 206	HAWTHORNE	CA	90250	5818	19	06037	33.9083784	-118.3523983	Los Angeles County
33061	Fee-for-Service	1679791404	1679791404	1	1	BAKERSFIELD ENDOSCOPY	7/17/1995	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER	1408 COMMERCIAL WAY	None	BAKERSFIELD	CA	93309	0407	15	06029	35.36688109	-119.0600049	Kern County
33062	Fee-for-Service	1336657204	1336657204	1	1	BAILON, LLURIANA NP	12/12/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
33077	Fee-for-Service	1780023150	1780023150	1	1	BRUNNER, PAMELA Z PHD	2/25/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	124 WIKIUP DR	None	SANTA ROSA	CA	95403	7700	49	06097	38.50773004	-122.7589881	Sonoma County
33084	Fee-for-Service	1154401941	1154401941	1	47	BASS MEDICAL GROUP	8/5/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1208 E ARQUES AVE	STE 113	SUNNYVALE	CA	94085	5418	43	06085	37.38040351	-121.994748	Santa Clara County
33102	Fee-for-Service	1518992585	1518992585	1	1	BAHADORI, AMIR H MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	65627	41	Internal Medicine	0	In state provider	None	5000 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1717	19	06037	34.16148087	-118.4486642	Los Angeles County
33115	Fee-for-Service	1457366940	1457366940	1	1	BROWNLOW, VICTORIA	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
33172	Fee-for-Service	1104991025	1104991025	1	1	BOLDEN, LISA PSYD	2/17/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8939 S SEPULVEDA BLVD	SUITE #200	LOS ANGELES	CA	90045	3631	19	06037	33.95485856	-118.3962461	Los Angeles County
33190	Fee-for-Service	1619122025	1619122025	1	1	BURDICK, ADAM J MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106880	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
33212	Fee-for-Service	1750624961	1750624961	1	1	BLAKE, ERIN A MD	4/1/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148612	None	None	0	In state provider	None	7130 MILLBROOK AVE	SUITE 112	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
33214	Fee-for-Service	1982741567	1982741567	1	3	BAART BEHAVIORAL HEALTH SERV	10/1/2016	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1235 E ST.	None	FRESNO	CA	93706	2024	10	06019	36.73272329	-119.7993386	Fresno County
33224	Fee-for-Service	1417132317	1417132317	1	1	BEST CARE HOME II	5/6/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6467 CALIFORNIA AVE	None	LONG BEACH	CA	90805	2409	19	06037	33.87236299	-118.1811291	Los Angeles County
33237	Fee-for-Service	1295142511	1295142511	1	1	BAY AREA ENDOSCOPY CENTER	8/1/2014	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	20400 LAKE CHABOT ROAD	SUITE 201	CASTRO VALLEY	CA	94546	5315	01	06001	37.69628351	-122.0866765	Alameda County
33243	Fee-for-Service	1841925344	1841925344	1	1	BARSTOW POST ACUTE LLC	8/16/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	27555 RIMROCK ROAD	None	BARSTOW	CA	92311	4230	36	06071	34.87749642	-117.0600426	San Bernardino County
33289	Fee-for-Service	1437231172	1437231172	1	1	BEACH, COURTNEY A MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76720	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
33295	Fee-for-Service	1538139035	1538139035	1	1	BOUCHER, RONALD J MD	2/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	60766	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
33303	Fee-for-Service	1053410878	1053410878	1	1	BRISON-MOLL, NANCY L PHD	3/8/2006	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	965 E YOSEMITE AVENUE	12	MANTECA	CA	95336	5943	39	06077	37.79749432	-121.2033865	San Joaquin County
33307	Fee-for-Service	1811169683	1811169683	1	1	BENNIS, BROOKE E DO	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14793	25	Physical Medicine and Rehabilitation	0	In state provider	None	3421 VILLA LANE	STE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
33322	Fee-for-Service	1003833948	1003833948	1	1	BAKHRU, JYOTI M MD	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	44963	41	Internal Medicine	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
33330	Fee-for-Service	1497795611	1497795611	1	1	BERETTA, VICTOR R MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	42347	05	Anesthesiology	0	In state provider	None	901 DOVER DR	STE 214	NEWPORT BEACH	CA	92660	5500	30	06059	33.62418668	-117.9053624	Orange County
33355	Fee-for-Service	1013946094	1013946094	1	1	BOUTSELIS, MAXIMINA MD	10/28/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
33372	Fee-for-Service	1154401941	1154401941	1	47	BASS MEDICAL GROUP	8/5/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1208 E ARQUES AVE	STE 113	SUNNYVALE	CA	94085	5418	43	06085	37.38040351	-121.994748	Santa Clara County
33383	Fee-for-Service	1639107550	1639107550	1	1	BARRETO, PATRICIA M MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63336	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
33388	Fee-for-Service	1730872706	1730872706	1	1	BE HAPPY BE HOME INC	8/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11035 MONOGRAM AVE	None	GRANADA HILLS	CA	91344	5217	19	06037	34.27046532	-118.4922983	Los Angeles County
33392	Fee-for-Service	1922362581	1922362581	1	1	BACHO, EDWARD A MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119179	08	Family Practice	0	In state provider	None	3055 W RAMSEY ST	None	BANNING	CA	92220	3781	33	06065	33.92577647	-116.910234	Riverside County
33395	Fee-for-Service	1740806678	1740806678	1	1	BLANKENDAAL-KRAMER, DYLAN M	10/30/2023	390200000X	NA	Other	026	PHYSICIANS	187576	None	None	0	In state provider	D	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
33410	Fee-for-Service	1811080187	1811080187	1	1	BIJAN FARAH, MD INC	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	35772	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17130 VENTURA BLVD	None	ENCINO	CA	91316	4003	19	06037	34.16034482	-118.5063659	Los Angeles County
33426	Fee-for-Service	1316301179	1316301179	1	1	BAYNE, JOSEPH MD	6/14/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162041	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33427	Fee-for-Service	1215331269	1215331269	1	1	BOVY, MITCH R OD	5/4/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3300 E SOUTH ST	SUITE 105	LONG BEACH	CA	90805	4579	19	06037	33.86018093	-118.1537163	Los Angeles County
33448	Fee-for-Service	1366726440	1366726440	1	1	BENUTTO, JOYTIKA D PSYD	7/4/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
33458	Fee-for-Service	1235135740	1235135740	1	1	BOWLES, LAVETTE S NP	6/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
33506	Fee-for-Service	1144395815	1144395815	1	1	BRADSHAW, JOHN PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 S ELLSWORTH AVE	STE 802	SAN MATEO	CA	94401	3926	41	06081	37.56665635	-122.3247743	San Mateo County
33526	Fee-for-Service	1508933425	1508933425	1	1	BASICAL, SOFRONIO A MD	3/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79124	40	Pediatrics	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
33535	Fee-for-Service	1790923191	1790923191	1	1	BAYDOUN, SALAH K MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
33536	Fee-for-Service	1467750851	1467750851	1	1	BEDI, HARVINDER S MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116374	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
33583	Fee-for-Service	1417462011	1417462011	1	1	BRIDGE PSYCHOLOGICAL SERVICE	8/22/2024	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	S, INC.	410 12TH ST	STE 325	OAKLAND	CA	94607	4497	01	06001	37.80268778	-122.2712274	Alameda County
33591	Fee-for-Service	1053410878	1053410878	1	1	BRISON-MOLL, NANCY L PHD	2/13/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	965 E YOSEMITE AVENUE	12	MANTECA	CA	95336	5943	39	06077	37.79749432	-121.2033865	San Joaquin County
33620	Fee-for-Service	1629315015	1629315015	1	1	BALLEW, ITZEL LMFT	1/16/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2831 CAMINO DEL RIO SOUT	STE. 206	SAN DIEGO	CA	92108	3827	37	06073	32.77018113	-117.1334016	San Diego County
33628	Fee-for-Service	1740639871	1740639871	1	1	BAKER, MONICA OD	6/30/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	516 E PALMDALE BLVD	None	PALMDALE	CA	93550	4603	19	06037	34.57961309	-118.1198918	Los Angeles County
33660	Fee-for-Service	1154401941	1154401941	1	47	BASS MEDICAL GROUP	8/5/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1208 E ARQUES AVE	STE 113	SUNNYVALE	CA	94085	5418	43	06085	37.38040351	-121.994748	Santa Clara County
33679	Fee-for-Service	1922362581	1922362581	1	1	BACHO, EDWARD A MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119179	01	General Practice	0	In state provider	None	3055 W RAMSEY ST	None	BANNING	CA	92220	3781	33	06065	33.92577647	-116.910234	Riverside County
33699	Fee-for-Service	1811080187	1811080187	1	1	BIJAN FARAH, MD INC	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	35772	41	Internal Medicine	0	In state provider	None	17130 VENTURA BLVD	None	ENCINO	CA	91316	4003	19	06037	34.16034482	-118.5063659	Los Angeles County
33703	Fee-for-Service	1346541554	1346541554	1	1	BALI, RACHNA DO	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11595	41	Internal Medicine	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
33765	Fee-for-Service	1447276548	1447276548	1	1	BECK, PHILLIP H MD	10/9/1979	208800000X	NA	Other	026	PHYSICIANS	21753	34	Urology and Urological Surgery	0	In state provider	None	1400 FLORIDA AVE	STE 4	MODESTO	CA	95350	4422	50	06099	37.66410995	-120.996159	Stanislaus County
33777	Fee-for-Service	1043707805	1043707805	1	1	BHANDARI, NIPUN MD	7/24/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	174291	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
33789	Fee-for-Service	1659781565	1659781565	1	1	BIRCH, KURTIS G MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121149	14	Neurological Surgery	0	In state provider	None	525 DOYLE PARK DR	STE 102	SANTA ROSA	CA	95405	4562	49	06097	38.442636	-122.69889	Sonoma County
33793	Fee-for-Service	1083844237	1083844237	1	1	BROWN, STEPHANIE Y MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113800	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
33854	Fee-for-Service	1881790418	1881790418	1	1	BHUPATHY, ANAND R	8/31/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6177	None	None	0	In state provider	None	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
33872	Fee-for-Service	1972700060	1972700060	1	1	BARLICS, BRIAN P MD	4/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98351	40	Pediatrics	0	In state provider	None	1900 DRESDEN DR	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
33876	Fee-for-Service	1427048487	1427048487	1	1	BIBLER, MARK S MD	7/30/1991	174400000X	NA	Other	026	PHYSICIANS	37015	08	Family Practice	0	In state provider	None	840 TOWNSITE DR	None	VISTA	CA	92084	5566	37	06073	33.20923325	-117.2343859	San Diego County
33926	Fee-for-Service	1083033575	1083033575	1	1	BOSWELL, BRITTANY R MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138574	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
33933	Fee-for-Service	1811994858	1811994858	1	1	BERENS BRUCE M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 JACKSON ST	None	SAINT PAUL	MN	55101	2502	00	None	44.95496967	-93.09587426	Ramsey County
33956	Fee-for-Service	1780054379	1780054379	1	2	BAY AREA COMMUNITY HEALTH	10/13/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
33968	Fee-for-Service	1063900165	1063900165	1	1	BORDEN, KIMBERLY G MD	3/25/2022	207R00000X	NA	Other	026	PHYSICIANS	164224	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
33971	Fee-for-Service	1083670863	1083670863	1	1	BANDT, PAUL D MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	SUITE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
33986	Fee-for-Service	1295806172	1295806172	1	1	BOKSBERGER, HANS-PETER	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44087	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
33996	Fee-for-Service	1528454188	1528454188	1	1	BAI-TONG, SHIYU S MD	7/1/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	155419	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
34048	Fee-for-Service	1760688394	1760688394	1	1	BASTIDAS, MYRA S MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99110	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
34091	Fee-for-Service	1568740090	1568740090	1	1	BISTA, BIRAJ B MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132850	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
34110	Fee-for-Service	1831723618	1831723618	1	1	BERMEJO, DAVID	8/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22926	08	Family Practice	0	In state provider	None	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
34127	Fee-for-Service	1790824340	1790824340	1	1	BRITTO, REGIS J MD	11/1/2002	207R00000X	NA	Other	026	PHYSICIANS	46636	41	Internal Medicine	0	In state provider	None	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
34143	Fee-for-Service	1104894336	1104894336	1	1	BARTH, BRAD C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66743	05	Anesthesiology	0	In state provider	None	1401 BAILEY AVE	None	NEEDLES	CA	92363	3103	36	06071	34.832997	-114.618293	San Bernardino County
34147	Fee-for-Service	1457439945	1457439945	1	1	BITGOOD, MARK J MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78462	84	Surgery-Head and Neck	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
34196	Fee-for-Service	1740377118	1740377118	1	1	BERNA, ZOE D MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80888	08	Family Practice	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
34208	Fee-for-Service	1699884858	1699884858	1	1	BANNER GATEWAY MED CNTR	11/22/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1900 NORTH HIGLEY RD	None	GILBERT	AZ	85234	1604	00	None	33.384528	-111.7222875	Maricopa County
34228	Fee-for-Service	1831289545	1831289545	1	1	BROOKS, JOHN O MD	3/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	54784	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
34230	Fee-for-Service	1992933485	1992933485	1	1	BARTUCCO, ERIN L PT	8/2/2019	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
34238	Fee-for-Service	1235820150	1235820150	1	1	BR MEDIVAN INC.	6/12/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2689 PRESIDIO DR	None	BRENTWOOD	CA	94513	5609	07	06013	37.93490844	-121.7503277	Contra Costa County
34246	Fee-for-Service	1780054379	1780054379	1	2	BAY AREA COMMUNITY HEALTH	10/13/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
34260	Fee-for-Service	1881163574	1881163574	1	1	BULLOCK, ASHLEY LMFT	1/21/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1640 CABANA AVE	None	WEST COVINA	CA	91790	4526	19	06037	34.054967	-117.9537932	Los Angeles County
34262	Fee-for-Service	1225533219	1225533219	1	1	BHAMIDI, HEMALATHA DO	2/12/2024	207R00000X	NA	Other	026	PHYSICIANS	19121	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
34274	Fee-for-Service	1295806172	1295806172	1	1	BOKSBERGER, HANS-PETER	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44087	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
34326	Fee-for-Service	1649347667	1649347667	1	1	BURROWS, ADRIENNE MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83277	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
34329	Fee-for-Service	1710312244	1710312244	1	1	BOOKMAN, SAMANTHA LMFT	12/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
34357	Fee-for-Service	1841224870	1841224870	1	1	BANNER GOOD SAMARITAN	11/23/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1111 E MCDOWELL RD	None	PHOENIX	AZ	85006	2612	00	None	33.463935	-112.0596975	Maricopa County
34361	Fee-for-Service	1295960938	1295960938	1	1	BECKETT, VANESSA T MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123153	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
34377	Fee-for-Service	1245254143	1245254143	1	1	BAO, KEXIN	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ACADEMIC MEDICAL CENTER	2712 SAN GABRIEL BLVD	None	ROSEMEAD	CA	91770	3256	19	06037	34.061049	-118.0905315	Los Angeles County
34407	Fee-for-Service	1801967849	1801967849	1	1	BERNBECK, JOHANNES A MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74978	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
34408	Fee-for-Service	1922119148	1922119148	1	1	BARTE, FELIX M MD	3/27/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	37283	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12949 JOLETTE AVE	None	GRANADA HILLS	CA	91344	1069	19	06037	34.30487803	-118.5168056	Los Angeles County
34409	Fee-for-Service	1306505383	1306505383	1	1	BARRETT, JASSIEL E LCSW	12/17/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
34415	Fee-for-Service	1790824340	1790824340	1	1	BRITTO, REGIS J MD	11/1/2002	207R00000X	NA	Other	026	PHYSICIANS	46636	01	General Practice	0	In state provider	None	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
34419	Fee-for-Service	1487605754	1487605754	1	1	BLEICH, JEFFERY L MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	48342	05	Anesthesiology	0	In state provider	None	701 WELCH RD	STE 216B	PALO ALTO	CA	94304	1705	43	06085	37.43702969	-122.1737907	Santa Clara County
34431	Fee-for-Service	1104894336	1104894336	1	1	BARTH, BRAD C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66743	01	General Practice	0	In state provider	None	1401 BAILEY AVE	None	NEEDLES	CA	92363	3103	36	06071	34.832997	-114.618293	San Bernardino County
34436	Fee-for-Service	1669810065	1669810065	1	1	BRISCOE, GABRIEL W MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136318	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
34437	Fee-for-Service	1700936374	1700936374	1	1	BMB MEDICAL GROUP INC	10/6/2014	207R00000X	NA	Other	026	PHYSICIANS	64109	41	Internal Medicine	0	In state provider	None	4160 WILSHIRE BLVD	SUITE 303	LOS ANGELES	CA	90010	3567	19	06037	34.06168938	-118.3183794	Los Angeles County
34478	Fee-for-Service	1841899705	1841899705	1	1	BELTRAN, GIANINA B NP	10/27/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
34494	Fee-for-Service	1295705010	1295705010	1	1	BEACH, GREGG J OD	3/27/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1104 PEAR TREE LANE	None	NAPA	CA	94558	6446	28	06055	38.32088172	-122.2945763	Napa County
34496	Fee-for-Service	1699884858	1699884858	1	1	BANNER GATEWAY MED CNTR	11/22/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1900 NORTH HIGLEY RD	None	GILBERT	AZ	85234	1604	00	None	33.384528	-111.7222875	Maricopa County
34513	Fee-for-Service	1982960704	1982960704	1	1	BERNSTEIN, DAVID A MD	11/3/2017	208600000X	NA	General Surgery	026	PHYSICIANS	149586	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
34521	Fee-for-Service	1710090162	1710090162	2	1	BROOKS, JOSEPH T MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	34676	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1405 MAGNOLIA AVE	STE A	CHICO	CA	95926	3226	04	06007	39.74046859	-121.8497839	Butte County
34523	Fee-for-Service	1780054379	1780054379	1	3	BAY AREA COMMUNITY HEALTH	1/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	40924 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53353137	-121.9601832	Alameda County
34527	Fee-for-Service	1306931357	1306931357	1	1	BARTON HEALTHCARE SYSTEM	7/6/2005	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3860 SADDLE RD	None	SOUTH LAKE TAHOE	CA	96150	8673	09	06017	38.934261	-119.9399445	El Dorado County
34528	Fee-for-Service	1851771547	1851771547	1	1	BRANDWENE, RACHEL E LCSW	8/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
34540	Fee-for-Service	1154401941	1154401941	1	62	BASS MEDICAL GROUP	7/5/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16360 MONTEREY ST	STE 270	MORGAN HILL	CA	95037	5453	43	06085	37.11781129	-121.6457012	Santa Clara County
34561	Fee-for-Service	1609908805	1609908805	1	1	BOGGS, HEATHER M LMFT	3/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15 ILAHEE LN	100	CHICO	CA	95973	6316	04	06007	39.75224248	-121.8701858	Butte County
34563	Fee-for-Service	1609422815	1609422815	1	1	BECTON, ALICIA LPCC	11/2/2022	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 149	FRESNO	CA	93710	7917	10	06019	36.80872147	-119.765979	Fresno County
34576	Fee-for-Service	1104143775	1104143775	1	1	BALANCE THERAPY, INC	10/17/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 PISTOIA WAY	None	SAN JOSE	CA	95138	2354	43	06085	37.27676954	-121.7620684	Santa Clara County
34624	Fee-for-Service	1982994802	1982994802	1	1	BUI, NAM Q MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122472	68	Hematology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
34628	Fee-for-Service	1134311293	1134311293	1	1	BACHMAN, KRISTIN R PHD	9/15/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30011 IVY GLENN DR	SUITE 216	LAGUNA NIGUEL	CA	92677	5018	30	06059	33.52732273	-117.715146	Orange County
34645	Fee-for-Service	1043621220	1043621220	1	1	BENEVOLENCE INDUSTRIES INC	7/31/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	303 N EAST STREET	None	ANAHEIM	CA	92805	3341	30	06059	33.84042094	-117.9034309	Orange County
34646	Fee-for-Service	1841224870	1841224870	1	1	BANNER GOOD SAMARITAN	11/23/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1111 E MCDOWELL RD	None	PHOENIX	AZ	85006	2612	00	None	33.463935	-112.0596975	Maricopa County
34657	Fee-for-Service	1447295167	1447295167	1	1	BRAKEMAN, PAUL R MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68014	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
34690	Fee-for-Service	1952409138	1952409138	1	1	BENDIG, DONALD W MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	32198	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
34694	Fee-for-Service	1801967849	1801967849	1	1	BERNBECK, JOHANNES A MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74978	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
34697	Fee-for-Service	1922119148	1922119148	1	1	BARTE, FELIX M MD	3/27/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	37283	41	Internal Medicine	0	In state provider	None	12949 JOLETTE AVE	None	GRANADA HILLS	CA	91344	1069	19	06037	34.30487803	-118.5168056	Los Angeles County
34710	Fee-for-Service	1740307800	1740307800	1	1	BEND, JR RICHARD L DC	9/1/2002	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	BEND CHIROPRACTIC CENTER	387 OCEAN AVE	STE A	MONTEREY	CA	93940	3571	27	06053	36.59730427	-121.8799293	Monterey County
34711	Fee-for-Service	1689808008	1689808008	1	1	BORGES, PAULA M MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113197	84	Surgery-Head and Neck	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
34721	Fee-for-Service	1326337437	1326337437	1	1	BEARFIELD, JEREMY C MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1240 EAST 9TH STREET	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
34722	Fee-for-Service	1346281284	1346281284	1	1	BHUTANI, CHIRDEEP MD	1/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145491	30	Radiology	0	In state provider	None	3301 C STREET	STE 500	SACRAMENTO	CA	95816	3386	34	06067	38.579877	-121.456143	Sacramento County
34724	Fee-for-Service	1861718389	1861718389	1	1	BESIMANTO, SHABNAM	2/8/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	111583	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
34810	Fee-for-Service	1780054379	1780054379	1	3	BAY AREA COMMUNITY HEALTH	1/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	40924 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53353137	-121.9601832	Alameda County
34817	Fee-for-Service	1902120520	1902120520	1	1	BECK, CHAD J MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136670	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
34818	Fee-for-Service	1285105387	1285105387	1	1	BAKERSFIELD COMMUNITY HEALTH	1/11/2021	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1801 OAK STREET	None	BAKERSFIELD	CA	93301	9274	15	06029	35.3753433	-119.0386865	Kern County
34827	Fee-for-Service	1154401941	1154401941	1	62	BASS MEDICAL GROUP	7/5/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	16360 MONTEREY ST	STE 270	MORGAN HILL	CA	95037	5453	43	06085	37.11781129	-121.6457012	Santa Clara County
34830	Fee-for-Service	1093358251	1093358251	1	1	BERNAL MENDOZA, MARIA LMFT	4/11/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
34836	Fee-for-Service	1508849795	1508849795	1	1	BINOYA, EDGARDO G MD INC	11/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	30593	01	General Practice	0	In state provider	None	10230 ARTESIA BLVD	STE 300	BELLFLOWER	CA	90706	6769	19	06037	33.8728276	-118.1160403	Los Angeles County
34837	Fee-for-Service	1962891440	1962891440	1	1	BAILONY, AHMAD MD INC	2/24/2015	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	655 EUCLID AVE	STE 205	NATIONAL CITY	CA	91950	2967	37	06073	32.68353398	-117.082625	San Diego County
34850	Fee-for-Service	1881795425	1881795425	1	1	BALITE-LACAP, MONETTE S	7/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79819	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
34881	Fee-for-Service	1548565542	1548565542	1	1	BERNAL, JESSE S LMFT	10/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
34887	Fee-for-Service	1598007544	1598007544	1	1	BAIU, IOANA MD	10/26/2021	208600000X	NA	General Surgery	026	PHYSICIANS	143354	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
34895	Fee-for-Service	1447719760	1447719760	1	1	BLOCK-WHEELER, NIKOLAS R MD	9/21/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	181590	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
34911	Fee-for-Service	1982994802	1982994802	1	1	BUI, NAM Q MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122472	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
34923	Fee-for-Service	1497792055	1497792055	1	1	BHATIA, ANJU R MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63686	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2501 FOREST AVE	None	SAN JOSE	CA	95117	1118	43	06085	37.32737951	-121.950486	Santa Clara County
34934	Fee-for-Service	1043621220	1043621220	1	1	BENEVOLENCE INDUSTRIES INC	7/31/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	303 N EAST STREET	None	ANAHEIM	CA	92805	3341	30	06059	33.84042094	-117.9034309	Orange County
34937	Fee-for-Service	1164818639	1164818639	1	1	BOROGOVAC, AZRA MD	6/23/2022	207RH0000X	NA	Hematology	026	PHYSICIANS	179647	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
34939	Fee-for-Service	1831568013	1831568013	1	1	BEUTNER, KATHERINE R NP	8/29/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
34948	Fee-for-Service	1962539882	1962539882	1	1	BONITA UNIFIED SCHOOL DIST	5/7/2000	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	115 W ALLEN AVE	None	SAN DIMAS	CA	91773	1437	19	06037	34.11758348	-117.808263	Los Angeles County
34953	Fee-for-Service	1952714065	1952714065	1	1	BOYD, CHRISTINA MD	5/13/2020	282N00000X	NA	Hospitals	026	PHYSICIANS	152178	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
34959	Fee-for-Service	1679591705	1679591705	1	1	BORECKY, DAVID A MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	64341	08	Family Practice	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
34977	Fee-for-Service	1952409138	1952409138	1	1	BENDIG, DONALD W MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	32198	10	Gastroenterology (M.D. only)	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
34982	Fee-for-Service	1366881971	1366881971	1	1	BONNONO, SCOTT A MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
34993	Fee-for-Service	1841654431	1841654431	1	1	BEST HEALTH SERVICES LLC	4/1/2016	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	676 S BONNIE BRAE STREET	None	LOS ANGELES	CA	90057	3710	19	06037	34.05612553	-118.2741096	Los Angeles County
34995	Fee-for-Service	1780623512	1780623512	1	1	BE, HING M DO	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7045	08	Family Practice	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
34998	Fee-for-Service	1679554778	1679554778	1	1	BERMAN, JOEL F	8/31/1987	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	812 4TH ST	STE D	MARYSVILLE	CA	95901	5667	58	06115	39.13860196	-121.5959755	Yuba County
35000	Fee-for-Service	1710398607	1710398607	1	1	BUCHBINDER, LIZA S MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140797	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 420, 365, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
35007	Fee-for-Service	1326159641	1326159641	1	1	BOKHARI, SAYED R MD FACS	2/27/2023	208600000X	NA	General Surgery	026	PHYSICIANS	51332	None	None	0	In state provider	None	838 NORDAHL RD	SUITE 270	SAN MARCOS	CA	92069	3513	37	06073	33.13569751	-117.1191477	San Diego County
35062	Fee-for-Service	1700346210	1700346210	1	1	BRENSEL, SCOTT I DO	7/12/2022	207P00000X	NA	Other	026	PHYSICIANS	19364	None	None	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
35065	Fee-for-Service	1295120681	1295120681	1	1	BLOOD, TIMOTHY C MD	4/2/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	168207	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
35114	Fee-for-Service	1194929356	1194929356	1	1	BASS, MARGARITA MD	11/2/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	93115	41	Internal Medicine	0	In state provider	None	18300 ROSCOE BLVD	None	LOS ANGELES	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
35115	Fee-for-Service	1154401941	1154401941	1	62	BASS MEDICAL GROUP	7/5/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	16360 MONTEREY ST	STE 270	MORGAN HILL	CA	95037	5453	43	06085	37.11781129	-121.6457012	Santa Clara County
35127	Fee-for-Service	1518983063	1518983063	1	1	BANOONI, MARJAN MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82603	None	None	0	In state provider	None	12922 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	2924	19	06037	34.18665352	-118.414773	Los Angeles County
35159	Fee-for-Service	1447763016	1447763016	1	1	BAUTISTA, MARJORIE FRANCES	5/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PT	2600 STANWELL DRIVE	SUITE 104	CONCORD	CA	94520	4862	07	06013	37.98689836	-122.047993	Contra Costa County
35169	Fee-for-Service	1497713150	1497713150	1	1	BURG, MICHAEL D MD	7/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65791	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
35188	Fee-for-Service	1215971999	1215971999	1	1	BURINGRUD, DUANE M MD	2/1/1999	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34140	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
35207	Fee-for-Service	1497792055	1497792055	1	1	BHATIA, ANJU R MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63686	40	Pediatrics	0	In state provider	None	2501 FOREST AVE	None	SAN JOSE	CA	95117	1118	43	06085	37.32737951	-121.950486	Santa Clara County
35229	Fee-for-Service	1952606675	1952606675	1	1	BLANDO, RUTH ANN D NP	6/21/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
35265	Fee-for-Service	1699779033	1699779033	1	1	BERMANI, JAAFAR MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	29471	None	None	0	In state provider	None	250 N FIRST STREET	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
35266	Fee-for-Service	1780713024	1780713024	1	2	BARTON, MURIEL LCSW	7/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4400 W KLING ST	None	BURBANK	CA	91505	3742	19	06037	34.15589667	-118.3503025	Los Angeles County
35288	Fee-for-Service	1215226568	1215226568	1	1	BAIK, FRED M MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156016	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
35289	Fee-for-Service	1043393663	1043393663	1	1	BIGELOW, JAMIE M MD	3/1/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	76533	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	815 HYDE ST	None	SAN FRANCISCO	CA	94109	5996	38	06075	37.78855	-122.416917	San Francisco County
35320	Fee-for-Service	1386973675	1386973675	1	1	BISCHOFF, ANDREA MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	85	Surgery-Pediatric	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
35321	Fee-for-Service	1639465446	1639465446	1	1	BANH, DIEM PHUC T DO	8/10/2020	207L00000X	NA	Other	026	PHYSICIANS	13009	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
35327	Fee-for-Service	1477513547	1477513547	1	1	BURTON, MICHAEL S MD	1/1/1979	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	28669	01	General Practice	0	In state provider	None	2101 HILLHURST AVE	None	LOS ANGELES	CA	90027	2003	19	06037	34.110144	-118.2874485	Los Angeles County
35358	Fee-for-Service	1588120133	1588120133	1	1	BENJAMIN, ALEXIS	7/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
35391	Fee-for-Service	1821172065	1821172065	1	1	BAGINGITO, ALWIN W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66628	01	General Practice	0	In state provider	INC	41238 MARGARITA RD	STE 104	TEMECULA	CA	92591	5552	33	06065	33.52503669	-117.1490127	Riverside County
35394	Fee-for-Service	1275569352	1275569352	1	1	BOUCHARD, LINDA J MD	5/13/2008	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	58369	None	None	0	In state provider	None	1234 E NORTH ST	None	MANTECA	CA	95336	4961	39	06077	37.80105524	-121.1968581	San Joaquin County
35411	Fee-for-Service	1043415235	1043415235	1	1	BASA, QUENNIE R PT	5/23/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
35416	Fee-for-Service	1487065892	1487065892	1	1	BECK, JUSTIN L MD	11/21/2023	208600000X	NA	General Surgery	026	PHYSICIANS	182493	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
35436	Fee-for-Service	1508886557	1508886557	1	1	BISHOP, DALE B MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55946	08	Family Practice	0	In state provider	None	1601 E HAZELTON AVE	None	STOCKTON	CA	95205	6229	39	06077	37.9501034	-121.2684501	San Joaquin County
35455	Fee-for-Service	1174848469	1174848469	1	1	BARNES, MEREDITH B MD	7/5/2018	207R00000X	NA	Other	026	PHYSICIANS	125853	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
35463	Fee-for-Service	1598867541	1598867541	1	1	BRANDON, CHARISSE A MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90821	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
35493	Fee-for-Service	1629255864	1629255864	1	1	BEN-TOV, MARLA D LMFT	10/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
35506	Fee-for-Service	1023181039	1023181039	1	1	BRENAN, ANDREW D	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
35533	Fee-for-Service	1386831279	1386831279	1	1	BANERJEE, RONADIP R MD	5/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96637	67	Endocrinology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
35536	Fee-for-Service	1518911726	1518911726	1	1	BOWNDS, SHANNON E	1/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175793	None	None	0	In state provider	None	207 LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
35547	Fee-for-Service	1720822133	1720822133	1	1	BALUCH, NARGES MD	9/1/2024	207K00000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
35556	Fee-for-Service	1821042532	1821042532	1	1	BRANT-ZAWADZKI, MICHAEL	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	31971	30	Radiology	0	In state provider	MD	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
35590	Fee-for-Service	1073160214	1073160214	1	1	BUENROSTRO, JEREMIAH	7/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
35597	Fee-for-Service	1649265182	1649265182	1	1	BUI, DANG T MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73677	22	Pathology (M.D. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
35603	Fee-for-Service	1598526691	1598526691	1	1	BECHTEL, BAILEY PT	4/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
35618	Fee-for-Service	1174557805	1174557805	1	4	BAY AREA RETINA ASSOCIATES,	9/30/2021	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EDICAL GROUP	20130 LAKE CHABOT RD	SUITE 303	CASTRO VALLEY	CA	94546	5340	01	06001	37.69738066	-122.087041	Alameda County
35654	Fee-for-Service	1487768719	1487768719	1	1	BURCK, KATHERINE L MD	3/1/1995	207R00000X	NA	Other	026	PHYSICIANS	58262	41	Internal Medicine	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
35670	Fee-for-Service	1023047586	1023047586	1	1	BREDENKAMP, JAMES K MD	11/16/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	58370	04	Otology, Laryngology, Rhinology	0	In state provider	None	27800 MEDICAL CENTER RD	STE 324	MISSION VIEJO	CA	92691	6409	30	06059	33.55952733	-117.6645199	Orange County
35716	Fee-for-Service	1770712879	1770712879	1	1	BRESS, AARON L DO	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15274	30	Radiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
35720	Fee-for-Service	1598901282	1598901282	1	1	BENSON, KATHLEEN M LMFT	6/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	565 BRUNSWICK ROAD	STE 9	GRASS VALLEY	CA	95945	9529	29	06057	39.23341432	-121.0294421	Nevada County
35767	Fee-for-Service	1942243563	1942243563	1	1	BOUTROS, JASON K MD	12/20/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	42891	41	Internal Medicine	0	In state provider	None	2750 E WASHINGTON BLVD	STE 260	PASADENA	CA	91107	6202	19	06037	34.1680038	-118.0943955	Los Angeles County
35777	Fee-for-Service	1205824000	1205824000	1	1	BRITT MARCUSSEN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
35802	Fee-for-Service	1750357539	1750357539	1	1	BAYSPRING MEDICAL GROUP	12/1/1987	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1199 BUSH ST	STE 500	SAN FRANCISCO	CA	94109	5976	38	06075	37.7891291	-122.4167087	San Francisco County
35819	Fee-for-Service	1386831279	1386831279	1	1	BANERJEE, RONADIP R MD	5/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96637	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
35836	Fee-for-Service	1720822133	1720822133	1	1	BALUCH, NARGES MD	9/1/2024	207K00000X	NA	Other	026	PHYSICIANS	None	03	Allergy	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
35899	Fee-for-Service	1427697374	1427697374	1	1	BARNES, ANTHONY M LCSW	3/2/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
35906	Fee-for-Service	1467796789	1467796789	1	1	BRAUNER, ASHER	6/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	903 PACIFIC AVE	SUITE 207B	SANTA CRUZ	CA	95060	4448	44	06087	36.970491	-122.0251429	Santa Cruz County
35916	Fee-for-Service	1407847312	1407847312	1	1	BOOTH, KAREN L MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65239	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
35917	Fee-for-Service	1063907905	1063907905	1	1	BEDROSIAN, ARMEN H MD INC	7/9/2018	207R00000X	NA	Other	026	PHYSICIANS	145237	41	Internal Medicine	0	In state provider	None	3510 E SHIELD AVE	None	FRESNO	CA	93705	6907	10	06019	36.77948647	-119.7658665	Fresno County
35926	Fee-for-Service	1457478604	1457478604	1	1	BAUGH, OLIVIA P MD	1/9/2009	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	B13	RENO	NV	89513	6840	00	None	39.47672552	-119.796471	Washoe County
35927	Fee-for-Service	1922567718	1922567718	1	1	BATE AKOACHERE, MONIQUE MD	10/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
35937	Fee-for-Service	1225128416	1225128416	1	1	BANGALORE, SRIHARI S MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144441	26	Psychiatry (child)	0	In state provider	None	1643 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
35947	Fee-for-Service	1821059767	1821059767	1	1	BAK, BENJAMIN H MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65318	30	Radiology	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
35959	Fee-for-Service	1023047586	1023047586	1	1	BREDENKAMP, JAMES K MD	11/16/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	58370	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	27800 MEDICAL CENTER RD	STE 324	MISSION VIEJO	CA	92691	6409	30	06059	33.55952733	-117.6645199	Orange County
35998	Fee-for-Service	1528651700	1528651700	1	1	BRIDGES TO UNDERSTANDING FAM	2/11/2025	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ILY THERAPY SERVICES, IN	132 MILL ST	STE 210	HEALDSBURG	CA	95448	4462	49	06097	38.60873636	-122.8682221	Sonoma County
36014	Fee-for-Service	1215034335	1215034335	1	1	BLACHARSKI, PAUL A MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	44451	None	None	0	In state provider	None	11306 MOUNTAIN VIEW AVE	STE B	LOMA LINDA	CA	92354	3832	36	06071	34.047513	-117.243647	San Bernardino County
36031	Fee-for-Service	1457073736	1457073736	1	1	BROWN, JOSHUA A PT	4/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
36064	Fee-for-Service	1235306374	1235306374	1	1	BARTON, JOSEPH D JR MD	10/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106394	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
36076	Fee-for-Service	1922342484	1922342484	1	1	BALUCATING, AMORY S CRNA	11/13/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	726 FOURTH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
36090	Fee-for-Service	1750357539	1750357539	1	1	BAYSPRING MEDICAL GROUP	12/1/1987	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1199 BUSH ST	STE 500	SAN FRANCISCO	CA	94109	5976	38	06075	37.7891291	-122.4167087	San Francisco County
36109	Fee-for-Service	1083840367	1083840367	1	1	BALASUNDARAM, RAJ MD	10/19/2010	207R00000X	NA	Other	026	PHYSICIANS	107910	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
36137	Fee-for-Service	1083664551	1083664551	1	1	BECHINI, DENNIS G DO	7/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	466 DEL NORTE AVE	None	YUBA CITY	CA	95991	4125	51	06101	39.14347627	-121.6200408	Sutter County
36142	Fee-for-Service	1275564197	1275564197	1	1	BERKOWITZ, PAUL M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	570 W BROWN RD	None	MESA	AZ	85201	3227	00	None	33.434577	-111.8444355	Maricopa County
36204	Fee-for-Service	1407847312	1407847312	1	1	BOOTH, KAREN L MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65239	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
36211	Fee-for-Service	1447242060	1447242060	1	1	BROWN, RONALD MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E. 3900 SOUTH	None	SALT LAKE CITY	UT	84124	0000	00	None	40.68703142	-111.857243	Salt Lake County
36213	Fee-for-Service	1639525074	1639525074	1	1	BHAKTA, AKASH DO	6/22/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18155	None	None	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
36225	Fee-for-Service	1710035738	1710035738	1	1	BALDWIN, SCOTT W MD	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95409	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
36246	Fee-for-Service	1023047586	1023047586	1	1	BREDENKAMP, JAMES K MD	11/16/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	58370	84	Surgery-Head and Neck	0	In state provider	None	27800 MEDICAL CENTER RD	STE 324	MISSION VIEJO	CA	92691	6409	30	06059	33.55952733	-117.6645199	Orange County
36251	Fee-for-Service	1568422418	1568422418	2	1	BOKHARI, RASHIDA MD	3/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70350	41	Internal Medicine	0	In state provider	None	2201 NORTHGATE BLVD	STE E	SACRAMENTO	CA	95833	2540	34	06067	38.607255	-121.4763165	Sacramento County
36270	Fee-for-Service	1144319609	1144319609	1	1	BAGGOT, PATRICK J MD	1/23/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84916	None	None	0	In state provider	None	1535 W MERCED AVE	STE 304	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
36283	Fee-for-Service	1972574085	1972574085	1	1	BRESLOW, ADAM DAVID	1/1/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60853	66	Emergency Medicine (Urgent Care)	0	In state provider	None	685 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.62788873	-117.0746104	San Diego County
36286	Fee-for-Service	1528651700	1528651700	1	1	BRIDGES TO UNDERSTANDING FAM	2/11/2025	104100000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ILY THERAPY SERVICES, IN	132 MILL ST	STE 210	HEALDSBURG	CA	95448	4462	49	06097	38.60873636	-122.8682221	Sonoma County
36296	Fee-for-Service	1457928871	1457928871	1	1	BORDEN, KIMBERLY A LMFT	10/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
36299	Fee-for-Service	1518156041	1518156041	1	1	BERNSTEIN, ERIC W MD	2/4/2020	207L00000X	NA	Other	026	PHYSICIANS	102656	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
36305	Fee-for-Service	1285865436	1285865436	1	1	BAGGA, SIDHARTH MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120181	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2809 OLIVE HIGHWAY	SUITE 350	OROVILLE	CA	95966	6118	04	06007	39.50386798	-121.5410203	Butte County
36309	Fee-for-Service	1538567474	1538567474	1	1	BENSON, CLAYTON J MD	2/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146157	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
36317	Fee-for-Service	1801559521	1801559521	1	1	BARTOSHUK, MEGAN C AU	11/6/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
36344	Fee-for-Service	1053469916	1053469916	1	1	BLISS, DANIEL W MD	1/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40265	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
36380	Fee-for-Service	1154401941	1154401941	1	63	BASS MEDICAL GROUP	6/28/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	16360 MONTEREY ST	SUITE 280	MORGAN HILL	CA	95037	5453	43	06085	37.11781129	-121.6457012	Santa Clara County
36385	Fee-for-Service	1730248337	1730248337	1	1	BATIN, HAROLD R MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81013	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
36395	Fee-for-Service	1528116332	1528116332	1	1	BHATT, DILIP R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25018	40	Pediatrics	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
36410	Fee-for-Service	1164592622	1164592622	1	1	BENKO, WILLIAM S MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144983	79	Neurology-Child	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
36432	Fee-for-Service	1952693467	1952693467	1	1	BOWEN, WILLIAM T MD	6/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136038	None	None	0	In state provider	None	1515 EAST OCEAN AVENUE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
36442	Fee-for-Service	1578545836	1578545836	1	1	BLUMBERG, DEAN A MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60479	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
36447	Fee-for-Service	1538189501	1538189501	1	1	BENNETT, ROBERT L MD	3/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	46086	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
36463	Fee-for-Service	1164946059	1164946059	1	1	BIRJANI, SEPIDEH LMFT	4/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
36477	Fee-for-Service	1659812147	1659812147	1	1	BILBREY, MALINDA A LMFT	5/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
36489	Fee-for-Service	1518570290	1518570290	1	1	BEVERLY HILLS HEALTH INC	8/24/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	9200 W PICO BLVD	None	LOS ANGELES	CA	90035	1319	19	06037	34.0552525	-118.3922955	Los Angeles County
36519	Fee-for-Service	1104864735	1104864735	1	1	BOYKO, OREST B MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48601	30	Radiology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
36526	Fee-for-Service	1376703454	1376703454	1	1	BENSCOTER, BRENT J MD	3/23/2018	207YX0901X	NA	ENT/Otolaryngology	026	PHYSICIANS	150679	04	Otology, Laryngology, Rhinology	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
36533	Fee-for-Service	1417152232	1417152232	1	1	BRODERICK, LORI MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106397	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
36572	Fee-for-Service	1972574085	1972574085	1	1	BRESLOW, ADAM DAVID	1/1/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60853	40	Pediatrics	0	In state provider	None	685 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.62788873	-117.0746104	San Diego County
36584	Fee-for-Service	1003085481	1003085481	1	1	BRUMMEL, KIRSTA L DO	4/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11590	None	None	0	In state provider	None	100 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90095	3075	19	06037	34.06489065	-118.4443287	Los Angeles County
36593	Fee-for-Service	1235284514	1235284514	1	1	BELLU, INNA	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
36603	Fee-for-Service	1558905174	1558905174	1	1	BOWDEN, ALEXAH C LMFT	2/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 E GARVEY AVE N	B2	WEST COVINA	CA	91791	1544	19	06037	34.07280989	-117.8995249	Los Angeles County
36616	Fee-for-Service	1477077816	1477077816	1	1	BRISTOL BAY HOLDINGS LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	76 FENTON ST	None	LIVERMORE	CA	94550	4144	01	06001	37.676853	-121.7834025	Alameda County
36619	Fee-for-Service	1235285214	1235285214	1	1	BARTHOLOMEW, SAMUEL V MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94877	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
36629	Fee-for-Service	1285813790	1285813790	1	1	BHATT, SANJAY A MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107513	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91773	3219	19	06037	34.20289797	-118.6294006	Los Angeles County
36632	Fee-for-Service	1417083734	1417083734	1	1	BINDA, TINA M LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1303 WEST WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
36661	Fee-for-Service	1336182229	1336182229	1	1	BURGDORFF, THOMAS R MD	1/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	31113	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
36667	Fee-for-Service	1154401941	1154401941	1	63	BASS MEDICAL GROUP	6/28/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	16360 MONTEREY ST	SUITE 280	MORGAN HILL	CA	95037	5453	43	06085	37.11781129	-121.6457012	Santa Clara County
36673	Fee-for-Service	1598280869	1598280869	2	1	BRITTAIN, ROBERT P LPCC	1/6/2022	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1231 8TH ST	STE 360	MODESTO	CA	95354	2235	50	06099	37.64160693	-121.0052759	Stanislaus County
36674	Fee-for-Service	1558657106	1558657106	1	1	BATTAGLIA, CHRISTINE L DO	7/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12492	None	None	0	In state provider	None	800 DELBON AVENUE	None	TURLOCK	CA	95382	2022	50	06099	37.51047152	-120.839499	Stanislaus County
36695	Fee-for-Service	1003562919	1003562919	1	1	BARRERA, CANDI	10/24/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	756 S DORA ST	None	UKIAH	CA	95482	5336	23	06045	39.14326994	-123.2109547	Mendocino County
36794	Fee-for-Service	1629247986	1629247986	1	1	BETZ, MARIAN E MD	7/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
36799	Fee-for-Service	1376690404	1376690404	1	1	BRENNER, GAIL F PHD	12/29/2003	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1031 MIRAMONTE DR	APT 3	SANTA BARBARA	CA	93109	1327	42	06083	34.40889062	-119.713942	Santa Barbara County
36820	Fee-for-Service	1982180121	1982180121	1	1	BONILLA, ELOISA LMFT	1/31/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2309 PACIFIC COAST	STE 202	HERMOSA BEACH	CA	90254	2751	19	06037	33.87101437	-118.3948248	Los Angeles County
36822	Fee-for-Service	1417152232	1417152232	1	1	BRODERICK, LORI MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106397	03	Allergy	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
36824	Fee-for-Service	1205991973	1205991973	1	1	BRICKER, SCOTT D MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90638	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
36827	Fee-for-Service	1851610976	1851610976	1	1	BURGART, ALYSSA M U MD	10/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131437	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
36837	Fee-for-Service	1396822193	1396822193	1	1	BEAUCHAMP, JON MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	53179	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
36845	Fee-for-Service	1659442697	1659442697	1	1	BOND, EMIO MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	47832	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
36855	Fee-for-Service	1568416311	1568416311	1	1	BORGESS MEDICAL CENTER	3/15/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1521 GULL RD	None	KALAMAZOO	MI	49001	1666	00	None	42.307947	-85.56021	Kalamazoo County
36860	Fee-for-Service	1154352011	1154352011	1	1	BRIDGES, DUANE E	2/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63954	None	None	0	In state provider	None	11633 HAWTHORNE BLVD	STE 400	HAWTHORNE	CA	90250	2321	19	06037	33.928488	-118.3527475	Los Angeles County
36883	Fee-for-Service	1508885088	1508885088	1	1	BOGHOSSIAN, NUBAR P MD	9/20/2005	207RH0003X	NA	Oncology	026	PHYSICIANS	88517	78	Neoplastic Diseases/Oncology	0	In state provider	None	222 W EULALIA ST	STE 100B	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
36884	Fee-for-Service	1992988422	1992988422	1	1	BOWDISH, MICHAEL E MD	10/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	71097	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06287152	-118.2029433	Los Angeles County
36935	Fee-for-Service	1871777664	1871777664	1	1	BRADSHAW, TONDA D DO INC	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6282	41	Internal Medicine	0	In state provider	None	35237 YUCAIPA BLVD	None	YUCAIPA	CA	92399	4340	36	06071	34.03383351	-117.0358111	San Bernardino County
36955	Fee-for-Service	1154401941	1154401941	1	63	BASS MEDICAL GROUP	6/28/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16360 MONTEREY ST	SUITE 280	MORGAN HILL	CA	95037	5453	43	06085	37.11781129	-121.6457012	Santa Clara County
36966	Fee-for-Service	1437933066	1437933066	1	1	BREAZELL, LASHANYA J BIRTH D	5/8/2024	171M00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
36972	Fee-for-Service	1154401941	1154401941	1	52	BASS MEDICAL GROUP	1/14/2021	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 LONE TREE WAY	None	BRENTWOOD	CA	94513	5256	07	06013	37.9617515	-121.730436	Contra Costa County
36979	Fee-for-Service	1003171661	1003171661	1	1	BORDER, DAVID J OD	12/8/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3301 E 12TH ST	STE 109	OAKLAND	CA	94601	2943	01	06001	37.77617499	-122.2247899	Alameda County
37003	Fee-for-Service	1598197121	1598197121	1	1	BARNES, CARLA	7/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
37006	Fee-for-Service	1689746208	1689746208	1	1	BAUTISTA RURAL MED CLIN	11/8/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2570 JENSEN AVE	STE 106	SANGER	CA	93657	2269	10	06019	36.70680647	-119.5736715	Fresno County
37013	Fee-for-Service	1386816528	1386816528	1	1	BITAR, JAMIL H MD	3/24/2010	207P00000X	NA	Other	026	PHYSICIANS	110772	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
37031	Fee-for-Service	1245621986	1245621986	1	1	BAN, NAM LAC	11/6/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	SUITE 201	GARDENA	CA	90247	3643	19	06037	33.8879044	-118.3111113	Los Angeles County
37037	Fee-for-Service	1063641348	1063641348	1	1	BOMMAN-SHIVASHANKER, SHIVANA	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	MD	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
37055	Fee-for-Service	1447340849	1447340849	1	1	BASS, LAWRENCE J MD INC	10/9/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	34793	07	Dermatology	0	In state provider	None	5340 ELVAS AVE	STE 600	SACRAMENTO	CA	95819	2385	34	06067	38.574819	-121.434867	Sacramento County
37059	Fee-for-Service	1033613039	1033613039	1	1	BELAI, BENJAMIN Z MD	7/7/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163570	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37068	Fee-for-Service	1982927505	1982927505	1	1	BLANCO, MARIA J LMFT	1/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
37073	Fee-for-Service	1134268881	1134268881	1	1	BARRY, MATTHEW J OD	7/15/2008	207L00000X	NA	Other	026	PHYSICIANS	8431	05	Anesthesiology	0	In state provider	None	616 E CHAPEL STREET	None	SANTA MARIA	CA	93454	0616	42	06083	34.95426953	-120.427596	Santa Barbara County
37075	Fee-for-Service	1073831079	1073831079	1	1	BUSH, KELLY A MD	1/7/2014	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	125141	40	Pediatrics	0	In state provider	None	207 W LEGION ST	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
37097	Fee-for-Service	1063417798	1063417798	1	1	BROCKMAN, LISA A DO	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8065	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
37110	Fee-for-Service	1205991973	1205991973	1	1	BRICKER, SCOTT D MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90638	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
37115	Fee-for-Service	1366890113	1366890113	1	2	BATTEN, ANNELISE M LMFT	8/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
37138	Fee-for-Service	1386720803	1386720803	1	1	BIRD, JAMES B MD	11/24/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52515	05	Anesthesiology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
37142	Fee-for-Service	1477565000	1477565000	1	1	BENBOW, CARMEL S	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
37151	Fee-for-Service	1568416311	1568416311	1	1	BORGESS MEDICAL CENTER	9/17/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1521 GULL RD	None	KALAMAZOO	MI	49001	1666	00	None	42.307947	-85.56021	Kalamazoo County
37160	Fee-for-Service	1124184601	1124184601	1	1	BARBUTA, CIPRIAN CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
37172	Fee-for-Service	1508885088	1508885088	1	1	BOGHOSSIAN, NUBAR P MD	9/20/2005	207RH0003X	NA	Oncology	026	PHYSICIANS	88517	68	Hematology	0	In state provider	None	222 W EULALIA ST	STE 100B	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
37174	Fee-for-Service	1629432612	1629432612	1	1	BEUTNER, MATTHEW R MD	9/23/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	157964	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
37203	Fee-for-Service	1154581247	1154581247	1	1	BENAVIDEZ-KNIGHT,	8/24/2009	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	TUESDAY M CNM	6632 STANLEY AVE	None	CARMICHAEL	CA	95608	3952	34	06067	38.621772	-121.3106625	Sacramento County
37204	Fee-for-Service	1760772073	1760772073	1	1	BATTER, BRENT K LMFT	11/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
37221	Fee-for-Service	1023694288	1023694288	1	1	BALTAZAR, STEPHANIE OT	8/4/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
37233	Fee-for-Service	1063020329	1063020329	1	1	BROOKE & SIMM INC	3/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6885 CEDAR CREEK RD	None	CORONA	CA	92880	8805	33	06065	33.96312159	-117.5800288	Riverside County
37253	Fee-for-Service	1154401941	1154401941	1	52	BASS MEDICAL GROUP	1/14/2021	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	6600 LONE TREE WAY	None	BRENTWOOD	CA	94513	5256	07	06013	37.9617515	-121.730436	Contra Costa County
37255	Fee-for-Service	1134239353	1134239353	1	1	BAGHOUMIAN, HAMLET MD	6/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70293	41	Internal Medicine	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
37272	Fee-for-Service	1952583155	1952583155	1	1	BOYDSTUN, ANA M LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
37278	Fee-for-Service	1710545421	1710545421	1	1	BRIGHT LIFE HOME HEALTH	5/18/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	26000 SPRINGBROOK AVE	STE 107	SANTA CLARITA	CA	91350	2590	19	06037	34.414992	-118.539162	Los Angeles County
37284	Fee-for-Service	1437150224	1437150224	1	1	BACHMAN, BARBARA A. MD	10/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2940 SQUALICUM PKWY	STE 101	BELLINGHAM	WA	98225	1892	00	None	48.77213785	-122.4744557	Whatcom County
37294	Fee-for-Service	1689746208	1689746208	1	1	BAUTISTA RURAL MED CLIN	11/8/2000	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2570 JENSEN AVE	STE 106	SANGER	CA	93657	2269	10	06019	36.70680647	-119.5736715	Fresno County
37302	Fee-for-Service	1396958062	1396958062	1	1	BHULLER, KOMALPREET K MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105947	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
37337	Fee-for-Service	1043261936	1043261936	1	1	BAN, VU Q MD	10/15/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34606	08	Family Practice	0	In state provider	None	14571 MAGNOLIA ST	STE 106	WESTMINSTER	CA	92683	5575	30	06059	33.75097286	-117.9723502	Orange County
37345	Fee-for-Service	1073546966	1073546966	1	1	BARTON, PAUL C MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85054	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3350 W BALL RD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
37354	Fee-for-Service	1699152454	1699152454	1	1	BANIK, GRACE L MD	10/12/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	182376	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37355	Fee-for-Service	1043221781	1043221781	1	2	BARBA, RIGOBERTO MD	7/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48752	None	None	0	In state provider	None	608 COTTONWOOD ST	None	WOODLAND	CA	95695	3615	57	06113	38.67351395	-121.7933438	Yolo County
37367	Fee-for-Service	1619159639	1619159639	1	1	BURCHETT IV, LAWRENCE R	3/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101752	None	None	0	In state provider	MD	2500 ALHAMBRA AVENUE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
37414	Fee-for-Service	1902858343	1902858343	1	1	BRIGHAM, ALFONSO L MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	48631	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
37429	Fee-for-Service	1457314452	1457314452	1	1	BRISCO, ELISE OD	5/26/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	HOLLYWOOD VISION CNTR	955 CARRILLO DR	STE 105	LOS ANGELES	CA	90048	5400	19	06037	34.05972732	-118.368048	Los Angeles County
37465	Fee-for-Service	1144999004	1144999004	1	1	BLOOM COUNSELING AND CONSULT	9/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ING, INC	19772 MACARTHUR BLVD	SUITE 200	IRVINE	CA	92612	2413	30	06059	33.65624304	-117.8623446	Orange County
37470	Fee-for-Service	1639164197	1639164197	1	1	BRIDGNELL, ERIC J MD	3/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89064	None	None	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
37494	Fee-for-Service	1457301038	1457301038	1	1	BRENDA SOMMERDORF MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 S MAPLE ST	None	WACONIA	MN	55387	1791	00	None	44.843139	-93.79078701	Carver County
37542	Fee-for-Service	1154401941	1154401941	1	52	BASS MEDICAL GROUP	1/14/2021	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	6600 LONE TREE WAY	None	BRENTWOOD	CA	94513	5256	07	06013	37.9617515	-121.730436	Contra Costa County
37550	Fee-for-Service	1437387198	1437387198	1	1	BOAZ, SAMMANTHA L NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37558	Fee-for-Service	1609887611	1609887611	1	1	BUCKLEY, JULIE A MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63276	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
37565	Fee-for-Service	1386687754	1386687754	1	1	BLACKMAN, DONALD M MD	2/22/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	11052	41	Internal Medicine	0	In state provider	None	4000 14TH ST	STE 302	RIVERSIDE	CA	92501	4018	33	06065	33.97771007	-117.3818381	Riverside County
37579	Fee-for-Service	1598884843	1598884843	1	1	BAHMANI, PARVANEH MD INC	4/17/2007	207RN0300X	NA	Nephrology	026	PHYSICIANS	81644	41	Internal Medicine	0	In state provider	None	8631 W 3RD ST BLVD	STE 1140E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
37656	Fee-for-Service	1457582488	1457582488	1	1	BRADFORD, KARA M MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114522	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
37681	Fee-for-Service	1023136702	1023136702	1	1	BROMBERG, JENNIFER D	6/18/2012	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
37702	Fee-for-Service	1821364241	1821364241	1	1	BESTERMAN, AARON D MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126809	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
37726	Fee-for-Service	1538417381	1538417381	1	1	BALLOW, SHANA L DO INC	10/5/2012	2086S0127X	NA	General Surgery	026	PHYSICIANS	10299	02	General Surgery	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
37741	Fee-for-Service	1689779597	1689779597	1	1	BEN-ISAAC, EYAL MD	7/1/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70134	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
37753	Fee-for-Service	1043785892	1043785892	1	1	BRIGHT INTERNATIONAL ENTERPR	2/19/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	PORT	3550 WATT AVE.	130-2	SACRAMENTO	CA	95821	2667	34	06067	38.630115	-121.3819245	Sacramento County
37784	Fee-for-Service	1962787366	1962787366	1	1	BILLINGTON, KATHERINE S CRNA	10/14/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	286 EUCLID AVE	STE 109	SAN DIEGO	CA	92114	3611	37	06073	32.70706919	-117.0850896	San Diego County
37798	Fee-for-Service	1295089902	1295089902	1	1	BRENUM, ELIZABETH	5/20/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
37803	Fee-for-Service	1093276131	1093276131	1	1	BENJAMIN, TANIA MD	5/31/2024	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	180709	84	Surgery-Head and Neck	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
37804	Fee-for-Service	1558667485	1558667485	1	1	BLIZE HEALTHCARE CALIFORNIA	2/10/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	750 ALFRED NOBEL DRIVE	SUITE 204	HERCULES	CA	94547	1836	07	06013	38.02012843	-122.2751657	Contra Costa County
37805	Fee-for-Service	1497101380	1497101380	1	1	BENNETT, CHRISTOPHER L MD	7/21/2020	207P00000X	NA	Other	026	PHYSICIANS	168772	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37878	Fee-for-Service	1598884843	1598884843	1	1	BAHMANI, PARVANEH MD INC	4/17/2007	207RN0300X	NA	Nephrology	026	PHYSICIANS	81644	45	Nephrology (Renal-Kidney)	0	In state provider	None	8631 W 3RD ST BLVD	STE 1140E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
37897	Fee-for-Service	1689993396	1689993396	1	1	BALDUZZI, KRYSTLE M MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135900	40	Pediatrics	0	In state provider	None	2505 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
37903	Fee-for-Service	1891893657	1891893657	1	1	BAHU BAUGH, NAJWA MD	3/21/2024	207R00000X	NA	Other	026	PHYSICIANS	171107	41	Internal Medicine	0	In state provider	None	5 LOWER RAGSDALE DR	100	MONTEREY	CA	93940	5817	27	06053	36.57544273	-121.8164209	Monterey County
37920	Fee-for-Service	1275868721	1275868721	1	1	BISCHOFF, KARA E MD	5/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117106	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37936	Fee-for-Service	1225219702	1225219702	1	1	BUI, TRUNG D MD	1/14/2011	208600000X	NA	General Surgery	026	PHYSICIANS	85488	02	General Surgery	0	In state provider	None	2220 LYNN RD	STE 102	THOUSAND OAKS	CA	91360	8000	56	06111	34.20863046	-118.8852156	Ventura County
37956	Fee-for-Service	1700874286	1700874286	1	1	BLACKHART, BRUCE A MD	10/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65918	08	Family Practice	0	In state provider	None	1425 W H ST	STE #200	OAKDALE	CA	95361	3588	50	06099	37.75771796	-120.8627767	Stanislaus County
37990	Fee-for-Service	1821364241	1821364241	1	1	BESTERMAN, AARON D MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126809	26	Psychiatry (child)	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
38008	Fee-for-Service	1578547105	1578547105	1	1	BUI, MATTHEW H MD	4/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71651	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
38010	Fee-for-Service	1154426179	1154426179	1	1	BERNARDO, MARINETTE G MD	6/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96571	41	Internal Medicine	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
38014	Fee-for-Service	1124349402	1124349402	1	1	BEAMER, BRANDON S MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135946	20	Orthopedic Surgery	0	In state provider	None	5137 GOLDEN FOOTHILLS	PARKWAY STE 120	EL DORADO HILLS	CA	95762	5137	09	06017	38.63972246	-121.0689815	El Dorado County
38047	Fee-for-Service	1396926754	1396926754	1	2	BEIT T'SHUVAH	10/31/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8831 VENICE BLVD	None	LOS ANGELES	CA	90034	3223	19	06037	34.03056062	-118.3863512	Los Angeles County
38084	Fee-for-Service	1770349078	1770349078	1	1	BRIGHT BALANCE INC	3/5/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10517 OAK CREEK DR	None	LAKESIDE	CA	92040	1624	37	06073	32.8688524	-116.9434852	San Diego County
38099	Fee-for-Service	1073773545	1073773545	1	1	BUTLER, TANITA B CNP	4/7/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16773 BERNARDO CENTER DR	None	SAN DIEGO	CA	92128	2525	37	06073	33.01874412	-117.0752752	San Diego County
38116	Fee-for-Service	1023081387	1023081387	2	1	BUI, LOC DAC MD	12/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	50198	41	Internal Medicine	0	In state provider	None	8900 BOLSA AVENUE	SUITE B	WESTMINSTER	CA	92683	5475	30	06059	33.74480556	-117.9740439	Orange County
38187	Fee-for-Service	1497855258	1497855258	1	1	BARTHOLOMEW, KARLOTTA L PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
38192	Fee-for-Service	1114210457	1114210457	1	1	BABUGLIA, SILVANA L LMFT	2/3/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
38211	Fee-for-Service	1306965942	1306965942	1	1	BARKER, AMANDA S MD	10/19/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	107071	25	Physical Medicine and Rehabilitation	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
38242	Fee-for-Service	1295815280	1295815280	2	1	BIRNBAUM, PETER S DO INC	12/23/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1211 WEST LA PALMA AVE	SUITE # 506	ANAHEIM	CA	92801	9280	30	06059	33.84718298	-117.933758	Orange County
38243	Fee-for-Service	1851826333	1851826333	1	1	BESADA, STEFAN MD	3/17/2021	207L00000X	NA	Other	026	PHYSICIANS	161593	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
38270	Fee-for-Service	1750329975	1750329975	1	1	BADEN, RACHEL P MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138444	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
38271	Fee-for-Service	1265745731	1265745731	1	1	BHARADWAJ, SUSHMA N MD	6/16/2021	207R00000X	NA	Other	026	PHYSICIANS	168707	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38286	Fee-for-Service	1174720072	1174720072	1	1	BAY HORIZON INC	4/7/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	516 OCEAN VIEW AVE	None	SAN MATEO	CA	94401	3029	41	06081	37.5728967	-122.3063198	San Mateo County
38326	Fee-for-Service	1306556980	1306556980	1	1	BLAKE UNRUH, AMANDA C BIRTH	1/3/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
38349	Fee-for-Service	1629182175	1629182175	2	1	BUTTRICK, PETER M MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
38351	Fee-for-Service	1508911892	1508911892	1	34	BAY AREA FOOT CARE, INC	9/19/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3031 W MARCH LANE	SUITE 310E	STOCKTON	CA	95219	6525	39	06077	37.9842796	-121.3494311	San Joaquin County
38382	Fee-for-Service	1003232976	1003232976	1	1	BANNER HEALTH	2/27/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1800 E FLORENCE BLVD	None	CASA GRANDE	AZ	85122	5303	00	None	32.881311	-111.7096155	Pinal County
38392	Fee-for-Service	1912529272	1912529272	1	1	BATTLE, SHALA M	7/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
38395	Fee-for-Service	1669907168	1669907168	1	1	BRANTING, ANDREW J MD	9/18/2020	207P00000X	NA	Other	026	PHYSICIANS	157717	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
38464	Fee-for-Service	1801939871	1801939871	1	1	BALOGA, DAVID M MD	11/27/1985	207L00000X	NA	Other	026	PHYSICIANS	44015	05	Anesthesiology	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
38470	Fee-for-Service	1205974482	1205974482	1	2	BAART BEHAVIORAL HEALTH SERV	2/17/2004	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1646 SOUTH COURT ST	None	VISALIA	CA	93277	4962	54	06107	36.315774	-119.2913235	Tulare County
38527	Fee-for-Service	1891853917	1891853917	1	1	BROWN, JEFFREY H	9/15/1984	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1175 BAKER ST	# 16	COSTA MESA	CA	92626	4101	30	06059	33.68010451	-117.906543	Orange County
38529	Fee-for-Service	1336145531	1336145531	1	1	BRUNO, ANTHONY J MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
38552	Fee-for-Service	1003091562	1003091562	1	1	BIERDRAGER-SALLEY, CHRISTINE	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17704	-	NOT APPLICABLE	0	In state provider	N PHD	1963 N EAST STREET	None	SAN BERNARDINO	CA	92405	3919	36	06071	34.133193	-117.294134	San Bernardino County
38554	Fee-for-Service	1750329975	1750329975	1	1	BADEN, RACHEL P MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138444	77	Infectious Disease	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
38555	Fee-for-Service	1154984417	1154984417	1	1	BOLO, KYLE A MD	6/8/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	181420	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
38561	Fee-for-Service	1033266275	1033266275	1	1	BROWN PHYSICAL THERAPY INC	4/17/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	13071 BROOKHURST ST	SUITE 110	GARDEN GROVE	CA	92843	1047	30	06059	33.77319252	-117.9551609	Orange County
38571	Fee-for-Service	1245349620	1245349620	1	1	BENNETT, JEFFREY L MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
38603	Fee-for-Service	1205218443	1205218443	1	1	BRACKEN, DAVID J MD	5/19/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	150836	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
38638	Fee-for-Service	1629182175	1629182175	2	1	BUTTRICK, PETER M MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
38641	Fee-for-Service	1225286941	1225286941	1	1	BAIG, SAMIR M MD	3/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149671	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.715035	-117.936993	Orange County
38644	Fee-for-Service	1518045376	1518045376	1	1	BHAKTA, YOGESH V MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81365	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
38670	Fee-for-Service	1003232976	1003232976	1	1	BANNER HEALTH	2/27/2014	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1800 E FLORENCE BLVD	None	CASA GRANDE	AZ	85122	5303	00	None	32.881311	-111.7096155	Pinal County
38677	Fee-for-Service	1154401941	1154401941	1	13	BASS MEDICAL GROUP	2/25/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2222 EAST ST	STE 300	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
38680	Fee-for-Service	1487681342	1487681342	1	1	BAXTER, BLAISE W MD	10/13/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171504	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
38683	Fee-for-Service	1669907168	1669907168	1	1	BRANTING, ANDREW J MD	9/18/2020	207P00000X	NA	Other	026	PHYSICIANS	157717	70	Clinic (mixed specialty)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
38689	Fee-for-Service	1508496720	1508496720	1	1	BRADY, KRISTY D CCC-SLP	6/13/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
38724	Fee-for-Service	1528265402	1528265402	1	1	BORROMEO, CARMELA F PT	8/2/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3401 SOUTH HARBOR BLVD	None	SANTA ANA	CA	92704	7933	30	06059	33.701166	-117.9194305	Orange County
38761	Fee-for-Service	1952415846	1952415846	1	1	BEHROOZI, SAEID MD	8/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93161	41	Internal Medicine	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
38776	Fee-for-Service	1538211834	1538211834	1	1	BIRTH CENTER, A NURSING	9/1/1999	261QB0400X	NA	Freestanding Birth Center	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	CORPORATION	5440 LAUREL HILLS DR	None	FAIR OAKS	CA	95841	3106	34	06067	38.661714	-121.337991	Sacramento County
38786	Fee-for-Service	1942271309	1942271309	1	1	BARNHILL, RAYMOND L MD	1/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52212	07	Dermatology	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
38794	Fee-for-Service	1568479756	1568479756	1	1	BHALLA, NAINA MD	12/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115110	40	Pediatrics	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
38847	Fee-for-Service	1033266275	1033266275	1	1	BROWN PHYSICAL THERAPY INC	4/17/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13071 BROOKHURST ST	SUITE 110	GARDEN GROVE	CA	92843	1047	30	06059	33.77319252	-117.9551609	Orange County
38854	Fee-for-Service	1629364112	1629364112	1	1	BEASLEY, KNOX J MD	10/25/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	176443	None	None	0	In state provider	None	6605 NANCY RIDGE DR	None	SAN DIEGO	CA	92121	2253	37	06073	32.88682438	-117.1796133	San Diego County
38876	Fee-for-Service	1790774990	1790774990	1	1	BURLESON, MICHAEL N MD	7/15/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32657	01	General Practice	0	In state provider	None	3115 G ST	None	EUREKA	CA	95503	5301	12	06023	40.78022422	-124.1624258	Humboldt County
38880	Fee-for-Service	1518937747	1518937747	1	1	BELL, KELLY L LMFT	10/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	G AND CONFLICT RESOLUTIO	5250 CLAREMONT AVE	229	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
38909	Fee-for-Service	1467475608	1467475608	1	1	BARRIO, JUAN C MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67407	41	Internal Medicine	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 100	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
38915	Fee-for-Service	1043337272	1043337272	1	1	BRETT PINKNEY, MPT & ASSOCIA	5/4/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	588 NORTH SUNRISE AVENUE	SUITE 100	ROSEVILLE	CA	95661	2843	31	06061	38.7585915	-121.2527015	Placer County
38940	Fee-for-Service	1659527695	1659527695	1	1	BLAKE, PARISSA LMFT	11/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
38965	Fee-for-Service	1154401941	1154401941	1	13	BASS MEDICAL GROUP	2/25/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	2222 EAST ST	STE 300	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
39028	Fee-for-Service	1063721462	1063721462	1	1	BROWN, STEFANIE M LMFT	2/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5400 VIA CARRIZO	UNIT B	LAGUNA WOODS	CA	92637	3601	30	06059	33.60828294	-117.7418212	Orange County
39041	Fee-for-Service	1699821553	1699821553	1	1	BHAT, SHALINI MD	5/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103189	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
39069	Fee-for-Service	1942271309	1942271309	1	1	BARNHILL, RAYMOND L MD	1/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52212	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
39083	Fee-for-Service	1568479756	1568479756	1	1	BHALLA, NAINA MD	12/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115110	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
39110	Fee-for-Service	1184150435	1184150435	1	1	BOZHILOV, KLIMENT K MD	8/26/2022	208600000X	NA	General Surgery	026	PHYSICIANS	180527	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39127	Fee-for-Service	1508115841	1508115841	1	1	BURNS, AILEEN M PA	8/16/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	54514	-	NOT APPLICABLE	0	In state provider	None	2107 1ST STREET	None	EUREKA	CA	95501	0840	12	06023	40.80718153	-124.14897	Humboldt County
39160	Fee-for-Service	1598905754	1598905754	1	1	BRYANT L VUONG	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2776 CLEVELAND AVE	None	FORT MYERS	FL	33901	5864	00	None	26.628237	-81.873945	Lee County
39175	Fee-for-Service	1932678323	1932678323	1	1	BIBRIESCA, JONATHAN LCSW	1/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
39184	Fee-for-Service	1649620063	1649620063	1	1	BACH, LINDSAY M MD	12/17/2023	208600000X	NA	General Surgery	026	PHYSICIANS	155391	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
39185	Fee-for-Service	1801240718	1801240718	1	1	BERRY, BRYAN J MD	6/25/2019	207R00000X	NA	Other	026	PHYSICIANS	152525	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
39203	Fee-for-Service	1326130568	1326130568	1	1	BELL, MARISA K MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91186	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
39210	Fee-for-Service	1629507207	1629507207	1	1	BEHNAMFAR, OMID MD	7/14/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169355	None	None	0	In state provider	None	2800 L ST	STE 10	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
39218	Fee-for-Service	1851869440	1851869440	1	1	BILLINGS, CRYSTAL	2/20/2019	224Z00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11151 SUN CENTER DR	C	RANCHO CORDOVA	CA	95670	6148	34	06067	38.596023	-121.2693075	Sacramento County
39229	Fee-for-Service	1508911892	1508911892	1	15	BAY AREA FOOT CARE, INC	1/5/2023	213ES0000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2925 SPAFFORD ST	SUITE A	DAVIS	CA	95618	6808	57	06113	38.55217149	-121.713617	Yolo County
39235	Fee-for-Service	1760794143	1760794143	1	1	BIMSON, BRIANNE E MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142438	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
39239	Fee-for-Service	1770016735	1770016735	1	1	BURCIAGA CALDERONI, CONSTANZ	8/2/2021	208M00000X	NA	Other	026	PHYSICIANS	157013	None	None	0	In state provider	A MD	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
39251	Fee-for-Service	1790456838	1790456838	1	1	BASS, AYESHA LCSW	1/21/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
39263	Fee-for-Service	1306042676	1306042676	1	1	BAJAJ, TARUN I MD	10/4/2013	208600000X	NA	General Surgery	026	PHYSICIANS	126734	None	None	0	In state provider	None	1033 LOS PALOS	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
39279	Fee-for-Service	1417915729	1417915729	1	1	BURI, MARKUS OD	10/2/1986	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	731 E FLORIDA AVE	None	HEMET	CA	92543	4337	33	06065	33.7475127	-116.9643533	Riverside County
39302	Fee-for-Service	1376597609	1376597609	1	1	BROWN, KEVIN E MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84486	08	Family Practice	0	In state provider	None	1423 MAGNOLIA	None	CHICO	CA	95926	3226	04	06007	39.74063551	-121.8499048	Butte County
39337	Fee-for-Service	1346496486	1346496486	1	1	BUCKALEW, ELIZABETH A DO	12/1/2022	207P00000X	NA	Other	026	PHYSICIANS	20391	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
39340	Fee-for-Service	1982444741	1982444741	1	1	BANKS, LARAE R DOULA	4/18/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
39350	Fee-for-Service	1780248633	1780248633	1	1	BOUMOULA, KENZA LMFT	9/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
39367	Fee-for-Service	1730616277	1730616277	1	1	BLUMENTHAL, SARAH R MD	9/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	185962	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
39387	Fee-for-Service	1285780718	1285780718	1	1	BROWN, WENDY E MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93452	13	Neurology (M.D. only)	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
39390	Fee-for-Service	1497710271	1497710271	1	1	BHATT, JAGDISH S MD	7/16/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	43333	40	Pediatrics	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
39393	Fee-for-Service	1386935393	1386935393	1	1	BARLAVI, LEAH MD	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112434	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
39448	Fee-for-Service	1871935601	1871935601	1	1	BALASUBRAMANIAN, RINA P MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132769	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
39449	Fee-for-Service	1710372180	1710372180	1	1	BARNETT, CHRISTINE LMFT	3/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
39459	Fee-for-Service	1477708709	1477708709	1	1	BINDER, SHIRLEY LMFT	7/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
39491	Fee-for-Service	1326130568	1326130568	1	1	BELL, MARISA K MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91186	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
39512	Fee-for-Service	1558387837	1558387837	1	1	BARTON, CYNTHIA F NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
39516	Fee-for-Service	1508911892	1508911892	1	15	BAY AREA FOOT CARE, INC	7/25/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2925 SPAFFORD ST	SUITE A	DAVIS	CA	95618	6808	57	06113	38.55217149	-121.713617	Yolo County
39521	Fee-for-Service	1508911892	1508911892	1	18	BAY AREA FOOT CARE, INC	6/13/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	400 CARLTON AVE	SUITE 200	LOS GATOS	CA	95032	2629	43	06085	37.24728836	-121.9514527	Santa Clara County
39527	Fee-for-Service	1942538004	1942538004	1	1	BIRBIGLIA, BRYAN PT	8/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
39601	Fee-for-Service	1437513199	1437513199	1	1	BERRIGAN, WILLIAM A MD	8/24/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	181065	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
39602	Fee-for-Service	1851374565	1851374565	1	1	BULLEN, THOMAS A MD	8/31/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60550	None	None	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
39627	Fee-for-Service	1346458643	1346458643	1	1	BRIAN P. RECTOR, CHIROPRACTI	11/11/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	C, INC.	2511 GARDEN RD.	C-100	MONTEREY	CA	93940	5333	27	06053	36.58615449	-121.8533458	Monterey County
39643	Fee-for-Service	1770549131	1770549131	1	2	BERTRAM, LYNN D	11/13/2020	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	50679	-	NOT APPLICABLE	0	In state provider	None	4645 PACHECO AVE	None	MARTINEZ	CA	94553	3625	07	06013	38.00367595	-122.0848185	Contra Costa County
39658	Fee-for-Service	1194736983	1194736983	1	1	BURSON, LESLIE R DO	12/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	5701	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
39683	Fee-for-Service	1114940731	1114940731	1	1	BRONSTEIN, JEFF M MD	11/30/1991	2084N0400X	NA	Neurology	026	PHYSICIANS	67890	13	Neurology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
39690	Fee-for-Service	1548837248	1548837248	1	1	BURSCH, ROBYN W PT	1/31/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
39716	Fee-for-Service	1053650440	1053650440	1	1	BEJANIAN, GEGAM D	1/14/2021	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ORTATION	1153 N BRAND BLVD	103	GLENDALE	CA	91202	2503	19	06037	34.16346	-118.2550895	Los Angeles County
39760	Fee-for-Service	1528137916	1528137916	1	1	BUSTO, CARLA J MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84487	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
39805	Fee-for-Service	1043393564	1043393564	1	1	BURGER, ROBERT A MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73145	78	Neoplastic Diseases/Oncology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
39817	Fee-for-Service	1265572903	1265572903	1	1	BROOKDALE MEDICA CENTER	12/5/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	2809 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5538	19	06037	33.94599284	-118.2211199	Los Angeles County
39832	Fee-for-Service	1689132110	1689132110	1	1	BRIGHT STAR HOME HEALTH CARE	9/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	150 E OLIVE AVE	STE 306	BURBANK	CA	91502	1850	19	06037	34.18064474	-118.3089507	Los Angeles County
39838	Fee-for-Service	1174572986	1174572986	1	1	BELISSARY, MEROPE N MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67536	08	Family Practice	0	In state provider	None	1329 SPANOS CT	STE B4	MODESTO	CA	95355	2806	50	06099	37.66976149	-120.9731145	Stanislaus County
39845	Fee-for-Service	1720099526	1720099526	1	1	BARBANT, SOPHIE D MD	2/1/2001	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56398	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3801 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
39921	Fee-for-Service	1336290113	1336290113	1	1	BALBAY, LEVON PT	4/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
39944	Fee-for-Service	1891710919	1891710919	1	1	BRAR, GURMAIL S MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63688	08	Family Practice	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
39980	Fee-for-Service	1588399844	1588399844	1	1	BICHIR, SARAH LPCC	1/27/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	700 N CENTRAL AVE STE 34	None	GLENDALE	CA	91203	4238	19	06037	34.15708991	-118.2579615	Los Angeles County
39998	Fee-for-Service	1902814080	1902814080	1	1	BUTLER, DENNIS M MD	7/2/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	66072	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
40005	Fee-for-Service	1487944575	1487944575	1	1	BIDLINGMEYER, NICOLETTE J LC	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	69525	-	NOT APPLICABLE	0	In state provider	None	710 E 111TH PLACE	None	LOS ANGELES	CA	90059	1518	19	06037	33.93454026	-118.2626368	Los Angeles County
40062	Fee-for-Service	1194506337	1194506337	1	1	BLESSED WELLNESS MENTAL HEAL	1/31/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	TH NURSING SERVICES IN	10501 S WESTERN AVE	UNIT B	LOS ANGELES	CA	90047	4458	19	06037	33.940845	-118.3090555	Los Angeles County
40080	Fee-for-Service	1831260801	1831260801	1	1	BALL, JAY M MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	45137	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
40093	Fee-for-Service	1043393564	1043393564	1	1	BURGER, ROBERT A MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73145	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
40097	Fee-for-Service	1851455315	1851455315	1	1	BONGIOVANNI, CATHERINE A	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
40108	Fee-for-Service	1265572903	1265572903	1	1	BROOKDALE MEDICA CENTER	12/5/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	2809 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5538	19	06037	33.94599284	-118.2211199	Los Angeles County
40114	Fee-for-Service	1578553046	1578553046	1	1	BURKE, BRIAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST LUKES EPISCOPAL HOSP	6720 BERTNER AVE	None	HOUSTON	TX	77030	0000	00	None	29.70858606	-95.39916179	Harris County
40128	Fee-for-Service	1003337858	1003337858	1	1	BOLAND, WILLIAM K MD	7/7/2021	207PE0004X	NA	Other	026	PHYSICIANS	170193	None	None	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
40130	Fee-for-Service	1720099526	1720099526	1	1	BARBANT, SOPHIE D MD	2/1/2001	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56398	41	Internal Medicine	0	In state provider	None	3801 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
40171	Fee-for-Service	1427528868	1427528868	1	1	BALLARD, APRIL M PSYD	2/15/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
40172	Fee-for-Service	1316371818	1316371818	1	1	BUCKLEY, MICHELLE M LCSW	10/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	64164	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	#223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
40194	Fee-for-Service	1740423870	1740423870	1	1	BRUNNER, JOHN F MD	10/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126650	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
40220	Fee-for-Service	1235419342	1235419342	1	1	BANKA, LORI P DO	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12541	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
40228	Fee-for-Service	1801141775	1801141775	1	1	BALL, AMANDA A	9/20/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
40233	Fee-for-Service	1134295132	1134295132	1	1	BAEZ, ALFONSO M MD	6/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35887	36	Psychiatry	0	In state provider	None	14127 S VERMONT AVE	None	GARDENA	CA	90247	2205	19	06037	33.9030225	-118.29201	Los Angeles County
40235	Fee-for-Service	1730704909	1730704909	1	1	BERZINS, DAINIS A DO	7/22/2023	207P00000X	NA	Other	026	PHYSICIANS	20689	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
40236	Fee-for-Service	1568520526	1568520526	1	1	BAUHOFER, JANENE L	9/1/1996	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11775 EDUCATION ST	STE 102	AUBURN	CA	95602	2453	31	06061	38.94431947	-121.0999275	Placer County
40239	Fee-for-Service	1134147986	1134147986	1	1	BRIDGEMAN, DAVID A MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67370	01	General Practice	0	In state provider	None	1035 SOUTH MAIN ST	None	FALLBROOK	CA	92028	3338	37	06073	33.373188	-117.2515065	San Diego County
40256	Fee-for-Service	1629311469	1629311469	1	1	BELCHER, HEATHER O MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135435	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
40258	Fee-for-Service	1013464767	1013464767	1	1	BENNETT, PATRICIA B LMFT	2/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	5947	30	06059	33.713937	-117.9892085	Orange County
40273	Fee-for-Service	1376707901	1376707901	1	1	BATES, DARRYL A MD	7/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	73385	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
40279	Fee-for-Service	1184661910	1184661910	1	1	BOND, BARBARA NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
40311	Fee-for-Service	1023109352	1023109352	1	1	BEILIN, NATASHA MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78634	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
40328	Fee-for-Service	1619934643	1619934643	1	1	BASH, ISAAC MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62981	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
40345	Fee-for-Service	1174555882	1174555882	1	1	BUI, KIM CHI T MD	7/1/1996	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	45053	01	General Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
40362	Fee-for-Service	1407913072	1407913072	1	1	BONAL, KATHLEEN A PHD	8/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
40367	Fee-for-Service	1831260801	1831260801	1	1	BALL, JAY M MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	45137	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
40373	Fee-for-Service	1760912083	1760912083	1	1	BENEFIELD, LARA N LMFT	8/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	244 CALIFORNIA	STE 300	SAN FRANCISCO	CA	94111	4302	38	06075	37.79331375	-122.3995607	San Francisco County
40387	Fee-for-Service	1497781355	1497781355	1	1	BAKER, PHILLIP D. MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
40388	Fee-for-Service	1578561692	1578561692	1	1	BUSHMAN, ROBERT E MD	4/18/1978	207N00000X	NA	Dermatology	026	PHYSICIANS	27334	07	Dermatology	0	In state provider	None	1260 15TH ST	STE 808	SANTA MONICA	CA	90404	1143	19	06037	34.02648965	-118.4867439	Los Angeles County
40391	Fee-for-Service	1881082519	1881082519	1	1	BECK, NATALIE MD	8/1/2022	390200000X	NA	Other	026	PHYSICIANS	178156	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
40410	Fee-for-Service	1952872459	1952872459	1	1	BACKUS, WAYNE LCSW	12/2/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
40452	Fee-for-Service	1417061797	1417061797	1	1	BAWA, JASVINDER MD	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102414	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
40473	Fee-for-Service	1437880507	1437880507	1	1	BULLO LLC	10/17/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6533 BELLHURST LN	None	CASTRO VALLEY	CA	94552	1653	01	06001	37.73250965	-122.0575888	Alameda County
40495	Fee-for-Service	1689627580	1689627580	1	1	BENGTSSON, BENGT-OLA MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63091	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
40502	Fee-for-Service	1124063060	1124063060	1	1	BALUCAN, JENNIFER P MD	1/13/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	86854	40	Pediatrics	0	In state provider	None	403 WEST ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
40523	Fee-for-Service	1134295132	1134295132	1	1	BAEZ, ALFONSO M MD	6/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35887	01	General Practice	0	In state provider	None	14127 S VERMONT AVE	None	GARDENA	CA	90247	2205	19	06037	33.9030225	-118.29201	Los Angeles County
40553	Fee-for-Service	1891731360	1891731360	1	1	BUSRACAMWONGS, ATICHAT	8/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71490	05	Anesthesiology	0	In state provider	MD	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
40556	Fee-for-Service	1356804884	1356804884	1	1	BONU MOCHUNGONG, TAFOR N MD	12/30/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180733	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
40563	Fee-for-Service	1376707901	1376707901	1	1	BATES, DARRYL A MD	7/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	73385	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
40571	Fee-for-Service	1538949029	1538949029	1	1	BOWER, NOEMI NP	1/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1981 N BROADWAY	SUITE 190	WALNUT CREEK	CA	94596	3671	07	06013	37.90582392	-122.0613697	Contra Costa County
40613	Fee-for-Service	1619934643	1619934643	1	1	BASH, ISAAC MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62981	08	Family Practice	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
40644	Fee-for-Service	1023269891	1023269891	1	1	BALINOS, FEBBIS V MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105450	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
40647	Fee-for-Service	1013057223	1013057223	1	1	BAXTER, JANE H	12/31/1983	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
40656	Fee-for-Service	1003924663	1003924663	1	1	BYNUM, JASON P MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82696	26	Psychiatry (child)	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
40667	Fee-for-Service	1063403707	1063403707	1	1	BOOHAR, LISA MD	12/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70556	32	Radiation Therapy (D.O. only)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
40669	Fee-for-Service	1922528744	1922528744	1	1	BRISKIN, JAMIE E LCSW	10/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
40671	Fee-for-Service	1144330069	1144330069	1	1	BENDAVID, ERAN MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89110	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
40691	Fee-for-Service	1871586271	1871586271	1	1	BLACKLEDGE, PATRICIA L NP	5/18/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
40695	Fee-for-Service	1700381639	1700381639	1	1	BRUNS, ELIZABETH B MD	2/2/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164277	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
40747	Fee-for-Service	1972990067	1972990067	1	2	BOBO, MICHELLE LCSW	9/25/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
40758	Fee-for-Service	1639181852	1639181852	1	1	BAKER, CATHERINE A MD	12/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81595	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
40775	Fee-for-Service	1275626228	1275626228	1	1	BESEM, SEYMOUR OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	998 S ROBERTSON BLVD	STE 204	LOS ANGELES	CA	90035	1638	19	06037	34.05974497	-118.3835974	Los Angeles County
40780	Fee-for-Service	1689627580	1689627580	1	1	BENGTSSON, BENGT-OLA MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63091	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
40793	Fee-for-Service	1588698161	1588698161	1	1	BROWN, STEPHEN E MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	28692	41	Internal Medicine	0	In state provider	None	701 E 28TH ST	STE 100	LONG BEACH	CA	90806	2769	19	06037	33.80803441	-118.1847137	Los Angeles County
40807	Fee-for-Service	1902225378	1902225378	1	1	BOYLE, SIMONE MD	7/26/2020	207P00000X	NA	Other	026	PHYSICIANS	155715	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
40859	Fee-for-Service	1730962424	1730962424	1	1	BARI, MONICA PT	8/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30141 ANTELOPE RD.	STE A	MENIFEE	CA	92584	7001	33	06065	33.68176015	-117.1680307	Riverside County
40863	Fee-for-Service	1982664496	1982664496	1	1	BOOKOFF, CHARLES N MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	21934	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
40884	Fee-for-Service	1710479233	1710479233	1	1	BRIDGE HOSPICE CENTRAL	7/1/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	COAST LLC	6 QUAIL RUN CIRCLE	SUITE 103	SALINAS	CA	93907	2345	27	06053	36.68655764	-121.6697976	Monterey County
40891	Fee-for-Service	1134375207	1134375207	1	1	BAY IMAGING CONSULTANTS	12/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
40903	Fee-for-Service	1043783830	1043783830	1	1	BOULTING, HEATHER B CNP	6/3/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
40904	Fee-for-Service	1619934643	1619934643	1	1	BASH, ISAAC MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62981	01	General Practice	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
40915	Fee-for-Service	1710375225	1710375225	1	1	BELL, TINA LMFT	7/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
40934	Fee-for-Service	1023269891	1023269891	1	1	BALINOS, FEBBIS V MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105450	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
40942	Fee-for-Service	1225483860	1225483860	1	1	BENGE, MARISSA M NP	2/3/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
40962	Fee-for-Service	1023008679	1023008679	1	1	BIORKMAN, JON MD	6/30/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40965	01	General Practice	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
40973	Fee-for-Service	1942231576	1942231576	1	1	BAILEY, DAVID N MD	6/30/1982	207ZP0104X	NA	Other	026	PHYSICIANS	34170	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H720	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
41005	Fee-for-Service	1730535899	1730535899	1	1	BOWEN, NICHOLAS P MD	12/12/2018	1835P1300X	NA	Other	026	PHYSICIANS	152524	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
41030	Fee-for-Service	1437369550	1437369550	1	1	BEACH IMAGING CENTER INC	9/30/2013	261QR0200X	NA	Mammography/MRI Provider	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	12600 BEACH BLVD	SUITE A1	STANTON	CA	90680	4089	30	06059	33.77938183	-117.9926679	Orange County
41048	Fee-for-Service	1316351331	1316351331	1	1	BISHARA, ANDREW M MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141372	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
41061	Fee-for-Service	1902885684	1902885684	1	1	BEDFORD, RUDOLPH A MD	8/1/1996	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52659	10	Gastroenterology (M.D. only)	0	In state provider	None	2100 WEBSTER ST	STE 404	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
41084	Fee-for-Service	1588698161	1588698161	1	1	BROWN, STEPHEN E MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	28692	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	701 E 28TH ST	STE 100	LONG BEACH	CA	90806	2769	19	06037	33.80803441	-118.1847137	Los Angeles County
41101	Fee-for-Service	1568768323	1568768323	1	1	BAEK, JOSH S DO	6/9/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11390	08	Family Practice	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
41138	Fee-for-Service	1649387952	1649387952	1	1	BENNETT, DELLA C MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77086	02	General Surgery	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
41144	Fee-for-Service	1851427314	1851427314	1	1	BENJAMIN, JONATHON E MD	9/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83491	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	FL 3	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
41172	Fee-for-Service	1710479233	1710479233	1	1	BRIDGE HOSPICE CENTRAL	7/1/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	COAST LLC	6 QUAIL RUN CIRCLE	SUITE 103	SALINAS	CA	93907	2345	27	06053	36.68655764	-121.6697976	Monterey County
41175	Fee-for-Service	1306924048	1306924048	1	1	BERMUDEZ, EDUARDO S MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63725	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
41182	Fee-for-Service	1679651400	1679651400	1	1	BERNIKER, KENNETH J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
41191	Fee-for-Service	1851367049	1851367049	1	1	BURNETTE, WILLIAM C MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64534	30	Radiology	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
41194	Fee-for-Service	1851563761	1851563761	1	1	BARRAGAN, JORGE A PSYD	2/7/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4643 BROADWAY	None	SALIDA	CA	95368	9308	50	06099	37.70615347	-121.0849197	Stanislaus County
41211	Fee-for-Service	1306001078	1306001078	1	1	BROCK S CUMMINGS MD INC	8/14/2003	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	70205	20	Orthopedic Surgery	0	In state provider	None	251 COHASSET RD	STE 130	CHICO	CA	95926	2241	04	06007	39.75090044	-121.8522609	Butte County
41228	Fee-for-Service	1619716149	1619716149	1	1	BERGLUND, SHAWNA BIRTH DOUL	6/14/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	17	06033	0	0	None
41247	Fee-for-Service	1518960327	1518960327	1	1	BASS, BARBARA N MD	10/31/1988	193200000X	NA	Other	026	PHYSICIANS	66037	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	# 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
41250	Fee-for-Service	1730271446	1730271446	1	1	BAUM-SHAPELL, ANNA	7/1/1996	2080P0204X	NA	Other	026	PHYSICIANS	49433	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
41257	Fee-for-Service	1104318211	1104318211	1	1	BLOCK COUNSELING, FAMILY & C	9/19/2018	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HILD THERAPY INC.	71777 SAN JACINTO DR.	SUITE 204	RANCHO MIRAGE	CA	92270	4457	33	06065	33.74394755	-116.4124572	Riverside County
41261	Fee-for-Service	1124268842	1124268842	1	2	BANERJEE, JOSH MD	10/16/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	103123	-	NOT APPLICABLE	0	In state provider	None	2010 ZONAL AVE	OPD 4P1 RM 1-15	LOS ANGELES	CA	90033	1026	19	06037	34.05986523	-118.2057472	Los Angeles County
41345	Fee-for-Service	1568999324	1568999324	1	1	BRYAN, THEODORE C MD	10/3/2023	390200000X	NA	Other	026	PHYSICIANS	165106	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
41349	Fee-for-Service	1013395227	1013395227	1	1	BENKO, FRANCES B DO	1/31/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20194	None	None	0	In state provider	None	4520 BUSINESS CENTER DR	200	FAIRFIELD	CA	94534	6888	48	06095	38.22519621	-122.1327459	Solano County
41361	Fee-for-Service	1639686934	1639686934	1	1	BYRD, SHARLISA LMFT	3/1/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
41366	Fee-for-Service	1962495325	1962495325	1	1	BOUDREAUX, CHARLES A MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76780	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
41368	Fee-for-Service	1477803468	1477803468	1	1	BONNETT ALONSO, ANDRE MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122882	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
41370	Fee-for-Service	1346468485	1346468485	1	1	BALL, CORDELL LMFT	8/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2030 E. 4TH STREET	SUITE 131C	SANTA ANA	CA	92705	3937	30	06059	33.74808045	-117.8378273	Orange County
41374	Fee-for-Service	1437142478	1437142478	1	1	BULUT, YONCA MD	8/8/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63208	40	Pediatrics	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
41382	Fee-for-Service	1255706677	1255706677	1	1	BARRAGAN, DANIEL PT	8/2/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
41383	Fee-for-Service	1770671992	1770671992	1	1	BOSSEN, INGRID MD	12/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	53907	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
41391	Fee-for-Service	1710083761	1710083761	1	1	BORELLI. LAWRENCE N MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25506	20	Orthopedic Surgery	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
41397	Fee-for-Service	1285152520	1285152520	1	1	BURGOS, MARIA M LCSW	9/20/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22330	-	NOT APPLICABLE	0	In state provider	None	30500 ARRASTRE CANYON RD	None	ACTON	CA	93510	2160	19	06037	34.449291	-118.1973465	Los Angeles County
41400	Fee-for-Service	1245745512	1245745512	1	1	BAHNER, ARIEL D LCSW	9/28/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
41423	Fee-for-Service	1023543394	1023543394	1	1	BIRD, BRENDAN E DO	9/20/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
41425	Fee-for-Service	1356317747	1356317747	1	1	BOLES, SCOTT M MD	3/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	85063	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
41426	Fee-for-Service	1477627065	1477627065	1	1	BIRLA, RAJNISH MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92911	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
41449	Fee-for-Service	1942488085	1942488085	1	1	BERGMANN, KEL M	11/2/2001	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	8881 FLETCHER PKWY	STE 241	LA MESA	CA	91942	3190	37	06073	32.78442148	-117.0073814	San Diego County
41459	Fee-for-Service	1841504958	1841504958	1	1	BHAMBHANI, SUNDEEP OD	7/23/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5832 BEACH BLVD	STE 109	BUENA PARK	CA	90621	2022	30	06059	33.875469	-117.9981525	Orange County
41512	Fee-for-Service	1265731921	1265731921	1	1	BEYOND PROSTHETICS,INC	10/26/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	4404 SCOTTS VALLEY DR	F	SCOTTS VALLEY	CA	95066	4588	44	06087	37.04690773	-122.0186751	Santa Cruz County
41522	Fee-for-Service	1790833655	1790833655	1	1	BURNS, DIANE E MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42303	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
41527	Fee-for-Service	1326508847	1326508847	1	1	BROWN, AARON D MD	8/8/2023	207L00000X	NA	Other	026	PHYSICIANS	182292	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
41541	Fee-for-Service	1831422377	1831422377	1	1	BREWER, EDWARD MD	8/12/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	132623	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
41559	Fee-for-Service	1487725362	1487725362	1	1	BECKER, ROBERT J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32196	01	General Practice	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
41563	Fee-for-Service	1376556183	1376556183	1	1	BROWN, JAY J MD	6/30/1988	207P00000X	NA	Other	026	PHYSICIANS	59036	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
41565	Fee-for-Service	1285796375	1285796375	1	1	BULAON, CARLOS	1/29/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48343	01	General Practice	0	In state provider	None	12440 FIRESTONE BLVD	STE 115	NORWALK	CA	90650	9314	19	06037	33.90523023	-118.0681168	Los Angeles County
41567	Fee-for-Service	1932411378	1932411378	1	1	BALL, LETICIA LMFT	4/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
41578	Fee-for-Service	1235366253	1235366253	1	1	BERGER, MILES MD	7/17/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
41584	Fee-for-Service	1790213304	1790213304	1	1	BYINGTON, DACODA PSYD	3/25/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
41591	Fee-for-Service	1023108602	1023108602	1	1	BULL, TODD M MD	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
41653	Fee-for-Service	1871776229	1871776229	1	1	BUENAVENTURA, BENILDA B	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
41662	Fee-for-Service	1437142478	1437142478	1	1	BULUT, YONCA MD	8/8/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63208	01	General Practice	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
41665	Fee-for-Service	1144419508	1144419508	1	2	BELOVA, LUBOV LMFT	3/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
41687	Fee-for-Service	1003859372	1003859372	1	1	BROOKE KYLE	6/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 MARTIN LUTHER KING	None	SPRINGFIELD	OR	97477	7514	00	None	44.0784397	-123.0311559	Lane County
41715	Fee-for-Service	1699474916	1699474916	1	1	BORDERS, KATHERINE PT	6/7/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
41759	Fee-for-Service	1922574789	1922574789	1	1	BAAS, ERIN CCC-SLP	7/21/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1225 EUREKA WAY	SUITE B	REDDING	CA	96001	0815	45	06089	40.58819524	-122.3900343	Shasta County
41764	Fee-for-Service	1962696674	1962696674	1	1	BERBEE, AMY M MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101424	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
41769	Fee-for-Service	1881751469	1881751469	1	1	BECKER, MAXINE F LCSW	3/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
41773	Fee-for-Service	1518387224	1518387224	1	1	BRUBAKER, WILLIAM D MD	6/11/2020	208800000X	NA	Other	026	PHYSICIANS	138666	34	Urology and Urological Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
41789	Fee-for-Service	1770631673	1770631673	1	1	BLOCK, RICHARD A MD	5/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	34561	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
41791	Fee-for-Service	1790001170	1790001170	1	1	BADLANI, RUPA B MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120893	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
41806	Fee-for-Service	1144717737	1144717737	1	1	BAYANZAY, KARIMULLAH MD	8/20/2021	208M00000X	NA	Other	026	PHYSICIANS	173991	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
41812	Fee-for-Service	1861564791	1861564791	1	1	BHATIA, POONAM P MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74847	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
41828	Fee-for-Service	1174557805	1174557805	1	1	BAY AREA RETINA ASSOCIATES,	6/1/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES MEDICAL GROUP	491 30TH ST	STE 102	OAKLAND	CA	94609	3235	01	06001	37.81935528	-122.2667902	Alameda County
41844	Fee-for-Service	1487725362	1487725362	1	1	BECKER, ROBERT J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32196	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
41853	Fee-for-Service	1013930866	1013930866	1	1	BZOSKIE, THOMAS ALLEN MD	9/16/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72448	08	Family Practice	0	In state provider	None	1255 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
41875	Fee-for-Service	1235582149	1235582149	1	1	BIAGGI, MICHELLE M OD	8/5/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	613 E GRAND AVENUE	None	ESCONDIDO	CA	92025	4402	37	06073	33.1245479	-117.0739933	San Diego County
41914	Fee-for-Service	1710207840	1710207840	1	1	BAGGA, UMA A MD	9/1/2022	208600000X	NA	General Surgery	026	PHYSICIANS	172760	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
41927	Fee-for-Service	1255862371	1255862371	1	1	BEDGOOD, MICHAEL A MD	8/30/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161948	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
41929	Fee-for-Service	1477096550	1477096550	1	1	BAY AREA MENTAL HEALTH AND F	10/29/2024	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1925 WINCHESTER BOULEVAR	SUITE 204	CAMPBELL	CA	95008	1038	43	06085	37.28904861	-121.9499866	Santa Clara County
41938	Fee-for-Service	1831116722	1831116722	1	1	BZOWEJ, NATALIE H MD	5/1/1998	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	54141	10	Gastroenterology (M.D. only)	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
41965	Fee-for-Service	1174557805	1174557805	1	10	BAY AREA RETINA ASSOCIATES,	1/24/2025	207WX0107X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	EDICAL GROUP	1350 BURTON DR	SUITE 210	VACAVILLE	CA	95687	3542	48	06095	38.36416107	-121.9552032	Solano County
41986	Fee-for-Service	1750423828	1750423828	1	1	BLACK, JED E MD	2/28/1993	2084P0800X	NA	Psychiatry	026	PHYSICIANS	74329	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
42009	Fee-for-Service	1609190180	1609190180	1	1	BROWNELL, ROBERT S MD	6/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118259	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
42043	Fee-for-Service	1962768200	1962768200	1	1	BURNS, ALAINA V MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128507	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
42048	Fee-for-Service	1639306061	1639306061	1	1	BLUME, JENNIFER L LMFT	10/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
42056	Fee-for-Service	1962696674	1962696674	1	1	BERBEE, AMY M MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101424	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
42057	Fee-for-Service	1568015626	1568015626	1	1	BUCHAN, KATHRYN TAYLOR PORTE	10/27/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	R LPCC	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
42060	Fee-for-Service	1891750220	1891750220	1	1	BRILES, RICHARD W MD	12/31/1987	207P00000X	NA	Other	026	PHYSICIANS	53318	41	Internal Medicine	0	In state provider	None	7860 MISSION CENTER CT	# 20	SAN DIEGO	CA	92108	1329	37	06073	32.77370228	-117.1549878	San Diego County
42069	Fee-for-Service	1073579173	1073579173	1	1	BAUTISTA, ARWINNAH MD	6/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51221	66	Emergency Medicine (Urgent Care)	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
42098	Fee-for-Service	1285674242	1285674242	1	1	BHATTI, MUHAMMAD T MD	5/2/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	175347	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
42099	Fee-for-Service	1356419584	1356419584	1	1	BANDONG, ALMA F PT	4/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
42113	Fee-for-Service	1073968640	1073968640	1	1	BADIYANI, NEHA R PT	9/8/2023	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39650 LIBERTY ST	SUITE 140	FREMONT	CA	94538	2225	01	06001	37.54662058	-121.9736002	Alameda County
42116	Fee-for-Service	1942426416	1942426416	1	1	BEST-COLLINS, MARGARET A	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	17326 EDWARD ROAD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
42174	Fee-for-Service	1881715084	1881715084	1	1	BIANCHI, MATT T MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154257	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
42207	Fee-for-Service	1598897167	1598897167	1	1	BURCIAGA, LORENZA LMFT	10/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7801 FOLSOM BLVD	208	SACRAMENTO	CA	95826	2620	34	06067	38.551419	-121.412997	Sacramento County
42213	Fee-for-Service	1093740110	1093740110	1	1	BALL, EDWARD D MD	6/1/1998	207R00000X	NA	Other	026	PHYSICIANS	84752	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42215	Fee-for-Service	1417146788	1417146788	1	1	BLACKNEY, KEVIN A MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136658	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
42217	Fee-for-Service	1477096550	1477096550	1	1	BAY AREA MENTAL HEALTH AND F	10/29/2024	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1925 WINCHESTER BOULEVAR	SUITE 204	CAMPBELL	CA	95008	1038	43	06085	37.28904861	-121.9499866	Santa Clara County
42274	Fee-for-Service	1831549823	1831549823	1	1	BAL, MINDER K DO	10/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17273	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
42277	Fee-for-Service	1962630293	1962630293	1	1	BHASIN, MEENAKSHI MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115566	22	Pathology (M.D. only)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
42297	Fee-for-Service	1609190180	1609190180	1	1	BROWNELL, ROBERT S MD	6/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118259	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
42321	Fee-for-Service	1831279918	1831279918	1	1	BEY, TAREG A, MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54195	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
42326	Fee-for-Service	1124061171	1124061171	1	1	BRANDT, THOMAS D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 OSTRUM ST	None	BETHLEHEM	PA	18015	1000	00	None	40.60853156	-75.39270674	Lehigh County
42342	Fee-for-Service	1467551499	1467551499	1	1	BUTTURINI, ANNA M MD	6/30/1995	2080P0207X	NA	Hematology	026	PHYSICIANS	56348	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
42344	Fee-for-Service	1720033780	1720033780	1	1	BROUCH, ERIC M MD	6/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74309	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
42347	Fee-for-Service	1891750220	1891750220	1	1	BRILES, RICHARD W MD	12/31/1987	207P00000X	NA	Other	026	PHYSICIANS	53318	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7860 MISSION CENTER CT	# 20	SAN DIEGO	CA	92108	1329	37	06073	32.77370228	-117.1549878	San Diego County
42355	Fee-for-Service	1932240611	1932240611	1	1	BROWN, MONIQUE A LCSW	12/22/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
42357	Fee-for-Service	1073579173	1073579173	1	1	BAUTISTA, ARWINNAH MD	6/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51221	41	Internal Medicine	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
42418	Fee-for-Service	1801445176	1801445176	1	1	BONILLA, LIZETTE LMFT	1/31/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95097	-	NOT APPLICABLE	0	In state provider	None	1135 S ALVARADO ST	None	LOS ANGELES	CA	90006	4100	19	06037	34.04932111	-118.2814182	Los Angeles County
42422	Fee-for-Service	1790793040	1790793040	1	1	BENJAMIN, ALICIA C MD	9/30/1989	207R00000X	NA	Other	026	PHYSICIANS	69721	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
42431	Fee-for-Service	1508070137	1508070137	1	1	BROOKS, CINDY LMFT	2/5/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3065 PORTER STREET	SUITE 200	SOQUEL	CA	95073	2231	44	06087	36.989559	-121.957318	Santa Cruz County
42458	Fee-for-Service	1679707319	1679707319	1	1	BRADLET M. HAVERKOS	2/21/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
42469	Fee-for-Service	1255607453	1255607453	1	1	BARNES, JAMES I IV MD	6/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126896	41	Internal Medicine	0	In state provider	None	751 SOUTH BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
42470	Fee-for-Service	1457342941	1457342941	1	1	BELL, LEONA L NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1301 CALIFORNIA STREET	None	REDLANDS	CA	92374	2910	36	06071	34.07159807	-117.2263378	San Bernardino County
42479	Fee-for-Service	1689610057	1689610057	1	1	BRECHNER, RUBEN R MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51022	30	Radiology	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
42484	Fee-for-Service	1861441560	1861441560	1	1	BLUM, STEPHEN M MD	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	28845	30	Radiology	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
42486	Fee-for-Service	1649788167	1649788167	1	1	BAUTISTA, LESLIE LCSW	7/12/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6809 INDIANA AVENUE	130-B26	RIVERSIDE	CA	92506	4218	33	06065	33.94312844	-117.3918196	Riverside County
42504	Fee-for-Service	1093740110	1093740110	1	1	BALL, EDWARD D MD	6/1/1998	207R00000X	NA	Other	026	PHYSICIANS	84752	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42507	Fee-for-Service	1477096550	1477096550	1	1	BAY AREA MENTAL HEALTH AND F	10/29/2024	1041C0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1925 WINCHESTER BOULEVAR	SUITE 204	CAMPBELL	CA	95008	1038	43	06085	37.28904861	-121.9499866	Santa Clara County
42511	Fee-for-Service	1366513129	1366513129	1	1	BENADOR, NADINE M MD	7/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84483	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
42542	Fee-for-Service	1497162689	1497162689	1	1	BRENES, JENNIFER LCSW	11/28/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
42560	Fee-for-Service	1629332796	1629332796	1	1	BHUSKUTE, ADITI A MD	3/1/2023	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	127498	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
42572	Fee-for-Service	1891259719	1891259719	1	1	BLOOM HOME HEALTH INC	6/2/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13746 VICTORY BLVD	SUITE 216	VAN NUYS	CA	91401	6725	19	06037	34.18664551	-118.432764	Los Angeles County
42585	Fee-for-Service	1679117972	1679117972	1	1	BLOSSOM RIDGE MEDICAL INC.	10/12/2022	261QC1500X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1420 RIVER PARK DR	STE 120	SACRAMENTO	CA	95815	4506	34	06067	38.597571	-121.4392905	Sacramento County
42591	Fee-for-Service	1558047431	1558047431	1	1	BELLA VITA HOME HEALTH INC.	5/9/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12125 VANOWEN ST	A/1	NORTH HOLLYWOOD	CA	91605	5665	19	06037	34.19396347	-118.397412	Los Angeles County
42613	Fee-for-Service	1205398609	1205398609	1	1	BOMMIREDDY, ADITI MD	5/17/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	186079	15	Obstetrics (D.O. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
42627	Fee-for-Service	1467551499	1467551499	1	1	BUTTURINI, ANNA M MD	6/30/1995	2080P0207X	NA	Hematology	026	PHYSICIANS	56348	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
42631	Fee-for-Service	1548402084	1548402084	1	1	BEDI, HARMEET S MD	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117625	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
42655	Fee-for-Service	1427333855	1427333855	1	1	BUENDIA, GABRIELA S	8/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	230 CALIFORNIA AVE	STE 205	PALO ALTO	CA	94306	1637	43	06085	37.42810577	-122.1434248	Santa Clara County
42659	Fee-for-Service	1831370725	1831370725	1	1	BUTTACAVOLI, STEPHANIE S	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
42660	Fee-for-Service	1164870499	1164870499	1	1	BHUVANESWARAN, KARTHIKEYAN	6/30/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	15848	None	None	0	In state provider	DO	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
42664	Fee-for-Service	1659494268	1659494268	1	1	BENJAMIN FAGO	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	715 N SAINT JOSEPH AVE	None	HASTINGS	NE	68901	4451	00	None	40.58976654	-98.3875094	Adams County
42705	Fee-for-Service	1558701284	1558701284	1	1	BHALLA, ANUSHKA R M MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139520	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
42709	Fee-for-Service	1790793040	1790793040	1	1	BENJAMIN, ALICIA C MD	9/30/1989	207R00000X	NA	Other	026	PHYSICIANS	69721	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
42721	Fee-for-Service	1992810592	1992810592	1	1	BONIFACE, DAVID R	9/17/1980	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	329 W 2ND ST	# C	CALEXICO	CA	92231	2114	13	06025	32.66665519	-115.5019889	Imperial County
42726	Fee-for-Service	1972777589	1972777589	1	1	BENNINGTON, NATHAN DO	9/8/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19309	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
42737	Fee-for-Service	1184607368	1184607368	1	1	BIRNBAUM, MARC E MD	8/25/2009	207L00000X	NA	Other	026	PHYSICIANS	83700	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
42739	Fee-for-Service	1598440091	1598440091	1	1	BOSCH, SAMUEL MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
42742	Fee-for-Service	1942752811	1942752811	1	1	BUTLER, CHRISTINE R LMFT	2/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
42772	Fee-for-Service	1255416335	1255416335	1	1	BROSMAN, STANLEY A MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	22619	34	Urology and Urological Surgery	0	In state provider	None	2021 SANTA MONICA BLVD	STE 510	SANTA MONICA	CA	90404	2219	19	06037	34.02922048	-118.4793681	Los Angeles County
42773	Fee-for-Service	1669456695	1669456695	1	1	BARNES, THOMAS B OD	12/11/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
42780	Fee-for-Service	1225216724	1225216724	1	1	BENKI, CRISTINA M PHD	2/9/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
42782	Fee-for-Service	1417057514	1417057514	1	1	BRODAK, PHILIP P MD FACS	6/28/2019	208800000X	NA	Other	026	PHYSICIANS	64287	34	Urology and Urological Surgery	0	In state provider	None	25495 MEDICAL CENTER DR	204	MURRIETA	CA	92562	4903	33	06065	33.55804188	-117.1834064	Riverside County
42796	Fee-for-Service	1114112372	1114112372	1	5	BEVERLY RADIOLOGY MED GR	8/31/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	457 GREENFIELD AVENUE	SUITE 150	HANFORD	CA	93230	3586	16	06031	36.32951016	-119.6581355	Kings County
42809	Fee-for-Service	1255626040	1255626040	1	1	BELSKY, GABRIEL J DO	9/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12557	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5239	34	06067	38.570076	-121.4657145	Sacramento County
42823	Fee-for-Service	1912009283	1912009283	1	1	BIESELIN, RONALD G	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41512	None	None	0	In state provider	None	480 REDWOOD ST	STE 14	VALLEJO	CA	94590	2958	48	06095	38.12315545	-122.2597619	Solano County
42844	Fee-for-Service	1043681752	1043681752	1	1	BEVERLY RADIOLOGY MEDICAL	4/18/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP III	521 E ELDER COURT	STE 101	FALLBROOK	CA	92028	3082	37	06073	33.38015149	-117.246267	San Diego County
42850	Fee-for-Service	1891919494	1891919494	1	1	BLACKWELL, LISA A MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89726	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
42863	Fee-for-Service	1487845319	1487845319	1	1	BRIGHT, MICHAEL J CPO	5/21/2002	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	95 MONTGOMERY DR	None	SANTA ROSA	CA	95404	6630	49	06097	38.442357	-122.704641	Sonoma County
42930	Fee-for-Service	1720209018	1720209018	1	1	BENJAMIN KARL HOM M.D.	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
42932	Fee-for-Service	1336466713	1336466713	1	1	BHARGAVA, ANU	3/28/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178824	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
42947	Fee-for-Service	1306033113	1306033113	1	1	BORBA, JULIE Y MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107223	41	Internal Medicine	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
42948	Fee-for-Service	1164881090	1164881090	1	1	BROOKS, HEATHER L CRNA	5/16/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2635 G STREET	None	BAKERSFIELD	CA	93301	2813	15	06029	35.38360448	-119.0223416	Kern County
42963	Fee-for-Service	1902276306	1902276306	1	1	BALLINGER, REBECCA E PSYD	8/8/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1030 NEVADA ST.	SUITE 103	REDLANDS	CA	92374	2957	36	06071	34.064172	-117.217431	San Bernardino County
42989	Fee-for-Service	1093348799	1093348799	1	1	BOOKER, COURTNEE M DOULA	1/24/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
43015	Fee-for-Service	1154401941	1154401941	1	46	BASS MEDICAL GROUP	7/9/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2250 MORELLO AVE	None	PLEASANT HILL	CA	94523	1860	07	06013	37.96164558	-122.0789528	Contra Costa County
43020	Fee-for-Service	1215429741	1215429741	1	1	BROOKS, ALANA	10/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
43047	Fee-for-Service	1790975886	1790975886	1	1	BERGER, ELIANA Y MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106927	41	Internal Medicine	0	In state provider	None	1500 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	3853	19	06037	34.12736888	-118.257777	Los Angeles County
43051	Fee-for-Service	1114523511	1114523511	1	1	BERRY, CHEYENNE LMFT	7/21/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
43054	Fee-for-Service	1396749123	1396749123	1	1	BARR, DALE I OD	9/8/1992	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2730 UNION AVE	STE A	SAN JOSE	CA	95124	1431	43	06085	37.27185266	-121.9326154	Santa Clara County
43079	Fee-for-Service	1386603421	1386603421	1	1	BHARGAVA, PANKAJ MD	2/28/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	52718	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
43080	Fee-for-Service	1124110523	1124110523	1	1	BEKENY, THOMAS G PHD	7/6/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
43112	Fee-for-Service	1730237660	1730237660	1	1	BAGHAMIAN, KAREN MD	4/1/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	76531	36	Psychiatry	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
43119	Fee-for-Service	1003345711	1003345711	1	1	BASTIN, MICHELLE E	6/7/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2908 WESTMINSTER	None	SEAL BEACH	CA	90740	5305	30	06059	33.7594287	-118.0804604	Orange County
43142	Fee-for-Service	1609828227	1609828227	1	1	BRUCE, STEVEN E PT	12/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	60 PENNY LANE	None	WATSONVILLE	CA	95076	3079	44	06087	36.93074806	-121.7788515	Santa Cruz County
43224	Fee-for-Service	1659830610	1659830610	1	1	BERNSTEIN, MEGAN E MD	4/21/2023	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180918	None	None	0	In state provider	None	13160 MINDANAO WAY	301, 303, 315	MARINA DEL REY	CA	90292	6358	19	06037	33.98450811	-118.4376278	Los Angeles County
43236	Fee-for-Service	1477842268	1477842268	1	1	BO BEUS	5/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 E WHEELER RD	None	MOSES LAKE	WA	98837	1820	00	None	47.128302	-119.2653765	Grant County
43237	Fee-for-Service	1568465649	1568465649	1	1	BABASHOFF, LISA L MD	1/13/2015	208600000X	NA	General Surgery	026	PHYSICIANS	61169	02	General Surgery	0	In state provider	None	5855 OLIVAS PARK DR	None	VENTURA	CA	93003	7672	56	06111	34.24238217	-119.2081351	Ventura County
43242	Fee-for-Service	1447688478	1447688478	1	1	BALTAZAR, BRITT BERNADETTE B	3/1/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
43258	Fee-for-Service	1619996840	1619996840	1	1	BENDA, GABOR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	931 HIGHLAND BLVD	STE 3360	BOZEMAN	MT	59715	6914	00	None	45.66951	-111.0209265	Gallatin County
43269	Fee-for-Service	1104117407	1104117407	1	1	BAHRAINWALA, JEHAN Z MD	3/30/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	184069	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
43277	Fee-for-Service	1457666810	1457666810	1	1	BECKER, ROSE M LCSW	8/27/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	350 E ST	STE 406	EUREKA	CA	95501	0352	12	06023	40.8030305	-124.1674522	Humboldt County
43292	Fee-for-Service	1750782488	1750782488	1	1	BOHLENDER, JERYLYN A LCSW	5/22/2020	163WP0807X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
43297	Fee-for-Service	1245287499	1245287499	1	1	BRASETH,ARIN T MD	5/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	413 LILLY RD NE	None	OLYMPIA	WA	98506	0000	00	None	47.052801	-122.847462	Thurston County
43302	Fee-for-Service	1154401941	1154401941	1	46	BASS MEDICAL GROUP	7/9/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2250 MORELLO AVE	None	PLEASANT HILL	CA	94523	1860	07	06013	37.96164558	-122.0789528	Contra Costa County
43321	Fee-for-Service	1730198128	1730198128	1	1	BUCKLEY, JILL C MD	10/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77631	34	Urology and Urological Surgery	0	In state provider	None	1001 POTRERO AVE	# 3A	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
43342	Fee-for-Service	1790975886	1790975886	1	1	BERGER, ELIANA Y MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106927	67	Endocrinology	0	In state provider	None	1500 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	3853	19	06037	34.12736888	-118.257777	Los Angeles County
43379	Fee-for-Service	1457332330	1457332330	1	1	BORGSTADT, DANIEL L MD	12/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53110	None	None	0	In state provider	None	141 N CLARK ST	STE B	FRESNO	CA	93701	2124	10	06019	36.744102	-119.7860465	Fresno County
43382	Fee-for-Service	1033144985	1033144985	1	1	BREWER, JAMES MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89348	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
43399	Fee-for-Service	1326400052	1326400052	1	2	BEARE, MATTHEW B MD	1/16/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159055	08	Family Practice	0	In state provider	None	301 BRUNDAGE LN	None	BAKERSFIELD	CA	93304	3248	15	06029	35.35386839	-119.0055269	Kern County
43444	Fee-for-Service	1033664461	1033664461	1	1	BAIRD, NANCY L LM	9/12/2016	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	3343 4TH AVE	None	SAN DIEGO	CA	92103	5703	37	06073	32.740353	-117.1612435	San Diego County
43454	Fee-for-Service	1043761117	1043761117	1	1	BALOGUN, VICTORIA NP	8/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
43471	Fee-for-Service	1750832267	1750832267	1	1	BALDONADO, ALESSANDRA E CCC-	10/14/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SLP	556 N 1ST ST	SUITE 201	SAN JOSE	CA	95112	5300	43	06085	37.34591974	-121.8977166	Santa Clara County
43499	Fee-for-Service	1386655520	1386655520	1	1	BOGGS, BRANDON E MD	9/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77822	08	Family Practice	0	In state provider	None	101 HOSPITAL RD	None	SONORA	CA	95370	5227	55	06109	37.9744944	-120.3778743	Tuolumne County
43529	Fee-for-Service	1588781173	1588781173	1	1	BHATTACHARJEE, RAKESH MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138339	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
43530	Fee-for-Service	1811994569	1811994569	1	1	BOETTGER, MARK MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	39579	41	Internal Medicine	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
43557	Fee-for-Service	1801273578	1801273578	1	1	BLISS-WILLIAMS, ADRIANNE R L	8/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	THERAPY	319 BIRCH STREET	1253	WESTWOOD	CA	96137	1253	18	06035	40.30307075	-121.0019096	Lassen County
43591	Fee-for-Service	1154401941	1154401941	1	46	BASS MEDICAL GROUP	7/9/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2250 MORELLO AVE	None	PLEASANT HILL	CA	94523	1860	07	06013	37.96164558	-122.0789528	Contra Costa County
43613	Fee-for-Service	1386023877	1386023877	1	1	BIDDLE, JOSHUA S MD	5/5/2024	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	147017	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
43617	Fee-for-Service	1528290244	1528290244	1	1	BLAIR, MONET D LMFT	2/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
43622	Fee-for-Service	1750332029	1750332029	1	1	BUENO, MAURICIO E MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54991	01	General Practice	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 402	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
43668	Fee-for-Service	1467415174	1467415174	1	1	BUSCH, HEIDI B MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51650	07	Dermatology	0	In state provider	None	3811 VALLEY CENTRE DR	None	SAN DIEGO	CA	92130	3318	37	06073	32.93760492	-117.2320932	San Diego County
43689	Fee-for-Service	1740528892	1740528892	1	1	BISHOP, BRANDON J PT	10/5/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
43716	Fee-for-Service	1992974083	1992974083	1	1	BURDICK, MICHAEL J MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127259	78	Neoplastic Diseases/Oncology	0	In state provider	None	5725 W LAS POSITAS BLVD	SUITE 100	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
43725	Fee-for-Service	1780016956	1780016956	1	1	BRADLEY, CHRISTINA M PHD	8/27/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
43730	Fee-for-Service	1902977812	1902977812	1	1	BRODER, BENJAMIN I MD	8/14/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84784	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
43758	Fee-for-Service	1649346198	1649346198	1	1	BLATT-LEWIS, CHERYL LMFT	5/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	854 10TH ST	None	ARCATA	CA	95521	6253	12	06023	40.8700309	-124.0871704	Humboldt County
43760	Fee-for-Service	1518440981	1518440981	1	1	BERNS WEISSBART, EMILY W LCS	6/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
43775	Fee-for-Service	1689175366	1689175366	1	1	BATES, GEORGIA L CCC-SLP	4/20/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
43778	Fee-for-Service	1154480069	1154480069	1	1	BORREGO COMMUNITY HEALTH	5/22/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	133 WEST MAIN STREET	STE 100	EL CAJON	CA	92020	3954	37	06073	32.79492453	-116.9627861	San Diego County
43787	Fee-for-Service	1386655520	1386655520	1	1	BOGGS, BRANDON E MD	9/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77822	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 HOSPITAL RD	None	SONORA	CA	95370	5227	55	06109	37.9744944	-120.3778743	Tuolumne County
43793	Fee-for-Service	1225009822	1225009822	1	1	BERKMAN, GERALD C MD FAAP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	21015	None	None	0	In state provider	None	32144 AGOURA RD	None	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
43823	Fee-for-Service	1588243455	1588243455	1	1	BACON, JOHN MD	1/10/2025	208M00000X	NA	Other	026	PHYSICIANS	186350	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
43843	Fee-for-Service	1649384025	1649384025	1	1	BRITE SPOT, INC	10/17/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	BRITE SPOT MEDICAL SUPPL	18840 VENTURA BLVD	STE 218	TARZANA	CA	91356	3388	19	06037	34.17204394	-118.5442921	Los Angeles County
43851	Fee-for-Service	1710004981	1710004981	1	1	BARNET, ANN M MD	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1476	00	None	39.52483792	-119.7968314	Washoe County
43878	Fee-for-Service	1932430212	1932430212	1	1	BAUTISTA, NICOLETTE L PSYD	2/2/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
43898	Fee-for-Service	1700921103	1700921103	1	1	BECK, PAUL V	6/26/2012	208600000X	NA	General Surgery	026	PHYSICIANS	120629	None	None	0	In state provider	None	1555 EAST STREET	SUITE 220	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
43904	Fee-for-Service	1942884887	1942884887	1	1	BUENO, JOEY C NP	12/27/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
43909	Fee-for-Service	1750332029	1750332029	1	1	BUENO, MAURICIO E MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54991	08	Family Practice	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 402	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
43923	Fee-for-Service	1760789762	1760789762	1	1	BIGELOW, TRACY DO INC	6/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11567	46	Hand Surgery	0	In state provider	None	1335 COFFEE RD	STE 100	MODESTO	CA	95355	3192	50	06099	37.66291854	-120.9756994	Stanislaus County
43930	Fee-for-Service	1386146413	1386146413	1	1	BIBB, REBECCA N PT	5/8/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
43936	Fee-for-Service	1265618995	1265618995	1	1	BHANUSHALI, MINAL J	12/26/2012	2084N0400X	NA	Neurology	026	PHYSICIANS	113308	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
43943	Fee-for-Service	1891127361	1891127361	1	1	BUXTON, MIRANDA B LCSW	3/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3429	43	06085	37.246896	-121.8040865	Santa Clara County
43963	Fee-for-Service	1134210362	1134210362	1	1	BUXTON, ERIC C MD	1/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	78113	67	Endocrinology	0	In state provider	None	1001 POTRERO AVE	BLDG 30 RM 3501K	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
43991	Fee-for-Service	1487638714	1487638714	1	1	BENAVIDES, ROBERT JR PSY	2/3/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2455 BENNETT VALLEY RD	STE 210 C	SANTA ROSA	CA	95404	8876	49	06097	38.434284	-122.6918565	Sonoma County
43999	Fee-for-Service	1629897103	1629897103	1	1	BRAR, RANDEEP S NP	12/13/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3035 EL CAMINO AVE	None	SACRAMENTO	CA	95821	6014	34	06067	38.610828	-121.3926255	Sacramento County
44013	Fee-for-Service	1154401941	1154401941	1	31	BASS MEDICAL GROUP	7/26/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	550 WATER ST	SUITE A	SANTA CRUZ	CA	95060	4126	44	06087	36.98046158	-122.018718	Santa Cruz County
44035	Fee-for-Service	1992705248	1992705248	1	1	BROWNE, DAVID G MD	2/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	71773	None	None	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
44041	Fee-for-Service	1043298417	1043298417	1	1	BURTON, DENNIS M MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88681	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
44044	Fee-for-Service	1265495139	1265495139	1	1	BOONE, KEITH B. MD	11/17/1994	208600000X	NA	General Surgery	026	PHYSICIANS	68568	None	None	0	In state provider	None	6175 N FRESNO ST	STE 101	FRESNO	CA	93710	5207	10	06019	36.82630543	-119.78143	Fresno County
44053	Fee-for-Service	1760074777	1760074777	1	1	BRAGANZA, RITCHELL CNP	8/29/2022	261Q00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25880 MCBEAN PKWY	None	SANTA CLARITA	CA	91355	2004	19	06037	34.40360638	-118.5522028	Los Angeles County
44067	Fee-for-Service	1154480069	1154480069	1	1	BORREGO COMMUNITY HEALTH	3/2/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	133 WEST MAIN STREET	STE 100	EL CAJON	CA	92020	3954	37	06073	32.79492453	-116.9627861	San Diego County
44078	Fee-for-Service	1386091361	1386091361	1	1	BOLANDER, MARGO NP	11/30/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6555 COYLE AVE	STE 301	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
44079	Fee-for-Service	1699202473	1699202473	1	1	BHATT, SHREYKUMAR P MD	10/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169644	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
44124	Fee-for-Service	1942236997	1942236997	1	1	BERRY, JOHN M MD	6/1/1985	207R00000X	NA	Other	026	PHYSICIANS	52443	01	General Practice	0	In state provider	None	1154 SUTTER ST	None	SAN FRANCISCO	CA	94109	5608	38	06075	37.78789709	-122.4194542	San Francisco County
44125	Fee-for-Service	1477166890	1477166890	1	2	BRADSHAW, FRANCOISE V	9/30/2020	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	181 GRACE AVE	None	SACRAMENTO	CA	95838	2008	34	06067	38.651634	-121.4663715	Sacramento County
44126	Fee-for-Service	1033266218	1033266218	1	1	BRONGERSMA, LUCILLE H OD	4/30/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DRIVE	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
44150	Fee-for-Service	1720366792	1720366792	1	1	BANSAL, NEERAJ MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117010	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
44177	Fee-for-Service	1447456033	1447456033	1	1	BABAKHANLOU, PEJMAN MD	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113674	02	General Surgery	0	In state provider	None	1211 W LA PALMA AVE	STE 705	ANAHEIM	CA	92801	2814	30	06059	33.84718298	-117.933758	Orange County
44186	Fee-for-Service	1194949883	1194949883	1	2	BRANDON, JONATHAN L MD	7/31/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	137273	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
44191	Fee-for-Service	1164500807	1164500807	1	1	BAKER, CATHY MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63835	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
44203	Fee-for-Service	1760727838	1760727838	1	1	BEKELE, MERON NP	2/12/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44219	Fee-for-Service	1467590901	1467590901	1	4	BEACH CITIES MIDWIFERY	5/12/2021	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	1353 OLD TEMESCAL ROAD	None	CORONA	CA	92881	7262	33	06065	33.85386752	-117.537732	Riverside County
44228	Fee-for-Service	1760535850	1760535850	1	1	BOYD, WILLIAM H MD	5/8/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	25082	40	Pediatrics	0	In state provider	None	828 SAN PABLO AVE	None	ALBANY	CA	94706	1567	01	06001	37.89159884	-122.2994097	Alameda County
44257	Fee-for-Service	1639526718	1639526718	1	1	BARHAM, DAVID W MD	5/15/2021	390200000X	NA	Other	026	PHYSICIANS	172270	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
44269	Fee-for-Service	1962788620	1962788620	1	1	BURNS, CRYSTAL V LCSW	12/28/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1325 E COOLEY DR.	STE. 106	COLTON	CA	92324	3966	36	06071	34.05468148	-117.306261	San Bernardino County
44274	Fee-for-Service	1639476278	1639476278	1	1	BENSING, BRIAN L LMFT	2/15/2019	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
44284	Fee-for-Service	1689752164	1689752164	1	1	BAJAJ, AKASH MD	5/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83927	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
44302	Fee-for-Service	1154401941	1154401941	1	31	BASS MEDICAL GROUP	7/26/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	550 WATER ST	SUITE A	SANTA CRUZ	CA	95060	4126	44	06087	36.98046158	-122.018718	Santa Cruz County
44303	Fee-for-Service	1447287156	1447287156	1	1	BERLINBERG, CRAIG MD	9/15/1986	207L00000X	NA	Other	026	PHYSICIANS	58589	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
44322	Fee-for-Service	1508000571	1508000571	1	1	BRAHLER, THOMAS M II MD	6/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135074	30	Radiology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
44342	Fee-for-Service	1891713533	1891713533	1	1	BIG HORN HOSPITAL	12/27/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ASSOCIATION	17 N MILES AVE	None	HARDIN	MT	59034	2323	00	None	45.728946	-107.616465	Big Horn County
44352	Fee-for-Service	1154480069	1154480069	1	1	BORREGO COMMUNITY HEALTH	3/2/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	133 WEST MAIN STREET	STE 100	EL CAJON	CA	92020	3954	37	06073	32.79492453	-116.9627861	San Diego County
44357	Fee-for-Service	1003843855	1003843855	1	1	BAKERSFIELD PATHOLOGY	3/16/2007	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	1661 29TH ST	None	BAKERSFIELD	CA	93301	1905	15	06029	35.38573251	-119.020851	Kern County
44374	Fee-for-Service	1467493163	1467493163	1	1	BAGHERI, BITA A MD	9/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86148	07	Dermatology	0	In state provider	None	7160 BROCKTON AVE	None	RIVERSIDE	CA	92506	2614	33	06065	33.94273905	-117.3941945	Riverside County
44386	Fee-for-Service	1174735427	1174735427	1	1	BINKLEY, PETER A MD	3/13/2008	390200000X	NA	Other	026	PHYSICIANS	103060	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 NO NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
44389	Fee-for-Service	1508432196	1508432196	1	1	BEGUM, SHAMEELA MD	11/4/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
44391	Fee-for-Service	1376637280	1376637280	1	1	BUEHL, ROBERT V MD	5/31/1988	207P00000X	NA	Other	026	PHYSICIANS	37624	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
44416	Fee-for-Service	1427453190	1427453190	1	1	BARRETTA, JANET K LMFT	5/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RVICES	210 SOUTH SIERRA AVE	209 #19	OAKDALE	CA	95361	0420	50	06099	37.76567841	-120.845156	Stanislaus County
44427	Fee-for-Service	1194965327	1194965327	1	1	BYRD-OLMSTEAD, JESSICA A PHD	3/25/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
44483	Fee-for-Service	1104826023	1104826023	1	1	BUSH C JOHN M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOSEPH S HOSPITAL ER	350 N WILMONT	None	TUCSON	AZ	85711	0000	00	None	32.227209	-110.8556595	Pima County
44484	Fee-for-Service	1609417930	1609417930	1	2	BK SURGICAL INC	3/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	41870 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
44493	Fee-for-Service	1427028703	1427028703	1	1	BORSKEY, W LAWRENCE MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	22110	01	General Practice	0	In state provider	None	25800 CARLOS BEE BLVD	None	HAYWARD	CA	94542	3000	01	06001	37.657395	-122.0576265	Alameda County
44499	Fee-for-Service	1366822025	1366822025	1	1	BEAN, YOKO T MD	7/2/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	136494	15	Obstetrics (D.O. only)	0	In state provider	None	1950 SUNNYCREST DR	None	FULLERTON	CA	92835	3644	30	06059	33.89240507	-117.9313904	Orange County
44503	Fee-for-Service	1467590901	1467590901	1	4	BEACH CITIES MIDWIFERY	5/12/2021	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1353 OLD TEMESCAL ROAD	None	CORONA	CA	92881	7262	33	06065	33.85386752	-117.537732	Riverside County
44512	Fee-for-Service	1205821253	1205821253	1	1	BEVERLY HILLS TOWER INC	12/1/1995	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2080 CENTURY PARK E	STE 102	LOS ANGELES	CA	90067	2004	19	06037	34.05887194	-118.4122914	Los Angeles County
44516	Fee-for-Service	1336987841	1336987841	1	1	BERRIOS, AIDA	3/3/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
44536	Fee-for-Service	1659492262	1659492262	1	1	BAKER, RALPH S OD INC	7/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	531 OAK ST	STE 2	ROSEVILLE	CA	95678	2615	31	06061	38.74555386	-121.2863963	Placer County
44537	Fee-for-Service	1346305950	1346305950	1	1	BAGA, JULIE M	3/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
44550	Fee-for-Service	1841421518	1841421518	1	1	BULKENS, AN A LMFT	9/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	186 E 12TH ST	None	CHICO	CA	95928	5737	04	06007	39.7244471	-121.8304484	Butte County
44555	Fee-for-Service	1932137866	1932137866	1	1	BROWNWOOD, JEFFRY O DO	5/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	6117	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
44587	Fee-for-Service	1154401941	1154401941	1	31	BASS MEDICAL GROUP	8/15/2022	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	550 WATER ST	SUITE A	SANTA CRUZ	CA	95060	4126	44	06087	36.98046158	-122.018718	Santa Cruz County
44609	Fee-for-Service	1699744383	1699744383	1	1	BANGALORE, NEELESH S MD	10/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70883	78	Neoplastic Diseases/Oncology	0	In state provider	None	4600 S TRACY BLVD	STE 108	TRACY	CA	95377	8105	39	06077	37.698111	-121.4345315	San Joaquin County
44616	Fee-for-Service	1821014168	1821014168	1	1	BLOCK, GEORGE T MD	1/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	44567	41	Internal Medicine	0	In state provider	None	39 BIRCH ST	None	REDWOOD CITY	CA	94062	1482	41	06081	37.48841063	-122.2406348	San Mateo County
44624	Fee-for-Service	1801058383	1801058383	1	1	BREE D DEWING	8/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
44628	Fee-for-Service	1619174513	1619174513	1	1	BAY HORIZON, INC	4/7/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1433 DAKOTA AVE	None	SAN MATEO	CA	94401	3007	41	06081	37.57019504	-122.3089796	San Mateo County
44629	Fee-for-Service	1932287687	1932287687	1	1	BLOOM, EVAN D MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51198	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
44631	Fee-for-Service	1891713533	1891713533	1	1	BIG HORN HOSPITAL	12/27/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ASSOCIATION	17 N MILES AVE	None	HARDIN	MT	59034	2323	00	None	45.728946	-107.616465	Big Horn County
44635	Fee-for-Service	1689083891	1689083891	1	1	BAGDASARIAN, ANI N NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
44644	Fee-for-Service	1154480069	1154480069	1	1	BORREGO COMMUNITY HEALTH	3/28/2008	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	133 WEST MAIN STREET	STE 100	EL CAJON	CA	92020	3954	37	06073	32.79492453	-116.9627861	San Diego County
44650	Fee-for-Service	1730686726	1730686726	1	1	BILLAH, TAUSIF MD	9/6/2022	390200000X	NA	Other	026	PHYSICIANS	176969	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
44678	Fee-for-Service	1992875983	1992875983	1	1	BJARNASON, RONALD V DO	11/1/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5161	01	General Practice	0	In state provider	INC	8397 LANDER AVE	None	HILMAR	CA	95324	8324	24	06047	37.4101079	-120.8500956	Merced County
44683	Fee-for-Service	1962063297	1962063297	1	1	BABO, KARA MD	3/11/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191531	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
44731	Fee-for-Service	1780628834	1780628834	1	1	BAJWA, MUHAMMAD R MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100477	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
44735	Fee-for-Service	1417180456	1417180456	1	1	BAUER, ADAM H MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129242	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
44737	Fee-for-Service	1497329940	1497329940	1	2	BAY AREA ESTHETICS PLASTIC S	12/28/2021	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	URGERY	490 POST ST	STE 1701	SAN FRANCISCO	CA	94102	1308	38	06075	37.78812774	-122.4096884	San Francisco County
44745	Fee-for-Service	1962112771	1962112771	1	1	BONILLA, NICOLASA	1/4/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
44752	Fee-for-Service	1053708602	1053708602	1	1	BURNS, ABIGAIL R MD	10/21/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	174839	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
44753	Fee-for-Service	1033758909	1033758909	1	1	BELTRAN, RITA LMFT	10/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
44761	Fee-for-Service	1295004687	1295004687	1	1	BRANDMAN, CRAIG MD	4/10/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	27509	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2830 GLENDESSARY LN	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
44794	Fee-for-Service	1417053935	1417053935	1	1	BHATIA, SMITA MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60703	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
44801	Fee-for-Service	1033293683	1033293683	1	1	BARROW, MAMIE V MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52986	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
44808	Fee-for-Service	1548473507	1548473507	1	1	BORSO, MAYA G MD	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97134	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
44812	Fee-for-Service	1427299965	1427299965	1	1	BELKOURA, CAROLINE R PHD	4/22/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44816	Fee-for-Service	1962587600	1962587600	1	1	BETZ, JENNIFER S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE CHILDRENS HOSPITAL	1056 E 19TH AVE	None	DENVER	CO	80218	0000	00	None	39.74608265	-104.9738482	Denver County
44817	Fee-for-Service	1801072897	1801072897	1	1	BAKIS, EMMANUEL P PT	11/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
44836	Fee-for-Service	1043648140	1043648140	1	1	BARNETT, ANDRIETTA NP	5/7/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
44849	Fee-for-Service	1477649382	1477649382	1	1	BENNETT, MARC W MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49300	40	Pediatrics	0	In state provider	None	2501 E CHAPMAN AVE	STE 301	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
44875	Fee-for-Service	1154401941	1154401941	1	31	BASS MEDICAL GROUP	7/26/2019	174400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	550 WATER ST	SUITE A	SANTA CRUZ	CA	95060	4126	44	06087	36.98046158	-122.018718	Santa Cruz County
44882	Fee-for-Service	1316442791	1316442791	1	1	BARON, RICHARD MD	3/30/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	166775	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
44883	Fee-for-Service	1528872694	1528872694	1	1	BABAYAN, ANNA LMFT	2/20/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 S FARRELL DR	STE B210	PALM SPRINGS	CA	92262	7933	33	06065	33.81787498	-116.5180068	Riverside County
44894	Fee-for-Service	1609436534	1609436534	1	1	BRIDGES FAMILY THERAPY, INC	6/26/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
44900	Fee-for-Service	1851374821	1851374821	1	1	BIANCHI, STEPHANIE L NP	12/27/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
44904	Fee-for-Service	1043649189	1043649189	1	1	BOSEL, AARON A	1/7/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
44905	Fee-for-Service	1821014168	1821014168	1	1	BLOCK, GEORGE T MD	1/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	44567	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39 BIRCH ST	None	REDWOOD CITY	CA	94062	1482	41	06081	37.48841063	-122.2406348	San Mateo County
44934	Fee-for-Service	1548529027	1548529027	1	1	BEATON, MELINA MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120828	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
44971	Fee-for-Service	1235236316	1235236316	1	1	BURNISTON, MARK T MD	11/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	93054	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
44974	Fee-for-Service	1386623973	1386623973	1	1	BUI, PHIET T MD	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96513	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
44975	Fee-for-Service	1508963653	1508963653	1	1	BEVERLY PEDIATRIC MED GR	6/1/1983	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP INC	1417 W BEVERLY BLVD	SUITE 102	MONTEBELLO	CA	90640	4146	19	06037	34.01879041	-118.1136083	Los Angeles County
45004	Fee-for-Service	1932662392	1932662392	1	1	BERNARDO, ALLISON B DO	10/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19478	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
45014	Fee-for-Service	1396905576	1396905576	1	1	BORTNIKER, ETHAN I MD	2/13/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	155188	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
45020	Fee-for-Service	1780628834	1780628834	1	1	BAJWA, MUHAMMAD R MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100477	01	General Practice	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
45024	Fee-for-Service	1912032962	1912032962	1	1	BOSCH, THEODORE R MD	6/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75333	02	General Surgery	0	In state provider	None	557 W MORTON AVE	STE B	PORTERVILLE	CA	93257	3303	54	06107	36.07322866	-119.0294842	Tulare County
45036	Fee-for-Service	1952549263	1952549263	1	1	BUCHAN, MARSINAH R LMFT	10/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12604 MOUNTAIN MESA RD	UNIT A	LAKE ISABELLA	CA	93240	9149	15	06029	35.63776606	-118.4020098	Kern County
45051	Fee-for-Service	1043337272	1043337272	1	2	BRETT PINKNEY, MPT & ASSOCIA	7/17/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11960 HERITAGE OAK PL	19	AUBURN	CA	95603	2401	31	06061	38.94072856	-121.0989265	Placer County
45052	Fee-for-Service	1225188162	1225188162	1	1	BAGHA, DALJIT MD	5/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93800	41	Internal Medicine	0	In state provider	None	2415 W VINE ST	STE 105	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
45065	Fee-for-Service	1346648201	1346648201	1	1	BITOWFT, ADRIAN K	1/4/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	0638	30	06059	33.66719598	-117.7642461	Orange County
45101	Fee-for-Service	1164711347	1164711347	1	1	BACHAR, BRADLEE J MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122738	05	Anesthesiology	0	In state provider	None	2635 G STREET	None	BAKERSFIELD	CA	93301	2813	15	06029	35.38360448	-119.0223416	Kern County
45103	Fee-for-Service	1851321145	1851321145	1	1	BALGUMA, FREDDIE B MD	4/1/1978	171W00000X	NA	Other	026	PHYSICIANS	24432	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	630 N 13TH AVE	STE C	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
45115	Fee-for-Service	1508412297	1508412297	1	1	BERNARD, SEAN A CRNA	1/29/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
45163	Fee-for-Service	1154401941	1154401941	1	32	BASS MEDICAL GROUP	7/25/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	112 LA CASA VIA	SUITE 300	WALNUT CREEK	CA	94598	3059	07	06013	37.91229899	-122.0423696	Contra Costa County
45167	Fee-for-Service	1154401941	1154401941	1	31	BASS MEDICAL GROUP	7/26/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	550 WATER ST	SUITE A	SANTA CRUZ	CA	95060	4126	44	06087	36.98046158	-122.018718	Santa Cruz County
45176	Fee-for-Service	1609436534	1609436534	1	1	BRIDGES FAMILY THERAPY, INC	1/20/2025	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
45179	Fee-for-Service	1114157518	1114157518	1	1	BANDARA, SEEDUWA O MD	6/26/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144138	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
45184	Fee-for-Service	1407354319	1407354319	1	1	BRIONES, ALICIA J CCC-SLP	5/24/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
45218	Fee-for-Service	1881625762	1881625762	1	1	BRZEZINSKI, MAREK MD	1/28/2025	207LC0200X	NA	Other	026	PHYSICIANS	186731	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
45227	Fee-for-Service	1861855827	1861855827	1	1	BENEFIEL, MICHAEL K MD	6/6/2019	207R00000X	NA	Other	026	PHYSICIANS	153387	None	None	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
45232	Fee-for-Service	1174013585	1174013585	1	1	BORENSZTEJN, IGNACIO MD	9/28/2021	207R00000X	NA	Other	026	PHYSICIANS	173532	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
45248	Fee-for-Service	1467574616	1467574616	1	1	BREEN, JOSEPH DPM	6/23/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3798 JANES RD	STE 9	ARCATA	CA	95521	4745	12	06023	40.89649119	-124.0930501	Humboldt County
45286	Fee-for-Service	1972570836	1972570836	1	1	BOOKMAN, MICHAEL A MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151269	78	Neoplastic Diseases/Oncology	0	In state provider	None	2238 GEARY BOULEVARD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
45297	Fee-for-Service	1154401941	1154401941	1	67	BASS MEDICAL GROUP	1/23/2024	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1320 EL CAPITAN DR	110	DANVILLE	CA	94526	6260	07	06013	37.78476866	-121.9658691	Contra Costa County
45323	Fee-for-Service	1619453461	1619453461	1	1	BROWN, TRACY LMFT	3/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
45382	Fee-for-Service	1255835484	1255835484	1	1	BARR, CAMERON Y MD	6/30/2021	207P00000X	NA	Other	026	PHYSICIANS	165003	None	None	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
45390	Fee-for-Service	1851321145	1851321145	1	1	BALGUMA, FREDDIE B MD	4/1/1978	171W00000X	NA	Other	026	PHYSICIANS	24432	40	Pediatrics	0	In state provider	None	630 N 13TH AVE	STE C	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
45395	Fee-for-Service	1447283486	1447283486	1	1	BOOSTANFAR, RACHAEL MD	8/31/1988	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	43272	01	General Practice	0	In state provider	None	3131 SANTA ANITA AVE	None	EL MONTE	CA	91733	1369	19	06037	34.064991	-118.0427595	Los Angeles County
45403	Fee-for-Service	1558518845	1558518845	1	1	BRIAN LOFGRAN	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1473 S HIGHWAY 40	STE E	HEBER CITY	UT	84032	3522	00	None	40.48899385	-111.4091374	Wasatch County
45424	Fee-for-Service	1710261284	1710261284	1	1	BELLA MEDICAL GROUP INC	3/26/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2933 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1528	19	06037	34.03080154	-118.2076632	Los Angeles County
45448	Fee-for-Service	1154401941	1154401941	1	32	BASS MEDICAL GROUP	7/25/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	112 LA CASA VIA	SUITE 300	WALNUT CREEK	CA	94598	3059	07	06013	37.91229899	-122.0423696	Contra Costa County
45500	Fee-for-Service	1497182414	1497182414	1	1	BROOK, AMARA T PHD	11/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
45570	Fee-for-Service	1346371119	1346371119	1	1	BARTE MEDICAL GROUP, INC	9/30/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	12949 JOLETTE AVE	None	GRANADA HILLS	CA	91344	1069	19	06037	34.30487803	-118.5168056	Los Angeles County
45576	Fee-for-Service	1972570836	1972570836	1	1	BOOKMAN, MICHAEL A MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151269	41	Internal Medicine	0	In state provider	None	2238 GEARY BOULEVARD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
45647	Fee-for-Service	1063482693	1063482693	1	1	BULJUBASIC, NEDA MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61912	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365 120 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
45649	Fee-for-Service	1689094542	1689094542	1	1	BAHRI, NATASHA MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149467	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
45652	Fee-for-Service	1174745244	1174745244	1	1	BEESAM, SHALINI R MD	3/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105525	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
45656	Fee-for-Service	1609007525	1609007525	1	1	BELLEVUE MEDICAL CENTER LLC	5/13/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2500 BELLEVUE MEDICAL	None	BELLEVUE	NE	68123	1591	00	None	41.13622374	-95.94753052	Sarpy County
45668	Fee-for-Service	1508176256	1508176256	1	1	BOXER, OREN R PHD	8/9/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
45671	Fee-for-Service	1063454064	1063454064	1	1	BOLTE ROBERT G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
45687	Fee-for-Service	1174160659	1174160659	1	1	BENARDO, AMARIS E PT	6/22/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	210 W PINE ST	None	LODI	CA	95240	2020	39	06077	38.13427214	-121.2755342	San Joaquin County
45699	Fee-for-Service	1225037054	1225037054	1	1	BARZAGA, GRACIELA A. MD.	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30287	25	Physical Medicine and Rehabilitation	0	In state provider	None	2626 N CALIFORNIA ST	STE C	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
45725	Fee-for-Service	1154401941	1154401941	1	33	BASS MEDICAL GROUP	8/15/2022	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	16130 JUAN HERNANDEZ DR	108	MORGAN HILL	CA	95037	5527	43	06085	37.12005551	-121.6305064	Santa Clara County
45731	Fee-for-Service	1396842498	1396842498	1	1	BUI, THANHMY N MD	2/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100618	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
45738	Fee-for-Service	1154401941	1154401941	1	7	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	125 MALL DR	STE 211B	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
45743	Fee-for-Service	1063644722	1063644722	1	1	BARNES, ANGELINE C MD AMC	5/25/1977	207L00000X	NA	Other	026	PHYSICIANS	27818	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
45760	Fee-for-Service	1073527081	1073527081	1	1	BEATY, JAMES T DPM	2/1/2001	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	115 PIRIE RD	STE A	OJAI	CA	93023	3100	56	06111	34.44311416	-119.2657233	Ventura County
45777	Fee-for-Service	1285868729	1285868729	1	1	BASHTAR, REZA MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119388	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
45797	Fee-for-Service	1891708806	1891708806	1	1	BRINCKHAUS, RUBEN E MD	1/8/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61840	08	Family Practice	0	In state provider	None	874 MAIN ST	None	FORTUNA	CA	95540	1926	12	06023	40.59801851	-124.158231	Humboldt County
45836	Fee-for-Service	1699740555	1699740555	1	1	BERDJIS, FARHOUCH MD	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43840	35	Pediatric Cardiology (M.D. only)	0	In state provider	MEDICAL CORPORATION	1120 W LA VETA AVE	STE 100	ORANGE	CA	92868	4215	30	06059	33.78029455	-117.864369	Orange County
45852	Fee-for-Service	1023539442	1023539442	1	1	BHATTI, AMARDEEP S MD	10/6/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169876	None	None	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
45868	Fee-for-Service	1508876699	1508876699	1	1	BRACKMANN, DERALD E MD	10/16/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	11124	01	General Practice	0	In state provider	None	2122 W 3RD ST	None	LOS ANGELES	CA	90057	1902	19	06037	34.0630888	-118.2733329	Los Angeles County
45887	Fee-for-Service	1154401941	1154401941	1	64	BASS MEDICAL GROUP	4/14/2023	174400000X	NA	Other	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	3270 VILLA LANE	None	NAPA	CA	94558	3085	28	06055	38.3228033	-122.2928343	Napa County
45904	Fee-for-Service	1972726255	1972726255	1	1	BEANE, VICKI L OT	10/18/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
45905	Fee-for-Service	1124584693	1124584693	1	1	BIO-MEDICAL APPLICATIONS OF	3/28/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1320 DECOTO RD	STE 100	UNION CITY	CA	94587	3597	01	06001	37.5917415	-122.0199383	Alameda County
45925	Fee-for-Service	1912437617	1912437617	1	1	BRANCH, LAUREL L	5/1/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	172755	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
45944	Fee-for-Service	1609007525	1609007525	1	1	BELLEVUE MEDICAL CENTER LLC	5/13/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2500 BELLEVUE MEDICAL	None	BELLEVUE	NE	68123	1591	00	None	41.13622374	-95.94753052	Sarpy County
45953	Fee-for-Service	1053726653	1053726653	1	1	BOISVERT, NICHOLE M MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142097	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
45978	Fee-for-Service	1871664631	1871664631	1	1	BANSAL, PREETI MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90890	18	Ophthalmology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
45982	Fee-for-Service	1578755781	1578755781	1	1	BANSAL, SHIPRA MD	3/11/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	97868	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
45985	Fee-for-Service	1891280772	1891280772	1	1	BHATTI, TALHA A DO	8/16/2023	208M00000X	NA	Other	026	PHYSICIANS	21350	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
46004	Fee-for-Service	1679682462	1679682462	1	1	BEALL, THOMAS J CP	5/9/2012	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3520 E SHIELDS AVE	SUITE 102	FRESNO	CA	93726	6923	10	06019	36.77947947	-119.765781	Fresno County
46014	Fee-for-Service	1154401941	1154401941	1	33	BASS MEDICAL GROUP	10/7/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	16130 JUAN HERNANDEZ DR	108	MORGAN HILL	CA	95037	5527	43	06085	37.12005551	-121.6305064	Santa Clara County
46026	Fee-for-Service	1154401941	1154401941	1	32	BASS MEDICAL GROUP	7/25/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	112 LA CASA VIA	SUITE 300	WALNUT CREEK	CA	94598	3059	07	06013	37.91229899	-122.0423696	Contra Costa County
46032	Fee-for-Service	1154401941	1154401941	1	53	BASS MEDICAL GROUP	2/17/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2211 MOORPARK AVE	STE 220	SAN JOSE	CA	95128	2654	43	06085	37.31613943	-121.9326665	Santa Clara County
46034	Fee-for-Service	1568860062	1568860062	1	1	BAYLOR MIRACA GENETICS LABOR	4/30/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2450 HOLCOMBE BLVD	STE. O104	HOUSTON	TX	77021	2024	00	None	29.70423719	-95.38247064	Harris County
46035	Fee-for-Service	1609083609	1609083609	1	1	BURTIS, PETER K LMFT	12/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	327 REDWOOD	B	FORT BRAGG	CA	95437	3550	23	06045	39.4442763	-123.80293	Mendocino County
46055	Fee-for-Service	1225135379	1225135379	1	1	BHATIA, SHEILA M MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73363	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
46101	Fee-for-Service	1275626871	1275626871	1	1	BARNES, GREGORY B MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	55470	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
46125	Fee-for-Service	1699740555	1699740555	1	1	BERDJIS, FARHOUCH MD	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43840	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL CORPORATION	1120 W LA VETA AVE	STE 100	ORANGE	CA	92868	4215	30	06059	33.78029455	-117.864369	Orange County
46145	Fee-for-Service	1457461832	1457461832	1	2	BRONER, KATHERINE A MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	59280	40	Pediatrics	0	In state provider	None	105 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3809	38	06075	37.78202683	-122.4123621	San Francisco County
46152	Fee-for-Service	1124581798	1124581798	1	1	BRIDGEWAY HOSPICE INC	7/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	100 N BARRANCA ST	STE 470	WEST COVINA	CA	91791	1637	19	06037	34.073073	-117.8812535	Los Angeles County
46166	Fee-for-Service	1497184162	1497184162	1	1	BENNETT, SUSAN A CRNA	8/14/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
46261	Fee-for-Service	1144419508	1144419508	1	1	BELOVA, LUBOV LMFT	11/24/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52320	-	NOT APPLICABLE	0	In state provider	None	795 WILLOW ROAD	BLDG 332	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
46265	Fee-for-Service	1932593225	1932593225	1	1	BERG, PATRICK MD	2/21/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	174941	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
46292	Fee-for-Service	1386682326	1386682326	1	1	BASAR, IRUM MD	9/12/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	181812	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
46301	Fee-for-Service	1154401941	1154401941	1	33	BASS MEDICAL GROUP	10/7/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	16130 JUAN HERNANDEZ DR	108	MORGAN HILL	CA	95037	5527	43	06085	37.12005551	-121.6305064	Santa Clara County
46303	Fee-for-Service	1346536547	1346536547	1	1	BOSE, NAMRATA MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123773	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
46314	Fee-for-Service	1154401941	1154401941	1	7	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	125 MALL DR	STE 211B	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
46321	Fee-for-Service	1154401941	1154401941	1	53	BASS MEDICAL GROUP	2/17/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2211 MOORPARK AVE	STE 220	SAN JOSE	CA	95128	2654	43	06085	37.31613943	-121.9326665	Santa Clara County
46359	Fee-for-Service	1063020329	1063020329	1	2	BROOKE & SIMM INC	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7902 NATOMA STREET	None	EASTVALE	CA	92880	0320	33	06065	33.94432571	-117.5848281	Riverside County
46364	Fee-for-Service	1740265909	1740265909	1	1	BAQUERO, VICTOR H MD	7/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70124	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
46375	Fee-for-Service	1225105745	1225105745	1	1	BIRNBAUM, WILLIAM B MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19532	30	Radiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
46383	Fee-for-Service	1508911892	1508911892	1	32	BAY AREA FOOT CARE, INC	8/17/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1580 CREEKSIDE DR	110	FOLSOM	CA	95630	3886	34	06067	38.668914	-121.148028	Sacramento County
46425	Fee-for-Service	1972600666	1972600666	1	1	BLOOMER, MICHELE M MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72716	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	MS 0644	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
46439	Fee-for-Service	1730317710	1730317710	1	1	BHALLA, PAULOMI K MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155340	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46441	Fee-for-Service	1124581798	1124581798	1	1	BRIDGEWAY HOSPICE INC	7/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	100 N BARRANCA ST	STE 470	WEST COVINA	CA	91791	1637	19	06037	34.073073	-117.8812535	Los Angeles County
46443	Fee-for-Service	1417263807	1417263807	1	1	BRENNAN, MEGAN F MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119914	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
46459	Fee-for-Service	1972085314	1972085314	1	1	BONOAN, JOHN G RCP	12/18/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
46469	Fee-for-Service	1154401941	1154401941	1	37	BASS MEDICAL GROUP	10/23/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	18181 BUTTERFIELD BLVD	185	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
46528	Fee-for-Service	1346534864	1346534864	1	1	BOUDREAU, MICHELLE DO	2/4/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	17443	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
46543	Fee-for-Service	1417914193	1417914193	1	1	BATARSE, RODOLFO R MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74778	41	Internal Medicine	0	In state provider	None	488 E VALLEY PKWY	STE 314	ESCONDIDO	CA	92025	3376	37	06073	33.12523814	-117.0769715	San Diego County
46551	Fee-for-Service	1609281450	1609281450	1	1	BIALOSTOZKY, MARIO M MD	7/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129257	40	Pediatrics	0	In state provider	None	769 MEDICAL CENTER COURT	STE 300	CHULA VISTA	CA	91911	6600	37	06073	32.619186	-117.0200925	San Diego County
46553	Fee-for-Service	1023135761	1023135761	1	1	BERJIS, VALA MD	4/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94638	41	Internal Medicine	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94958	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
46559	Fee-for-Service	1598892580	1598892580	1	1	BORNE, DEBORAH E MD	1/29/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	75224	-	NOT APPLICABLE	0	In state provider	None	3103 E CARTWRIGHT AVENUE	None	FRESNO	CA	93725	9385	10	06019	36.67617437	-119.7344474	Fresno County
46570	Fee-for-Service	1730663865	1730663865	1	1	BASTIN, DANIEL J PT	10/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2835 CHILDRESS DR	None	ANDERSON	CA	96007	3563	45	06089	40.45498247	-122.2907255	Shasta County
46589	Fee-for-Service	1154401941	1154401941	1	33	BASS MEDICAL GROUP	8/31/2021	174400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	16130 JUAN HERNANDEZ DR	108	MORGAN HILL	CA	95037	5527	43	06085	37.12005551	-121.6305064	Santa Clara County
46602	Fee-for-Service	1235875493	1235875493	1	1	BENJAMIN, NATALIE	3/5/2025	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
46606	Fee-for-Service	1154401941	1154401941	1	53	BASS MEDICAL GROUP	2/17/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2211 MOORPARK AVE	STE 220	SAN JOSE	CA	95128	2654	43	06085	37.31613943	-121.9326665	Santa Clara County
46614	Fee-for-Service	1750353488	1750353488	1	1	BERGEN, RONNIE MD	6/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146479	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	#B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
46617	Fee-for-Service	1568438836	1568438836	1	1	BIRD, ANN B MD	5/21/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55679	41	Internal Medicine	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
46622	Fee-for-Service	1659651214	1659651214	1	1	BOURQUE, JASON MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117876	20	Orthopedic Surgery	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
46628	Fee-for-Service	1750526224	1750526224	1	1	BUI VAN, REBECCA OD INC	11/20/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4005 MANZANITA AVE	SUITE 57	CARMICHAEL	CA	95608	1784	34	06067	38.637936	-121.330494	Sacramento County
46637	Fee-for-Service	1588396519	1588396519	1	1	BITO-ONON, BJ RRT	3/22/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
46658	Fee-for-Service	1912902131	1912902131	1	1	BILLIGMEIER, STEVEN L MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	79415	40	Pediatrics	0	In state provider	None	89 W MARCH LN	STE 1	STOCKTON	CA	95207	5723	39	06077	37.9950695	-121.307499	San Joaquin County
46662	Fee-for-Service	1699119032	1699119032	1	1	BUSS, ALLISON R MD	2/19/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143754	40	Pediatrics	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
46667	Fee-for-Service	1801125406	1801125406	1	1	BERLETTI, MONICA J MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123274	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
46679	Fee-for-Service	1407941081	1407941081	1	2	BENJAMIN, DAVID S MD	5/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	75256	34	Urology and Urological Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2050	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
46692	Fee-for-Service	1124000724	1124000724	1	1	BECKER, RONALD P	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58254	40	Pediatrics	0	In state provider	None	41011 CALIFORNIA OAKS RD	STE 101	MURRIETA	CA	92562	5751	33	06065	33.56684933	-117.2064118	Riverside County
46721	Fee-for-Service	1841342649	1841342649	1	1	BUGAY, MARIA V MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86462	08	Family Practice	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
46725	Fee-for-Service	1821198748	1821198748	1	1	BARNES, BRIAN L MD	2/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	235 W 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
46758	Fee-for-Service	1154401941	1154401941	1	37	BASS MEDICAL GROUP	10/23/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18181 BUTTERFIELD BLVD	185	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
46766	Fee-for-Service	1174532667	1174532667	1	1	BARNES, CAMILLE Y MD	1/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110083	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	770 MASON STREET	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
46769	Fee-for-Service	1396752093	1396752093	1	1	BLUMENFELD, ARNOLD I PHD	5/16/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23560 LYONS AVE	SUITE 202	NEWHALL	CA	91321	2521	19	06037	34.37936213	-118.5462451	Los Angeles County
46815	Fee-for-Service	1134218837	1134218837	1	1	BRENT L STEFFEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KEARNEY CLINIC P.C	31ST CENTRAL AVE	None	KEARNEY	NE	68847	0000	00	None	40.66483044	-99.08252093	Buffalo County
46849	Fee-for-Service	1871169896	1871169896	1	1	BHAMRE, SNEHA MD	11/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
46853	Fee-for-Service	1548227408	1548227408	1	1	BAXTER, RONALD N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2929 5TH ST	STE 100	RAPID CITY	SD	57701	7355	00	None	44.05598594	-103.2274757	Pennington County
46858	Fee-for-Service	1487101119	1487101119	1	1	BELLE VIE HOME HEALTH INC	6/8/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1220 GREENFIELD DR	None	EL CAJON	CA	92021	3316	37	06073	32.81336347	-116.939412	San Diego County
46872	Fee-for-Service	1659833754	1659833754	1	1	BOWDITCH, SYLVIA P MD	10/24/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180163	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
46874	Fee-for-Service	1003016262	1003016262	1	1	BENJAMIN, ROBERT A MD	3/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	33673	01	General Practice	0	In state provider	None	3240 KERNER BOULEVARD	None	SAN RAFAEL	CA	94901	4840	21	06041	37.960254	-122.5019535	Marin County
46879	Fee-for-Service	1154401941	1154401941	1	33	BASS MEDICAL GROUP	10/7/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16130 JUAN HERNANDEZ DR	108	MORGAN HILL	CA	95037	5527	43	06085	37.12005551	-121.6305064	Santa Clara County
46890	Fee-for-Service	1154401941	1154401941	1	68	BASS MEDICAL GROUP	11/21/2024	174400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	7700 MORRO RD	None	ATASCADERO	CA	93422	4435	40	06079	35.47579542	-120.6678702	San Luis Obispo County
46915	Fee-for-Service	1356546337	1356546337	1	1	BEAUPARLANT, PAUL J LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
46929	Fee-for-Service	1588950653	1588950653	1	1	BROADHURST, LUCAS BOCP	3/3/2023	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 SECRET RAVINE PKWY	SUITE 100	ROSEVILLE	CA	95661	3096	31	06061	38.7634713	-121.2456577	Placer County
46930	Fee-for-Service	1447435151	1447435151	1	1	BROYLES, ZHENGHONG Z CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19121 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2307	30	06059	33.685155	-117.988868	Orange County
46932	Fee-for-Service	1134653223	1134653223	1	1	BAYCROFT, ALIXANDRA M MD	8/16/2021	207L00000X	NA	Other	026	PHYSICIANS	157283	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46964	Fee-for-Service	1861832214	1861832214	1	1	BHESANIA, NATALIE MD	6/28/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
46974	Fee-for-Service	1295709335	1295709335	1	1	BARRON, WILLIAM M MD	7/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	34551	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
46991	Fee-for-Service	1700486271	1700486271	1	1	BRIGHT HOME HEALTH CARE	9/6/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 135	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
46994	Fee-for-Service	1245879337	1245879337	1	1	BURGA, JOANNA	8/8/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
47011	Fee-for-Service	1114953650	1114953650	1	1	BASHAR MOHSEN MD	3/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1190 NW 95TH ST	STE 303	MIAMI	FL	33150	2066	00	None	25.859304	-80.214633	Miami-Dade County
47012	Fee-for-Service	1285645002	1285645002	1	1	BRODERICK, PETER W MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63629	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
47035	Fee-for-Service	1255339099	1255339099	1	1	BUGNA, ERIC E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28612	20	Orthopedic Surgery	0	In state provider	None	500 FIRST AVE	None	PORTOLA	CA	96122	9406	32	06063	39.80595392	-120.4626723	Plumas County
47040	Fee-for-Service	1851484919	1851484919	1	1	BROWN, LLOYD JEFFREY MD	10/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72955	40	Pediatrics	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
47044	Fee-for-Service	1184685281	1184685281	1	1	BARRIENTOS, DOMINGO C MD	8/7/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56239	01	General Practice	0	In state provider	INC	10800 PARAMOUNT BLVD	STE 203	DOWNEY	CA	90241	3317	19	06037	33.94604301	-118.1354831	Los Angeles County
47048	Fee-for-Service	1154401941	1154401941	1	37	BASS MEDICAL GROUP	10/23/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	18181 BUTTERFIELD BLVD	185	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
47051	Fee-for-Service	1548230071	1548230071	1	1	BALLENTINE, KENNETH H OD	9/5/1980	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5275 PROSPECT RD	None	SAN JOSE	CA	95129	5031	43	06085	37.29212088	-121.9942484	Santa Clara County
47090	Fee-for-Service	1831197920	1831197920	1	1	BRANDEIS, JUDSON M MD	1/1/2001	208800000X	NA	Other	026	PHYSICIANS	62541	34	Urology and Urological Surgery	0	In state provider	None	2222 EAST ST	STE 250	CONCORD	CA	94520	2096	07	06013	37.98125538	-122.0329375	Contra Costa County
47094	Fee-for-Service	1851402184	1851402184	1	1	BRUNS-GARCIA, JERRY R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41569	36	Psychiatry	0	In state provider	None	333 N LANTANA ST	None	CAMARILLO	CA	93010	9010	56	06111	34.219503	-119.055108	Ventura County
47134	Fee-for-Service	1518936947	1518936947	1	1	BENHAM, LISA ANN	1/23/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2791 GREEN RIVER RD	STE 106	CORONA	CA	92882	7453	33	06065	33.87058838	-117.622429	Riverside County
47136	Fee-for-Service	1063439842	1063439842	1	1	BEST MEDICAL LLC	7/20/2015	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	20325 N 51ST AVE	BLDG 6, SUITE 142	GLENDALE	AZ	85308	4610	00	None	33.6699417	-112.1692712	Maricopa County
47140	Fee-for-Service	1578628707	1578628707	1	1	BARSKY-EX, BRYNA G PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95213	3640	43	06085	37.246896	-121.8040865	Santa Clara County
47144	Fee-for-Service	1023074820	1023074820	1	1	BETZ, DAVID A MD	8/12/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72771	05	Anesthesiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
47154	Fee-for-Service	1689902942	1689902942	1	1	BERGMAN, NANCY H	4/16/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2648 MAIN STREET	SUITE B AND C	CHULA VISTA	CA	91911	4664	37	06073	32.5948443	-117.0761526	San Diego County
47169	Fee-for-Service	1689812307	1689812307	1	1	BERNARDINO, JAMES CPO	10/1/1995	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	AND ORTHOTICS	1524 21ST STREET	SUITE B	BAKERSFIELD	CA	93301	4002	15	06029	35.3781555	-119.0195505	Kern County
47179	Fee-for-Service	1154401941	1154401941	1	68	BASS MEDICAL GROUP	11/21/2024	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7700 MORRO RD	None	ATASCADERO	CA	93422	4435	40	06079	35.47579542	-120.6678702	San Luis Obispo County
47224	Fee-for-Service	1740551688	1740551688	1	1	BASU, SHARMILA MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120703	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
47228	Fee-for-Service	1669547618	1669547618	1	1	BARARSANI, MOHAMMAD MD	10/9/2012	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	35392	None	None	0	In state provider	None	18051 CRENSHAW BLVD	SUITE #C	TORRANCE	CA	90504	5144	19	06037	33.866523	-118.3265185	Los Angeles County
47251	Fee-for-Service	1225233398	1225233398	1	1	BAGDASARIAN, LEVICK A MD	8/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89418	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
47268	Fee-for-Service	1003824020	1003824020	1	2	BAYLON, PAUL M MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	48547	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7301 STATE ST	None	HUNTINGTON PARK	CA	90255	5823	19	06037	33.97149395	-118.2097278	Los Angeles County
47286	Fee-for-Service	1508911892	1508911892	1	13	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5924 STONE RIDGE DR	SUITE 102	PLEASANTON	CA	94588	0000	01	06001	37.69132593	-121.8988844	Alameda County
47294	Fee-for-Service	1538178876	1538178876	1	1	BLITZ, JAMES P MD INC	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	27255	02	General Surgery	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
47316	Fee-for-Service	1821008913	1821008913	1	2	BANGASH, ISHTIAQUE A MD	6/6/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	50964	-	NOT APPLICABLE	0	In state provider	None	10535 RD 35	None	MADERA	CA	93636	8487	20	06039	36.90376264	-119.9101802	Madera County
47322	Fee-for-Service	1104859164	1104859164	1	1	BONNI-SAEED,ARAM L MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66385	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
47327	Fee-for-Service	1477578698	1477578698	1	1	BOLIVAR, ALVARO MD	11/30/1983	208600000X	NA	General Surgery	026	PHYSICIANS	38312	02	General Surgery	0	In state provider	None	598 N F ST	None	SAN BERNARDINO	CA	92410	3110	36	06071	34.109865	-117.296439	San Bernardino County
47331	Fee-for-Service	1184685281	1184685281	1	1	BARRIENTOS, DOMINGO C MD	8/7/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56239	41	Internal Medicine	0	In state provider	INC	10800 PARAMOUNT BLVD	STE 203	DOWNEY	CA	90241	3317	19	06037	33.94604301	-118.1354831	Los Angeles County
47408	Fee-for-Service	1417345091	1417345091	1	1	BTLA VI	6/22/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5555 RESERVOIR DR	STE 209	SAN DIEGO	CA	92120	5186	37	06073	32.77628471	-117.0563688	San Diego County
47439	Fee-for-Service	1669578951	1669578951	1	1	BALINT, EVA MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91096	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
47447	Fee-for-Service	1467530063	1467530063	1	1	BARRY, MICHELLE S MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85355	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
47462	Fee-for-Service	1609308519	1609308519	1	1	BARRERAS CORTES, PAULA V MD	9/1/2023	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	188666	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
47469	Fee-for-Service	1093861346	1093861346	1	1	BIVONA, TREVER G MD	10/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119835	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
47475	Fee-for-Service	1588020630	1588020630	1	1	BROOKS, KATLIN A LCSW	5/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
47480	Fee-for-Service	1598711855	1598711855	1	1	BUTHAINA RICHEH MD	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6000 HOSPITAL DR	None	HANNIBAL	MO	63401	6887	00	None	39.71060756	-91.44988518	Marion County
47483	Fee-for-Service	1831170950	1831170950	2	1	BUI, DUC C MD	4/3/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	45958	45	Nephrology (Renal-Kidney)	0	In state provider	None	801 S CHEVY CHASE DR	STE 101	GLENDALE	CA	91205	4432	19	06037	34.136757	-118.2396195	Los Angeles County
47489	Fee-for-Service	1104334598	1104334598	1	1	BOGUES, CATHERINE M	5/18/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	202 FASHION LN	STE 101	TUSTIN	CA	92780	3319	30	06059	33.7470725	-117.8179335	Orange County
47496	Fee-for-Service	1417035908	1417035908	1	1	BLUMBERG, BRUCE D MD	5/19/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	30453	40	Pediatrics	0	In state provider	None	4760 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
47520	Fee-for-Service	1609898758	1609898758	1	1	BATIN, FRANCES P MD	6/15/1994	174400000X	NA	Other	026	PHYSICIANS	66244	66	Emergency Medicine (Urgent Care)	0	In state provider	None	460 GREENFIELD AVE	STE 4	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
47534	Fee-for-Service	1427288265	1427288265	1	1	BIESBROECK, ERIC B MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 SAINT ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
47547	Fee-for-Service	1669492237	1669492237	1	1	BROWN, TERESA T MD	1/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
47571	Fee-for-Service	1508911892	1508911892	1	13	BAY AREA FOOT CARE, INC	7/28/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5924 STONE RIDGE DR	SUITE 102	PLEASANTON	CA	94588	0000	01	06001	37.69132593	-121.8988844	Alameda County
47578	Fee-for-Service	1104605567	1104605567	1	1	BUTLER, AMANDA B LCSW	2/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
47614	Fee-for-Service	1154401941	1154401941	1	3	BASS MEDICAL GROUP	2/25/2019	208C00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	365 LENNON LN	STE 290	WALNUT CREEK	CA	94598	5915	07	06013	37.92784983	-122.0301444	Contra Costa County
47616	Fee-for-Service	1497136287	1497136287	1	1	BRUNO, CONNIE K MD	8/27/2020	207L00000X	NA	Other	026	PHYSICIANS	169262	05	Anesthesiology	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
47638	Fee-for-Service	1417264227	1417264227	1	1	BAFFI, CYNTHIA W MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113502	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
47693	Fee-for-Service	1417418559	1417418559	1	1	BLESSING HOME CARE INC	12/19/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 213	VAN NUYS	CA	91411	2399	19	06037	34.18570347	-118.450386	Los Angeles County
47722	Fee-for-Service	1699738385	1699738385	1	1	BACKMAN, MARTIN J MD	3/9/1996	2084N0400X	NA	Neurology	026	PHYSICIANS	44638	13	Neurology (M.D. only)	0	In state provider	None	3706 W SUNSET BLVD	None	LOS ANGELES	CA	90026	1528	19	06037	34.09060765	-118.2780935	Los Angeles County
47745	Fee-for-Service	1144877952	1144877952	1	3	BEST PACIFIC MD GROUP INC	6/18/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	7400 VAN NUYS BLVD	SUITE 111	VAN NUYS	CA	91405	1972	19	06037	34.205454	-118.448724	Los Angeles County
47771	Fee-for-Service	1720013618	1720013618	1	1	BROWN, ARLEEN MD	7/31/1995	207R00000X	NA	Other	026	PHYSICIANS	78722	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
47774	Fee-for-Service	1831170950	1831170950	2	1	BUI, DUC C MD	4/3/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	45958	41	Internal Medicine	0	In state provider	None	801 S CHEVY CHASE DR	STE 101	GLENDALE	CA	91205	4432	19	06037	34.136757	-118.2396195	Los Angeles County
47793	Fee-for-Service	1194711945	1194711945	1	1	BAE,ANTHONY I MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67618	41	Internal Medicine	0	In state provider	None	1041 E YORBA LINDA BLVD	STE 5	PLACENTIA	CA	92870	3736	30	06059	33.88848865	-117.8451029	Orange County
47803	Fee-for-Service	1447283775	1447283775	1	1	BANKS, AARON E MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83169	40	Pediatrics	0	In state provider	None	500 OLD RIVER ROAD	SUITE 105	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
47827	Fee-for-Service	1487639290	1487639290	1	1	BARAN, ILONA A	1/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	45912	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
47849	Fee-for-Service	1407934946	1407934946	1	1	BURLINGTON CONVALESCENT	7/1/2001	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	845 S BURLINGTON AVE	None	LOS ANGELES	CA	90057	4207	19	06037	34.05221622	-118.2752975	Los Angeles County
47893	Fee-for-Service	1609082478	1609082478	1	1	BRADFORD HOME INC	2/16/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	59 BRADFORD DR	None	S SAN FRANCISCO	CA	94080	1129	41	06081	37.66745044	-122.4576382	San Mateo County
47900	Fee-for-Service	1154401941	1154401941	1	3	BASS MEDICAL GROUP	2/25/2019	208C00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	365 LENNON LN	STE 290	WALNUT CREEK	CA	94598	5915	07	06013	37.92784983	-122.0301444	Contra Costa County
47944	Fee-for-Service	1013957125	1013957125	1	1	BUI, BRIAN A MD	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	67716	41	Internal Medicine	0	In state provider	None	39755 MURRIETA HOT SPRG	E-130	MURRIETA	CA	92563	9101	33	06065	33.55575954	-117.1627899	Riverside County
47960	Fee-for-Service	1730381518	1730381518	1	1	BENGIAMIN, RIMON N MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98765	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
47993	Fee-for-Service	1962415794	1962415794	1	2	BRAR, YASH G D SINGH MD	3/2/2004	207R00000X	NA	Other	026	PHYSICIANS	51440	01	General Practice	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
47995	Fee-for-Service	1851528376	1851528376	1	1	BARNERT, ELIZABETH S MD	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113383	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
48004	Fee-for-Service	1134306830	1134306830	1	1	BUOTE, ANN R MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98767	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
48018	Fee-for-Service	1356386577	1356386577	1	1	BAERG, JOANNE E	1/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73774	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
48033	Fee-for-Service	1144877952	1144877952	1	3	BEST PACIFIC MD GROUP INC	6/18/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	7400 VAN NUYS BLVD	SUITE 111	VAN NUYS	CA	91405	1972	19	06037	34.205454	-118.448724	Los Angeles County
48053	Fee-for-Service	1558497982	1558497982	1	1	BANFFY, MICHAEL B MD	8/16/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	113942	20	Orthopedic Surgery	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
48072	Fee-for-Service	1538497540	1538497540	1	1	BRENT P. CHINN, OD AND DAVID	3/1/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1039 EL MONTE AVE	SUITE K	MOUNTAIN VIEW	CA	94040	2371	43	06085	37.39058176	-122.0958518	Santa Clara County
48086	Fee-for-Service	1528343415	1528343415	1	1	BIZAOUI, SHIRA A CRNA	3/6/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
48088	Fee-for-Service	1902337264	1902337264	1	1	BECKA, ALEXANDER MD	10/13/2020	207R00000X	NA	Other	026	PHYSICIANS	161802	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
48091	Fee-for-Service	1447283775	1447283775	1	1	BANKS, AARON E MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83169	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 OLD RIVER ROAD	SUITE 105	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
48173	Fee-for-Service	1912004698	1912004698	1	1	BUONO, DARREN M MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86769	None	None	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
48205	Fee-for-Service	1811917396	1811917396	1	1	BODDU, NAVNEET K MD	5/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	54188	05	Anesthesiology	0	In state provider	None	23201 LAKE CENTER DR	STE 214	LAKE FOREST	CA	92630	6808	30	06059	33.6255281	-117.7160257	Orange County
48212	Fee-for-Service	1033305610	1033305610	1	1	BAKILANA, MARTINA LMFT	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	M/B 10, SUITE B	SANTA CLARA	CA	95050	4721	43	06085	37.34637328	-121.9509049	Santa Clara County
48217	Fee-for-Service	1629301627	1629301627	1	1	BECERRA MACIEL, MARCELA LMF	4/3/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
48232	Fee-for-Service	1184783805	1184783805	1	1	BAIR, JESSICA P CRNA	6/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
48247	Fee-for-Service	1508335514	1508335514	1	1	BAUMANN, ALLISON K LCSW	4/9/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
48256	Fee-for-Service	1558681379	1558681379	1	1	BAJESTAN, SEPIDEH N MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117763	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48339	Fee-for-Service	1902164874	1902164874	1	1	BHAK, GRACE E MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140322	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
48372	Fee-for-Service	1255302485	1255302485	1	1	BAUGH, THOMAS C DO	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9661	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
48379	Fee-for-Service	1629054291	1629054291	1	1	BYRD, RICHARD A MD	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
48418	Fee-for-Service	1750423802	1750423802	1	1	BUCKLEY, MARYELLEN PHD	9/20/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
48453	Fee-for-Service	1538148655	1538148655	1	1	BECKETT, JAMES H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24778	07	Dermatology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
48471	Fee-for-Service	1710035761	1710035761	1	1	BARBEE, GLEN J MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70073	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
48481	Fee-for-Service	1154401941	1154401941	1	50	BASS MEDICAL GROUP	2/8/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	18181 BUTTERFIELD BLVD	180A & B	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
48500	Fee-for-Service	1336645142	1336645142	1	1	BASKIND, MELANIE J MD	5/14/2021	390200000X	NA	Other	026	PHYSICIANS	164717	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
48504	Fee-for-Service	1043331283	1043331283	1	1	BECKER, LAREN S MD	12/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109613	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48520	Fee-for-Service	1407940117	1407940117	1	1	BURKE, GREGORY W MD	9/3/1991	207P00000X	NA	Other	026	PHYSICIANS	72365	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
48533	Fee-for-Service	1114967130	1114967130	1	1	BOWER, KURT S MD	8/1/1998	207P00000X	NA	Other	026	PHYSICIANS	57570	08	Family Practice	0	In state provider	None	14130 SKYWAY	# H	MAGALIA	CA	95954	9446	04	06007	39.81792964	-121.5923816	Butte County
48539	Fee-for-Service	1265469563	1265469563	1	1	BRIERE, SARAH B NP	10/7/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 CRAVEN RD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
48566	Fee-for-Service	1962478107	1962478107	2	1	BHASIN, PARAMDEEP	6/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	66108	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
48570	Fee-for-Service	1740570100	1740570100	1	1	BAHNG, AGNES Y MD	3/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128840	01	General Practice	0	In state provider	None	18625 SHERMAN WAY	None	RESEDA	CA	91335	4139	19	06037	34.20121398	-118.5393529	Los Angeles County
48584	Fee-for-Service	1073532610	1073532610	1	1	BROOSKY, SAMUEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	30 SHELBURNE RD	None	STAMFORD	CT	06902	3628	00	None	41.054958	-73.55391404	Western Connecticut Planning Region
48593	Fee-for-Service	1851376123	1851376123	1	1	BAEZ, STEPHEN A MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
48603	Fee-for-Service	1326573627	1326573627	1	1	BAUTISTA, SARAH	8/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
48617	Fee-for-Service	1144424102	1144424102	1	1	BAI, BRIAN C MD	10/2/2011	193400000X	NA	Other	026	PHYSICIANS	101489	08	Family Practice	0	In state provider	None	1200 N VENTURA ROAD	STE A	OXNARD	CA	93030	3790	56	06111	34.21435634	-119.1943831	Ventura County
48633	Fee-for-Service	1063472736	1063472736	1	1	BUTLER, VERONICA W MD	2/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	86665	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
48651	Fee-for-Service	1396776548	1396776548	1	1	BROUTSKI, VASSILI MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94151	08	Family Practice	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
48661	Fee-for-Service	1568488971	1568488971	1	1	BEY, THOMAS M MD	10/31/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	75671	None	None	0	In state provider	None	1617 N CALIFORNIA ST	STE 1A	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
48683	Fee-for-Service	1043864895	1043864895	1	1	BEST CHOICE HOME HEALTH INC	12/21/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR STREET	SUITE 150	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
48708	Fee-for-Service	1154401941	1154401941	1	35	BASS MEDICAL GROUP	10/8/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	6060 HELLYER AVE	150	SAN JOSE	CA	95138	1046	43	06085	37.25670154	-121.7796404	Santa Clara County
48721	Fee-for-Service	1417343575	1417343575	1	1	BODE, JESSICA L MD	11/27/2020	207P00000X	NA	Other	026	PHYSICIANS	170445	None	None	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
48746	Fee-for-Service	1013209972	1013209972	1	1	BOOKER, ERICA LCSW	8/25/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	119 FIGUEROA ST	None	VENTURA	CA	93001	2756	56	06111	34.27916165	-119.2977526	Ventura County
48759	Fee-for-Service	1467167965	1467167965	1	1	BUCKELEW PROGRAMS	11/5/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	540 MIDDLE RINCON RD	None	SANTA ROSA	CA	95409	3107	49	06097	38.471364	-122.6695725	Sonoma County
48771	Fee-for-Service	1154401941	1154401941	1	50	BASS MEDICAL GROUP	2/8/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	18181 BUTTERFIELD BLVD	180A & B	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
48778	Fee-for-Service	1154589471	1154589471	1	1	BOYER, GEORGE P CO	1/22/2001	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 E BONITA AVE	None	POMONA	CA	91767	1926	19	06037	34.09618648	-117.7443519	Los Angeles County
48782	Fee-for-Service	1841851201	1841851201	1	1	BASSO PODIATRY GROUP, INC	7/20/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	635 ANDERSON RD STE 19	None	DAVIS	CA	95616	3505	57	06113	38.54876426	-121.7587542	Yolo County
48802	Fee-for-Service	1467534644	1467534644	1	1	BATNIJI, RAMI K MD	11/20/2008	207YS0123X	NA	ENT/Otolaryngology	026	PHYSICIANS	89307	04	Otology, Laryngology, Rhinology	0	In state provider	None	1300 N VERMONT	STE 604	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
48807	Fee-for-Service	1790730984	1790730984	1	1	BAKER, DIANA B MD	12/17/2003	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68958	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
48829	Fee-for-Service	1457781676	1457781676	1	1	BENEVOLENCE INDUSTRIES INC	9/24/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	611 E IMPERIAL HWY	SUITE 107	LOS ANGELES	CA	90059	2358	19	06037	33.93106348	-118.264662	Los Angeles County
48853	Fee-for-Service	1891256913	1891256913	1	1	BATTINI, SAHITHI MD	10/7/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
48869	Fee-for-Service	1215960851	1215960851	1	1	BABAD, JOSHUA N MD A MEDICAL	1/1/1979	261QM2500X	NA	Other	026	PHYSICIANS	22841	18	Ophthalmology	0	In state provider	CORP	515 SOQUEL AVE	None	SANTA CRUZ	CA	95062	2309	44	06087	36.9755839	-122.0175832	Santa Cruz County
48874	Fee-for-Service	1245869759	1245869759	1	1	BRAR, YUVNEET K MD	4/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192459	08	Family Practice	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
48876	Fee-for-Service	1851376123	1851376123	1	1	BAEZ, STEPHEN A MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
48882	Fee-for-Service	1679784664	1679784664	1	1	BUBLIK, MICHAEL MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112615	04	Otology, Laryngology, Rhinology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
48894	Fee-for-Service	1659429447	1659429447	1	1	BOYD JR, HOMER MD	1/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	55821	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
48918	Fee-for-Service	1245323179	1245323179	1	1	BUI VAN, REBECCA OD	11/20/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5931 STANLEY AVE	STE 1	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
48947	Fee-for-Service	1659922755	1659922755	1	1	BRION NEELY, EDEN M LCSW	6/15/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19712 MACARTHUR BOULEVAR	SUITE 110	IRVINE	CA	92612	9266	30	06059	33.65788122	-117.8626278	Orange County
48961	Fee-for-Service	1083010920	1083010920	1	1	BRIGHT SKY HOME HEALTH CARE	4/27/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	502 CAJON STREET	None	REDLANDS	CA	92373	5904	36	06071	34.04873385	-117.1775922	San Bernardino County
48993	Fee-for-Service	1982716205	1982716205	1	1	BIGLER, TERRI E MD	9/30/1995	207R00000X	NA	Other	026	PHYSICIANS	78179	41	Internal Medicine	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
48998	Fee-for-Service	1154401941	1154401941	1	35	BASS MEDICAL GROUP	10/8/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6060 HELLYER AVE	150	SAN JOSE	CA	95138	1046	43	06085	37.25670154	-121.7796404	Santa Clara County
49004	Fee-for-Service	1407417736	1407417736	1	1	BAHAEE, MITRA B MD	9/6/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178502	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
49017	Fee-for-Service	1619921707	1619921707	1	1	BILLS, BRENT MD	8/1/1998	207P00000X	NA	Other	026	PHYSICIANS	34047	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5774 PENTZ RD	None	PARADISE	CA	95969	6046	04	06007	39.74954652	-121.5724541	Butte County
49034	Fee-for-Service	1083934244	1083934244	1	1	BRIGHTHEAR	2/15/2011	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9056 SANTA MONICA BLVD	STE 307	WEST HOLLYWOOD	CA	90069	5545	19	06037	34.08164577	-118.3885792	Los Angeles County
49039	Fee-for-Service	1194353698	1194353698	1	1	BEROUKHIM, SHAWHIN MD	10/16/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
49046	Fee-for-Service	1336271766	1336271766	1	1	BURNEY, ANNE MD	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
49048	Fee-for-Service	1790532661	1790532661	1	1	BEST CARE ASSISTED LIVING	12/12/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ON HASKELL	9756 HASKELL AVE	None	NORTH HILLS	CA	91343	1936	19	06037	34.248096	-118.476164	Los Angeles County
49059	Fee-for-Service	1154401941	1154401941	1	50	BASS MEDICAL GROUP	2/8/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18181 BUTTERFIELD BLVD	180A & B	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
49064	Fee-for-Service	1841851201	1841851201	1	1	BASSO PODIATRY GROUP, INC	1/11/2021	213E00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	635 ANDERSON RD STE 19	None	DAVIS	CA	95616	3505	57	06113	38.54876426	-121.7587542	Yolo County
49066	Fee-for-Service	1891825667	1891825667	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	1318A AND 1314B NORTH A	None	WILMINGTON	CA	90744	2639	19	06037	33.7900693	-118.2624203	Los Angeles County
49086	Fee-for-Service	1467534644	1467534644	1	1	BATNIJI, RAMI K MD	11/20/2008	207YS0123X	NA	ENT/Otolaryngology	026	PHYSICIANS	89307	24	Plastic Surgery	0	In state provider	None	1300 N VERMONT	STE 604	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
49090	Fee-for-Service	1407288236	1407288236	1	1	BODILY, APRIL M NP	3/2/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
49099	Fee-for-Service	1093863169	1093863169	1	1	BLEVINS, NIKOLAS H MD	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	68567	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
49102	Fee-for-Service	1710351705	1710351705	1	1	BERG, ERIK A MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139144	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
49104	Fee-for-Service	1457781676	1457781676	1	1	BENEVOLENCE INDUSTRIES INC	9/24/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	611 E IMPERIAL HWY	SUITE 107	LOS ANGELES	CA	90059	2358	19	06037	33.93106348	-118.264662	Los Angeles County
49163	Fee-for-Service	1174579700	1174579700	1	1	BAHN, DUKE K MD	1/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50752	30	Radiology	0	In state provider	None	422 ARNEILL RD	STE A	CAMARILLO	CA	93010	6434	56	06111	34.221492	-119.0389245	Ventura County
49173	Fee-for-Service	1750477758	1750477758	1	1	BROWN, JEFFREY H MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	40067	83	Rheumatology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
49182	Fee-for-Service	1548614050	1548614050	1	1	BERGMAN, ALEX G MD	6/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	156010	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
49197	Fee-for-Service	1053752568	1053752568	1	1	BULAND, MICHELE LCSW	3/8/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
49206	Fee-for-Service	1780621375	1780621375	1	1	BRIAN PATERICK M.D.	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
49208	Fee-for-Service	1508012634	1508012634	1	1	BHAVSAR, ANIL S MD	11/5/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	168589	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
49219	Fee-for-Service	1770549131	1770549131	1	1	BERTRAM, LYNN D MD	5/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	50679	36	Psychiatry	0	In state provider	None	10 WOODLAND RD	STE 502	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
49237	Fee-for-Service	1073873634	1073873634	1	1	BELLFIELD, EDWARD J MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122699	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
49239	Fee-for-Service	1407167703	1407167703	1	1	BROOKS, ADAM G MD	11/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119135	20	Orthopedic Surgery	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
49264	Fee-for-Service	1306915764	1306915764	1	1	BLEIWEISS, STEVEN P MD	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
49267	Fee-for-Service	1861641953	1861641953	1	1	BOYD, JONATHAN W MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112064	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
49283	Fee-for-Service	1154401941	1154401941	1	35	BASS MEDICAL GROUP	8/15/2022	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6060 HELLYER AVE	150	SAN JOSE	CA	95138	1046	43	06085	37.25670154	-121.7796404	Santa Clara County
49289	Fee-for-Service	1508944349	1508944349	1	1	BUI, CHRISTOPHER T MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78064	22	Pathology (M.D. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
49321	Fee-for-Service	1780029413	1780029413	1	1	BEN ARI LAZCANO, JUDITH S M	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
49322	Fee-for-Service	1053747279	1053747279	1	1	BAUTISTA, PALOMA D LCSW	10/11/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
49333	Fee-for-Service	1598919839	1598919839	1	1	BHAMBRA, PREET P DO	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10515	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
49344	Fee-for-Service	1649581349	1649581349	1	1	BAIMA, STEVEN A LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
49359	Fee-for-Service	1629301700	1629301700	1	1	BACH, DYLAN M MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107094	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
49362	Fee-for-Service	1790754455	1790754455	1	1	BOTNICK, BEVERLY S MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49720	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
49388	Fee-for-Service	1982044004	1982044004	1	1	BARRAZA, ROSA A	11/17/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
49426	Fee-for-Service	1346857695	1346857695	1	1	BETA CARING HANDS HOSPICE	8/3/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	110 W FIR ST	SUITE 4	BREA	CA	92821	6407	30	06059	33.90996429	-117.9045996	Orange County
49445	Fee-for-Service	1205917051	1205917051	1	1	BAY WIDE DME CO IN	10/20/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	BAY WIDE DME CO	60 EUREKA SQ	None	PACIFICA	CA	94044	2653	41	06081	37.6325943	-122.4888334	San Mateo County
49449	Fee-for-Service	1003401910	1003401910	1	1	BITTERROOT FAMILY THERAPY IN	3/29/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C.	347 CYPRESS ST	SUITE A	FORT BRAGG	CA	95437	5458	23	06045	39.43270236	-123.8026618	Mendocino County
49484	Fee-for-Service	1669890588	1669890588	1	1	BOOKER, MICHAEL T MD	7/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	140037	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
49491	Fee-for-Service	1689806317	1689806317	1	1	BUCHSBAUM, ANNA M MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107516	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3838 CALIFORNIA ST	STE805	SAN FRANCISCO	CA	94118	1510	38	06075	37.78591809	-122.4575439	San Francisco County
49493	Fee-for-Service	1154401941	1154401941	1	57	BASS MEDICAL GROUP	6/28/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3010 COLBY	STE 118	BERKELEY	CA	94705	2091	01	06001	37.85492078	-122.2576101	Alameda County
49538	Fee-for-Service	1629734496	1629734496	1	1	BROWN, CATHERINE NP	11/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
49541	Fee-for-Service	1992230684	1992230684	1	1	BHATT, VIVEK V MD	9/21/2020	207R00000X	NA	Other	026	PHYSICIANS	160749	41	Internal Medicine	0	In state provider	None	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
49542	Fee-for-Service	1235241480	1235241480	1	1	BROWN, LINDA M	6/8/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	888 S HILL RD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
49564	Fee-for-Service	1508911892	1508911892	1	17	BAY AREA FOOT CARE, INC	7/25/2023	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6000 FAIRWAY DR	SUITE 18	ROCKLIN	CA	95677	4246	31	06061	38.79220243	-121.2621624	Placer County
49572	Fee-for-Service	1154401941	1154401941	1	35	BASS MEDICAL GROUP	10/8/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	6060 HELLYER AVE	150	SAN JOSE	CA	95138	1046	43	06085	37.25670154	-121.7796404	Santa Clara County
49574	Fee-for-Service	1316085988	1316085988	1	1	BUENA VISTA WOMAN'S	2/6/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	COMP. CARE MED. ASSOCS.	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
49576	Fee-for-Service	1417944471	1417944471	1	1	BUI, HONG HUU MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	51168	41	Internal Medicine	0	In state provider	None	1661 BURDETTE DR	STE I	SAN JOSE	CA	95121	1681	43	06085	37.32012377	-121.8254031	Santa Clara County
49586	Fee-for-Service	1588702575	1588702575	1	1	BURGOS, RAFAEL MD	4/7/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52482	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
49591	Fee-for-Service	1275517070	1275517070	1	1	BAKER, SAMUEL S JR MD	2/8/2015	207RC0200X	NA	Other	026	PHYSICIANS	36900	01	General Practice	0	In state provider	None	1401 SPANOS CT	STE 230	MODESTO	CA	95355	2816	50	06099	37.66975543	-120.9724048	Stanislaus County
49598	Fee-for-Service	1144681404	1144681404	1	1	BOERSMA, MEAGAN A LCSW	2/25/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
49615	Fee-for-Service	1265895379	1265895379	1	1	BECK, CHRISTOPHER MD	2/24/2020	207P00000X	NA	Other	026	PHYSICIANS	152475	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
49622	Fee-for-Service	1891969564	1891969564	1	1	BEN-ARTZI, DANA O MD	1/31/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	102367	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
49637	Fee-for-Service	1760446033	1760446033	1	1	BELENKY, INNA MD	4/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88360	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
49642	Fee-for-Service	1760612816	1760612816	1	1	BAROLIA, KHURRAM K MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118960	08	Family Practice	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
49647	Fee-for-Service	1861669327	1861669327	1	1	BADILLO, ADRIAN I DO	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12286	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
49649	Fee-for-Service	1790754455	1790754455	1	1	BOTNICK, BEVERLY S MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49720	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
49678	Fee-for-Service	1164403531	1164403531	1	1	BATTA, ALEX GEORGE	1/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42230	34	Urology and Urological Surgery	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
49699	Fee-for-Service	1730133133	1730133133	1	1	BEILIN, LEONID B MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	16168	02	General Surgery	0	In state provider	None	150 W ALOSTA AVE	None	GLENDORA	CA	91740	0000	19	06037	34.1286357	-117.8661313	Los Angeles County
49714	Fee-for-Service	1346857695	1346857695	1	1	BETA CARING HANDS HOSPICE	8/3/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	110 W FIR ST	SUITE 4	BREA	CA	92821	6407	30	06059	33.90996429	-117.9045996	Orange County
49729	Fee-for-Service	1942286562	1942286562	1	1	BROWN, MICHAEL A MD	7/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88678	20	Orthopedic Surgery	0	In state provider	None	357 PERKINS ST	None	SONOMA	CA	95476	6826	49	06097	38.28911428	-122.4652697	Sonoma County
49733	Fee-for-Service	1922555051	1922555051	1	1	BRUCE, KRISTEN K CCC-SLP	10/7/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
49753	Fee-for-Service	1609991629	1609991629	1	1	BIGLER, JOSHUA MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108446	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
49755	Fee-for-Service	1023108651	1023108651	1	1	BERNSTEIN, PAUL S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	65 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84132	0005	00	None	40.77084736	-111.8399634	Salt Lake County
49782	Fee-for-Service	1154401941	1154401941	1	57	BASS MEDICAL GROUP	6/28/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	3010 COLBY	STE 118	BERKELEY	CA	94705	2091	01	06001	37.85492078	-122.2576101	Alameda County
49787	Fee-for-Service	1861595829	1861595829	1	1	BROUKHIM, BEHROOZ MD INC	1/1/1979	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	30853	20	Orthopedic Surgery	0	In state provider	None	10767 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91602	2324	19	06037	34.15228949	-118.365732	Los Angeles County
49814	Fee-for-Service	1689785651	1689785651	1	1	BARNES-LE BLANC C A OD	8/6/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1688 N PERRIS BLVD	STE L5	PERRIS	CA	92571	4701	33	06065	33.802488	-117.2262385	Riverside County
49816	Fee-for-Service	1003000639	1003000639	1	1	BENHARASH, PEYMAN MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85379	33	Thoracic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
49853	Fee-for-Service	1508911892	1508911892	1	17	BAY AREA FOOT CARE, INC	1/5/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6000 FAIRWAY DR	SUITE 18	ROCKLIN	CA	95677	4246	31	06061	38.79220243	-121.2621624	Placer County
49856	Fee-for-Service	1922263383	1922263383	1	1	BAHRAMI, HOSSEIN MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116307	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
49860	Fee-for-Service	1154401941	1154401941	1	35	BASS MEDICAL GROUP	8/31/2021	174400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6060 HELLYER AVE	150	SAN JOSE	CA	95138	1046	43	06085	37.25670154	-121.7796404	Santa Clara County
49869	Fee-for-Service	1891813200	1891813200	1	1	BERNARD, RICK J LAC	1/22/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
49880	Fee-for-Service	1396709978	1396709978	1	1	BAPTIST MEMORIAL HOSP	6/21/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	BOONEVILLE	100 HOSPITAL ST	None	BOONEVILLE	MS	38829	3354	00	None	34.6574523	-88.56579091	Prentiss County
49913	Fee-for-Service	1639205354	1639205354	1	1	BAUER, ANDREA S MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116226	20	Orthopedic Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
49952	Fee-for-Service	1609483403	1609483403	1	1	BOYCE, JULIA NP	10/8/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
49968	Fee-for-Service	1831212885	1831212885	1	1	BADIE, MEHRNAZ MD	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98114	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6384	30	06059	33.56286021	-117.6673449	Orange County
49975	Fee-for-Service	1700415445	1700415445	1	1	BARSH, SAMUEL MD	9/17/2024	207L00000X	NA	Other	026	PHYSICIANS	179551	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
49986	Fee-for-Service	1730133133	1730133133	1	1	BEILIN, LEONID B MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	16168	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 W ALOSTA AVE	None	GLENDORA	CA	91740	0000	19	06037	34.1286357	-117.8661313	Los Angeles County
50032	Fee-for-Service	1801370580	1801370580	1	1	BOND, ANA E RCP	8/30/2020	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
50038	Fee-for-Service	1689694119	1689694119	1	1	BENKE, PAUL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3435 HAYES ST	None	HOLLYWOOD	FL	33021	5410	00	None	26.02007747	-80.1780165	Broward County
50051	Fee-for-Service	1487340568	1487340568	1	1	BRAVO, JEAN PIERRE LMFT	3/26/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
50071	Fee-for-Service	1154401941	1154401941	1	57	BASS MEDICAL GROUP	6/28/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3010 COLBY	STE 118	BERKELEY	CA	94705	2091	01	06001	37.85492078	-122.2576101	Alameda County
50102	Fee-for-Service	1104364447	1104364447	1	1	BENEDICT, ESTHER R NP	5/9/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
50143	Fee-for-Service	1922263383	1922263383	1	1	BAHRAMI, HOSSEIN MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116307	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
50157	Fee-for-Service	1649224866	1649224866	1	1	BARMAN, LINDA K MD	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77164	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
50167	Fee-for-Service	1396709978	1396709978	1	1	BAPTIST MEMORIAL HOSP	6/21/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	BOONEVILLE	100 HOSPITAL ST	None	BOONEVILLE	MS	38829	3354	00	None	34.6574523	-88.56579091	Prentiss County
50188	Fee-for-Service	1780713024	1780713024	1	1	BARTON, MURIEL LCSW	6/1/2017	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	4400 W KLING ST	None	BURBANK	CA	91505	3742	19	06037	34.15589667	-118.3503025	Los Angeles County
50201	Fee-for-Service	1982788972	1982788972	1	1	BLITZ, NEAL M DPM	5/17/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
50210	Fee-for-Service	1205104726	1205104726	1	1	BREID, MONA R NP	2/9/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
50212	Fee-for-Service	1871319731	1871319731	1	1	BALINGASA, ERWIN JAMES NP	2/10/2025	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
50214	Fee-for-Service	1770644296	1770644296	1	1	BELL, RODRIC J M D INC	4/1/2001	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	79282	25	Physical Medicine and Rehabilitation	0	In state provider	None	14851 YORBA ST	None	TUSTIN	CA	92780	2925	30	06059	33.7473438	-117.8302735	Orange County
50247	Fee-for-Service	1548562580	1548562580	1	1	BHARDWAJ, RAHUL MD	6/10/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	160911	None	None	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
50261	Fee-for-Service	1760458053	1760458053	1	1	BEHL, ANDREW DO	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
50270	Fee-for-Service	1447444567	1447444567	1	1	BARNETT, MARISA D NP	11/15/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
50275	Fee-for-Service	1730133133	1730133133	1	1	BEILIN, LEONID B MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	16168	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	150 W ALOSTA AVE	None	GLENDORA	CA	91740	0000	19	06037	34.1286357	-117.8661313	Los Angeles County
50276	Fee-for-Service	1497924658	1497924658	1	1	BUSTAMANTE, GEORGINA M MD	10/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	114041	08	Family Practice	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
50317	Fee-for-Service	1407471535	1407471535	1	1	BONA FIDE HOSPICE INC	8/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5315 LAUREL CANYON	STE 201	VALLEY VILLAGE	CA	91607	4916	19	06037	34.16713798	-118.3965446	Los Angeles County
50349	Fee-for-Service	1477878031	1477878031	1	1	BATRA, ANITA MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131539	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
50385	Fee-for-Service	1558596585	1558596585	1	1	BAUTISTA, NICOLE M MD	4/17/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	166593	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
50408	Fee-for-Service	1154401941	1154401941	1	2	BASS MEDICAL GROUP	9/26/2018	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
50443	Fee-for-Service	1821358094	1821358094	1	1	BEHRENDS-GELFMAN, MELISSA A	12/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	2034 COTNER AVE	200	LOS ANGELES	CA	90025	5664	19	06037	34.0413463	-118.441113	Los Angeles County
50474	Fee-for-Service	1023341989	1023341989	1	1	BAKER, SHEILA LMFT	7/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5362 LEMEE LANE	None	MARIPOSA	CA	95338	0099	22	06043	37.499481	-119.984238	Mariposa County
50477	Fee-for-Service	1780713024	1780713024	1	1	BARTON, MURIEL LCSW	3/1/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4400 W KLING ST	None	BURBANK	CA	91505	3742	19	06037	34.15589667	-118.3503025	Los Angeles County
50496	Fee-for-Service	1962918334	1962918334	1	1	BROWN AND PIPKINS CORP	4/22/2019	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	10924 SOUTH VERMONT AVE	None	LOS ANGELES	CA	90044	0000	19	06037	33.93659323	-118.2915675	Los Angeles County
50498	Fee-for-Service	1285095752	1285095752	1	1	BUI, CHRISTINE DO	11/19/2020	208M00000X	NA	Other	026	PHYSICIANS	18468	None	None	0	In state provider	None	15248 ELEVENTH ST	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
50540	Fee-for-Service	1013015486	1013015486	1	2	BARNES, DELORIS Y MD	2/2/2018	207L00000X	NA	Other	026	PHYSICIANS	79573	05	Anesthesiology	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
50580	Fee-for-Service	1710196019	1710196019	2	1	BAE, JAE-O MD	10/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
50585	Fee-for-Service	1609821891	1609821891	1	1	BRODERICK, KELLY C MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	78759	None	None	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
50602	Fee-for-Service	1407471535	1407471535	1	1	BONA FIDE HOSPICE INC	8/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5315 LAUREL CANYON	STE 201	VALLEY VILLAGE	CA	91607	4916	19	06037	34.16713798	-118.3965446	Los Angeles County
50630	Fee-for-Service	1245418060	1245418060	1	1	BYRNE, EDEN M LMFT	7/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E DAILY DR	210	CAMARILLO	CA	93010	5806	56	06111	34.21906637	-119.0621709	Ventura County
50633	Fee-for-Service	1861414856	1861414856	1	1	BRAUN, MARIA M MD	11/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73014	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
50635	Fee-for-Service	1437332442	1437332442	1	1	BEUMER, HALTON W MD	5/5/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	167104	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
50641	Fee-for-Service	1760561807	1760561807	1	1	BHOPALE, SUNIL A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62286	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
50648	Fee-for-Service	1881137008	1881137008	1	1	BELL, DANIEL M CRNA	12/7/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
50649	Fee-for-Service	1871851428	1871851428	1	1	BALTIC, TAMMY E NP	3/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94142	2202	38	06075	37.76344756	-122.4581992	San Francisco County
50674	Fee-for-Service	1558596585	1558596585	1	1	BAUTISTA, NICOLE M MD	4/17/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	166593	45	Nephrology (Renal-Kidney)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
50697	Fee-for-Service	1154401941	1154401941	1	2	BASS MEDICAL GROUP	9/26/2018	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
50790	Fee-for-Service	1043716145	1043716145	1	1	BALDWIN, ERIN J NP	3/4/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1035 PLACER STREET	None	REDDING	CA	96001	1125	45	06089	40.58349378	-122.3853903	Shasta County
50859	Fee-for-Service	1740711225	1740711225	1	1	BASA, KRYSTYNE MD	12/8/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	191880	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
50860	Fee-for-Service	1184403180	1184403180	1	1	BALOTO, ROWENA URBINA	11/14/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	587 CHAPARRAL LOOP	None	VACAVILLE	CA	95688	3132	48	06095	38.35683386	-121.9768464	Solano County
50861	Fee-for-Service	1760597454	1760597454	1	1	BARCEGA, BESH RHYL B MD	4/30/1991	207P00000X	NA	Other	026	PHYSICIANS	72953	40	Pediatrics	0	In state provider	None	9661 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3645	33	06065	33.91877221	-117.4495032	Riverside County
50887	Fee-for-Service	1487722989	1487722989	1	1	BURNEY, MAUREEN A PHD	10/13/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ES	13751 ROSWELL AVE	SUITE A	CHINO	CA	91710	5464	36	06071	34.00289717	-117.7218115	San Bernardino County
50924	Fee-for-Service	1528623949	1528623949	1	1	BEIT SHALOM CARE	2/22/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1931 PREUSS RD	None	LOS ANGELES	CA	90034	1106	19	06037	34.0433776	-118.3857272	Los Angeles County
50955	Fee-for-Service	1417451352	1417451352	1	1	BONDAREV, DAYLE MD	8/16/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	30 MARK WEST SPRINGS	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
50974	Fee-for-Service	1265649487	1265649487	1	1	BONETI, CRISTIANO MD	11/10/2021	208200000X	NA	General Surgery	026	PHYSICIANS	149114	None	None	0	In state provider	None	4650 LINCOLN	None	LOS ANGELES	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
50977	Fee-for-Service	1861695678	1861695678	1	1	BANTA, WARREN MD	11/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88514	78	Neoplastic Diseases/Oncology	0	In state provider	None	1700 CEASAR E CHAVEZ AVE	STE 3500	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
50984	Fee-for-Service	1154401941	1154401941	1	2	BASS MEDICAL GROUP	9/26/2018	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
50991	Fee-for-Service	1649632357	1649632357	1	1	BOLGER, STEVEN J MD	7/23/2019	207P00000X	NA	Other	026	PHYSICIANS	154840	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
50996	Fee-for-Service	1508911892	1508911892	1	10	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1720 MARCO POLO WAY	STE A	BURLINGAME	CA	94010	4512	41	06081	37.58986055	-122.3842811	San Mateo County
51000	Fee-for-Service	1114978277	1114978277	1	1	BELVILLE, JOHN S MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65179	30	Radiology	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 103	GARDEN GROVE	CA	92843	1915	30	06059	33.77450141	-117.9123364	Orange County
51002	Fee-for-Service	1477625945	1477625945	2	1	BADALIAN, VAHE MD	7/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	45222	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1560 E CHEVY CHASE DRIVE	#240	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
51017	Fee-for-Service	1427011345	1427011345	1	1	BABA, DAVID OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3178 COLLINS DR	STE A	MERCED	CA	95348	3132	24	06047	37.32153787	-120.4761447	Merced County
51020	Fee-for-Service	1720196256	1720196256	1	1	BAZ,SAMUEL MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67115	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
51037	Fee-for-Service	1346641982	1346641982	1	1	BROWN BURNS, WILLIAM J PT	8/9/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
51047	Fee-for-Service	1588806483	1588806483	1	1	BORNE, RYAN T MD	9/1/2017	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
51088	Fee-for-Service	1194858860	1194858860	1	1	BALAREZO-RUVALCABA, JACKELIN	5/15/2023	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	E	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
51089	Fee-for-Service	1376547299	1376547299	1	1	BROOKS, DENNIS L MD	6/21/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37010	06	Cardiovascular Disease (M.D. only)	0	In state provider	VENTURA COUNTY MED CTR	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
51092	Fee-for-Service	1013959121	1013959121	1	1	BISHOP, JUDITH T CNM	6/5/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51123	Fee-for-Service	1720166770	1720166770	1	1	BUENAFLOR, JAY K MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82945	40	Pediatrics	0	In state provider	None	608 G ST	STE 1-A	BRAWLEY	CA	92227	2568	13	06025	32.97749255	-115.5318435	Imperial County
51124	Fee-for-Service	1891721718	1891721718	1	1	BUDDEBERGE, ANGELIKA MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81245	41	Internal Medicine	0	In state provider	None	1920 COLORADO BLVD	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
51137	Fee-for-Service	1447313184	1447313184	1	1	BLATTNER, JENNIFER W CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
51148	Fee-for-Service	1225075849	1225075849	1	1	BOYD, DEVEE R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N. EAST ST	None	JOSEPH	OR	97846	1038	00	None	45.35337814	-117.2258292	Wallowa County
51149	Fee-for-Service	1760597454	1760597454	1	1	BARCEGA, BESH RHYL B MD	4/30/1991	207P00000X	NA	Other	026	PHYSICIANS	72953	01	General Practice	0	In state provider	None	9661 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3645	33	06065	33.91877221	-117.4495032	Riverside County
51150	Fee-for-Service	1184403180	1184403180	1	1	BALOTO, ROWENA URBINA	11/14/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	587 CHAPARRAL LOOP	None	VACAVILLE	CA	95688	3132	48	06095	38.35683386	-121.9768464	Solano County
51153	Fee-for-Service	1487680393	1487680393	1	1	BENSON, PETER C MD	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69360	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
51157	Fee-for-Service	1871978924	1871978924	1	1	BENNETT, LACEE	5/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
51160	Fee-for-Service	1679691356	1679691356	1	2	BOOTY, ANDREW D MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103502	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51177	Fee-for-Service	1720118896	1720118896	1	1	BONNIE JUNE HASCALL	3/1/2012	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2580 S MCCALL AVE	None	SANGER	CA	93657	9720	10	06019	36.6978086	-119.610296	Fresno County
51184	Fee-for-Service	1285784868	1285784868	1	1	BEHAL, RAJNEESH MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135343	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51207	Fee-for-Service	1568902716	1568902716	1	1	BOGDAN, IULIA LMFT	1/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6840 INDIANA AVE	275	RIVERSIDE	CA	92506	4279	33	06065	33.94246965	-117.3926366	Riverside County
51223	Fee-for-Service	1093161473	1093161473	1	1	BAGBY, JESSICA MD	6/17/2020	390200000X	NA	Other	026	PHYSICIANS	150392	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
51232	Fee-for-Service	1881788933	1881788933	1	1	BAXTER COUNTY REG HOSP	6/5/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	624 HOSPITAL DR	None	MOUNTAIN HOME	AR	72653	2955	00	None	36.342738	-92.3962095	Baxter County
51233	Fee-for-Service	1235204751	1235204751	2	1	BILLHEIMER, KENNETH D	9/15/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4460 BLACK AVE	STE F	PLEASANTON	CA	94566	6139	01	06001	37.67215839	-121.8770704	Alameda County
51269	Fee-for-Service	1477903516	1477903516	1	1	BEAUDRY, AMANDA OD	1/18/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
51271	Fee-for-Service	1447360110	1447360110	1	1	BEL AIR MARKET INC.	2/2/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7465 RUSH RIVER DR	None	SACRAMENTO	CA	95831	5255	34	06067	38.485881	-121.5347175	Sacramento County
51273	Fee-for-Service	1154401941	1154401941	1	2	BASS MEDICAL GROUP	4/5/2019	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
51282	Fee-for-Service	1508911892	1508911892	1	10	BAY AREA FOOT CARE, INC	5/13/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1720 MARCO POLO WAY	STE A	BURLINGAME	CA	94010	4512	41	06081	37.58986055	-122.3842811	San Mateo County
51340	Fee-for-Service	1083121008	1083121008	1	2	BROWN, DAKOTA W LMFT	6/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
51357	Fee-for-Service	1346275237	1346275237	1	1	BROWN, KATHLEEN MD	3/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	40397	30	Radiology	0	In state provider	UCLA RADIOLOGY MED GRP	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
51418	Fee-for-Service	1184648909	1184648909	1	1	BLAISCH, BRIAN MD	9/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64161	40	Pediatrics	0	In state provider	PEDIATRICS INC	2700 INTERNATIONAL BLVD	STE 11	OAKLAND	CA	94601	1520	01	06001	37.78067498	-122.2312906	Alameda County
51419	Fee-for-Service	1821304882	1821304882	1	1	BRUESEKE, TAYLOR J MD	7/25/2017	390200000X	NA	Other	026	PHYSICIANS	121053	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
51462	Fee-for-Service	1720118896	1720118896	1	1	BONNIE JUNE HASCALL	6/14/2003	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2580 S MCCALL AVE	None	SANGER	CA	93657	9720	10	06019	36.6978086	-119.610296	Fresno County
51474	Fee-for-Service	1225053291	1225053291	1	1	BARBA, WILLIAM	1/4/1995	208800000X	NA	Other	026	PHYSICIANS	74473	34	Urology and Urological Surgery	0	In state provider	None	1700 E CESAR E CHAVEZ AV	STE 15	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
51476	Fee-for-Service	1952389751	1952389751	1	1	BRAUNSTEIN, GLENN D MD	10/8/1991	174400000X	NA	Other	026	PHYSICIANS	23334	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
51480	Fee-for-Service	1972972172	1972972172	1	1	BENDER, HEIDI F	9/22/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	217 WEST CERRITOS AVENUE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
51522	Fee-for-Service	1881788933	1881788933	1	1	BAXTER COUNTY REG HOSP	6/5/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	624 HOSPITAL DR	None	MOUNTAIN HOME	AR	72653	2955	00	None	36.342738	-92.3962095	Baxter County
51530	Fee-for-Service	1508159344	1508159344	1	1	BEDELL, MATTHEW G S MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124311	18	Ophthalmology	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
51538	Fee-for-Service	1821557745	1821557745	1	1	BUI, JEREMIAH DO	8/16/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	19571	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
51542	Fee-for-Service	1447202692	1447202692	1	1	BELLINGER, ANKE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IA HOSP & CLNS	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
51561	Fee-for-Service	1154401941	1154401941	1	2	BASS MEDICAL GROUP	2/19/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
51565	Fee-for-Service	1639158165	1639158165	1	1	BEALL, MARIE H MD	1/31/1995	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	49730	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
51566	Fee-for-Service	1134145345	1134145345	1	1	BERNACKI, RACHELLE E MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96640	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51574	Fee-for-Service	1265893317	1265893317	1	1	BURGESS, LESLIE CNP	7/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
51663	Fee-for-Service	1770549339	1770549339	1	1	BELL, PARVEEN K MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86036	08	Family Practice	0	In state provider	None	2020 SUTTER PLACE	None	DAVIS	CA	95616	6213	57	06113	38.56287659	-121.7715536	Yolo County
51679	Fee-for-Service	1932822418	1932822418	1	1	BELTRAN, ROSALBA C NP	8/29/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	10	06019	36.80840238	-119.8594473	Fresno County
51685	Fee-for-Service	1700828944	1700828944	1	1	BLUEBIRD O & P INC	8/16/2002	335E00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4373 VIEWRIDGE AVE	STE A	SAN DIEGO	CA	92123	1619	37	06073	32.82137765	-117.1245201	San Diego County
51707	Fee-for-Service	1487180261	1487180261	1	1	BYRNE, EILEEN MD	10/5/2023	208800000X	NA	Other	026	PHYSICIANS	160779	None	None	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
51710	Fee-for-Service	1174598403	1174598403	1	1	BETHEL, KELLY J MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78019	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
51713	Fee-for-Service	1124065214	1124065214	1	1	BRAMWELL,KENNETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
51717	Fee-for-Service	1316021397	1316021397	1	1	BELL, PATRICIA	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	53105	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
51722	Fee-for-Service	1891086534	1891086534	1	1	BOWEN, LAURA K CRNA	3/12/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	05	Anesthesiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
51730	Fee-for-Service	1427079045	1427079045	1	1	BALDOCK-MAHLOCH, KIM R	7/30/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	20911 EARL ST	SUITE 340	TORRANCE	CA	90503	4355	19	06037	33.840459	-118.3580985	Los Angeles County
51747	Fee-for-Service	1265780332	1265780332	1	1	BERESFORD, BRANDI NP	4/15/2019	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
51751	Fee-for-Service	1477601771	1477601771	1	1	BONSALL UNION ELEMENTARY SD	10/15/2002	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	31505 OLD RIVER RD	None	BONSALL	CA	92003	5112	37	06073	33.28749	-117.2185785	San Diego County
51769	Fee-for-Service	1366978751	1366978751	1	1	BOZORGI, SEYED MD	7/1/2020	208M00000X	NA	Other	026	PHYSICIANS	163561	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
51783	Fee-for-Service	1548089360	1548089360	1	1	BUSH, NATALIE DOULA	1/22/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	41	06081	0	0	None
51793	Fee-for-Service	1952479966	1952479966	1	1	BLOCK-KURBISCH, INGRID J	4/30/1993	174400000X	NA	Other	026	PHYSICIANS	49578	01	General Practice	0	In state provider	MD	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
51799	Fee-for-Service	1154401941	1154401941	1	58	BASS MEDICAL GROUP	11/9/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27206 CALAROGA AVE	STE 206	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
51814	Fee-for-Service	1619916236	1619916236	1	1	BUSHELL, DOUGLAS G	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9029	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
51836	Fee-for-Service	1669273470	1669273470	1	1	BUZEL, BRANA A	4/28/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
51846	Fee-for-Service	1386906923	1386906923	1	1	BEDI, DANIEL MD	6/1/2019	207P00000X	NA	Other	026	PHYSICIANS	158428	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
51857	Fee-for-Service	1760407787	1760407787	1	1	BERRONG,STACY J MD	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8432	08	Family Practice	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
51864	Fee-for-Service	1669776399	1669776399	1	1	BRANDT, CHRISTINA LAC	11/15/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1601 ANACAPA ST.	None	SANTA BARBARA	CA	93101	1909	42	06083	34.42829603	-119.7086699	Santa Barbara County
51866	Fee-for-Service	1578900635	1578900635	1	1	BABBITT, WILLIAM B MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141553	40	Pediatrics	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
51886	Fee-for-Service	1104873801	1104873801	1	1	BILLINGTON, JULIA A MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85529	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51913	Fee-for-Service	1174523245	1174523245	1	1	BREWER, TIMOTHY F MD	8/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89333	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE #365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
51980	Fee-for-Service	1922368505	1922368505	1	1	BATT, JOSHUA D DO	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12922	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
52043	Fee-for-Service	1679845325	1679845325	1	1	BARCELLOS, TERESA L MD	3/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119797	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	372 ARDEN AVE	SUITE 200	GLENDALE	CA	91203	1129	19	06037	34.1584394	-118.261212	Los Angeles County
52070	Fee-for-Service	1568949709	1568949709	1	1	BAHRAINWALA, LULUA Z MD	5/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165601	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
52086	Fee-for-Service	1154401941	1154401941	1	58	BASS MEDICAL GROUP	11/9/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	27206 CALAROGA AVE	STE 206	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
52120	Fee-for-Service	1033175237	1033175237	1	1	BILLINGSLEY, ESTHER J PA	11/23/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	12066	-	NOT APPLICABLE	0	In state provider	None	441 S HAM LANE	SUITE A	LODI	CA	95242	3525	39	06077	38.12839172	-121.2883127	San Joaquin County
52126	Fee-for-Service	1497929996	1497929996	1	1	BAROLD, DAVID C MD	10/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	73298	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
52129	Fee-for-Service	1417941907	1417941907	1	1	BREEDLOVE, JAMES W DPM	3/1/1996	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1500 PALM ST	STE B	SAN LUIS OBISPO	CA	93401	2998	40	06079	35.28694306	-120.6550369	San Luis Obispo County
52145	Fee-for-Service	1760407787	1760407787	1	1	BERRONG,STACY J MD	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8432	15	Obstetrics (D.O. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
52164	Fee-for-Service	1508911892	1508911892	1	7	BAY AREA FOOT CARE, INC	4/15/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15035 E 14TH ST	None	SAN LEANDRO	CA	94578	1901	07	06013	37.70496067	-122.1281915	Alameda County
52167	Fee-for-Service	1346426244	1346426244	1	1	BRADSHAW, HANS R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
52182	Fee-for-Service	1730253170	1730253170	1	1	BURNEY FIRE DISTRICT	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	37072 MAIN ST	None	BURNEY	CA	96013	4126	45	06089	40.88200453	-121.6673977	Shasta County
52187	Fee-for-Service	1821320011	1821320011	1	1	BATTH, SUKHJEET S MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126928	78	Neoplastic Diseases/Oncology	0	In state provider	None	7130 N MILLBROOK AVE	STE 112	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
52192	Fee-for-Service	1184117525	1184117525	1	1	BALDWIN, AMY J CNP	8/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2791 AGOURA RD	None	THOUSAND OAKS	CA	91361	3101	56	06111	34.15068671	-118.8255597	Ventura County
52193	Fee-for-Service	1932594264	1932594264	1	1	BARON, MICHELE B MD	7/29/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148527	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
52214	Fee-for-Service	1952603615	1952603615	1	1	BOLLICH, SUZAN L PHD	1/29/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
52252	Fee-for-Service	1306479381	1306479381	1	1	BURGER, LESLIE A NP	7/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
52271	Fee-for-Service	1992929699	1992929699	1	1	BALARES III, JORGE R DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	MOTION CHIROPRACTIC	1168 SAN GABRIEL BLVD	STE K	ROSEMEAD	CA	91770	4236	19	06037	34.04272643	-118.086007	Los Angeles County
52293	Fee-for-Service	1831554237	1831554237	1	1	BROLLINI, MICHAEL LMFT	2/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
52355	Fee-for-Service	1932378965	1932378965	1	1	BRIM, VINCE P PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
52376	Fee-for-Service	1154401941	1154401941	1	58	BASS MEDICAL GROUP	11/9/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	27206 CALAROGA AVE	STE 206	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
52377	Fee-for-Service	1043507205	1043507205	1	1	BROADBENT, TALMAGE J MD	6/24/2024	207WX0200X	NA	Ophthalmology	026	PHYSICIANS	-	18	Ophthalmology	2	Out of state provider	None	626 S SHERIDAN ST	None	SPOKANE	WA	99202	1325	00	None	47.650167	-117.4020345	Spokane County
52380	Fee-for-Service	1538451588	1538451588	1	1	BATHINI, LEON JR MD	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125822	01	General Practice	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
52401	Fee-for-Service	1770554016	1770554016	1	1	BHAN, VINOD C CRNA	11/30/1990	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	940 SYLVA LN	STE G	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
52404	Fee-for-Service	1407934292	1407934292	1	1	BROWN, RICHARD A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23910	18	Ophthalmology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
52428	Fee-for-Service	1801327499	1801327499	1	1	BRANTINGHAM, GRACE E DO	6/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16762	08	Family Practice	0	In state provider	None	2433 CENTRAL AVENUE	SUITE A	ALAMEDA	CA	94501	4564	01	06001	37.76358675	-122.2413153	Alameda County
52445	Fee-for-Service	1487680112	1487680112	1	1	BALAZY, KATHERINE H MD	7/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89482	08	Family Practice	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 200	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
52448	Fee-for-Service	1194836429	1194836429	1	1	BOBO, JERRY C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84025	36	Psychiatry	0	In state provider	None	7200 PARKWAY DR	STE 113	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
52452	Fee-for-Service	1508911892	1508911892	1	7	BAY AREA FOOT CARE, INC	1/19/2023	207QS0010X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15035 E 14TH ST	None	SAN LEANDRO	CA	94578	1901	07	06013	37.70496067	-122.1281915	Alameda County
52453	Fee-for-Service	1225846918	1225846918	1	1	BLAYLOCK, NICOLE B DOULA	5/13/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
52470	Fee-for-Service	1821320011	1821320011	1	1	BATTH, SUKHJEET S MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126928	30	Radiology	0	In state provider	None	7130 N MILLBROOK AVE	STE 112	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
52485	Fee-for-Service	1275634529	1275634529	1	1	BLOMKALNS, ANDRA L MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156810	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52490	Fee-for-Service	1386900157	1386900157	1	1	BARAK, RON MD	7/24/2017	207LC0200X	NA	Other	026	PHYSICIANS	128560	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
52504	Fee-for-Service	1457588253	1457588253	1	1	BALTASAR, FRANCIS E MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121015	41	Internal Medicine	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
52525	Fee-for-Service	1487299673	1487299673	1	1	BANGURA, SAFFIE NP	1/8/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
52539	Fee-for-Service	1184657538	1184657538	1	1	BELOGORSKY, EUGENE MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	29625	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	585 W COLLEGE AVE	STE A	SANTA ROSA	CA	95401	5060	49	06097	38.445903	-122.735601	Sonoma County
52557	Fee-for-Service	1346292091	1346292091	1	1	BRAVOS, PETER D MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72361	05	Anesthesiology	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
52558	Fee-for-Service	1912590217	1912590217	1	1	BELLA TERRA HOSPICE OF THE	8/16/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	DESERT	75410 GERALD FORD DR	STE 202	PALM DESERT	CA	92211	3500	33	06065	33.77937954	-116.3480175	Riverside County
52560	Fee-for-Service	1619917465	1619917465	1	1	BORGER, RODNEY W MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80457	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
52573	Fee-for-Service	1326020983	1326020983	1	1	BARNHILL, BRADLEY W MD	5/15/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	49456	41	Internal Medicine	0	In state provider	None	3105 CEDAR RAVINE RD	STE 201	PLACERVILLE	CA	95667	6561	09	06017	38.72626462	-120.7945035	El Dorado County
52586	Fee-for-Service	1417158122	1417158122	1	1	BARAJAS, LISA M LCSW	5/26/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
52604	Fee-for-Service	1326009200	1326009200	1	1	BURNETT, KEITH R MD	3/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	40959	None	None	0	In state provider	None	7677 CENTER AVE	STE 212	HUNTINGTON BEACH	CA	92647	9103	30	06059	33.736257	-117.995535	Orange County
52607	Fee-for-Service	1508878133	1508878133	1	1	BELZER, KATHLEEN M CNM	11/20/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
52613	Fee-for-Service	1700276177	1700276177	1	1	BRIDGE MEDICAL CONSULTANTS	1/11/2016	2084N0400X	NA	Neurology	026	PHYSICIANS	133381	13	Neurology (M.D. only)	0	In state provider	INC	3155 KEARNEY ST.,	SUITE 100	FREMONT	CA	94538	2384	01	06001	37.5490951	-121.974815	Alameda County
52627	Fee-for-Service	1396775086	1396775086	1	1	BADDAY MEDICAL PROFESSIONAL	4/30/2021	174400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	CORPORATION	1060 E FOOTHILL BLVD	SUITE 201	UPLAND	CA	91786	4027	36	06071	34.1070235	-117.6371235	San Bernardino County
52645	Fee-for-Service	1700127248	1700127248	1	1	BELLUCCI, JEAN E OT	3/31/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	31764 CASINO DR	STE 106A&B	LAKE ELSINORE	CA	92530	4571	33	06065	33.65724839	-117.29582	Riverside County
52646	Fee-for-Service	1154401941	1154401941	1	9	BASS MEDICAL GROUP	2/25/2019	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 311	CONCORD	CA	94520	1814	07	06013	37.98507961	-122.034189	Contra Costa County
52647	Fee-for-Service	1447226386	1447226386	1	1	BENIK, KAREN G MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60765	07	Dermatology	0	In state provider	None	24432 MUIRLANDS BLVD	STE 219	LAKE FOREST	CA	92630	3939	30	06059	33.62755212	-117.7028876	Orange County
52657	Fee-for-Service	1609123504	1609123504	1	1	BROWN, CHRISTOPHER O MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126975	41	Internal Medicine	0	In state provider	None	1000 WEST CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
52672	Fee-for-Service	1689994329	1689994329	1	1	BALDEOSINGH, KEISHA L MD	6/27/2017	207R00000X	NA	Other	026	PHYSICIANS	125820	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
52677	Fee-for-Service	1205138674	1205138674	1	1	BARCH, CAROL A NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52685	Fee-for-Service	1396325429	1396325429	1	1	BLOCK, TRINA I PT	1/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
52719	Fee-for-Service	1740349307	1740349307	1	1	BELEN, NENITA C MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	29925	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
52720	Fee-for-Service	1841218229	1841218229	1	1	BERGER, JOEL S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45427	02	General Surgery	0	In state provider	None	8008 FROST ST	STE 311	SAN DIEGO	CA	92123	4288	37	06073	32.80027859	-117.1524832	San Diego County
52731	Fee-for-Service	1982650776	1982650776	1	1	BENNETT, VINCENT J MD	2/16/1993	207P00000X	NA	Other	026	PHYSICIANS	75983	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5974 PENTZ RD	None	LOS ANGELES	CA	90007	2629	19	06037	0	0	None
52755	Fee-for-Service	1952963662	1952963662	1	1	BREEN, LEAH F MD	1/26/2025	207L00000X	NA	Other	026	PHYSICIANS	180606	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
52787	Fee-for-Service	1144397977	1144397977	1	1	BOXX, STACEY L NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1183 FOOTHILL BLVD	None	UPLAND	CA	91786	4007	36	06071	34.10724648	-117.6359175	San Bernardino County
52794	Fee-for-Service	1487209367	1487209367	1	1	BEEHIVE TRANSPORTATION LLC	8/2/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	555 ANTON BLVD	STE 150	COSTA MESA	CA	92626	7036	30	06059	33.69005054	-117.8769195	Orange County
52801	Fee-for-Service	1780054379	1780054379	1	1	BAY AREA COMMUNITY HEALTH	11/15/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
52816	Fee-for-Service	1639672124	1639672124	1	1	BELL, DARRIN C	11/6/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6637 LIME RD	None	LANCASTER	CA	93536	4567	19	06037	34.65557288	-118.2485435	Los Angeles County
52837	Fee-for-Service	1477720001	1477720001	1	1	BURZLAFF, JESSICA L MFT	5/12/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	77884	-	NOT APPLICABLE	0	In state provider	None	1018 21ST STREET	None	BAKERSFIELD	CA	93301	4709	15	06029	35.37813217	-119.0132767	Kern County
52848	Fee-for-Service	1619917465	1619917465	1	1	BORGER, RODNEY W MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80457	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
52850	Fee-for-Service	1912590217	1912590217	1	1	BELLA TERRA HOSPICE OF THE	8/16/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	DESERT	75410 GERALD FORD DR	STE 202	PALM DESERT	CA	92211	3500	33	06065	33.77937954	-116.3480175	Riverside County
52851	Fee-for-Service	1770678427	1770678427	1	1	BERRY, GERALD J MD	12/31/1990	207ZP0101X	NA	Other	026	PHYSICIANS	43119	22	Pathology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
52863	Fee-for-Service	1154988319	1154988319	1	1	BURGA, LORRAINE M LMFT	10/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17772 IRVINE BLVD	SUITE 209	TUSTIN	CA	92780	3234	30	06059	33.74824746	-117.8220736	Orange County
52899	Fee-for-Service	1700276177	1700276177	1	1	BRIDGE MEDICAL CONSULTANTS	1/11/2016	2084N0400X	NA	Neurology	026	PHYSICIANS	133381	36	Psychiatry	0	In state provider	INC	3155 KEARNEY ST.,	SUITE 100	FREMONT	CA	94538	2384	01	06001	37.5490951	-121.974815	Alameda County
52918	Fee-for-Service	1225183569	1225183569	1	1	BADINER, JAMES L LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
52945	Fee-for-Service	1427410406	1427410406	1	1	BREAM OPTOMETRY, INC.	10/8/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 E VENTURA BLVD.	None	OXNARD	CA	93036	1813	56	06111	34.22378048	-119.1501106	Ventura County
52965	Fee-for-Service	1619965696	1619965696	1	1	BANNON, MICHAEL G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7777 FOREST LN	None	DALLAS	TX	75230	2505	00	None	32.911965	-96.7732155	Dallas County
53012	Fee-for-Service	1356703953	1356703953	1	1	BOYDSTUN, DEVON DO	8/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18626	None	None	0	In state provider	None	8701 CUYAMACA ST	None	SANTEE	CA	92071	4253	37	06073	32.83439779	-116.98366	San Diego County
53039	Fee-for-Service	1952401838	1952401838	1	1	BRZEZNY, ALEXANDER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 NAT WASHINGTON WAY	None	EPHRATA	WA	98823	1982	00	None	47.31503673	-119.5461579	Grant County
53046	Fee-for-Service	1891971578	1891971578	1	1	BRAXLEY, NICOLE M MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116841	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
53061	Fee-for-Service	1386008811	1386008811	1	1	BROWN, CORINA C MD	9/27/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171341	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
53070	Fee-for-Service	1528083284	1528083284	1	1	BONHAM, CLARK ANDREW MD	1/9/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50750	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
53071	Fee-for-Service	1144384181	1144384181	1	1	BOLLIER, MARIA LUISA PT	1/1/2002	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13426 EDGEBROOK RD	None	LA MIRADA	CA	90638	3459	19	06037	33.90957452	-117.985527	Los Angeles County
53085	Fee-for-Service	1831357177	1831357177	1	1	BLEY, JULIA J MD	5/26/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	105553	None	None	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
53087	Fee-for-Service	1699953893	1699953893	1	1	BUDD, MICHAEL E MD	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78687	24	Plastic Surgery	0	In state provider	None	1401 SPANOS COURT	STE 207	MODESTO	CA	95355	2810	50	06099	37.66975543	-120.9724048	Stanislaus County
53090	Fee-for-Service	1780054379	1780054379	1	1	BAY AREA COMMUNITY HEALTH	8/1/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
53105	Fee-for-Service	1639672124	1639672124	1	1	BELL, DARRIN C	11/6/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6637 LIME RD	None	LANCASTER	CA	93536	4567	19	06037	34.65557288	-118.2485435	Los Angeles County
53124	Fee-for-Service	1568639185	1568639185	1	1	BRUNE, BRIAN J MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103836	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
53138	Fee-for-Service	1972530970	1972530970	1	1	BECKLEY, BRANDON E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST	None	SALEM	OR	97301	3919	00	None	44.933211	-123.0355125	Marion County
53141	Fee-for-Service	1336216217	1336216217	1	1	BAI, MARK M MD	12/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84557	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
53164	Fee-for-Service	1417275116	1417275116	1	1	BHOGAL, MARJORIE W MD	3/7/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	183586	None	None	0	In state provider	None	2400 SAMARITAN DR	STE 105	SAN JOSE	CA	95124	3910	43	06085	37.25103365	-121.9442147	Santa Clara County
53174	Fee-for-Service	1902168826	1902168826	1	1	BAGHDANIAN, ARTHUR H MD	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148035	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
53223	Fee-for-Service	1649260845	1649260845	1	1	BRIDGEPORT HOSPITAL	7/2/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	267 GRANT STREET	None	BRIDGEPORT	CT	06610	2805	00	None	41.18886648	-73.16639173	Greater Bridgeport Planning Region
53239	Fee-for-Service	1134112196	1134112196	1	1	BROWER, STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
53250	Fee-for-Service	1437543402	1437543402	1	1	BRITO, GARY PT	11/19/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3117 FLORINDA	None	POMONA	CA	91767	1013	19	06037	34.10397671	-117.7556703	Los Angeles County
53254	Fee-for-Service	1952369589	1952369589	1	1	BARNETT, CHARLES A MD	5/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	35446	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
53275	Fee-for-Service	1841851201	1841851201	1	2	BASSO PODIATRY GROUP, INC	7/24/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1712 PICASSO AVE	SUITE C	DAVIS	CA	95618	0546	57	06113	38.56413437	-121.7303634	Yolo County
53316	Fee-for-Service	1326126038	1326126038	1	1	BURGER, ROBERT S MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56003	20	Orthopedic Surgery	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
53334	Fee-for-Service	1578050597	1578050597	1	1	BATRA, AAKASH D MD	3/10/2020	111NR0200X	NA	Other	026	PHYSICIANS	166344	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
53367	Fee-for-Service	1043571151	1043571151	1	1	BANGA, PRITISHEEL K DO	8/3/2017	207RE0101X	NA	Endocrinology	026	PHYSICIANS	13135	67	Endocrinology	0	In state provider	None	1595 SOQUEL DR	STE 411	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
53378	Fee-for-Service	1780054379	1780054379	1	1	BAY AREA COMMUNITY HEALTH	11/15/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
53382	Fee-for-Service	1346200730	1346200730	1	1	BUCH, KENNETH L MD	9/30/1990	207ZP0102X	NA	Other	026	PHYSICIANS	44883	10	Gastroenterology (M.D. only)	0	In state provider	None	16311 VENTURA BLVD	STE 775	ENCINO	CA	91436	4326	19	06037	34.15706864	-118.4885978	Los Angeles County
53427	Fee-for-Service	1467590901	1467590901	1	1	BEACH CITIES MIDWIFERY	5/12/2021	261QM2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	& WOMEN'S HEALTH CARE	23141 MOULTON PKWY	108	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
53446	Fee-for-Service	1144647033	1144647033	1	1	BOHAN, ERICA MD	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
53455	Fee-for-Service	1073547477	1073547477	1	1	BROWNLEE, DENISE A MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36006	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
53466	Fee-for-Service	1306282728	1306282728	1	1	BARR, RICHARD	3/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
53481	Fee-for-Service	1376584698	1376584698	1	1	BROUKHIM, BIJAN MD	2/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	29782	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16311 VENTURA BLVD	STE 1080	ENCINO	CA	91436	2165	19	06037	34.15706864	-118.4885978	Los Angeles County
53509	Fee-for-Service	1558450932	1558450932	1	1	BIRNDORF, LAWRENCE A MD	12/10/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	42584	18	Ophthalmology	0	In state provider	None	160 GREEN VALLEY RD	STE 202	FREEDOM	CA	95019	3160	44	06087	36.93732602	-121.7715374	Santa Cruz County
53510	Fee-for-Service	1649260845	1649260845	1	1	BRIDGEPORT HOSPITAL	7/2/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	267 GRANT STREET	None	BRIDGEPORT	CT	06610	2805	00	None	41.18886648	-73.16639173	Greater Bridgeport Planning Region
53520	Fee-for-Service	1336236488	1336236488	1	2	BARNES, DERRICK J MD	4/11/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	133289	None	None	0	In state provider	None	220 S PALISADE DR	SUITE 203	SANTA MARIA	CA	93454	8902	42	06083	34.95143521	-120.412098	Santa Barbara County
53548	Fee-for-Service	1043321060	1043321060	1	1	BERMAN, STEPHEN M MD	3/31/1989	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	50670	77	Infectious Disease	0	In state provider	None	101 CITY DR S	BLDG 53	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
53549	Fee-for-Service	1700413010	1700413010	1	1	BURCH, JOHANNA MD	11/13/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187647	09	Gynecology (D.O. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
53560	Fee-for-Service	1346809506	1346809506	1	1	BIRDA, VAIBHAV MD	1/28/2024	208M00000X	NA	Other	026	PHYSICIANS	192368	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
53562	Fee-for-Service	1841851201	1841851201	1	2	BASSO PODIATRY GROUP, INC	9/15/2022	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1712 PICASSO AVE	SUITE C	DAVIS	CA	95618	0546	57	06113	38.56413437	-121.7303634	Yolo County
53585	Fee-for-Service	1043535008	1043535008	1	1	BANWAIT, PREMILLA OD	3/21/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
53609	Fee-for-Service	1326126038	1326126038	1	1	BURGER, ROBERT S MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56003	02	General Surgery	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
53629	Fee-for-Service	1124482609	1124482609	1	1	BOUZ, TONY DO	3/22/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	16075	None	None	0	In state provider	None	1334 W COVINA BLVD 105	None	SAN DIMAS	CA	91773	3211	19	06037	34.097067	-117.833751	Los Angeles County
53656	Fee-for-Service	1942833025	1942833025	1	1	BELLA MEDICAL GROUP INC	8/4/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	9916 SAN JUAN AVE	None	SOUTH GATE	CA	90280	6108	19	06037	33.94353376	-118.2031054	Los Angeles County
53664	Fee-for-Service	1780054379	1780054379	1	1	BAY AREA COMMUNITY HEALTH	9/20/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
53681	Fee-for-Service	1700295425	1700295425	1	1	BERRY, EMILY R MD	12/2/2022	208600000X	NA	General Surgery	026	PHYSICIANS	131321	None	None	0	In state provider	None	315 E ROUTE 66	None	GLENDORA	CA	91740	6244	19	06037	34.1288429	-117.8607244	Los Angeles County
53686	Fee-for-Service	1073745733	1073745733	1	1	BERNER, MITCHELL A MD	6/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120451	30	Radiology	0	In state provider	None	4334 CENTRAL AVE	None	RIVERSIDE	CA	92506	2918	33	06065	33.95346346	-117.3993495	Riverside County
53714	Fee-for-Service	1467590901	1467590901	1	1	BEACH CITIES MIDWIFERY	5/12/2021	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	& WOMEN'S HEALTH CARE	23141 MOULTON PKWY	108	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
53735	Fee-for-Service	1548381999	1548381999	1	1	BISHOP, JULIUS A MD	8/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112438	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
53750	Fee-for-Service	1154684041	1154684041	1	1	BERNSTEIN, NAMITA MD FAAP	3/26/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	152685	40	Pediatrics	0	In state provider	None	505 E ROMIE LN	STE K	SALINAS	CA	93901	4072	27	06053	36.65998191	-121.6461895	Monterey County
53822	Fee-for-Service	1770786881	1770786881	1	1	BALDWIN, ERIN L MD	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97418	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
53836	Fee-for-Service	1700413010	1700413010	1	1	BURCH, JOHANNA MD	11/13/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187647	15	Obstetrics (D.O. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
53858	Fee-for-Service	1003555889	1003555889	1	1	BUI, BREANNA M NP	1/27/2025	207QA0505X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
53872	Fee-for-Service	1548329204	1548329204	1	1	BUNSONGSIKUL, PED MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78772	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
53879	Fee-for-Service	1558823997	1558823997	1	1	BUGSCH, SCOTT M MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	179138	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
53923	Fee-for-Service	1891246740	1891246740	1	1	BORQUEZ, JOVANNA LMFT	10/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
53944	Fee-for-Service	1942833025	1942833025	1	1	BELLA MEDICAL GROUP INC	8/4/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	9916 SAN JUAN AVE	None	SOUTH GATE	CA	90280	6108	19	06037	33.94353376	-118.2031054	Los Angeles County
53954	Fee-for-Service	1851705958	1851705958	1	1	BITUIN, ERNEST JORREL G NP	12/22/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
53967	Fee-for-Service	1407944218	1407944218	1	1	BALBAS, ANGELITA G MD	10/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83354	25	Physical Medicine and Rehabilitation	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
53971	Fee-for-Service	1912071366	1912071366	1	1	BARRON, MATTHEW J MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111523	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
53973	Fee-for-Service	1891146270	1891146270	1	1	BAYRAMYAN, JANET LCSW	1/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NICAL SOCIAL WORKER PC	5535 BALBOA BLVD	SUITE 202	ENCINO	CA	91316	1516	19	06037	34.171632	-118.5011955	Los Angeles County
53987	Fee-for-Service	1801311790	1801311790	1	1	BELLO, BEATRIZ PSYD	7/12/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
53997	Fee-for-Service	1669825584	1669825584	1	1	BARRETO, STEPHANY C MD	7/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171040	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
54024	Fee-for-Service	1487821971	1487821971	1	1	BRISC, IOANA F MD	8/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112096	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
54038	Fee-for-Service	1952767220	1952767220	1	1	BAEZ, MARITZA NP	11/4/2024	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
54090	Fee-for-Service	1619265204	1619265204	1	1	BARKATAKI, KIERON K DO	1/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12567	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
54094	Fee-for-Service	1396902052	1396902052	1	1	BURT, BRYAN M MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121995	None	None	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
54098	Fee-for-Service	1245623123	1245623123	1	1	BUMB, ADRIANA G DO	8/25/2022	207L00000X	NA	Other	026	PHYSICIANS	16813	None	None	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
54133	Fee-for-Service	1013937853	1013937853	1	1	BOLTIN, CAROLYN MD	9/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96142	30	Radiology	0	In state provider	None	320 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4311	42	06083	34.42954414	-119.7230551	Santa Barbara County
54139	Fee-for-Service	1780743427	1780743427	1	1	BJERK, JENNIFER L CRNA	7/29/2008	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1818	36	06071	34.073505	-117.3505995	San Bernardino County
54171	Fee-for-Service	1811900491	1811900491	1	1	BENNETT, TELLEN D MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
54180	Fee-for-Service	1780867606	1780867606	1	1	BROYLES, DONNY R OD A PROCP	1/26/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31685 TEMECULA PARKWAY	SUITE A	TEMECULA	CA	92592	2872	33	06065	33.47935158	-117.1048334	Riverside County
54181	Fee-for-Service	1568505170	1568505170	1	1	BEN-ARTZI, AMI MD	5/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90532	83	Rheumatology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
54193	Fee-for-Service	1891706354	1891706354	1	1	BURKART, KIETH J OD	1/1/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	29099 HOSPITAL RD #201	PO BOX 22226	LAKE ARROWHEAD	CA	92352	2226	36	06071	34.26652661	-117.1690546	San Bernardino County
54195	Fee-for-Service	1134102338	1134102338	1	1	BOWMAN, WILLIAM F MD	12/31/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45323	08	Family Practice	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
54207	Fee-for-Service	1518139377	1518139377	1	2	BARRERAS, THERESA L LCSW	10/5/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2820 PORTER ST	None	SOQUEL	CA	95073	2423	44	06087	36.987156	-121.9573505	Santa Cruz County
54209	Fee-for-Service	1043770191	1043770191	1	1	BARRERA, RYAN A MD	11/21/2023	207L00000X	NA	Other	026	PHYSICIANS	186756	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
54210	Fee-for-Service	1154401941	1154401941	1	12	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1 DANIEL BURNHAM CT	STE 205C	SAN FRANCISCO	CA	94109	5472	38	06075	37.78693724	-122.4225429	San Francisco County
54235	Fee-for-Service	1942833025	1942833025	1	1	BELLA MEDICAL GROUP INC	8/4/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9916 SAN JUAN AVE	None	SOUTH GATE	CA	90280	6108	19	06037	33.94353376	-118.2031054	Los Angeles County
54242	Fee-for-Service	1396095519	1396095519	1	1	BRECEDA TINOCO, ERIKA Y	12/2/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 E 4TH ST	None	SANTA ANA	CA	92705	3910	30	06059	33.74805463	-117.8400671	Orange County
54264	Fee-for-Service	1346905858	1346905858	1	1	BAER, KIMBERLY	12/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
54280	Fee-for-Service	1093049017	1093049017	1	1	BRYANT, AJA	2/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
54297	Fee-for-Service	1427498914	1427498914	1	1	BHUPATHIRAJU, NINA MD	10/10/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	183918	None	None	0	In state provider	None	2181 CITRACADO PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11995854	-117.1204723	San Diego County
54354	Fee-for-Service	1346220589	1346220589	1	1	BARINGOLDZ, GREGG M PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17215 STUDEBAKER RD	STE 300	CERRITOS	CA	90703	2522	19	06037	33.874686	-118.0998595	Los Angeles County
54361	Fee-for-Service	1629498274	1629498274	1	1	BUL, VADIM MD	10/13/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	169119	None	None	0	In state provider	None	1160 SUNSET BLVD	None	ROCKLIN	CA	95677	3772	31	06061	38.8125	-121.2848698	Placer County
54371	Fee-for-Service	1841640919	1841640919	1	1	BAKER LEYVA, SA VANNA DO	10/21/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16054	08	Family Practice	0	In state provider	None	5 LOWER RAGSDALE DR	100	MONTEREY	CA	93940	5817	27	06053	36.57544273	-121.8164209	Monterey County
54377	Fee-for-Service	1881643914	1881643914	1	1	BALA, PADMA MD	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55678	40	Pediatrics	0	In state provider	None	8940 RESEDA BLVD	STE 101	NORTHRIDGE	CA	91324	5833	19	06037	34.233084	-118.5360505	Los Angeles County
54387	Fee-for-Service	1811075534	1811075534	1	1	BRYANT, JR, BURCH MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71841	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
54404	Fee-for-Service	1740860956	1740860956	1	1	BELL, ANTHONY MD	8/19/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	189356	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
54427	Fee-for-Service	1336593417	1336593417	1	1	BARON, ZACHARY N LCSW	1/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
54466	Fee-for-Service	1023060506	1023060506	1	1	BAILEY, CHRISTINA L MD	3/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
54468	Fee-for-Service	1821032442	1821032442	1	1	BLACK, RONALD V	12/1/2003	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	839 N GLENDALE AVE	None	GLENDALE	CA	91206	2128	19	06037	34.15874733	-118.2401453	Los Angeles County
54494	Fee-for-Service	1154401941	1154401941	1	12	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1 DANIEL BURNHAM CT	STE 205C	SAN FRANCISCO	CA	94109	5472	38	06075	37.78693724	-122.4225429	San Francisco County
54497	Fee-for-Service	1396916524	1396916524	1	1	BROWN, ERIN G MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114914	85	Surgery-Pediatric	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
54509	Fee-for-Service	1649358383	1649358383	1	1	BERA, JANINE W MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74308	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
54517	Fee-for-Service	1992740237	1992740237	1	1	BERG, BRIAN MD	11/24/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DRIVE	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
54518	Fee-for-Service	1376594267	1376594267	1	1	BACH, PHILIP M MD	2/28/1994	207R00000X	NA	Other	026	PHYSICIANS	44566	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	34	06067	38.568402	-121.418019	Sacramento County
54520	Fee-for-Service	1083934244	1083934244	1	5	BRIGHTHEAR	4/7/2023	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	16661 VENTURA BLVD	SUITE 400D	ENCINO	CA	91436	4805	19	06037	34.15820737	-118.496492	Los Angeles County
54525	Fee-for-Service	1346899101	1346899101	1	1	BOLT, JASON CRNA	1/21/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
54558	Fee-for-Service	1235398389	1235398389	1	1	BUI,QUOC-CHUONG J MD	7/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97615	05	Anesthesiology	0	In state provider	None	1100 W STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
54617	Fee-for-Service	1891372173	1891372173	1	1	BRIGHT LIFE HOSPICE, INC	7/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 626	GLENDALE	CA	91203	4447	19	06037	34.151958	-118.255149	Los Angeles County
54648	Fee-for-Service	1114033529	1114033529	1	1	BARTON HEALTHCARE SYSTEM	7/6/2005	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1111 SIERRA AT TAHOE RD	None	TWIN BRIDGES	CA	95735	9505	09	06017	38.797137	-120.0743505	El Dorado County
54701	Fee-for-Service	1386725646	1386725646	1	1	BROWN C JULIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	NE 100	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
54761	Fee-for-Service	1871672501	1871672501	1	1	BROWN, TRACY S MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68692	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
54785	Fee-for-Service	1154401941	1154401941	1	54	BASS MEDICAL GROUP	4/1/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	13939 E 14TH ST	STE 180	SAN LEANDRO	CA	94578	2601	01	06001	37.71377536	-122.1407447	Alameda County
54797	Fee-for-Service	1578829198	1578829198	1	1	BASHEY, SAMEER MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117671	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
54807	Fee-for-Service	1538659933	1538659933	1	1	BEACHWOOD HOME HEALTH	11/25/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	21049 DEVONSHIRE STREET	SUITE 103B	CHATSWORTH	CA	91311	2366	19	06037	34.25727553	-118.592343	Los Angeles County
54819	Fee-for-Service	1972117653	1972117653	1	1	BREKELMANS, VICTORIA LMFT	1/31/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
54830	Fee-for-Service	1194125658	1194125658	1	1	BALDWIN PARK CONGREGATE HOME	1/7/2015	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3462 VINELAND AVENUE	None	BALDWIN PARK	CA	91706	5314	19	06037	34.07640778	-117.9637693	Los Angeles County
54833	Fee-for-Service	1205949914	1205949914	1	1	BROWNLOW, ROY C MD	3/4/2021	208VP0014X	NA	Other	026	PHYSICIANS	72363	None	None	0	In state provider	None	5565 GROSSMONT CENTER DR	BLGD 3, SUITE 540	LA MESA	CA	91942	3024	37	06073	32.77978322	-117.0094766	San Diego County
54837	Fee-for-Service	1285936989	1285936989	1	1	BARRAGAN, ELIZABETH G LMFT	10/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AN LMFT	1818 W BEVERLY BLVD	STE 208	MONTEBELLO	CA	90640	3966	19	06037	34.02000009	-118.1188413	Los Angeles County
54880	Fee-for-Service	1508911892	1508911892	1	1	BAY AREA FOOT CARE, INC	6/2/2009	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	20130 LAKE CHABOT ROAD	SUITE 202	CASTRO VALLEY	CA	94546	5306	01	06001	37.69738066	-122.087041	Alameda County
54892	Fee-for-Service	1467976605	1467976605	1	1	BENOIT, RYAN D PT	11/13/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
54894	Fee-for-Service	1366890113	1366890113	1	1	BATTEN, ANNELISE M LMFT	10/13/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118724	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
54906	Fee-for-Service	1891372173	1891372173	1	1	BRIGHT LIFE HOSPICE, INC	7/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 626	GLENDALE	CA	91203	4447	19	06037	34.151958	-118.255149	Los Angeles County
54909	Fee-for-Service	1609852656	1609852656	1	1	BRUCE F BURTENSHAW MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2121 N 1700 W	None	LAYTON	UT	84041	8803	00	None	41.090832	-111.9973165	Davis County
54911	Fee-for-Service	1629518725	1629518725	1	1	BURKETT, MEGAN NP	10/10/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	901 OAK PARK BLVD	SUITE 101	PISMO BEACH	CA	93449	3408	40	06079	35.13460775	-120.6050814	San Luis Obispo County
54912	Fee-for-Service	1386361129	1386361129	1	1	BRADLEY, COLLEEN DOULA	8/6/2024	163WX0002X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
54934	Fee-for-Service	1710370424	1710370424	1	1	BENADOR-SHEN, CHRISTINE L MD	7/12/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172384	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
54947	Fee-for-Service	1407918576	1407918576	1	1	BEACH, HORACE J PHD	6/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
54984	Fee-for-Service	1720025802	1720025802	1	1	BAL,JASDEEP S MD	9/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81239	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
54987	Fee-for-Service	1194928416	1194928416	2	1	BANERJEE, SARA MD	7/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	108483	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
55036	Fee-for-Service	1770849523	1770849523	1	1	BEAR, JONATHAN R MD	12/13/2022	2085R0001X	NA	Other	026	PHYSICIANS	126546	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
55045	Fee-for-Service	1578874251	1578874251	1	1	BLANKENSHIP, JORDAN R PSYD	10/4/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
55048	Fee-for-Service	1619057049	1619057049	1	1	BRUNICARDI, FRANCIS C MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	71944	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
55073	Fee-for-Service	1154401941	1154401941	1	54	BASS MEDICAL GROUP	4/1/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	13939 E 14TH ST	STE 180	SAN LEANDRO	CA	94578	2601	01	06001	37.71377536	-122.1407447	Alameda County
55094	Fee-for-Service	1063598589	1063598589	1	1	BERTOLDO, MYRIAM A MD	3/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51942	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
55100	Fee-for-Service	1861675373	1861675373	1	1	BEIK, FARIBA LCSW	7/3/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
55109	Fee-for-Service	1265430177	1265430177	1	1	BAYLOR MEDICAL CENTER AT	12/29/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WAXAHACHIE	1405 W JEFFERSON	None	WAXAHACHIE	TX	75165	2231	00	None	32.39642075	-96.86438638	Ellis County
55116	Fee-for-Service	1487668893	1487668893	1	1	BILLINGSLEY, ROBERT MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 W POPLAR ST	None	WALLA WALLA	WA	99362	2846	00	None	46.06269104	-118.3437284	Walla Walla County
55119	Fee-for-Service	1669465894	1669465894	1	1	BARLEY, AMY J DO	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
55129	Fee-for-Service	1508911892	1508911892	1	37	BAY AREA FOOT CARE, INC	8/17/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5860 OWENS DR	STE 130	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
55149	Fee-for-Service	1477581544	1477581544	3	1	BETHANY MEDICAL SUPPLY INC	11/20/2014	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	525 N AZUSA AVE	SUITE 111	LA PUENTE	CA	91744	4261	19	06037	34.02676148	-117.9169027	Los Angeles County
55161	Fee-for-Service	1699833996	1699833996	1	1	BORIS, GEORGE T MD	10/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	27267	04	Otology, Laryngology, Rhinology	0	In state provider	None	9700 VENICE BLVD	None	CULVER CITY	CA	90232	2717	19	06037	34.02426068	-118.3969926	Los Angeles County
55168	Fee-for-Service	1508911892	1508911892	1	1	BAY AREA FOOT CARE, INC	1/19/2023	207QS0010X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	20130 LAKE CHABOT ROAD	SUITE 202	CASTRO VALLEY	CA	94546	5306	01	06001	37.69738066	-122.087041	Alameda County
55170	Fee-for-Service	1073716510	1073716510	1	1	BERNKLAU, YVETTE LMFT	9/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
55194	Fee-for-Service	1740705367	1740705367	1	1	BALASHOVA-SHAMIS, ELENA PSY	11/21/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
55200	Fee-for-Service	1669905287	1669905287	1	1	BAILEY, BRETT D DO	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	18241	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
55210	Fee-for-Service	1124686282	1124686282	1	1	BOLSTER, ZACHARY J PT	11/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
55234	Fee-for-Service	1538197231	1538197231	1	2	BANNER LASSEN MEDICAL CENTER	4/4/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2940 RIVERSIDE DRIVE	SUITE A	SUSANVILLE	CA	96130	4710	18	06035	40.40743643	-120.6369335	Lassen County
55240	Fee-for-Service	1013211101	1013211101	1	1	BRYANT, MARK D LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
55262	Fee-for-Service	1184628919	1184628919	1	1	BEVERLY HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
55271	Fee-for-Service	1508911892	1508911892	1	6	BAY AREA FOOT CARE, INC	1/19/2023	207QS0010X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2844 SUMMIT ST	SUITE 107	OAKLAND	CA	94609	3641	01	06001	37.81754276	-122.2646445	Alameda County
55279	Fee-for-Service	1417005737	1417005737	1	1	BLOOM, DAVID R MD	9/17/2021	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	69614	None	None	0	In state provider	None	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	30	06059	33.66214655	-117.6532809	Orange County
55300	Fee-for-Service	1720079130	1720079130	1	1	BECK, CYNTHIA MAXINE MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65996	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
55302	Fee-for-Service	1679919138	1679919138	1	1	BOGGS, JOHN B NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55311	Fee-for-Service	1679787295	1679787295	1	1	BEZDIKIAN, VATCHE K MD	2/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99340	05	Anesthesiology	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
55313	Fee-for-Service	1528088846	1528088846	1	1	BENNETT, NATHAN DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	TWIN CITIES MED CLN	103 HUNTINGTON AVE	None	MANSFIELD	AR	72944	0000	00	None	35.05972942	-94.25018846	Scott County
55322	Fee-for-Service	1548316136	1548316136	1	1	BRINCKMAN, MARK A MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126852	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
55335	Fee-for-Service	1174936330	1174936330	1	1	BASHIR, FERAS S MD	2/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149567	41	Internal Medicine	0	In state provider	None	1420 S CENTRAL AVENUE	None	GLENDALE	CA	91204	1000	19	06037	34.12811155	-118.2577764	Los Angeles County
55363	Fee-for-Service	1154401941	1154401941	1	54	BASS MEDICAL GROUP	4/1/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13939 E 14TH ST	STE 180	SAN LEANDRO	CA	94578	2601	01	06001	37.71377536	-122.1407447	Alameda County
55376	Fee-for-Service	1124134820	1124134820	1	1	BARROWS, KEVIN A MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79743	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
55396	Fee-for-Service	1265430177	1265430177	1	1	BAYLOR MEDICAL CENTER AT	12/29/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WAXAHACHIE	1405 W JEFFERSON	None	WAXAHACHIE	TX	75165	2231	00	None	32.39642075	-96.86438638	Ellis County
55402	Fee-for-Service	1821322108	1821322108	1	1	BHAT, SUNDEEP R MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113240	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
55405	Fee-for-Service	1942219092	1942219092	1	1	BAKER, JOHN M MD	11/30/1988	207P00000X	NA	Other	026	PHYSICIANS	21329	08	Family Practice	0	In state provider	None	26485 INLAND VALLEY DR	None	WILDOMAR	CA	92395	0000	33	06065	33.59408721	-117.2367937	Riverside County
55421	Fee-for-Service	1932855608	1932855608	1	1	BOULAY, MEAGEN A LMFT	9/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
55424	Fee-for-Service	1659611754	1659611754	1	1	BAZZELL OBALLES, SHARONDA D	2/8/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
55446	Fee-for-Service	1437371432	1437371432	1	1	BALAZS, ANDREA MD	10/1/2020	2080P0205X	NA	Endocrinology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
55463	Fee-for-Service	1336243393	1336243393	1	1	BOND PHARMACY INC	9/25/2019	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	623 HIGHLAND COLONY PKWY	STE 100	RIDGELAND	MS	39157	6076	00	None	32.41862633	-90.1567756	Madison County
55501	Fee-for-Service	1790738839	1790738839	1	1	BEIER,KEVIN H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1900 CHRUCH STREET STE	#511	NASHVILLE	TN	37203	0000	00	None	36.15425776	-86.79919989	Davidson County
55528	Fee-for-Service	1467596916	1467596916	1	1	BAJRA, RIKA U MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85892	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55546	Fee-for-Service	1033776810	1033776810	1	1	BEESON, CRAIG PSYD	4/20/2023	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
55550	Fee-for-Service	1184628919	1184628919	1	1	BEVERLY HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
55554	Fee-for-Service	1477871945	1477871945	1	1	BOWEN, ANDREA S-G MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127319	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
55557	Fee-for-Service	1508911892	1508911892	1	6	BAY AREA FOOT CARE, INC	4/15/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2844 SUMMIT ST	SUITE 107	OAKLAND	CA	94609	3641	01	06001	37.81754276	-122.2646445	Alameda County
55638	Fee-for-Service	1154401941	1154401941	1	66	BASS MEDICAL GROUP	7/19/2023	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	581 MCCRAY ST	SUITE F	HOLLISTER	CA	95023	4091	35	06069	36.85042871	-121.3976694	San Benito County
55653	Fee-for-Service	1912915364	1912915364	1	1	BENVENUTI,DAREL J MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39572	41	Internal Medicine	0	In state provider	None	355 PLACENTIA AVE	STE 100	NEWPORT BEACH	CA	92663	3301	30	06059	33.62672719	-117.9312941	Orange County
55662	Fee-for-Service	1265486625	1265486625	1	1	BATHINA, RURALI N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
55671	Fee-for-Service	1104480144	1104480144	1	1	BORJIAN, ALBORZ DO	11/6/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21415	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
55691	Fee-for-Service	1942219092	1942219092	1	1	BAKER, JOHN M MD	11/30/1988	207P00000X	NA	Other	026	PHYSICIANS	21329	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26485 INLAND VALLEY DR	None	WILDOMAR	CA	92395	0000	33	06065	33.59408721	-117.2367937	Riverside County
55716	Fee-for-Service	1811612021	1811612021	1	1	BASQUE, ROBERT LCSW	1/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	777 E TAHQUITZ CANYON WA	None	PALM SPRINGS	CA	92262	6784	33	06065	33.82304055	-116.540676	Riverside County
55761	Fee-for-Service	1902202773	1902202773	1	1	BOUSKOS, TERRI E	7/25/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
55780	Fee-for-Service	1780236364	1780236364	1	1	BALINGIT, JACLYN LMFT	1/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
55800	Fee-for-Service	1316150816	1316150816	1	1	BECK, JASON G MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89896	None	None	0	In state provider	None	25020 LAS BRISAS RD	SUITE 205D	MURRIETA	CA	92562	4064	33	06065	33.57370977	-117.1829111	Riverside County
55804	Fee-for-Service	1043282957	1043282957	2	1	BLAIR, SLOANE R MD	6/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87085	20	Orthopedic Surgery	0	In state provider	None	210 CANAL STREET	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
55825	Fee-for-Service	1386643831	1386643831	2	1	BOLAN, ROBERT K MD	5/25/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	39301	-	NOT APPLICABLE	0	In state provider	None	1919 N BEACHWOOD DR	None	LOS ANGELES	CA	90068	4006	19	06037	34.105806	-118.3213065	Los Angeles County
55881	Fee-for-Service	1780620906	1780620906	1	1	BOUTELLE, KERRI N PHD	8/2/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
55887	Fee-for-Service	1700099645	1700099645	1	1	BARBA, LAURA A NP	6/29/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
55902	Fee-for-Service	1386932374	1386932374	1	1	BUTLER, ASHLEY K OD	1/13/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
55914	Fee-for-Service	1083731509	1083731509	1	1	BINA, SHARON LMFT	12/5/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
55927	Fee-for-Service	1154401941	1154401941	1	66	BASS MEDICAL GROUP	7/19/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	581 MCCRAY ST	SUITE F	HOLLISTER	CA	95023	4091	35	06069	36.85042871	-121.3976694	San Benito County
55930	Fee-for-Service	1417032376	1417032376	1	1	BRISKIN, JONATHAN G MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	31838	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 S SAN MATEO DR	STE 213	SAN MATEO	CA	94401	3843	41	06081	37.56590481	-122.325549	San Mateo County
55945	Fee-for-Service	1760803654	1760803654	1	1	BAILEY, DEBRA L	4/10/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
55951	Fee-for-Service	1639576499	1639576499	1	1	BIRNBAUM, HAE M NP	4/12/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
55962	Fee-for-Service	1073963997	1073963997	1	1	BAHRANI, EMAN MD	7/29/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	152474	None	None	0	In state provider	None	1001 POTRERO AVE BLDG 90	WARD 92, RM 224	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
55964	Fee-for-Service	1811073877	1811073877	1	1	BLAYNEY, DOUGLAS W MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37829	01	General Practice	0	In state provider	None	50 BELLEFONTAINE ST	STE 304	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
55973	Fee-for-Service	1720081631	1720081631	1	1	BASIT, ADDUL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 SW RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
56027	Fee-for-Service	1285667022	1285667022	1	1	BROCK-UTNE, JOHN MD	1/1/1988	207L00000X	NA	Other	026	PHYSICIANS	32932	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
56054	Fee-for-Service	1598080053	1598080053	1	1	BYRD, ERICA A S MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130778	13	Neurology (M.D. only)	0	In state provider	None	TWO MEDICAL PLAZA	STE 205	ROSEVILLE	CA	95661	3044	31	06061	38.76507948	-121.2477476	Placer County
56064	Fee-for-Service	1285608166	1285608166	1	1	BALLER, DONNA L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9395 CROWN CREST BLVD	None	PARKER	CO	80138	8573	00	None	39.5497445	-104.7700003	Douglas County
56085	Fee-for-Service	1871089169	1871089169	1	1	BHALLI, RABIA MD	11/8/2024	207ZP0102X	NA	Other	026	PHYSICIANS	176107	22	Pathology (M.D. only)	0	In state provider	None	6125 N FRESNO STREET	None	FRESNO	CA	93710	5207	10	06019	36.825057	-119.7814395	Fresno County
56103	Fee-for-Service	1720168594	1720168594	1	1	BILLINGSLEY, CRISTINA P LMFT	6/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	4915 WHITMAN CT	None	CAMERON PARK	CA	95682	7317	09	06017	38.6538763	-121.0062117	El Dorado County
56112	Fee-for-Service	1275534539	1275534539	1	1	BANKS JASON T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 GOVERNORS DRIVE 1ST	FLOOR	HUNTSVILLE	AL	35801	0000	00	None	34.71979065	-86.5815475	Madison County
56120	Fee-for-Service	1881239820	1881239820	1	1	BRIGHT JOURNEY HOSPICE INC	6/6/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2913 N GLENOAKS BLVD	None	BURBANK	CA	91504	2606	19	06037	34.20400579	-118.3357798	Los Angeles County
56153	Fee-for-Service	1083843924	1083843924	1	1	BALMADRID, DULCE VIDA A MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115508	40	Pediatrics	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
56174	Fee-for-Service	1730800459	1730800459	1	1	BEST CARE HOMES, INC.	12/26/2024	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13551 YOCKEY ST	None	GARDEN GROVE	CA	92844	2615	30	06059	33.765714	-117.976838	Orange County
56188	Fee-for-Service	1528080256	1528080256	1	1	BINDRA, SANJAY M MD	8/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72359	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2110 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3703	15	06029	35.37344851	-119.0261655	Kern County
56209	Fee-for-Service	1073135778	1073135778	1	1	BOSLEY, PATRICE R	5/21/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4365 CASA GRANDE CIR.	UNIT 304	CYPRESS	CA	90630	2519	30	06059	33.8288973	-118.0565227	Orange County
56211	Fee-for-Service	1144596966	1144596966	1	1	BENDITO PEDIATRICS, INC	9/3/2012	261QP2300X	NA	Other	026	PHYSICIANS	102218	08	Family Practice	0	In state provider	None	22030 SHERMAN WAY	STE 210	CANOGA PARK	CA	91303	1855	19	06037	34.20099551	-118.6071615	Los Angeles County
56212	Fee-for-Service	1033433966	1033433966	1	1	BILBAO, CHRISTOPHER J DO	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13685	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56253	Fee-for-Service	1912331653	1912331653	1	1	BEVERLY CARDIOLOGY GROUP	9/30/2013	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	112970	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3919 BEVERLY BLVD	SUITE 100	LOS ANGELES	CA	90004	3432	19	06037	34.07634552	-118.294164	Los Angeles County
56281	Fee-for-Service	1073569307	1073569307	1	1	BOHORQUEZ, MARTIN A	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75482	None	None	0	In state provider	None	1200 N STATE ST	# 14-901	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
56290	Fee-for-Service	1265606354	1265606354	1	1	BRENER, SETH A MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117011	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
56295	Fee-for-Service	1407908221	1407908221	1	1	BENDER, SHARON A LCSW	12/14/2015	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	609 JEFFERSON ST	STE E	FAIRFIELD	CA	94533	6203	48	06095	38.24835974	-122.041932	Solano County
56296	Fee-for-Service	1720475049	1720475049	1	1	BRANHAM, CHRISTOPHER DO	9/26/2022	207P00000X	NA	Other	026	PHYSICIANS	16511	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
56301	Fee-for-Service	1235300047	1235300047	1	1	BROOKS, LINDSAY M LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
56306	Fee-for-Service	1861839607	1861839607	1	1	BRESKER, OXANA S MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133372	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
56307	Fee-for-Service	1124176920	1124176920	1	1	BURSTEIN, CLAUDIO A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63807	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
56318	Fee-for-Service	1851328835	1851328835	1	1	BENJAMIN, JEANNETTE S MD	2/8/2015	173000000X	NA	Other	026	PHYSICIANS	39542	41	Internal Medicine	0	In state provider	None	811 E 11TH ST	STE 101	UPLAND	CA	91786	4872	36	06071	34.1034335	-117.6398415	San Bernardino County
56342	Fee-for-Service	1508925256	1508925256	1	1	BARTLETT, TERESA L MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74687	66	Emergency Medicine (Urgent Care)	0	In state provider	None	393 E WALNUT ST	None	PASADENA	CA	91188	0001	19	06037	34.14955087	-118.1422348	Los Angeles County
56360	Fee-for-Service	1497304794	1497304794	1	1	BRYCE JOLLEY DPM INC	11/13/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON DRIVE	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
56362	Fee-for-Service	1760869309	1760869309	1	1	BLAIS, BENJAMIN A MD	3/16/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	147019	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
56372	Fee-for-Service	1871089169	1871089169	1	1	BHALLI, RABIA MD	11/8/2024	207ZP0102X	NA	Other	026	PHYSICIANS	176107	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	6125 N FRESNO STREET	None	FRESNO	CA	93710	5207	10	06019	36.825057	-119.7814395	Fresno County
56391	Fee-for-Service	1346484490	1346484490	1	1	BARNES, CAROLYN J MD	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113217	78	Neoplastic Diseases/Oncology	0	In state provider	None	18280 SISKIYOU RD	None	APPLE VALLEY	CA	92307	1410	36	06071	34.5445115	-117.2648745	San Bernardino County
56392	Fee-for-Service	1235576141	1235576141	1	1	BUI, DANA T MD	4/7/2022	208M00000X	NA	Other	026	PHYSICIANS	121638	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
56396	Fee-for-Service	1336120070	1336120070	1	1	BRESLER, PETER A MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	24971	08	Family Practice	0	In state provider	None	328 TRAVIS DRIVE	None	LOS OSOS	CA	93402	4330	40	06079	35.30419643	-120.8485207	San Luis Obispo County
56398	Fee-for-Service	1326284480	1326284480	1	1	BHAKTA, SAVITA G MD	6/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126487	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
56405	Fee-for-Service	1881239820	1881239820	1	1	BRIGHT JOURNEY HOSPICE INC	6/6/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2913 N GLENOAKS BLVD	None	BURBANK	CA	91504	2606	19	06037	34.20400579	-118.3357798	Los Angeles County
56425	Fee-for-Service	1427084854	1427084854	1	1	BEHREND, ALBERT J MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40277	02	General Surgery	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
56430	Fee-for-Service	1841851201	1841851201	1	3	BASSO PODIATRY GROUP, INC	10/27/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ERS	7601 HOSPITAL DR	STE 202	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
56439	Fee-for-Service	1588291447	1588291447	1	1	BUTLER, SANTINO S MD	4/14/2025	261QX0203X	NA	Other	026	PHYSICIANS	188938	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56476	Fee-for-Service	1528080256	1528080256	1	1	BINDRA, SANJAY M MD	8/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72359	41	Internal Medicine	0	In state provider	None	2110 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3703	15	06029	35.37344851	-119.0261655	Kern County
56496	Fee-for-Service	1073135778	1073135778	1	1	BOSLEY, PATRICE R	5/21/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4365 CASA GRANDE CIR.	UNIT 304	CYPRESS	CA	90630	2519	30	06059	33.8288973	-118.0565227	Orange County
56499	Fee-for-Service	1619945342	1619945342	1	1	BENANTI, MICHAEL J DO	11/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23546	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
56502	Fee-for-Service	1629167747	1629167747	1	1	BOYKOFF, ALLA MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56315	41	Internal Medicine	0	In state provider	None	2299 POST ST	STE 303	SAN FRANCISCO	CA	94115	3474	38	06075	37.78434298	-122.4392033	San Francisco County
56525	Fee-for-Service	1659306017	1659306017	1	1	BERGER, ANDREW T MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	57142	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
56540	Fee-for-Service	1619990587	1619990587	1	1	BUI, THUY T L MD	6/17/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	36237	01	General Practice	0	In state provider	None	10362 BOLSA AVE	STE 110	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
56577	Fee-for-Service	1265606354	1265606354	1	1	BRENER, SETH A MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117011	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
56581	Fee-for-Service	1275611170	1275611170	1	1	BUBNIC, BRIAN J MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44932	18	Ophthalmology	0	In state provider	C B O VALLEJO	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
56598	Fee-for-Service	1619917465	1619917465	1	2	BORGER, RODNEY W MD	4/18/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80457	-	NOT APPLICABLE	0	In state provider	None	1841 E MAIN STREET	None	BARSTOW	CA	92311	3234	36	06071	34.8901829	-116.9978731	San Bernardino County
56651	Fee-for-Service	1366605453	1366605453	1	1	BASIT, SHANTRINIA LCSW	12/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
56666	Fee-for-Service	1326574971	1326574971	1	1	BENCK, ANDREW MD	5/5/2020	207R00000X	NA	Other	026	PHYSICIANS	158913	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
56679	Fee-for-Service	1346484490	1346484490	1	1	BARNES, CAROLYN J MD	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113217	30	Radiology	0	In state provider	None	18280 SISKIYOU RD	None	APPLE VALLEY	CA	92307	1410	36	06071	34.5445115	-117.2648745	San Bernardino County
56683	Fee-for-Service	1336120070	1336120070	1	1	BRESLER, PETER A MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	24971	66	Emergency Medicine (Urgent Care)	0	In state provider	None	328 TRAVIS DRIVE	None	LOS OSOS	CA	93402	4330	40	06079	35.30419643	-120.8485207	San Luis Obispo County
56711	Fee-for-Service	1427084854	1427084854	1	1	BEHREND, ALBERT J MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40277	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
56720	Fee-for-Service	1841851201	1841851201	1	3	BASSO PODIATRY GROUP, INC	10/27/2023	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ERS	7601 HOSPITAL DR	STE 202	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
56722	Fee-for-Service	1396130100	1396130100	1	1	BROWN, ERIK MD	9/12/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	190135	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
56738	Fee-for-Service	1073702213	1073702213	1	1	BENNANI, HIND DPM	8/11/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
56774	Fee-for-Service	1366444838	1366444838	1	1	BARAG, STEVEN H DO	12/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	3825	01	General Practice	0	In state provider	None	7974 HAVEN AVE	STE 250	RANCHO CUCAMONGA	CA	91730	3063	36	06071	34.10875445	-117.5759905	San Bernardino County
56805	Fee-for-Service	1073042289	1073042289	1	1	BRADLEY, SEAN P	11/20/2018	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1850 DOUGLAS BLVD	STE 992	ROSEVILLE	CA	95661	3639	31	06061	38.74415734	-121.2570324	Placer County
56834	Fee-for-Service	1154461051	1154461051	1	1	BAZYANI, MENOUCHEHR MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87582	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
56835	Fee-for-Service	1699188532	1699188532	1	1	BERRY, BARBARA J MD	1/9/2024	207P00000X	NA	Other	026	PHYSICIANS	137657	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
56836	Fee-for-Service	1134386956	1134386956	1	1	BONET, ANTONIO MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111251	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
56846	Fee-for-Service	1912912569	1912912569	1	1	BAVOR, CLAYTON W MD	8/13/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	40530	41	Internal Medicine	0	In state provider	None	2660 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4315	43	06085	37.36653288	-122.0778348	Santa Clara County
56856	Fee-for-Service	1508911892	1508911892	1	22	BAY AREA FOOT CARE, INC	1/15/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2114 MCKEE RD	None	SAN JOSE	CA	95116	1427	43	06085	37.36309299	-121.8531192	Santa Clara County
56858	Fee-for-Service	1790780484	1790780484	1	1	BEHREND, TERRY L MD	7/12/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75812	45	Nephrology (Renal-Kidney)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
56880	Fee-for-Service	1376115774	1376115774	1	1	BERGMARK, JENNA M PT	8/19/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
56929	Fee-for-Service	1023549102	1023549102	1	1	BARRETT, JASON A MD	9/25/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	186685	-	NOT APPLICABLE	0	In state provider	None	5190 ATLANTIC AVE	None	LONG BEACH	CA	90805	6510	19	06037	33.850449	-118.1848215	Los Angeles County
56979	Fee-for-Service	1225578206	1225578206	1	1	BURIANEK, DEBRA LMFT	10/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2200 PACIFIC COAST HWY	STE 302	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
56981	Fee-for-Service	1215096052	1215096052	1	1	BERGER, ANDREW C PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
56995	Fee-for-Service	1235646662	1235646662	1	1	BH-SD RX LLC	6/6/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7200 PARKWAY DRIVE	STE 104	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
57030	Fee-for-Service	1508911892	1508911892	1	4	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	228 N. WIGET LN	None	WALNUT CREEK	CA	94598	2404	07	06013	37.92695565	-122.0251489	Contra Costa County
57039	Fee-for-Service	1184788960	1184788960	1	1	BOWERS, MARK R MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103275	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1010 HURLEY WAY	SUITE 500	SACRAMENTO	CA	95825	3216	34	06067	38.587752	-121.419468	Sacramento County
57056	Fee-for-Service	1609807569	1609807569	1	1	BOOKHEIMER, SUSAN PHD	5/22/1998	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
57061	Fee-for-Service	1710261284	1710261284	1	2	BELLA MEDICAL GROUP INC	5/2/2013	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9916 SAN JUAN AVE	None	SOUTH GATE	CA	90280	6108	19	06037	33.94353376	-118.2031054	Los Angeles County
57067	Fee-for-Service	1356362750	1356362750	1	1	BJORKLUND, PAMELA A	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	501 STOCKTON AVE	None	SAN JOSE	CA	95126	2431	43	06085	37.33785683	-121.9104038	Santa Clara County
57075	Fee-for-Service	1154401941	1154401941	1	29	BASS MEDICAL GROUP	7/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1199 BUSH ST	290	SAN FRANCISCO	CA	94109	5973	38	06075	37.7891291	-122.4167087	San Francisco County
57077	Fee-for-Service	1326134909	1326134909	1	1	BELLINO, MICHAEL J MD	7/13/1994	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	79413	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
57090	Fee-for-Service	1407360563	1407360563	1	2	BELFORD, EMILY R LCSW	4/4/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
57094	Fee-for-Service	1790796753	1790796753	2	1	BARDOWELL, RICHARD MD	2/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	41037	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2701 W ALAMEDA AVE	STE 303	BURBANK	CA	91505	4408	19	06037	34.15751343	-118.3303715	Los Angeles County
57100	Fee-for-Service	1740368497	1740368497	1	1	BELL, MICHAEL D MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55822	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
57101	Fee-for-Service	1447768973	1447768973	1	1	BROWN, JENNIFER CRNA	3/26/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
57119	Fee-for-Service	1154461051	1154461051	1	1	BAZYANI, MENOUCHEHR MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87582	40	Pediatrics	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
57130	Fee-for-Service	1134386956	1134386956	1	1	BONET, ANTONIO MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111251	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
57135	Fee-for-Service	1508911892	1508911892	1	29	BAY AREA FOOT CARE, INC	7/5/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1511 CLEMENT ST	None	SAN FRANCISCO	CA	94118	1031	38	06075	37.7823969	-122.475506	San Francisco County
57140	Fee-for-Service	1740067958	1740067958	1	1	BRISCOE, ROXANA	1/31/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
57146	Fee-for-Service	1790780484	1790780484	1	1	BEHREND, TERRY L MD	7/12/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75812	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
57147	Fee-for-Service	1861612731	1861612731	1	1	BOTHA, ROSANNE L MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94103	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
57162	Fee-for-Service	1124268842	1124268842	1	1	BANERJEE, JOSH MD	11/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103123	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
57195	Fee-for-Service	1356560668	1356560668	1	1	BENIGNO, ANTHONY O	9/5/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
57196	Fee-for-Service	1639269087	1639269087	1	1	BAINS, SUCHDEEP S MD	8/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	67856	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
57211	Fee-for-Service	1639511686	1639511686	1	1	BREAUX, JARED A MD	5/23/2018	207L00000X	NA	Other	026	PHYSICIANS	136459	05	Anesthesiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
57241	Fee-for-Service	1962500454	1962500454	1	1	BOLSA OUTPATIENT SURGERY	10/5/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER A MEDICAL CORP	10362 BOLSA AVE	STE 100	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
57296	Fee-for-Service	1336330141	1336330141	1	1	BENMOSHE, DANNY MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100249	13	Neurology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
57301	Fee-for-Service	1013013150	1013013150	1	1	BROOKS, OLIVER T MD	12/16/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	49006	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
57317	Fee-for-Service	1508911892	1508911892	1	4	BAY AREA FOOT CARE, INC	5/9/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	228 N. WIGET LN	None	WALNUT CREEK	CA	94598	2404	07	06013	37.92695565	-122.0251489	Contra Costa County
57331	Fee-for-Service	1346540903	1346540903	1	1	BAHREMAND, ROSHANAK K MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114732	08	Family Practice	0	In state provider	None	450 E HUNTINGTON DRIVE	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
57350	Fee-for-Service	1154401941	1154401941	1	29	BASS MEDICAL GROUP	7/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1199 BUSH ST	290	SAN FRANCISCO	CA	94109	5973	38	06075	37.7891291	-122.4167087	San Francisco County
57357	Fee-for-Service	1073887022	1073887022	1	1	BENZ ROSSAN, ALLISON P LMFT	11/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
57365	Fee-for-Service	1326134909	1326134909	1	1	BELLINO, MICHAEL J MD	7/13/1994	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	79413	20	Orthopedic Surgery	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
57383	Fee-for-Service	1841338985	1841338985	1	1	BABBITT, SHARYN L CRNA	3/26/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCE VILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
57412	Fee-for-Service	1134386956	1134386956	1	1	BONET, ANTONIO MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111251	41	Internal Medicine	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
57436	Fee-for-Service	1538816541	1538816541	1	1	BUTLER, DSHARA DEPRESE DONES	3/9/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	HA	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
57448	Fee-for-Service	1780025114	1780025114	1	1	BROWN, COLIN D MD	10/16/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
57464	Fee-for-Service	1578822698	1578822698	1	1	BHANDARKAR, POORTI V MD	1/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132063	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
57518	Fee-for-Service	1538780432	1538780432	1	1	BURGESS, BENJAMIN N MD	7/23/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
57520	Fee-for-Service	1225188352	1225188352	1	1	BATRA, PRAMOD K MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	36745	01	General Practice	0	In state provider	None	1781 W ROMNEYA DR	STE G	ANAHEIM	CA	92801	1818	30	06059	33.85067272	-117.9447342	Orange County
57569	Fee-for-Service	1275594368	1275594368	1	1	BURELBACH, ANN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5475 S 500 EAST	None	OGDEN	UT	84405	6905	00	None	41.16449014	-111.9686412	Weber County
57643	Fee-for-Service	1154401941	1154401941	1	29	BASS MEDICAL GROUP	7/24/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1199 BUSH ST	290	SAN FRANCISCO	CA	94109	5973	38	06075	37.7891291	-122.4167087	San Francisco County
57644	Fee-for-Service	1154401941	1154401941	1	22	BASS MEDICAL GROUP	2/25/2019	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	112 LA CASA VIA	STE 340	WALNUT CREEK	CA	94598	3018	07	06013	37.91229899	-122.0423696	Contra Costa County
57649	Fee-for-Service	1982328175	1982328175	1	1	BARNES, ALICE MD	7/11/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
57706	Fee-for-Service	1457588964	1457588964	1	1	BARR, ANGELLA A MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103265	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
57736	Fee-for-Service	1780025114	1780025114	1	1	BROWN, COLIN D MD	10/16/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
57764	Fee-for-Service	1972572253	1972572253	1	1	BLAESS, DANIEL R PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3864 5TH AVE	STE K	SAN DIEGO	CA	92103	3167	37	06073	32.74788504	-117.1604934	San Diego County
57765	Fee-for-Service	1124320726	1124320726	1	1	BOULDER CITY HOSPITAL INC	7/10/2018	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	901 ADAMS BOULEVARD	None	BOULDER CITY	NV	89005	2213	00	None	35.96821237	-114.8424842	Clark County
57784	Fee-for-Service	1689968844	1689968844	1	1	BRIAN C NYBERG M.D.	6/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	544 S 400 E	None	ST GEORGE	UT	84770	3705	00	None	37.09902122	-113.5748483	Washington County
57799	Fee-for-Service	1013908607	1013908607	1	1	BLAKE, DONALD C MD	5/2/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175148	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
57806	Fee-for-Service	1760542583	1760542583	1	1	BORDOFSKY, THADDEUS M MD	6/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	70932	01	General Practice	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
57826	Fee-for-Service	1740428911	1740428911	1	1	BALAN, YENER A MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128559	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
57845	Fee-for-Service	1609882125	1609882125	1	1	BRATT,SEEMA R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	0000	00	None	39.14105892	-84.50040782	Hamilton County
57846	Fee-for-Service	1285102939	1285102939	1	1	BODY AND SPIRIT WELLNESS	5/21/2021	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	980 W 17TH ST	SUITE C	SANTA ANA	CA	92706	3554	30	06059	33.75994454	-117.8770455	Orange County
57850	Fee-for-Service	1710366844	1710366844	1	1	BROWN, YVETTE M MD	3/14/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	176612	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
57855	Fee-for-Service	1215241740	1215241740	1	1	BHASIN, RUCHIKA MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112947	None	None	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
57870	Fee-for-Service	1023527371	1023527371	1	1	BIGLARPOUR-WATSON, MELIKA L	7/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	325 27TH ST	UNIT 727	OAKLAND	CA	94612	3236	01	06001	37.8155123	-122.2638185	Alameda County
57872	Fee-for-Service	1023043767	1023043767	1	1	BAKER, BRANDEE M CRNA	3/14/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
57878	Fee-for-Service	1881922664	1881922664	1	1	BREWER, CASEY A	5/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DRIVE	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
57882	Fee-for-Service	1114007226	1114007226	1	1	BRANDAU, JACK R MD	9/12/2023	208600000X	NA	General Surgery	026	PHYSICIANS	18790	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
57899	Fee-for-Service	1154401941	1154401941	1	61	BASS MEDICAL GROUP	3/9/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	575 LENNON LN	None	WALNUT CREEK	CA	94598	2443	07	06013	37.92946711	-122.0316061	Contra Costa County
57966	Fee-for-Service	1154346799	1154346799	1	1	BAI, SHUANG MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68895	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 502	SAN BERNARDINO	CA	92404	3842	36	06071	34.1358627	-117.2757898	San Bernardino County
57974	Fee-for-Service	1649602004	1649602004	1	1	BYUN, SEULGIE W	7/20/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	582 S SUNNYVALE RD	None	SUNNYVALE	CA	94086	6215	43	06085	37.36886669	-122.0316101	Santa Clara County
57978	Fee-for-Service	1457485500	1457485500	1	1	BORSADA, MINAL W MD	5/5/2003	174400000X	NA	Other	026	PHYSICIANS	66056	41	Internal Medicine	0	In state provider	None	1075 N WESTERN AVE	STE 110	LOS ANGELES	CA	90029	2307	19	06037	34.090398	-118.309198	Los Angeles County
57979	Fee-for-Service	1063754448	1063754448	1	1	BRONDFIELD, SAMUEL C MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132415	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
57980	Fee-for-Service	1033472022	1033472022	1	1	BAWA, HARPREET S MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154346	20	Orthopedic Surgery	0	In state provider	None	375 ROLLING OAKS	STE 210	THOUSAND OAKS	CA	91361	1000	56	06111	34.17433197	-118.8706258	Ventura County
57996	Fee-for-Service	1831116672	1831116672	1	1	BERTMAN, LOUISE I PHD	10/7/2003	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2340 CLAY ST	FL 7	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
58002	Fee-for-Service	1538225719	1538225719	1	1	BASCO, MAXIMINO P MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51404	30	Radiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
58018	Fee-for-Service	1568728806	1568728806	1	1	BIZARGITY, PEYMAN MD	11/11/2022	207SG0201X	NA	Other	026	PHYSICIANS	180128	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
58027	Fee-for-Service	1033571732	1033571732	1	1	BRENNING, BENJAMIN MD	10/7/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
58054	Fee-for-Service	1124320726	1124320726	1	1	BOULDER CITY HOSPITAL INC	7/10/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	901 ADAMS BOULEVARD	None	BOULDER CITY	NV	89005	2213	00	None	35.96821237	-114.8424842	Clark County
58063	Fee-for-Service	1619954633	1619954633	1	1	BROWN, ERIC D I MD	4/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	72839	None	None	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
58067	Fee-for-Service	1477560290	1477560290	1	1	BROWN, NANCY L MD	4/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76228	40	Pediatrics	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
58069	Fee-for-Service	1548503154	1548503154	1	1	BROOKS, MICHELLE M MD	12/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	141738	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
58088	Fee-for-Service	1760440465	1760440465	1	1	BOTVINICK, ELIAS H MD	11/27/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22161	06	Cardiovascular Disease (M.D. only)	0	In state provider	UC AND MOFFITT HOSP	3RD AND PARNASSUS AVE 11	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.762974	-122.459769	San Francisco County
58094	Fee-for-Service	1760542583	1760542583	1	1	BORDOFSKY, THADDEUS M MD	6/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	70932	41	Internal Medicine	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
58107	Fee-for-Service	1629693585	1629693585	1	1	BIG HEARTS HOSPICE CORP	8/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14349 VICTORY BLVD	UNIT 304	VAN NUYS	CA	91401	6559	19	06037	34.18669646	-118.4460435	Los Angeles County
58116	Fee-for-Service	1497030852	1497030852	1	1	BULLARDS DIALYSIS LLC	12/1/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3311 COACH LANE	SUITE C	CAMERON PARK	CA	95682	7247	09	06017	38.65815691	-120.9735907	El Dorado County
58135	Fee-for-Service	1902892441	1902892441	1	1	BEESLEY, RULON D MD	4/30/1990	207W00000X	NA	Ophthalmology	026	PHYSICIANS	63031	18	Ophthalmology	0	In state provider	None	44404 16TH ST W	STE 102	LANCASTER	CA	93534	2839	19	06037	34.68975789	-118.1584698	Los Angeles County
58143	Fee-for-Service	1528104924	1528104924	1	1	BURKS, BRUCE MD	5/14/2024	207ZP0102X	NA	Other	026	PHYSICIANS	55912	22	Pathology (M.D. only)	0	In state provider	None	4301 NORTHSTAR WAY	None	MODESTO	CA	95356	9535	50	06099	0	0	None
58168	Fee-for-Service	1548398118	1548398118	1	1	BROWN, LISA M MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98718	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
58173	Fee-for-Service	1013128297	1013128297	1	1	BRONSTEIN, DAVID E MD	11/14/2007	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	81772	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
58178	Fee-for-Service	1740622695	1740622695	1	1	BARKOVICH, MATTHEW J MD	7/30/2019	2085N0700X	NA	MRI Provider	026	PHYSICIANS	132892	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
58186	Fee-for-Service	1306182464	1306182464	1	1	BARBOSA, MICHELLE A DO	3/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12299	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
58187	Fee-for-Service	1154401941	1154401941	1	61	BASS MEDICAL GROUP	3/9/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	575 LENNON LN	None	WALNUT CREEK	CA	94598	2443	07	06013	37.92946711	-122.0316061	Contra Costa County
58218	Fee-for-Service	1710017074	1710017074	1	1	BANH, CO V MD	12/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	95318	None	None	0	In state provider	None	39350 CIVIC CENTER DR	STE 300	FREMONT	CA	94538	2331	01	06001	37.55399458	-121.9756047	Alameda County
58233	Fee-for-Service	1669591798	1669591798	1	1	BERKELEY UNIFIED SD	12/5/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2134 MARTIN LUTHER KING	None	BERKELEY	CA	94704	1109	01	06001	37.86977816	-122.2728413	Alameda County
58236	Fee-for-Service	1881702611	1881702611	1	1	BREWER, JAMES G MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63837	40	Pediatrics	0	In state provider	None	2421 BATH ST	STE A	SANTA BARBARA	CA	93105	4324	42	06083	34.43199173	-119.7240038	Santa Barbara County
58238	Fee-for-Service	1245591783	1245591783	1	1	BROWN, ASHLEY L MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142779	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
58250	Fee-for-Service	1669454427	1669454427	1	1	BROOKSHIRE, GRAIL L MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
58283	Fee-for-Service	1700149317	1700149317	1	1	BIRKELAND, ANDREW C MD	5/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152853	84	Surgery-Head and Neck	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58334	Fee-for-Service	1306883111	1306883111	1	1	BELIKOV, SERGEY M MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76721	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
58336	Fee-for-Service	1932899481	1932899481	1	1	BROUKHIM, LEAH LMFT	5/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
58340	Fee-for-Service	1275572372	1275572372	1	1	BALLESTEROS, DOUGLAS MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74965	66	Emergency Medicine (Urgent Care)	0	In state provider	PARADISE VALLEY HOSP ER	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
58395	Fee-for-Service	1477039386	1477039386	1	1	BAUMAN, ASHLEY A LPCC	2/14/2025	171M00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
58396	Fee-for-Service	1629693585	1629693585	1	1	BIG HEARTS HOSPICE CORP	8/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14349 VICTORY BLVD	UNIT 304	VAN NUYS	CA	91401	6559	19	06037	34.18669646	-118.4460435	Los Angeles County
58398	Fee-for-Service	1023029253	1023029253	1	1	BURNSIDE, CAROLINE LMFT	7/25/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	565 BRUNSWICK RD	STE 10	GRASS VALLEY	CA	95945	9529	29	06057	39.23341432	-121.0294421	Nevada County
58401	Fee-for-Service	1336235779	1336235779	1	1	BLAND, DUANE D MD	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	74030	01	General Practice	0	In state provider	None	2480 SONOMA ST	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
58407	Fee-for-Service	1447228267	1447228267	1	1	BEGGS, LELAND K MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42406	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
58432	Fee-for-Service	1184693376	1184693376	1	1	BRAZIL, LEONARD J MD	6/21/2000	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	83236	20	Orthopedic Surgery	0	In state provider	None	1600 ESPLANADE	STE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
58436	Fee-for-Service	1942378666	1942378666	1	1	BOUCHER, RICHARD D MD	7/13/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36799	08	Family Practice	0	In state provider	None	1760 TERMINO AVE	STE 104	LONG BEACH	CA	90804	2169	19	06037	33.78889871	-118.1458784	Los Angeles County
58445	Fee-for-Service	1912950635	1912950635	1	1	BULLEY, DAVID A MD	8/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
58457	Fee-for-Service	1104269729	1104269729	1	1	BAHRI, SHADFAR MD	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140110	42	Nuclear Medicine	0	In state provider	None	10833 LE CONTE AVE	BLDG AR130	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
58475	Fee-for-Service	1306182464	1306182464	1	1	BARBOSA, MICHELLE A DO	3/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12299	01	General Practice	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
58476	Fee-for-Service	1154401941	1154401941	1	61	BASS MEDICAL GROUP	3/9/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	575 LENNON LN	None	WALNUT CREEK	CA	94598	2443	07	06013	37.92946711	-122.0316061	Contra Costa County
58495	Fee-for-Service	1699447268	1699447268	1	1	BOLSA CARE PHARMACY INC	1/18/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9550 BOLSA AVE	109	WESTMINSTER	CA	92683	5944	30	06059	33.7447587	-117.9625358	Orange County
58512	Fee-for-Service	1821178906	1821178906	1	2	BOCIAN, MAUREEN E MD	6/30/1990	207SG0205X	NA	Other	026	PHYSICIANS	30454	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
58517	Fee-for-Service	1154401941	1154401941	1	16	BASS MEDICAL GROUP	2/25/2019	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2350 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7436	07	06013	37.97049791	-121.7832879	Contra Costa County
58518	Fee-for-Service	1669591798	1669591798	1	1	BERKELEY UNIFIED SD	3/12/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	2134 MARTIN LUTHER KING	None	BERKELEY	CA	94704	1109	01	06001	37.86977816	-122.2728413	Alameda County
58526	Fee-for-Service	1215541024	1215541024	1	1	BRESSETTE, ERL PT	9/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6759 SIERRA CT	SUITE A	DUBLIN	CA	94568	2670	01	06001	37.70825702	-121.9144925	Alameda County
58538	Fee-for-Service	1407990716	1407990716	1	1	BERNSTEIN, ALETHEA A MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98204	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
58561	Fee-for-Service	1972791614	1972791614	1	1	BASHO, SHRUTI MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
58576	Fee-for-Service	1700149317	1700149317	1	1	BIRKELAND, ANDREW C MD	5/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152853	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58600	Fee-for-Service	1669818993	1669818993	1	1	BARTZ, BRYAN M PT	10/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
58641	Fee-for-Service	1508339292	1508339292	1	1	BLAIS, CLAIR A	12/20/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	22150 DELIGHTFUL WAY	None	REDDING	CA	96003	9196	45	06089	40.70479351	-122.2353948	Shasta County
58682	Fee-for-Service	1225332018	1225332018	1	1	BERU, LELINA T LCSW	4/5/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3711 LONG BEACH BLVD	STE 500	LONG BEACH	CA	90807	3315	19	06037	33.824583	-118.1893785	Los Angeles County
58683	Fee-for-Service	1114412939	1114412939	1	1	BOGARD, MICHAEL DO	1/20/2025	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	17716	20	Orthopedic Surgery	0	In state provider	None	250 PROSPECT PL	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
58695	Fee-for-Service	1932399193	1932399193	1	2	BROWN, HEIDI MD	9/12/2023	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	110956	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
58698	Fee-for-Service	1447228267	1447228267	1	1	BEGGS, LELAND K MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42406	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
58703	Fee-for-Service	1134445679	1134445679	1	1	BENES, ANGELA J CCC-SLP	6/5/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
58715	Fee-for-Service	1154797439	1154797439	1	1	BARRIOS, MARIANA C LCSW	3/4/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
58730	Fee-for-Service	1285864918	1285864918	1	1	BRENER, MADELINE E PSYD	5/11/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
58731	Fee-for-Service	1730245051	1730245051	1	1	BAY OBSTETRICS & GYNECOLOGY	11/9/2009	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL GROUP, INC	101 SOUTH SAN MATEO DR	SUITE 115	SAN MATEO	CA	94401	3840	41	06081	37.56590481	-122.325549	San Mateo County
58777	Fee-for-Service	1639106438	1639106438	1	1	BRIAN GALLMAN, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2050 W SOUTHERN AVE	None	APACHE JCT	AZ	85120	7305	00	None	33.39423	-111.56679	Pinal County
58789	Fee-for-Service	1639524341	1639524341	1	1	BARNARD, JENNIFER M MD	1/7/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	152470	40	Pediatrics	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
58797	Fee-for-Service	1285951160	1285951160	1	1	BRUNO, ALICIA G LMFT	1/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
58807	Fee-for-Service	1154401941	1154401941	1	16	BASS MEDICAL GROUP	9/1/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2350 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7436	07	06013	37.97049791	-121.7832879	Contra Costa County
58847	Fee-for-Service	1831166644	1831166644	1	1	BODNER, SOHILA A.	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	BODNER CHIROPRACTIC PC	1675 BROADWAY ST	None	REDWOOD CITY	CA	94063	2401	41	06081	37.48688347	-122.220266	San Mateo County
58857	Fee-for-Service	1932104213	1932104213	1	1	BIXBY KNOLLS TOWERS NURS	7/1/1981	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOME	3747 ATLANTIC AVE	None	LONG BEACH	CA	90807	3428	19	06037	33.826077	-118.185057	Los Angeles County
58860	Fee-for-Service	1780883082	1780883082	1	1	BAHADORANI, JOHN N MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123767	01	General Practice	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
58862	Fee-for-Service	1093380016	1093380016	1	1	BREEN, CHRISTOPHER T MD	6/10/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
58873	Fee-for-Service	1295047389	1295047389	1	1	BIXBY, ERRINN A PHD	1/1/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 TERRADO PLAZA	246	COVINA	CA	91723	3419	19	06037	34.07598226	-117.8892839	Los Angeles County
58874	Fee-for-Service	1871702233	1871702233	1	1	BIEHL, KENNETH J MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124036	78	Neoplastic Diseases/Oncology	0	In state provider	None	1069 LOS PALOS DRIVE	None	SALINAS	CA	93901	3916	27	06053	36.65855557	-121.6450018	Monterey County
58910	Fee-for-Service	1982096921	1982096921	1	1	BERG, CHRISTOPHER PT	12/12/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
58928	Fee-for-Service	1508339292	1508339292	1	1	BLAIS, CLAIR A	12/20/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	22150 DELIGHTFUL WAY	None	REDDING	CA	96003	9196	45	06089	40.70479351	-122.2353948	Shasta County
58937	Fee-for-Service	1700198801	1700198801	1	1	BOONYAPUTTHIKUL, ROBERT DO	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11849	08	Family Practice	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
58946	Fee-for-Service	1528642519	1528642519	1	1	BENZ, MATTHIAS R MD	10/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	42	Nuclear Medicine	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
58979	Fee-for-Service	1548263825	1548263825	1	1	BRAR, JUGROOP S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14961 W BELL RD	STE 175	SURPRISE	AZ	85374	3220	00	None	33.638175	-112.3827615	Maricopa County
58986	Fee-for-Service	1932273539	1932273539	1	1	BHASKAR, BHANU REKHA MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88818	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
58995	Fee-for-Service	1649860586	1649860586	1	1	BIGLIMER INCORPORATED	7/28/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	5189 HOSPITAL ROAD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
59029	Fee-for-Service	1619288438	1619288438	1	1	BLAIR-ROGERS, MARY E MD	1/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138664	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
59038	Fee-for-Service	1891256780	1891256780	1	1	BHATTI, INDERPREET S DO	7/15/2022	207R00000X	NA	Other	026	PHYSICIANS	19472	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
59056	Fee-for-Service	1730144528	1730144528	1	1	BEINGESSER, KELLI R MD	4/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70133	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7050 N RECREATION AVE	STE 102	FRESNO	CA	93720	8001	10	06019	36.83835219	-119.7404373	Fresno County
59066	Fee-for-Service	1639170491	1639170491	1	1	BRYON J STEPHENS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7910 W JEFFERSON BLVD	None	FORT WAYNE	IN	46804	4159	00	None	41.039064	-85.249935	Allen County
59092	Fee-for-Service	1275624991	1275624991	1	1	BASS, DORSEY M MD	10/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62260	10	Gastroenterology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
59097	Fee-for-Service	1154401941	1154401941	1	16	BASS MEDICAL GROUP	2/25/2019	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2350 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7436	07	06013	37.97049791	-121.7832879	Contra Costa County
59102	Fee-for-Service	1467498758	1467498758	1	1	BROWN-RANDHAWA, TANYA L MD	12/18/2014	208600000X	NA	General Surgery	026	PHYSICIANS	87823	02	General Surgery	0	In state provider	None	284 SPRUCE ST	None	GRIDLEY	CA	95948	2216	04	06007	39.36699345	-121.6910745	Butte County
59121	Fee-for-Service	1639120900	1639120900	1	1	BOILLOT, DOMINIQUE C MD	7/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77005	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
59127	Fee-for-Service	1679657696	1679657696	1	1	BICE, CALVIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
59164	Fee-for-Service	1760837306	1760837306	1	1	BALENTINE, ASHLEY S MD	11/19/2020	207L00000X	NA	Other	026	PHYSICIANS	143921	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
59171	Fee-for-Service	1417161704	1417161704	1	1	BHATNAGAR, AJAY MD	11/6/2023	2085R0001X	NA	Other	026	PHYSICIANS	110561	None	None	0	In state provider	None	11100 WARNER AVE	SUITE 206	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
59206	Fee-for-Service	1679822480	1679822480	1	1	BOHLMANN, GENE L	8/13/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12501 SEAL BEACH BLVD	SUITE 230	SEAL BEACH	CA	90740	8815	30	06059	33.78079432	-118.0721158	Orange County
59232	Fee-for-Service	1942642897	1942642897	1	1	BROCHARD-DES ROCHES, KIMBERL	4/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	Y M LMFT	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
59238	Fee-for-Service	1528642519	1528642519	1	1	BENZ, MATTHIAS R MD	10/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
59268	Fee-for-Service	1962683763	1962683763	1	1	BRIGGS, VITALINE R LCSW	9/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
59281	Fee-for-Service	1518926435	1518926435	1	1	BECKERMAN, BROM D MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	43660	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39600 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3265	33	06065	33.7614267	-116.4080191	Riverside County
59284	Fee-for-Service	1710306709	1710306709	1	1	BLOCK, MICHAEL W MD	7/31/2019	207L00000X	NA	Other	026	PHYSICIANS	154578	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
59313	Fee-for-Service	1811306558	1811306558	1	1	BETTING, DAVID J MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	151153	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
59323	Fee-for-Service	1316623317	1316623317	1	1	BAINS, KANWALDIP NP	2/10/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	10	06019	36.80840238	-119.8594473	Fresno County
59357	Fee-for-Service	1669492724	1669492724	1	1	BHAKTA, KETEN G MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81186	41	Internal Medicine	0	In state provider	None	8700 WARNER AVE	STE 140	FOUNTAIN VALLEY	CA	92708	3209	30	06059	33.71568247	-117.977193	Orange County
59359	Fee-for-Service	1760844856	1760844856	1	1	BINKLEY, MICHAEL S MD	6/4/2021	2085R0001X	NA	Other	026	PHYSICIANS	150743	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59379	Fee-for-Service	1275624991	1275624991	1	1	BASS, DORSEY M MD	10/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62260	40	Pediatrics	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
59381	Fee-for-Service	1801062302	1801062302	1	1	BAE, JAMES J MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55894	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANF0RD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59383	Fee-for-Service	1154401941	1154401941	1	16	BASS MEDICAL GROUP	8/15/2022	207XX0005X	NA	Orthopedic Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2350 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7436	07	06013	37.97049791	-121.7832879	Contra Costa County
59391	Fee-for-Service	1124248844	1124248844	1	1	BALDEV S RAI MD INC	1/2/2019	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EEP MEDICINE ASSOCIATES	4234 RIVERWALK PKWY	280	RIVERSIDE	CA	92505	3370	33	06065	33.90290859	-117.4941562	Riverside County
59400	Fee-for-Service	1043290398	1043290398	1	1	BRUCE A MCLELLAN, M.D.	7/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 NE NEFF RD	None	BEND	OR	97701	6015	00	None	44.067735	-121.268187	Deschutes County
59408	Fee-for-Service	1639120900	1639120900	1	1	BOILLOT, DOMINIQUE C MD	7/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77005	08	Family Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
59436	Fee-for-Service	1801861216	1801861216	1	1	BUTTE, MANISH J MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110453	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
59473	Fee-for-Service	1346278587	1346278587	1	1	BROOKS, MARLON R MD	1/1/1998	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71729	None	None	0	In state provider	None	10515 BALBOA BLVD	STE 160	GRANADA HILLS	CA	91344	6368	19	06037	34.261497	-118.502318	Los Angeles County
59487	Fee-for-Service	1134560428	1134560428	1	1	BABBITT, JILL LMFT	10/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17298 JONES RIDGE RD	None	GRASS VALLEY	CA	95945	9398	29	06057	39.21510777	-120.9359916	Nevada County
59511	Fee-for-Service	1578761409	1578761409	1	1	BUITENHUYS, CASEY W MD	11/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101203	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2180	37	06073	32.75034388	-117.161023	San Diego County
59512	Fee-for-Service	1407655897	1407655897	1	1	BARTLETT, SHANA J	4/16/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
59520	Fee-for-Service	1801103130	1801103130	1	1	BARDALES MENDOZA, RICARDO	9/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113225	41	Internal Medicine	0	In state provider	MD	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
59523	Fee-for-Service	1528642519	1528642519	1	1	BENZ, MATTHIAS R MD	10/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
59553	Fee-for-Service	1508911892	1508911892	1	14	BAY AREA FOOT CARE, INC	7/25/2023	207QS0010X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 100	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
59561	Fee-for-Service	1508404310	1508404310	1	2	BELL OCD AND ANXIETY TREATME	5/31/2024	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	NT CENTER	5150 CANDLEWOOD ST	STE. 18J	LAKEWOOD	CA	90712	1928	19	06037	33.85362254	-118.1326815	Los Angeles County
59575	Fee-for-Service	1932292901	1932292901	1	1	BORBA, KARISA M OD	10/9/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
59597	Fee-for-Service	1972130771	1972130771	1	1	BACHER, NICHOLAS M MD	3/13/2024	207L00000X	NA	Other	026	PHYSICIANS	189359	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
59602	Fee-for-Service	1508911892	1508911892	1	8	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1580 VALENCIA STREET	SUITE 109	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
59604	Fee-for-Service	1053460873	1053460873	1	1	BEGOSSI, GIOVANNI MD	2/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112608	02	General Surgery	0	In state provider	None	365 HAWTHORNE AVE	STE 101	OAKLAND	CA	94609	3115	01	06001	37.82079728	-122.2633226	Alameda County
59611	Fee-for-Service	1134146111	1134146111	1	1	BADY-MOGHADDAM, PEJMAN	11/27/2007	204C00000X	NA	Other	026	PHYSICIANS	6686	01	General Practice	0	In state provider	None	1617 E 1ST ST	STE A	SANTA ANA	CA	92701	6385	30	06059	33.74616534	-117.8462414	Orange County
59626	Fee-for-Service	1780967364	1780967364	1	1	BROADUS, TRENT M NP	7/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1695 NORTH SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
59679	Fee-for-Service	1447362249	1447362249	1	1	BIO-MEDICAL APPS OF CA	8/8/2000	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	FMC DIALYSIS SVS	511 N BROOKHURST ST	STE 100	ANAHEIM	CA	92801	5229	30	06059	33.839253	-117.959068	Orange County
59691	Fee-for-Service	1841295607	1841295607	1	1	BAKER, JOHN E MD	12/5/1986	207ZP0102X	NA	Other	026	PHYSICIANS	27612	22	Pathology (M.D. only)	0	In state provider	None	1325 MELROSE AVE	None	MODESTO	CA	95350	5508	50	06099	37.66257726	-120.9871212	Stanislaus County
59702	Fee-for-Service	1538247218	1538247218	1	1	BUTERA, FRANK W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38031	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
59723	Fee-for-Service	1801861216	1801861216	1	1	BUTTE, MANISH J MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110453	03	Allergy	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
59762	Fee-for-Service	1134232259	1134232259	1	1	BROWNELL, KRISTEN J MD	10/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80154	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
59763	Fee-for-Service	1669637328	1669637328	1	1	BESS, JOY A LMFT	2/24/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
59772	Fee-for-Service	1306088174	1306088174	1	1	BUXBAUM, JAMES L MD	2/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89525	10	Gastroenterology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
59803	Fee-for-Service	1023627627	1023627627	1	1	BOYER, PAUL LCSW	3/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
59806	Fee-for-Service	1699193367	1699193367	1	1	BUSSEL, IGOR I MD	6/8/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161695	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
59817	Fee-for-Service	1811055726	1811055726	1	1	BLANK, WENDY N LCSW	6/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
59837	Fee-for-Service	1588649065	1588649065	1	1	BURKHARDT, LINDA S	10/24/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
59840	Fee-for-Service	1508911892	1508911892	1	14	BAY AREA FOOT CARE, INC	8/26/2024	207QS0010X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 100	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
59847	Fee-for-Service	1417381401	1417381401	1	1	BLANDINO, VALERIE LCSW	12/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
59851	Fee-for-Service	1508404310	1508404310	1	2	BELL OCD AND ANXIETY TREATME	5/31/2024	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NT CENTER	5150 CANDLEWOOD ST	STE. 18J	LAKEWOOD	CA	90712	1928	19	06037	33.85362254	-118.1326815	Los Angeles County
59857	Fee-for-Service	1154335370	1154335370	1	1	BRAUN, RUSSELL U MD	2/4/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59871	Fee-for-Service	1295751824	1295751824	1	1	BHENDE, KISHORE S MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40579	05	Anesthesiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
59890	Fee-for-Service	1508911892	1508911892	1	8	BAY AREA FOOT CARE, INC	5/13/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1580 VALENCIA STREET	SUITE 109	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
59907	Fee-for-Service	1487640314	1487640314	1	2	BIOLOGICS, INC.	4/1/2020	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	11800 WESTON PKWY	None	CARY	NC	27513	2292	00	None	35.82819	-78.803055	Wake County
59956	Fee-for-Service	1154401941	1154401941	1	69	BASS MEDICAL GROUP	3/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	175 JACKSON AVE	STE 200	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
59971	Fee-for-Service	1821626243	1821626243	1	1	BLOOM, ALEC MD	5/29/2024	207P00000X	NA	Other	026	PHYSICIANS	20881	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
59993	Fee-for-Service	1093248510	1093248510	1	1	BHAKTA, RAVI P MD	7/31/2020	390200000X	NA	Other	026	PHYSICIANS	167225	08	Family Practice	0	In state provider	None	901 W CIVIC CENTER DR	STE 120	SANTA ANA	CA	92703	2380	30	06059	33.75155572	-117.8778014	Orange County
60034	Fee-for-Service	1972561835	1972561835	1	1	BALACUIT, NORMAN P DPM	6/13/1999	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	633 N CENTRAL AVE	STE 102	GLENDALE	CA	91203	1808	19	06037	34.155054	-118.2579675	Los Angeles County
60036	Fee-for-Service	1801423686	1801423686	1	1	BHATT, KUNJ MD	7/22/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
60048	Fee-for-Service	1457971178	1457971178	1	1	BARBARA ISRAELS, MARRIAGE FA	4/27/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MILY THERAPIST, INC.	3300 TULLY ROAD	C-1	MODESTO	CA	95350	0849	50	06099	37.68597355	-121.012414	Stanislaus County
60052	Fee-for-Service	1437113859	1437113859	1	1	BUCHTA, RICHARD M MD	7/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	16721	01	General Practice	0	In state provider	None	6529 LA JOLLA BLVD	None	LA JOLLA	CA	92037	6016	37	06073	32.82725176	-117.2768784	San Diego County
60065	Fee-for-Service	1275013807	1275013807	1	1	BASCOU, NICHOLETT A LPCC	6/25/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2050 PEABODY RD	SUITE 300	VACAVILLE	CA	95687	6695	48	06095	38.333556	-121.9704855	Solano County
60070	Fee-for-Service	1710071410	1710071410	1	1	BULLHEAD CITY FIRE DEPT	7/1/1990	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	AMBULANCE SERVICE	1260 HANCOCK RD	None	BULLHEAD CITY	AZ	86442	5906	00	None	35.107443	-114.603543	Mohave County
60092	Fee-for-Service	1891053773	1891053773	1	1	BRESSLER, STEVEN D MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129502	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
60128	Fee-for-Service	1508911892	1508911892	1	14	BAY AREA FOOT CARE, INC	1/5/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 100	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
60132	Fee-for-Service	1386720985	1386720985	1	1	BHAT, RESHMA G MD	1/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96255	36	Psychiatry	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
60154	Fee-for-Service	1356072474	1356072474	1	1	BOLLENS, SARA H PHD	4/26/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
60168	Fee-for-Service	1497140594	1497140594	1	1	BORNSTEIN, LEA M MD	9/13/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161625	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
60184	Fee-for-Service	1841866183	1841866183	1	1	BOGONKO, FREDRICK N	6/29/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1601 VINEYARD RD	APT 1623	ROSEVILLE	CA	95747	9118	31	06061	38.741706	-121.3109235	Placer County
60186	Fee-for-Service	1487959946	1487959946	1	1	BERG, EMILY R CRNA	6/22/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
60215	Fee-for-Service	1588870372	1588870372	1	1	BECK, CHARLES A DO JR	2/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11014	14	Neurological Surgery	0	In state provider	None	160 GLEN COVE MARINA RD	STE 103	VALLEJO	CA	94591	7283	48	06095	38.07062486	-122.2124251	Solano County
60227	Fee-for-Service	1669452801	1669452801	1	1	BENKLE, DAVID J OD	1/1/1998	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	DOWNTOWN OPTOMETRY	319 E WEBER AVE	None	STOCKTON	CA	95202	2707	39	06077	37.95436333	-121.2869636	San Joaquin County
60238	Fee-for-Service	1023062510	1023062510	1	1	BOLDER, KEVIN G AU	5/1/2001	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4842 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	2101	19	06037	34.15886631	-118.448689	Los Angeles County
60313	Fee-for-Service	1780769455	1780769455	1	1	BOMDICA, JYOTSNA R MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55836	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
60327	Fee-for-Service	1568210334	1568210334	1	1	BRAIN HEAVEN WITH ADONAI A N	12/26/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	URSING CORPORATION	18952 MACARTHUR BLVD	SUITE 100	IRVINE	CA	92612	1432	30	06059	33.67311036	-117.8632754	Orange County
60335	Fee-for-Service	1053553826	1053553826	1	1	BARBER, SUPARNA B MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120122	40	Pediatrics	0	In state provider	None	2400 WIBLE ROAD	SUITE 14	BAKERSFIELD	CA	93304	4734	15	06029	35.3328934	-119.0389535	Kern County
60340	Fee-for-Service	1437113859	1437113859	1	1	BUCHTA, RICHARD M MD	7/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	16721	40	Pediatrics	0	In state provider	None	6529 LA JOLLA BLVD	None	LA JOLLA	CA	92037	6016	37	06073	32.82725176	-117.2768784	San Diego County
60344	Fee-for-Service	1508911892	1508911892	1	31	BAY AREA FOOT CARE, INC	8/17/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6600 MERCY CT	SUITE 260	FAIR OAKS	CA	95628	3158	34	06067	38.666565	-121.309857	Sacramento County
60369	Fee-for-Service	1518036888	1518036888	1	1	BANDUKWALA, RAHIL A DO	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7863	67	Endocrinology	0	In state provider	None	855 3RD AVE	STE 2210	CHULA VISTA	CA	91911	1350	37	06073	32.62197574	-117.0723222	San Diego County
60371	Fee-for-Service	1033406574	1033406574	1	1	BERA, SAGIR G DO	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13747	01	General Practice	0	In state provider	None	2007 SANTA MONICA BLVD	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02916202	-118.4795022	Los Angeles County
60377	Fee-for-Service	1184630303	1184630303	1	1	BRANNIGAN, MARGARET M MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86248	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
60397	Fee-for-Service	1053782862	1053782862	1	1	BOYD, JACQUELINE LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	614 GRAND AVE	SUITE 203	OAKLAND	CA	94610	3554	01	06001	37.80970653	-122.2493811	Alameda County
60412	Fee-for-Service	1942936620	1942936620	1	1	BLK HAVEN CORP.	4/11/2023	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1079 CALLE DECEO	None	CHULA VISTA	CA	91913	3345	37	06073	32.59639061	-116.9997166	San Diego County
60428	Fee-for-Service	1508911892	1508911892	1	21	BAY AREA FOOT CARE, INC	1/15/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1600 CREEKSIDE DR	STE 3100	FOLSOM	CA	95630	3444	34	06067	38.669994	-121.147488	Sacramento County
60452	Fee-for-Service	1083881841	1083881841	1	1	BAHRAMI, GHAZALEH MD	1/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117471	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
60455	Fee-for-Service	1235111329	1235111329	1	1	BEVAN, HEATHER J MD	2/28/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66378	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
60464	Fee-for-Service	1639156771	1639156771	1	1	BOBICK, BRIAN S DPM	1/3/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
60475	Fee-for-Service	1841866183	1841866183	1	1	BOGONKO, FREDRICK N	6/29/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1601 VINEYARD RD	APT 1623	ROSEVILLE	CA	95747	9118	31	06061	38.741706	-121.3109235	Placer County
60481	Fee-for-Service	1841256856	1841256856	1	1	BECKER, DANIEL F MD	10/16/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	62593	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
60514	Fee-for-Service	1598947962	1598947962	1	1	BATLAPENUMARTHY, APARNA MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	177057	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
60523	Fee-for-Service	1578933099	1578933099	1	1	BATES, CHELSEA M CCC-SLP	6/13/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
60538	Fee-for-Service	1912950510	1912950510	1	1	BALAN, AURELIA MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142751	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60586	Fee-for-Service	1679767313	1679767313	1	1	BAKAYA, SUNAYNA MD	9/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104749	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
60595	Fee-for-Service	1184125312	1184125312	1	1	BRIGHT DAY ADULT DAY HEALTH	11/1/2018	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER, LLC	6330 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91606	3213	19	06037	34.185663	-118.396504	Los Angeles County
60609	Fee-for-Service	1740717149	1740717149	1	1	BURKE, SAMUEL P MD	7/30/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172933	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
60620	Fee-for-Service	1083701247	1083701247	1	1	BRADFORD PHARMACY INC	5/6/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	445 8TH ST	None	OAKLAND	CA	94607	3901	01	06001	37.80008025	-122.2735097	Alameda County
60633	Fee-for-Service	1508911892	1508911892	1	31	BAY AREA FOOT CARE, INC	8/17/2024	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	6600 MERCY CT	SUITE 260	FAIR OAKS	CA	95628	3158	34	06067	38.666565	-121.309857	Sacramento County
60638	Fee-for-Service	1881742617	1881742617	1	1	BUI, TRIEN MD	12/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77531	10	Gastroenterology (M.D. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
60639	Fee-for-Service	1710956412	1710956412	2	1	BIEGEL, SUSAN C MD	8/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66575	None	None	0	In state provider	None	1113 ALTA AVE	STE 220	UPLAND	CA	91786	2803	36	06071	34.10824455	-117.6322743	San Bernardino County
60674	Fee-for-Service	1063777951	1063777951	1	1	BEGLARYAN, DENNIS DO	4/10/2019	2085R0204X	NA	Other	026	PHYSICIANS	15669	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
60677	Fee-for-Service	1780236695	1780236695	1	1	BADRAN, FATIMAH DPM	9/2/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	728 N. EUCLID AVE	None	ONTARIO	CA	91762	2712	36	06071	34.071399	-117.65061	San Bernardino County
60685	Fee-for-Service	1003983974	1003983974	1	1	BALL, MARINA MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39561	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
60736	Fee-for-Service	1598101578	1598101578	1	1	BOST, NEAL W MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131760	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
60739	Fee-for-Service	1710236336	1710236336	1	1	BOOTH, THOMAS M LCSW	9/25/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4869 TOPANGA CANYON BLVD	STE 1	WOODLAND HILLS	CA	91364	4255	19	06037	34.156404	-118.605838	Los Angeles County
60758	Fee-for-Service	1144245895	1144245895	1	1	BONILLA, VICTOR O MD	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51183	None	None	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
60764	Fee-for-Service	1114112372	1114112372	1	3	BEVERLY RADIOLOGY MED GR	4/23/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	17260 BEAR VALLEY RD	STE 109	VICTORVILLE	CA	92395	7778	36	06071	34.47103651	-117.2855205	San Bernardino County
60768	Fee-for-Service	1205955671	1205955671	1	1	BERKOWITZ, STEVEN M LMFT	8/23/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	77643	-	NOT APPLICABLE	0	In state provider	None	1401 11TH ST	None	MODESTO	CA	95354	0728	50	06099	37.64518413	-121.0040818	Stanislaus County
60791	Fee-for-Service	1336193812	1336193812	1	1	BERVEN, SIGURD H MD	3/1/1999	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	85133	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
60821	Fee-for-Service	1649382920	1649382920	1	1	BAER, HAROLD J JR MD	1/1/1982	207RN0300X	NA	Nephrology	026	PHYSICIANS	30336	41	Internal Medicine	0	In state provider	None	2431 F ST	None	BAKERSFIELD	CA	93301	3821	15	06029	35.38136258	-119.0235344	Kern County
60846	Fee-for-Service	1609033588	1609033588	1	1	BURNS, CYNTHIA	3/1/2007	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1890 BEDFORD DR	None	CHICO	CA	95928	7352	04	06007	39.72986033	-121.7969963	Butte County
60856	Fee-for-Service	1790147270	1790147270	1	1	BOAN, ARDELIUS S CNP	11/26/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60884	Fee-for-Service	1508911892	1508911892	1	30	BAY AREA FOOT CARE, INC	7/29/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	595 BUCKINGHAM WAY	SUITE 330	SAN FRANCISCO	CA	94132	1909	38	06075	37.73012679	-122.4767395	San Francisco County
60937	Fee-for-Service	1508911892	1508911892	1	40	BAY AREA FOOT CARE, INC	3/31/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2287 MOWRY AVE	SUITE A	FREMONT	CA	94538	1622	01	06001	37.55664244	-121.9818434	Alameda County
60956	Fee-for-Service	1417125808	1417125808	1	1	BYRNE, EILISH M	10/10/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
60986	Fee-for-Service	1750485363	1750485363	1	1	BAHADURSINGH, ANIL M MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52471	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
60990	Fee-for-Service	1982922308	1982922308	1	1	BARAD, JUSTIN H MD	2/1/2020	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	120702	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
60997	Fee-for-Service	1598331449	1598331449	1	1	BAY RX INC	1/19/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1661 BURDETTE DR	SUITE AB	SAN JOSE	CA	95121	1665	43	06085	37.32012377	-121.8254031	Santa Clara County
61001	Fee-for-Service	1619494044	1619494044	1	1	BAY AREA CLINICAL ASSOCIATES	5/7/2021	2084P0804X	NA	Psychiatry	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	, P.C.	1175 SARATOGA AVE	STE 14	SAN JOSE	CA	95129	3427	43	06085	37.30311805	-121.9800175	Santa Clara County
61002	Fee-for-Service	1871517763	1871517763	1	1	BHASIN, SHARDA MD	8/14/2001	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	35177	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	WOMEN PHYSICIANS MED GRP	3440 LOMITA BLVD	SUITE 447	TORRANCE	CA	90505	4858	19	06037	33.81328127	-118.3452927	Los Angeles County
61046	Fee-for-Service	1508911892	1508911892	1	3	BAY AREA FOOT CARE, INC	4/15/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1100 LAUREL ST	STE E	SAN CARLOS	CA	94070	5000	41	06081	37.49983088	-122.2532086	San Mateo County
61075	Fee-for-Service	1700467438	1700467438	1	1	BIXBY, CRISTINA G CCC-SLP	6/20/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
61076	Fee-for-Service	1437550498	1437550498	1	1	BULLOCK, KATIE LMFT	10/3/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
61106	Fee-for-Service	1407408552	1407408552	1	1	BLANCO, SILVIA E LCSW	12/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
61109	Fee-for-Service	1649382920	1649382920	1	1	BAER, HAROLD J JR MD	1/1/1982	207RN0300X	NA	Nephrology	026	PHYSICIANS	30336	45	Nephrology (Renal-Kidney)	0	In state provider	None	2431 F ST	None	BAKERSFIELD	CA	93301	3821	15	06029	35.38136258	-119.0235344	Kern County
61115	Fee-for-Service	1689685745	1689685745	2	1	BURNHAM, ELLEN L MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
61127	Fee-for-Service	1972080752	1972080752	1	2	BORIS SHLOPOV MD PATHOLOGY M	11/14/2022	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	EDICAL CORPORATION	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
61138	Fee-for-Service	1841724234	1841724234	1	1	BRUNELLE, LISA M PHD	7/5/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	22231 MULHOLLAND HWY	106	CALABASAS	CA	91302	5178	19	06037	34.14821793	-118.6123368	Los Angeles County
61153	Fee-for-Service	1154482396	1154482396	1	1	BOWEN, CECIL D JR MD	10/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	66633	None	None	0	In state provider	None	250 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
61156	Fee-for-Service	1679175186	1679175186	1	1	BOYER, ALEXIS C PT	12/14/2022	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
61162	Fee-for-Service	1346288214	1346288214	1	1	BURKHARDT, MARK C MD	5/31/1996	207L00000X	NA	Other	026	PHYSICIANS	81372	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
61179	Fee-for-Service	1801879879	1801879879	1	1	BLACK, COLLEEN R CNM	8/17/2015	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2760 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700542	-119.790868	Fresno County
61240	Fee-for-Service	1255969309	1255969309	1	1	BOOZER, KAVIDA J	4/22/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	409 SUTRO CT	None	HEMET	CA	92544	1760	33	06065	33.75375005	-116.9132574	Riverside County
61289	Fee-for-Service	1619494044	1619494044	1	1	BAY AREA CLINICAL ASSOCIATES	5/7/2021	2084P0804X	NA	Psychiatry	022	PHYSICIANS GROUP	-	26	Psychiatry (child)	0	In state provider	, P.C.	1175 SARATOGA AVE	STE 14	SAN JOSE	CA	95129	3427	43	06085	37.30311805	-121.9800175	Santa Clara County
61310	Fee-for-Service	1396966149	1396966149	1	1	BOLDRICK, JENNIFER C MD	8/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88543	07	Dermatology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
61318	Fee-for-Service	1417043993	1417043993	1	1	BELZER, JOHN P MD	1/31/1994	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	68596	20	Orthopedic Surgery	0	In state provider	None	500 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2203	38	06075	37.76351054	-122.4579681	San Francisco County
61340	Fee-for-Service	1508911892	1508911892	1	3	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1100 LAUREL ST	STE E	SAN CARLOS	CA	94070	5000	41	06081	37.49983088	-122.2532086	San Mateo County
61351	Fee-for-Service	1215355334	1215355334	1	1	BASSIN, AMAN DO	6/3/2019	2279P3800X	NA	Other	026	PHYSICIANS	16625	08	Family Practice	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
61371	Fee-for-Service	1548374754	1548374754	1	1	BLACK, M. K PA-C	4/4/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	750 CENTRAL AVE	None	WILLITS	CA	95490	3938	23	06045	39.40470494	-123.3500473	Mendocino County
61373	Fee-for-Service	1336265164	1336265164	1	2	BALLELOS, RODERICK Y DO	3/8/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
61411	Fee-for-Service	1164592119	1164592119	1	1	BAY AREA DIGESTIVE HLTH	5/31/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL GROUP, INC	1850 SULLIVAN AVE	STE 520	DALY CITY	CA	94015	2204	41	06081	37.68085904	-122.4728842	San Mateo County
61435	Fee-for-Service	1407868557	1407868557	1	1	BLOSK, SHARON A MD	11/12/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50139	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
61438	Fee-for-Service	1700194073	1700194073	1	1	BAMBHANIA MEDICAL CORPORATIO	10/5/2010	207R00000X	NA	Other	026	PHYSICIANS	45672	41	Internal Medicine	0	In state provider	None	16003 TUSCOLA ROAD	SUITE H	APPLE VALLEY	CA	92307	0825	36	06071	34.54197921	-117.2692581	San Bernardino County
61444	Fee-for-Service	1174955801	1174955801	1	1	BI, YU PHD	8/3/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
61482	Fee-for-Service	1891724910	1891724910	1	1	BENMAR MEDICAL INC	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2020 N GLENOAKS BLVD	None	BURBANK	CA	91504	2898	19	06037	34.19746465	-118.3257417	Los Angeles County
61488	Fee-for-Service	1134137615	1134137615	1	1	BON SECOURS DEPAUL MEDIC	12/1/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	150 KINGSLEY LN	None	NORFOLK	VA	23505	4650	00	None	36.89854549	-76.28187102	Norfolk city
61489	Fee-for-Service	1174783773	1174783773	1	1	BORNSTEIN,NATHAN W MD	11/23/2011	261QU0200X	NA	Other	026	PHYSICIANS	116154	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
61518	Fee-for-Service	1073567574	1073567574	1	1	BINNON,DIANNA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	0000	00	None	43.61455048	-116.256231	Ada County
61520	Fee-for-Service	1982458717	1982458717	1	1	BROWN, ELEANOR DOULA	12/11/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	10	06019	0	0	None
61523	Fee-for-Service	1104252071	1104252071	1	1	BEST, MACHEL LCSW	2/4/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
61527	Fee-for-Service	1255969309	1255969309	1	1	BOOZER, KAVIDA J	4/22/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	409 SUTRO CT	None	HEMET	CA	92544	1760	33	06065	33.75375005	-116.9132574	Riverside County
61564	Fee-for-Service	1508911892	1508911892	1	2	BAY AREA FOOT CARE, INC	5/9/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1320 EL CAPITAN DRIVE	SUITE 450	DANVILLE	CA	94526	0000	07	06013	37.78476866	-121.9658691	Contra Costa County
61567	Fee-for-Service	1992814602	1992814602	1	1	BEUTLER, STEVEN M MD INC	5/1/1983	207RN0300X	NA	Nephrology	026	PHYSICIANS	39216	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 100	SAN BERNARDINO	CA	92404	3841	36	06071	34.1358627	-117.2757898	San Bernardino County
61616	Fee-for-Service	1487764148	1487764148	1	1	BEL AIR MARKET INC	2/18/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7901 WALERGA RD	None	ANTELOPE	CA	95843	5722	34	06067	38.711961	-121.366278	Sacramento County
61659	Fee-for-Service	1659026045	1659026045	1	1	BINGHAM, TRACEY PT	2/24/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
61665	Fee-for-Service	1063501229	1063501229	1	1	BARIEL, KENNETH PT	12/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	900 MAIN ST	None	CAMBRIA	CA	93428	2820	40	06079	35.56580276	-121.0979727	San Luis Obispo County
61681	Fee-for-Service	1821404096	1821404096	1	1	BHASIN, GURLEEN MD	3/25/2020	207R00000X	NA	Other	026	PHYSICIANS	158945	41	Internal Medicine	0	In state provider	None	7325 MEDICAL CENTER DRIV	SUITE 300	WEST HILLS	CA	91307	4117	19	06037	34.20369349	-118.629837	Los Angeles County
61688	Fee-for-Service	1760988091	1760988091	1	1	BARTON, SUSAN CNM	6/14/2019	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
61717	Fee-for-Service	1285075028	1285075028	1	2	BLUMBERG, RACHEL J DO	11/12/2019	207P00000X	NA	Other	026	PHYSICIANS	15707	66	Emergency Medicine (Urgent Care)	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
61722	Fee-for-Service	1295296150	1295296150	1	1	BROOKSHIER, TRENT R DPM	5/29/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3989 32ND ST	None	SAN DIEGO	CA	92104	2001	37	06073	32.75020917	-117.1251946	San Diego County
61761	Fee-for-Service	1144777897	1144777897	1	1	BAKERSFIELD RECOVERY SERVICE	10/21/2016	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	TPATIENT	1000 PACIFIC ST	None	BAKERSFIELD	CA	93305	4528	15	06029	35.38298375	-118.9854539	Kern County
61764	Fee-for-Service	1851325047	1851325047	1	1	BODOR, MARKO MD A	10/10/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	3421 VILLA LANE	SUITE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
61775	Fee-for-Service	1134137615	1134137615	1	1	BON SECOURS DEPAUL MEDIC	11/8/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	150 KINGSLEY LN	None	NORFOLK	VA	23505	4650	00	None	36.89854549	-76.28187102	Norfolk city
61813	Fee-for-Service	1639238470	1639238470	1	1	BRAME, MARIAN P	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
61814	Fee-for-Service	1215137823	1215137823	1	1	BOJALIAN, MICHAEL O MD	4/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80124	02	General Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
61821	Fee-for-Service	1740740406	1740740406	1	1	BOLTE, COLLEEN	11/20/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	780 W OLIVE AVE	100	MERCED	CA	95348	2437	24	06047	37.31916174	-120.4814268	Merced County
61852	Fee-for-Service	1770818205	1770818205	1	1	BARRY, AARON E MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115405	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVENUE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
61853	Fee-for-Service	1508911892	1508911892	1	19	BAY AREA FOOT CARE, INC	6/13/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	10353 TORRE AVE	None	CUPERTINO	CA	95014	3217	43	06085	37.31739526	-122.0293011	Santa Clara County
61854	Fee-for-Service	1083168439	1083168439	1	1	BHARDWAJ, KARISHMA A NP	3/27/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
61859	Fee-for-Service	1245385376	1245385376	1	1	BARRETO, RACHAEL E LCSW	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	65820	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
61886	Fee-for-Service	1407298813	1407298813	1	1	BHALLA, ANSHUL MD	10/28/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
61894	Fee-for-Service	1588727309	1588727309	1	1	BURSCH, RONI P MD	1/19/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
61896	Fee-for-Service	1770774457	1770774457	1	1	BIRD ROCK OPTICAL	1/31/1995	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	KRON, ELENA	865 3RD STREET	STE 121	CHULA VISTA	CA	91911	1300	37	06073	32.62189562	-117.0722453	San Diego County
61920	Fee-for-Service	1134138803	1134138803	1	1	BASSI, DEEP G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2799 W GRAND BLVD	None	DETROIT	MI	48202	2608	00	None	42.36645079	-83.08385497	Wayne County
61922	Fee-for-Service	1841495165	1841495165	1	1	BELGARDE, JOANNE P MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116610	40	Pediatrics	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
61931	Fee-for-Service	1306924956	1306924956	1	1	BOYLE, JAMES J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31446	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
61934	Fee-for-Service	1154401941	1154401941	1	45	BASS MEDICAL GROUP	6/30/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3903 LONE TREE WAY	SUITE 104A	ANTIOCH	CA	94509	6249	07	06013	37.98216807	-121.8054744	Contra Costa County
61936	Fee-for-Service	1578230512	1578230512	1	1	BEST CARE HH	2/28/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	671 W BROADWAY	STE 102	GLENDALE	CA	91204	1007	19	06037	34.14680392	-118.2695599	Los Angeles County
61943	Fee-for-Service	1467482430	1467482430	1	1	BEAUMONT, MICHAEL J MD	5/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	27319	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A PROFESSIONAL CORP	17190 BERNARDO CENTER DR	None	SAN DIEGO	CA	92128	7030	37	06073	33.02473938	-117.0778645	San Diego County
61951	Fee-for-Service	1972544880	1972544880	1	1	BAJOR, OLIVIA M DO	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8508	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
61958	Fee-for-Service	1154401941	1154401941	1	6	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	820 S AKERS ST	STE 100	VISALIA	CA	93277	8306	54	06107	36.323757	-119.3491755	Tulare County
61971	Fee-for-Service	1053421123	1053421123	2	1	BAGHERI, BRUCE B MD	4/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	70830	41	Internal Medicine	0	In state provider	None	1219 S CENTRAL AVE	None	GLENDALE	CA	91204	2503	19	06037	34.131501	-118.257846	Los Angeles County
61982	Fee-for-Service	1023180338	1023180338	1	1	BROOKS, DOUGLAS C DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2222 E ST	STE 3	BAKERSFIELD	CA	93301	3810	15	06029	35.3796357	-119.0245697	Kern County
61984	Fee-for-Service	1780920355	1780920355	1	1	BARMPARAS, GALINOS MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123382	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
62010	Fee-for-Service	1699978445	1699978445	1	1	BELL, JOHN F MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120667	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
62028	Fee-for-Service	1265409874	1265409874	1	1	BHATT, MRUNAL R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84457	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
62050	Fee-for-Service	1447241237	1447241237	1	1	BECK MICHEAL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	515 N MESA DRIVE	None	MESA	AZ	85201	0000	00	None	33.424767	-111.8219445	Maricopa County
62085	Fee-for-Service	1467532010	1467532010	1	1	BLACK, WILLIAM J MD	10/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80669	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
62086	Fee-for-Service	1093710634	1093710634	1	1	BALASU, ANCA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST.JOHN MED CTR DBA BH	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
62102	Fee-for-Service	1013929611	1013929611	1	1	BROWN, JEFFREY P MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60338	40	Pediatrics	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
62139	Fee-for-Service	1508911892	1508911892	1	2	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1320 EL CAPITAN DRIVE	SUITE 450	DANVILLE	CA	94526	0000	07	06013	37.78476866	-121.9658691	Contra Costa County
62147	Fee-for-Service	1316576077	1316576077	1	1	BASHIR, RAME B MD	1/15/2023	207P00000X	NA	Other	026	PHYSICIANS	179100	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
62149	Fee-for-Service	1508911892	1508911892	1	11	BAY AREA FOOT CARE, INC	4/15/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	750 LAS GALLINAS AVE	#115	SAN RAFAEL	CA	94903	3431	21	06041	38.00688138	-122.5463961	Marin County
62155	Fee-for-Service	1114121860	1114121860	1	1	BUTLER, JARET M MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111912	20	Orthopedic Surgery	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
62179	Fee-for-Service	1710299821	1710299821	1	1	BASTIAN, PETER MD	2/14/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147445	08	Family Practice	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
62185	Fee-for-Service	1629256391	1629256391	2	1	BORGES, MANUEL T III MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
62192	Fee-for-Service	1235364894	1235364894	1	1	BALAWI, TARIQ H MD	1/30/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	115992	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
62193	Fee-for-Service	1063507382	1063507382	1	1	BOLDY, ROBERT M MD	4/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80969	41	Internal Medicine	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
62197	Fee-for-Service	1790951200	1790951200	1	1	BONTHALA, NIRUPAMA MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121636	41	Internal Medicine	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
62206	Fee-for-Service	1841495165	1841495165	1	1	BELGARDE, JOANNE P MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116610	41	Internal Medicine	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
62222	Fee-for-Service	1154401941	1154401941	1	8	BASS MEDICAL GROUP	2/25/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	3903 LONE TREE WAY	STE 205	ANTIOCH	CA	94509	6269	07	06013	37.98216807	-121.8054744	Contra Costa County
62236	Fee-for-Service	1972544880	1972544880	1	1	BAJOR, OLIVIA M DO	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8508	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
62241	Fee-for-Service	1154401941	1154401941	1	6	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	820 S AKERS ST	STE 100	VISALIA	CA	93277	8306	54	06107	36.323757	-119.3491755	Tulare County
62259	Fee-for-Service	1053421123	1053421123	2	1	BAGHERI, BRUCE B MD	4/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	70830	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1219 S CENTRAL AVE	None	GLENDALE	CA	91204	2503	19	06037	34.131501	-118.257846	Los Angeles County
62262	Fee-for-Service	1013069426	1013069426	1	1	BELLEVILLE, JON P MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	57679	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
62340	Fee-for-Service	1972921088	1972921088	1	1	BHATT, JIKEN M MD	5/7/2020	390200000X	NA	Other	026	PHYSICIANS	138631	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3131 BERGER AVE	None	SAN DIEGO	CA	92123	4233	37	06073	32.8019999	-117.1515447	San Diego County
62357	Fee-for-Service	1427498260	1427498260	1	1	BECKLER, ADAM Y DPM	10/12/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	27200 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.8955513	-117.189743	Riverside County
62372	Fee-for-Service	1710994678	1710994678	1	1	BASCO, DAVID M DC	1/14/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
62378	Fee-for-Service	1225692874	1225692874	1	1	BANG, SUNNY MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	176390	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
62379	Fee-for-Service	1255446688	1255446688	1	1	BOOTH, GEOFFREY A MD	6/25/2019	207R00000X	NA	Other	086	MEDICAL DIRECTORS	74560	-	NOT APPLICABLE	0	In state provider	None	18663 VENTURA BLVD	SUITE 300	TARZANA	CA	91356	4162	19	06037	34.17051848	-118.5402557	Los Angeles County
62384	Fee-for-Service	1255409298	1255409298	1	1	BRADY, KAREN L	10/30/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
62390	Fee-for-Service	1013929611	1013929611	1	1	BROWN, JEFFREY P MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60338	01	General Practice	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
62393	Fee-for-Service	1548604192	1548604192	1	2	BAART BEHAVIORAL HEALTH SERV	3/4/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	310 HARRIS AVE	A, E, F, AND G	SACRAMENTO	CA	95838	3249	34	06067	38.638134	-121.458573	Sacramento County
62426	Fee-for-Service	1437229671	1437229671	1	1	BIOCONCEPTS, INC	1/13/2009	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	BIO CONCEPTS INC	2424 E UNIVERSITY DRIVE	None	PHOENIX	AZ	85034	6911	00	None	33.424308	-112.0291785	Maricopa County
62438	Fee-for-Service	1508911892	1508911892	1	11	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	750 LAS GALLINAS AVE	#115	SAN RAFAEL	CA	94903	3431	21	06041	38.00688138	-122.5463961	Marin County
62460	Fee-for-Service	1508911892	1508911892	1	33	BAY AREA FOOT CARE, INC	9/19/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3000 COLBY ST.	STE 107	BERKELEY	CA	94705	2027	01	06001	37.85473248	-122.2575793	Alameda County
62462	Fee-for-Service	1104024330	1104024330	1	1	BEAL, BENJAMIN R MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103582	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
62464	Fee-for-Service	1760055263	1760055263	1	1	BAPTIE, JESSICA L OT	8/3/2021	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
62465	Fee-for-Service	1710299821	1710299821	1	1	BASTIAN, PETER MD	2/14/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147445	39	Preventive (M.D. only)	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
62481	Fee-for-Service	1144395435	1144395435	1	1	BORAH, MICHAEL F	1/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	20356	None	None	0	In state provider	None	2100 WEBSTER ST	STE 405	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
62484	Fee-for-Service	1790951200	1790951200	1	1	BONTHALA, NIRUPAMA MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121636	10	Gastroenterology (M.D. only)	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
62490	Fee-for-Service	1114031762	1114031762	1	1	BOSE, SHELLEY MD	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84458	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
62501	Fee-for-Service	1053469080	1053469080	1	1	BENNETT, MELISSA P MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92274	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
62506	Fee-for-Service	1598159410	1598159410	1	1	BALKISSOON, CHRISTOPHER J NP	12/15/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
62509	Fee-for-Service	1154401941	1154401941	1	45	BASS MEDICAL GROUP	6/30/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	3903 LONE TREE WAY	SUITE 104A	ANTIOCH	CA	94509	6249	07	06013	37.98216807	-121.8054744	Contra Costa County
62517	Fee-for-Service	1528331238	1528331238	1	1	BRAMBILA, ALEJANDRINA LMFT	3/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
62542	Fee-for-Service	1003902735	1003902735	1	1	BUDROVICH, NOELLE G PT	7/10/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2842 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2803	19	06037	33.82340521	-118.3361739	Los Angeles County
62544	Fee-for-Service	1457531618	1457531618	1	1	BACKER, TAMARA L CCC-SLP	2/21/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
62554	Fee-for-Service	1396923868	1396923868	1	1	BROWN, SAMUEL A II MD	8/19/2011	2084P0800X	NA	Psychiatry	026	PHYSICIANS	13419	36	Psychiatry	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
62567	Fee-for-Service	1275568479	1275568479	1	1	BROWN, CALVANESE, CAMERON	12/1/1997	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	LTD	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
62569	Fee-for-Service	1225355357	1225355357	1	1	BATRA, PRIYA MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120311	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
62579	Fee-for-Service	1316087612	1316087612	1	1	BERTA, THERESA M MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48830	38	Geriatrics	0	In state provider	None	375 LAGUNA HONDA BLVD	RM B200	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
62583	Fee-for-Service	1487144820	1487144820	1	1	BELANI HOME HEALTH CARE INC	11/13/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2609 W WYOMING AVE	SUITE B	BURBANK	CA	91505	1950	19	06037	34.17854757	-118.3401609	Los Angeles County
62601	Fee-for-Service	1053310326	1053310326	1	1	BARTON HEALTHCARE SYSTEM	8/23/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2201 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	38.91235444	-119.996422	El Dorado County
62603	Fee-for-Service	1003890872	1003890872	1	1	BUI, DIANA M MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70753	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
62615	Fee-for-Service	1902986094	1902986094	1	1	BUTLER, JOHN A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35047	02	General Surgery	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
62628	Fee-for-Service	1790137388	1790137388	1	1	BRANA, SABRINA MD	5/15/2020	207R00000X	NA	Other	026	PHYSICIANS	163040	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
62649	Fee-for-Service	1205149341	1205149341	1	1	BARTHOLDI, MARIE C MD	3/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118001	40	Pediatrics	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
62650	Fee-for-Service	1679590509	1679590509	1	1	BOZDECH, MAREK J MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	29386	01	General Practice	0	In state provider	None	3555 ROUND BARN CIR	None	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
62653	Fee-for-Service	1932541257	1932541257	1	1	BAYS, DEREK J MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149095	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
62655	Fee-for-Service	1215983440	1215983440	1	1	BERNENS, ANTHONY T MD	1/1/1997	207R00000X	NA	Other	026	PHYSICIANS	55164	41	Internal Medicine	0	In state provider	None	106 LA CASA VIA	STE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
62695	Fee-for-Service	1528590775	1528590775	1	1	BONILLA, KEVIN MD	1/3/2024	207L00000X	NA	Other	026	PHYSICIANS	184981	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
62703	Fee-for-Service	1679663207	1679663207	1	1	BENTZ, BRANDON G MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89294	04	Otology, Laryngology, Rhinology	0	In state provider	None	307 DEL NORTE AVE	STE 203	YUBA CITY	CA	95991	4142	51	06101	39.1454597	-121.614696	Sutter County
62710	Fee-for-Service	1134516131	1134516131	1	1	BODEPUDI, SWETA V MD	9/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148401	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
62755	Fee-for-Service	1538110499	1538110499	1	1	BULLIAS, BRUCE A MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	27217	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
62790	Fee-for-Service	1386141208	1386141208	1	1	BHATIA, MONISHA C MD	9/20/2022	208M00000X	NA	Other	026	PHYSICIANS	180256	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
62796	Fee-for-Service	1154401941	1154401941	1	45	BASS MEDICAL GROUP	6/30/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3903 LONE TREE WAY	SUITE 104A	ANTIOCH	CA	94509	6249	07	06013	37.98216807	-121.8054744	Contra Costa County
62813	Fee-for-Service	1467747188	1467747188	1	1	BARRERA, KAYLENE A MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155585	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
62817	Fee-for-Service	1740886043	1740886043	1	1	BARNES, MICHELLE D	12/24/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	929 ALLEGHANY CIRCLE	None	SAN DIMAS	CA	91773	1583	19	06037	34.11880421	-117.7965722	Los Angeles County
62820	Fee-for-Service	1275037459	1275037459	1	1	BEROOKHIM, JOSHUA MD	10/8/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 420-440	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
62863	Fee-for-Service	1154401941	1154401941	1	39	BASS MEDICAL GROUP	12/4/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	130 LA CASA VIA	208	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
62869	Fee-for-Service	1316087612	1316087612	1	1	BERTA, THERESA M MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48830	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	RM B200	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
62870	Fee-for-Service	1154352391	1154352391	3	1	BAKERSFIELD PROSTHETICS &	6/26/2017	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS CENTER INC	2023 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	5012	19	06037	35.37327251	-119.025432	Kern County
62890	Fee-for-Service	1053310326	1053310326	1	1	BARTON HEALTHCARE SYSTEM	8/23/2002	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2201 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	38.91235444	-119.996422	El Dorado County
62916	Fee-for-Service	1508911892	1508911892	1	27	BAY AREA FOOT CARE, INC	7/11/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1241 E HILLSDALE BLVD	SUITE 200	FOSTER CITY	CA	94404	1241	41	06081	37.56768233	-122.2671401	San Mateo County
62953	Fee-for-Service	1376977744	1376977744	1	1	BORJA, ANDRES LCSW	8/27/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
63043	Fee-for-Service	1538110499	1538110499	1	1	BULLIAS, BRUCE A MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	27217	41	Internal Medicine	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
63080	Fee-for-Service	1225227812	1225227812	1	1	BAKER, REGINA Y MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91060	02	General Surgery	0	In state provider	None	1520 SAN PABLO STREET	STE 4300	LOS ANGELES	CA	90033	5330	19	06037	34.06269295	-118.2030006	Los Angeles County
63100	Fee-for-Service	1528216249	1528216249	1	1	BIYYAM, DEEPA R MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	1919 E THOMAS RD	MAIN BLDG	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
63104	Fee-for-Service	1740886043	1740886043	1	1	BARNES, MICHELLE D	12/24/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	929 ALLEGHANY CIRCLE	None	SAN DIMAS	CA	91773	1583	19	06037	34.11880421	-117.7965722	Los Angeles County
63140	Fee-for-Service	1154401941	1154401941	1	39	BASS MEDICAL GROUP	12/4/2019	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	130 LA CASA VIA	208	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
63168	Fee-for-Service	1861073280	1861073280	1	1	BELLARA, JAYESH M PT	11/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 S MERCEY SPRINGS RD	STE I	LOS BANOS	CA	93635	4928	24	06047	37.054854	-120.835392	Merced County
63177	Fee-for-Service	1053310326	1053310326	1	1	BARTON HEALTHCARE SYSTEM	3/2/2004	261QR1300X	NA	Rural Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2201 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	38.91235444	-119.996422	El Dorado County
63183	Fee-for-Service	1558304451	1558304451	1	1	BRANSCOM, JAMES J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	12652	30	Radiology	0	In state provider	None	1505 SAINT ALPHONSUS CT	None	ALAMO	CA	94507	1533	07	06013	37.85356704	-122.03496	Contra Costa County
63201	Fee-for-Service	1245255835	1245255835	1	1	BOIVIN,MICHAEL A MD	4/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	0000	00	None	35.08771808	-106.6192188	Bernalillo County
63210	Fee-for-Service	1093259145	1093259145	1	1	BAKER, KATHERINE LMFT	3/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	619 N IRWIN ST	None	HANFORD	CA	93230	3825	16	06031	36.33189434	-119.6476432	Kings County
63226	Fee-for-Service	1669505756	1669505756	1	1	BIG PINE FIRE PROTECTION	9/2/2014	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	181 NORTH MAIN STREET	None	BIG PINE	CA	93513	0000	14	06027	37.167399	-118.2895765	Inyo County
63234	Fee-for-Service	1629311394	1629311394	1	1	BUTLER, TATAVIA L LCSW	2/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
63249	Fee-for-Service	1821162140	1821162140	1	1	BOURNE, GERALD W MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	61089	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
63257	Fee-for-Service	1083934244	1083934244	1	4	BRIGHTHEAR	6/14/2022	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6360 WILSHIRE BLVD	SUITE 203	LOS ANGELES	CA	90048	5603	19	06037	34.06363617	-118.3676811	Los Angeles County
63262	Fee-for-Service	1699429621	1699429621	1	1	BENITEZ, MARISOL CNP	3/17/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26357 MCBEAN PKWY	SUITE 210	SANTA CLARITA	CA	91355	4497	19	06037	34.41257644	-118.5597683	Los Angeles County
63279	Fee-for-Service	1275001067	1275001067	1	1	BRYAN'S HOUSE RECOVERY HOME,	1/31/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC.	5655 ARDILLA AVE	None	ATASCADERO	CA	93422	3222	40	06079	35.48908646	-120.6740835	San Luis Obispo County
63327	Fee-for-Service	1831278977	1831278977	1	1	BANERJEE, AMIT MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93425	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
63346	Fee-for-Service	1861578668	1861578668	1	1	BECKER, PAMELA S MD	3/23/2020	207RH0000X	NA	Hematology	026	PHYSICIANS	167080	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
63368	Fee-for-Service	1225227812	1225227812	1	1	BAKER, REGINA Y MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91060	24	Plastic Surgery	0	In state provider	None	1520 SAN PABLO STREET	STE 4300	LOS ANGELES	CA	90033	5330	19	06037	34.06269295	-118.2030006	Los Angeles County
63426	Fee-for-Service	1154401941	1154401941	1	39	BASS MEDICAL GROUP	12/4/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	130 LA CASA VIA	208	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
63437	Fee-for-Service	1821595307	1821595307	1	1	BARRIOS, CHESCA CZARINA A MD	4/12/2023	207RR0500X	NA	Other	026	PHYSICIANS	167008	None	None	0	In state provider	None	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
63441	Fee-for-Service	1760770259	1760770259	1	1	BRENNER, WILLIAM I MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25702	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
63471	Fee-for-Service	1053310326	1053310326	1	1	BARTON HEALTHCARE SYSTEM	4/20/2005	261QR1300X	NA	Rural Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2201 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	38.91235444	-119.996422	El Dorado County
63492	Fee-for-Service	1508911892	1508911892	1	26	BAY AREA FOOT CARE, INC	7/3/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9029 SOQUEL AVE	STE D	SANTA CRUZ	CA	95062	2085	44	06087	36.98177269	-121.9661	Santa Cruz County
63538	Fee-for-Service	1578576047	1578576047	1	1	BACON, CARRIE W MD	4/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	85044	08	Family Practice	0	In state provider	None	2499 E LAKESHORE DRIVE	None	LAKE ELSINORE	CA	92530	4446	33	06065	33.66050702	-117.3018956	Riverside County
63544	Fee-for-Service	1821438581	1821438581	1	1	BALEILEVUKA-HART, MARICA MD	2/23/2024	2080P0203X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
63561	Fee-for-Service	1225098189	1225098189	1	1	BLOCK, JOEL H MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44323	30	Radiology	0	In state provider	None	8300 TELEGRAPH RD	None	DOWNEY	CA	90240	2228	19	06037	33.96466869	-118.113682	Los Angeles County
63624	Fee-for-Service	1467452995	1467452995	1	1	BEUCHERT, PHILIP MD	1/20/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54580	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
63639	Fee-for-Service	1306017421	1306017421	1	1	BRISCOE, AUDREY D MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101149	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
63663	Fee-for-Service	1245822659	1245822659	1	1	BRITO, YVETTE M LMFT	10/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	325 W HOSPITALITY LN	STE 200	SAN BERNARDINO	CA	92374	2861	36	06071	34.0658995	-117.29034	San Bernardino County
63673	Fee-for-Service	1346469780	1346469780	1	1	BRAR, JASPRET S MD	5/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89207	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
63682	Fee-for-Service	1700020575	1700020575	1	1	BHURIA, UPASNA	2/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120981	None	None	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
63717	Fee-for-Service	1154401941	1154401941	1	39	BASS MEDICAL GROUP	12/4/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	130 LA CASA VIA	208	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
63736	Fee-for-Service	1124368667	1124368667	1	1	BRADY, CANDICE DO	2/25/2020	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	14792	None	None	0	In state provider	None	400 CAMARILLO RANCH RD	101	CAMARILLO	CA	93012	5901	56	06111	34.220943	-119.0186825	Ventura County
63743	Fee-for-Service	1083800304	1083800304	1	1	BREWER, JODY L LMFT	1/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
63760	Fee-for-Service	1154598571	1154598571	1	1	BAWA, MEENU MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109612	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
63761	Fee-for-Service	1235158254	1235158254	1	1	BLUMENFELD, KENNETH S MD	11/30/1991	174400000X	NA	Other	026	PHYSICIANS	50900	14	Neurological Surgery	0	In state provider	None	2505 SAMARITAN DR	None	SAN JOSE	CA	95124	4006	43	06085	37.25111447	-121.9483395	Santa Clara County
63764	Fee-for-Service	1730593666	1730593666	1	1	BALAN, JULIE M MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145253	01	General Practice	0	In state provider	None	11420 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
63767	Fee-for-Service	1881092922	1881092922	1	1	BARNES, HILARY N	9/1/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
63780	Fee-for-Service	1952400939	1952400939	1	1	BLOOMBERG, DAVID I OD	12/8/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2067 WEST VISTA WAY	SUITE 120	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
63790	Fee-for-Service	1801214630	1801214630	1	1	BUNKER, KYLE MD	7/16/2018	207L00000X	NA	Other	026	PHYSICIANS	138450	05	Anesthesiology	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
63832	Fee-for-Service	1487826871	1487826871	1	1	BARONI, ANI OD	1/25/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2027 VERDUGO BLVD STE A	None	MONTROSE	CA	91020	1626	19	06037	34.20482174	-118.2208331	Los Angeles County
63847	Fee-for-Service	1912982075	1912982075	1	1	BRET HEILESON	10/3/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1213 GARFIELD AVE	None	HARLAN	IA	51537	2057	00	None	41.64744933	-95.3270283	Shelby County
63872	Fee-for-Service	1083751861	1083751861	1	1	BUI, DUNG V	10/18/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
63907	Fee-for-Service	1285253237	1285253237	1	1	BAKHSHAEI, SINA MD	9/23/2023	207R00000X	NA	Other	026	PHYSICIANS	187179	None	None	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
63977	Fee-for-Service	1619083144	1619083144	1	1	BUTTERFIELD, KAREN L MD	3/31/1990	207R00000X	NA	Other	026	PHYSICIANS	69715	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
63990	Fee-for-Service	1649378084	1649378084	1	1	BRAR, BALBIR MD INC	7/31/1988	207R00000X	NA	Other	026	PHYSICIANS	43171	41	Internal Medicine	0	In state provider	None	23861 MCBEAN PKWY	STE D 16	VALENCIA	CA	91355	4456	19	06037	34.39567343	-118.5542698	Los Angeles County
64008	Fee-for-Service	1821058413	1821058413	1	1	BLEASDALE, SUSAN C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 E CENTRAL RD	None	ARLINGTON HTS	IL	60005	2857	00	None	42.06647051	-87.966846	Cook County
64011	Fee-for-Service	1720617715	1720617715	1	1	BELTRAN, AMADO JONATHAN MD	8/17/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187104	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
64043	Fee-for-Service	1427046986	1427046986	1	1	BOOZER, JAMES W MD	4/30/1987	207R00000X	NA	Other	026	PHYSICIANS	55121	89	Surgery-Traumatic	0	In state provider	None	1524 MCHENRY AVE	STE B1	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
64052	Fee-for-Service	1518555325	1518555325	1	2	BUGAY, JOEL S LMFT	11/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
64053	Fee-for-Service	1871962795	1871962795	1	1	BEST QUALITY LIVING, INC	4/26/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16725 BAHAMA STREET	None	NORTHRIDGE	CA	91343	4003	19	06037	34.23319749	-118.4974875	Los Angeles County
64054	Fee-for-Service	1811940901	1811940901	1	1	BRAVERMAN, STUART E MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	61296	30	Radiology	0	In state provider	None	345 S A ST	None	OXNARD	CA	93030	5804	56	06111	34.19938431	-119.1786013	Ventura County
64065	Fee-for-Service	1447503925	1447503925	1	1	BRADY, MOLLY S MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123311	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
64070	Fee-for-Service	1891143897	1891143897	1	1	BARKAN, SEAN T MD	11/1/2020	207P00000X	NA	Other	026	PHYSICIANS	168725	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
64085	Fee-for-Service	1982193926	1982193926	1	1	BARTON, DANE MD	8/17/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	181033	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
64104	Fee-for-Service	1740598283	1740598283	1	1	BRAKE, KAILE N PHD	1/22/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
64143	Fee-for-Service	1316099732	1316099732	1	1	BECK, BRUCE W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32495	01	General Practice	0	In state provider	None	2500 HOSPITAL DR	BLDG 4	MOUNTAIN VIEW	CA	94040	4106	43	06085	37.36908	-122.081819	Santa Clara County
64153	Fee-for-Service	1417114588	1417114588	1	1	BARBOSA, TODD M MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122962	05	Anesthesiology	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
64174	Fee-for-Service	1750675542	1750675542	1	1	BLUMENSTEIN, ROSALYNE LCSW	2/22/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
64177	Fee-for-Service	1629036470	1629036470	1	1	BOLLEN, ANDREW W MD	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	59408	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
64181	Fee-for-Service	1073640447	1073640447	1	1	BALLINGER, BARBARA A MD	3/1/1993	2084P0800X	NA	Psychiatry	026	PHYSICIANS	70131	36	Psychiatry	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
64198	Fee-for-Service	1881977718	1881977718	1	1	BALAKRISHNAN, SAMANTHA N CNP	1/23/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
64210	Fee-for-Service	1447434154	1447434154	1	1	BATRA, SANJEEV DO	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	10213	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
64236	Fee-for-Service	1659799450	1659799450	1	1	BINESH, MARTIN M MD	8/21/2017	207R00000X	NA	Other	026	PHYSICIANS	146857	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
64241	Fee-for-Service	1447226824	1447226824	1	1	BUI, MINH V MD	4/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55230	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	969 PLUMAS ST	STE 200	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
64252	Fee-for-Service	1467530154	1467530154	1	1	BRADBURY, DAVID R MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60078	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
64253	Fee-for-Service	1790973808	1790973808	1	1	BURTON, JON MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120239	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
64263	Fee-for-Service	1346275278	1346275278	1	1	BAYER, MARK J MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34160	66	Emergency Medicine (Urgent Care)	0	In state provider	None	78822 HIGHWAY 111	None	LA QUINTA	CA	92253	2046	33	06065	33.71099998	-116.290154	Riverside County
64279	Fee-for-Service	1649378084	1649378084	1	1	BRAR, BALBIR MD INC	7/31/1988	207R00000X	NA	Other	026	PHYSICIANS	43171	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23861 MCBEAN PKWY	STE D 16	VALENCIA	CA	91355	4456	19	06037	34.39567343	-118.5542698	Los Angeles County
64286	Fee-for-Service	1396030052	1396030052	1	1	BITTNER, FRANK MD	8/22/2022	208M00000X	NA	Other	026	PHYSICIANS	19466	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
64298	Fee-for-Service	1285096057	1285096057	1	1	BORHANIAN, SARRA MD	7/26/2020	208M00000X	NA	Other	026	PHYSICIANS	150934	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
64327	Fee-for-Service	1487655064	1487655064	1	1	BAYSTATE MEDICAL CENTER	8/26/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	759 CHESTNUT ST	None	SPRINGFIELD	MA	01199	1001	00	None	42.122601	-72.602856	Hampden County
64332	Fee-for-Service	1427046986	1427046986	1	1	BOOZER, JAMES W MD	4/30/1987	207R00000X	NA	Other	026	PHYSICIANS	55121	41	Internal Medicine	0	In state provider	None	1524 MCHENRY AVE	STE B1	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
64345	Fee-for-Service	1437165370	1437165370	1	1	BORSOOK, BRIAN D MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63206	08	Family Practice	0	In state provider	None	20911 EARL ST	STE 440	TORRANCE	CA	90503	4355	19	06037	33.840459	-118.3580985	Los Angeles County
64350	Fee-for-Service	1407873425	1407873425	1	1	BERKELEY PED MEDICAL GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1650 WALNUT ST	None	BERKELEY	CA	94709	1606	01	06001	37.87689376	-122.267835	Alameda County
64379	Fee-for-Service	1598150476	1598150476	1	1	BRACKETT, SAMANTHA L MD	10/14/2020	207LP3000X	NA	Other	026	PHYSICIANS	168435	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
64408	Fee-for-Service	1356638969	1356638969	1	1	BURGOYNE, ADAM M MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123081	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
64424	Fee-for-Service	1710949821	1710949821	1	1	BUDMAN, MARGO MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74779	08	Family Practice	0	In state provider	None	1400 MEDICAL CENTER DR	None	ROHNERT PARK	CA	94928	2924	49	06097	38.34761053	-122.682654	Sonoma County
64435	Fee-for-Service	1902069131	1902069131	1	1	BRET BIRRER BOZMMAN	6/14/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
64454	Fee-for-Service	1588967749	1588967749	1	1	BENEJ PEDIATRICS INC	10/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102676	40	Pediatrics	0	In state provider	None	11306 MOUNTAIN VIEW AVE	STE E	LOMA LINDA	CA	92354	3832	36	06071	34.047513	-117.243647	San Bernardino County
64463	Fee-for-Service	1629036470	1629036470	1	1	BOLLEN, ANDREW W MD	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	59408	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
64496	Fee-for-Service	1912347691	1912347691	1	1	BAKHACH, MARWAN MD	6/7/2023	2080P0205X	NA	Endocrinology	026	PHYSICIANS	142163	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
64500	Fee-for-Service	1598780769	1598780769	1	1	BUTLER, JENNIFER R MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127796	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
64551	Fee-for-Service	1407974249	1407974249	1	1	BOAKYE, DOUGLAS O DO	4/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9717	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
64564	Fee-for-Service	1447244389	1447244389	1	1	BURRUSS, RICHARD P MD	1/1/1988	207P00000X	NA	Other	026	PHYSICIANS	59370	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2182 S EL CAMINO REAL	STE 106	OCEANSIDE	CA	92054	6206	37	06073	33.18739807	-117.3282389	San Diego County
64598	Fee-for-Service	1093208084	1093208084	1	1	BHATIA, RAVNIT DO	11/16/2023	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	19738	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
64606	Fee-for-Service	1215137633	1215137633	1	1	BAY INFECTIOUS DISEASE	12/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	MED GRP	1 COUNTRY CLUB PLZ	None	ORINDA	CA	94563	2308	07	06013	37.88568592	-122.1926401	Contra Costa County
64608	Fee-for-Service	1487655064	1487655064	1	1	BAYSTATE MEDICAL CENTER	8/26/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	759 CHESTNUT ST	None	SPRINGFIELD	MA	01199	1001	00	None	42.122601	-72.602856	Hampden County
64611	Fee-for-Service	1508911892	1508911892	1	9	BAY AREA FOOT CARE, INC	5/13/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2299 POST STREET	SUITE 205	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
64620	Fee-for-Service	1427046986	1427046986	1	1	BOOZER, JAMES W MD	4/30/1987	207R00000X	NA	Other	026	PHYSICIANS	55121	08	Family Practice	0	In state provider	None	1524 MCHENRY AVE	STE B1	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
64626	Fee-for-Service	1891777967	1891777967	1	1	BERTMAN, JACK M MD	10/15/1991	207P00000X	NA	Other	026	PHYSICIANS	33641	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 TWIN LAKES RD.	None	BRIDGEPORT	CA	93517	0000	26	06051	38.24298058	-119.2361053	Mono County
64655	Fee-for-Service	1356874218	1356874218	1	1	BESHAY, ABRAM MD	8/13/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	157977	None	None	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
64666	Fee-for-Service	1134332463	1134332463	1	1	BUCKENMEYER, ERIC J LCSW	6/14/2005	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4700 SPRING ST	STE 306	LA MESA	CA	91941	2204	37	06073	32.76503682	-117.0203822	San Diego County
64679	Fee-for-Service	1194736637	1194736637	1	1	BRUGMAN, THOMAS M MD	12/11/2002	207RP1001X	NA	Pulmonology	026	PHYSICIANS	49982	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
64690	Fee-for-Service	1942355953	1942355953	1	1	BENTON, ANNE F MD	10/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82266	18	Ophthalmology	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
64694	Fee-for-Service	1972980191	1972980191	1	2	BETHEL EYE CENTER MEDICAL CO	6/3/2020	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	266 S HARVARD BLVD	SUITE 500	LOS ANGELES	CA	90004	4372	19	06037	34.069221	-118.3041245	Los Angeles County
64704	Fee-for-Service	1942225917	1942225917	1	1	BAKER, WENDY L LMFT	8/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41865 BOARDWALK	STE112	PALM DESERT	CA	92211	9031	33	06065	33.74625125	-116.3549824	Riverside County
64706	Fee-for-Service	1447238324	1447238324	1	1	BAIREY, CATHLEEN N MD	5/13/1999	174400000X	NA	Other	026	PHYSICIANS	49670	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
64707	Fee-for-Service	1366908568	1366908568	1	1	BRAATEN, MARTHA A NP	5/23/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
64709	Fee-for-Service	1669447355	1669447355	1	1	BHARADIA, SUNITHA A MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62539	13	Neurology (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
64767	Fee-for-Service	1346327053	1346327053	1	1	BURBRIDGE, LARRY B.	11/30/1988	207P00000X	NA	Other	026	PHYSICIANS	5489	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
64779	Fee-for-Service	1942779756	1942779756	1	1	BECHARA, GHASSAN RCP	8/14/2022	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
64802	Fee-for-Service	1730484403	1730484403	1	1	BRICKEY, SARAH R MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126122	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
64823	Fee-for-Service	1285745422	1285745422	1	1	BYRNE, AMY D	12/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
64828	Fee-for-Service	1124656020	1124656020	1	1	BIGELOW, SPENCER M	11/4/2024	207L00000X	NA	Other	026	PHYSICIANS	189160	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
64901	Fee-for-Service	1508911892	1508911892	1	9	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2299 POST STREET	SUITE 205	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
64910	Fee-for-Service	1891777967	1891777967	1	1	BERTMAN, JACK M MD	10/15/1991	207P00000X	NA	Other	026	PHYSICIANS	33641	47	Miscellaneous	0	In state provider	None	1000 TWIN LAKES RD.	None	BRIDGEPORT	CA	93517	0000	26	06051	38.24298058	-119.2361053	Mono County
64916	Fee-for-Service	1730528803	1730528803	1	1	BAINS, APAR MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145352	01	General Practice	0	In state provider	None	1160 SUNSET BLVD	None	ROCKLIN	CA	95677	3772	31	06061	38.8125	-121.2848698	Placer County
64959	Fee-for-Service	1154765139	1154765139	1	1	BARNETT, BRADLEY P MD	7/18/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	154913	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
64970	Fee-for-Service	1114247137	1114247137	1	1	BABB, CHERYL J LCSW	10/3/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	27383	-	NOT APPLICABLE	0	In state provider	None	12402 INDUSTRIAL BLVD	SUITE B-6	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
64991	Fee-for-Service	1336248285	1336248285	1	1	BHAKTA, HETAL R	1/4/2008	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	83788	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
64996	Fee-for-Service	1881203602	1881203602	1	1	BEHRENS, MOLLY J LMFT	12/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	419 ELIZABETH STREET	SUITE 1	VACAVILLE	CA	95688	4602	48	06095	38.35435832	-121.9875168	Solano County
65039	Fee-for-Service	1992772610	1992772610	1	1	BAYSAL, DENIZ MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100582	20	Orthopedic Surgery	0	In state provider	None	5176 HILL RD EAST	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
65052	Fee-for-Service	1447368410	1447368410	1	1	BIRNBAUM, DANIEL C MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49267	79	Neurology-Child	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
65053	Fee-for-Service	1609982115	1609982115	1	1	BARIA, EFREN P DO	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9188	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
65067	Fee-for-Service	1942428958	1942428958	1	1	BARDAKCIOGLU, OVUNC MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	28	Proctology (colon and rectal)	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 160	LAS VEGAS	NV	89102	2354	00	None	36.15879353	-115.1643015	Clark County
65086	Fee-for-Service	1639240534	1639240534	1	1	BEVLI, SANGEETA MD	5/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79657	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
65101	Fee-for-Service	1801011176	1801011176	1	1	BODE, ILA B MFT	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47139	-	NOT APPLICABLE	0	In state provider	None	709 MISSION STREET	None	SANTA CRUZ	CA	95060	3614	44	06087	36.97380944	-122.0345408	Santa Cruz County
65108	Fee-for-Service	1699074716	1699074716	1	1	BLACKSTONE MEDICAL SERVICES	4/13/2020	261QS1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	550 N REO ST	STE 250	TAMPA	FL	33609	1039	00	None	27.94999721	-82.53652287	Hillsborough County
65139	Fee-for-Service	1922746460	1922746460	1	1	BAILEY, CLINTON H NP	6/19/2023	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
65155	Fee-for-Service	1578576328	1578576328	1	1	BOROOKHIM, MICHAEL D MD	1/12/2021	207R00000X	NA	Other	086	MEDICAL DIRECTORS	68706	-	NOT APPLICABLE	0	In state provider	None	180 MISSION	None	POMONA	CA	91766	1843	19	06037	34.05510524	-117.7491982	Los Angeles County
65168	Fee-for-Service	1134179401	1134179401	1	1	BOTROS, NANCY E MD FAAP	10/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45610	40	Pediatrics	0	In state provider	None	440 N MOUNTAIN AVE	STE 112	UPLAND	CA	91786	5183	36	06071	34.09896749	-117.6700715	San Bernardino County
65238	Fee-for-Service	1740774041	1740774041	1	1	BHUYAN, RASHMI MD	7/7/2023	261QX0100X	NA	Other	026	PHYSICIANS	173900	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
65246	Fee-for-Service	1508911892	1508911892	1	16	BAY AREA FOOT CARE, INC	7/25/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5030 J STREET	STE 300	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
65253	Fee-for-Service	1225545528	1225545528	1	1	BELLEZA, ABERDOVEY CHARTZ C	3/26/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	401 POTTERS LN	None	VACAVILLE	CA	95687	8256	48	06095	38.32573403	-121.9462963	Solano County
65260	Fee-for-Service	1508841602	1508841602	1	1	BERTAKIS, KLEA D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38468	08	Family Practice	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
65262	Fee-for-Service	1932580602	1932580602	1	1	BELTRAN, KARLA LMFT	7/13/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
65310	Fee-for-Service	1457513236	1457513236	1	1	BHATT, AMIT R MD	10/1/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
65311	Fee-for-Service	1578977336	1578977336	1	1	BRINSKY, KELLEY M DO	9/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18772	None	None	0	In state provider	None	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	41	06081	37.5239043	-122.2667778	San Mateo County
65314	Fee-for-Service	1801854732	1801854732	1	1	BLOSS, MICHAEL F MD	4/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53882	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
65318	Fee-for-Service	1114216298	1114216298	1	1	BOBAN, RAIMY L MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123770	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
65327	Fee-for-Service	1386637437	1386637437	1	1	BRODY, DAVID MD	9/20/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	56780	36	Psychiatry	0	In state provider	None	25 EVERGREEN AVE	STE 3A	MILL VALLEY	CA	94941	3399	21	06041	37.89602472	-122.5369359	Marin County
65329	Fee-for-Service	1053463414	1053463414	1	1	BAUTISTA, EARL J MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81940	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
65342	Fee-for-Service	1447368410	1447368410	1	1	BIRNBAUM, DANIEL C MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49267	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
65348	Fee-for-Service	1548659105	1548659105	1	3	BEHAVIORAL HEALTH SERVICES	4/18/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2180 VALLEY BLVD	None	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
65357	Fee-for-Service	1942428958	1942428958	1	1	BARDAKCIOGLU, OVUNC MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 160	LAS VEGAS	NV	89102	2354	00	None	36.15879353	-115.1643015	Clark County
65359	Fee-for-Service	1235747460	1235747460	1	1	BETTER CHOICE HOSPICE CARE	2/26/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	3436 N VERDUGO RD	SUITE 107	GLENDALE	CA	91208	1546	19	06037	34.20125581	-118.2276565	Los Angeles County
65364	Fee-for-Service	1720191851	1720191851	1	1	BARCLAY, BEVERLY J PHD	8/12/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1198 NAVIGATOR DR	#54 SUITE A-4	VENTURA	CA	93001	4334	56	06111	34.24738147	-119.2602595	Ventura County
65383	Fee-for-Service	1164807954	1164807954	1	1	BAYAN, STACEY M PSYD	6/8/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
65415	Fee-for-Service	1962726273	1962726273	1	1	BATAN, ANA T LMFT	9/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11110 LOS ALAMITOS BLVD	209	LOS ALAMITOS	CA	90720	3602	30	06059	33.801516	-118.0717825	Orange County
65455	Fee-for-Service	1821439514	1821439514	1	1	BABAEI, SEPIDEH MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126382	30	Radiology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
65476	Fee-for-Service	1033603337	1033603337	1	1	BENNETT, KELLY E PHD	1/13/2022	103TH0004X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
65485	Fee-for-Service	1891737946	1891737946	1	1	BILUNOS, PAULA A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33529	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3637 MISSION AVE	STE 6	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
65496	Fee-for-Service	1922001189	1922001189	1	1	BINSON'S HOSP SUPPLIES	8/28/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	BINSON'S HOSP SUPPLIES	26834 LAWRENCE	None	CENTER LINE	MI	48015	1269	00	None	42.49038055	-83.03258064	Macomb County
65521	Fee-for-Service	1942568803	1942568803	1	1	BURKE, SARAH C MD	1/27/2023	207L00000X	NA	Other	026	PHYSICIANS	128563	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
65522	Fee-for-Service	1356462873	1356462873	1	1	BOUAJRAM, RAMI H MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96055	41	Internal Medicine	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
65530	Fee-for-Service	1740535129	1740535129	1	1	BASSETT, ELIZABETH R MD	7/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138729	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
65531	Fee-for-Service	1669920757	1669920757	1	1	BERGMARK, JAMIE L OD	3/1/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
65533	Fee-for-Service	1508911892	1508911892	1	16	BAY AREA FOOT CARE, INC	1/5/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5030 J STREET	STE 300	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
65539	Fee-for-Service	1225545528	1225545528	1	1	BELLEZA, ABERDOVEY CHARTZ C	3/26/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	401 POTTERS LN	None	VACAVILLE	CA	95687	8256	48	06095	38.32573403	-121.9462963	Solano County
65552	Fee-for-Service	1730231531	1730231531	1	1	BUENAVENTURA, EMERITA MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67934	03	Allergy	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
65579	Fee-for-Service	1720166317	1720166317	1	1	BECKER, ELEANOR K MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67430	18	Ophthalmology	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
65600	Fee-for-Service	1710906706	1710906706	1	1	BROWN, ANDREA L MD	11/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77661	01	General Practice	0	In state provider	None	3460 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	2334	30	06059	33.8029707	-118.073517	Orange County
65627	Fee-for-Service	1164474649	1164474649	1	1	BIGELOW, MICHAEL W MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69495	05	Anesthesiology	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
65635	Fee-for-Service	1548659105	1548659105	1	3	BEHAVIORAL HEALTH SERVICES	4/18/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2180 VALLEY BLVD	None	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
65645	Fee-for-Service	1174544092	1174544092	1	1	BI-VALLEY MEDICAL CLINIC, IN	5/22/1991	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	NORWOOD	310 HARRIS AVE	None	SACRAMENTO	CA	95838	3249	34	06067	38.638134	-121.458573	Sacramento County
65647	Fee-for-Service	1235747460	1235747460	1	1	BETTER CHOICE HOSPICE CARE	2/26/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	3436 N VERDUGO RD	SUITE 107	GLENDALE	CA	91208	1546	19	06037	34.20125581	-118.2276565	Los Angeles County
65655	Fee-for-Service	1972732139	1972732139	1	1	BECK, AMY L MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108077	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
65659	Fee-for-Service	1922518547	1922518547	1	1	BRIGHTER PATH COUNSELING SER	10/11/2019	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	VICES, A LICENSED CLINIC	255 NORTH D STREET	401 - C	SAN BERNARDINO	CA	92401	1701	36	06071	34.1036709	-117.291874	San Bernardino County
65664	Fee-for-Service	1073663274	1073663274	1	1	BERKSHIRE MANOR, INC	10/7/2004	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2820 BERKSHIRE DR	None	SAN BRUNO	CA	94066	1754	41	06081	37.63402592	-122.452862	San Mateo County
65700	Fee-for-Service	1467530022	1467530022	1	1	BLOSSER, ANITA L MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88622	08	Family Practice	0	In state provider	None	1650 WALNUT STREET	None	RED BLUFF	CA	96080	0400	52	06103	40.17069637	-122.2510474	Tehama County
65707	Fee-for-Service	1104847037	1104847037	1	1	BEGGS, RONALD A MD	2/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	30725	30	Radiology	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
65736	Fee-for-Service	1588736326	1588736326	1	1	BASAWAPRASAD, VIJAYA S	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93871	41	Internal Medicine	0	In state provider	MD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
65767	Fee-for-Service	1073158770	1073158770	1	1	BELLA VISTA HOSPICE CARE INC	10/12/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8700 RESEDA BLVD	STE 205	NORTHRIDGE	CA	91324	6127	19	06037	34.229988	-118.536062	Los Angeles County
65772	Fee-for-Service	1891737946	1891737946	1	1	BILUNOS, PAULA A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33529	41	Internal Medicine	0	In state provider	None	3637 MISSION AVE	STE 6	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
65789	Fee-for-Service	1568469708	1568469708	1	1	BOLTON, GEORGE T MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85204	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
65814	Fee-for-Service	1811379324	1811379324	1	1	BHOGAL, NEIL MD	6/10/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	154584	None	None	0	In state provider	None	5959 TRUXTUN AVE	STE 200	BAKERSFIELD	CA	93309	0437	15	06029	35.36306164	-119.0711264	Kern County
65822	Fee-for-Service	1285307280	1285307280	1	1	BRANDY PIERCE	8/18/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	SAINT GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
65835	Fee-for-Service	1811902257	1811902257	1	1	BASICH, FRANK M MD	6/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	70463	18	Ophthalmology	0	In state provider	None	2232 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2312	19	06037	34.0306404	-118.4775425	Los Angeles County
65859	Fee-for-Service	1225055205	1225055205	1	1	BRILL, ANDREW I MD	1/1/1982	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34388	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2900 WHIPPLE AVE	None	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
65878	Fee-for-Service	1366911901	1366911901	1	1	BANE, LETICIA ISABEL LMFT	8/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
65885	Fee-for-Service	1821095654	1821095654	1	1	BRADFORD, WESLEY G MD	2/28/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30342	08	Family Practice	0	In state provider	None	23560 CRENSHAW BLVD	None	TORRANCE	CA	90505	5233	19	06037	33.811677	-118.328042	Los Angeles County
65896	Fee-for-Service	1053193326	1053193326	1	1	BRENTWOOD INC	1/14/2025	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1767 W BRENTWOOD PL	None	AHAHEIM	CA	92804	2508	30	06059	33.83024213	-117.9446434	Orange County
65942	Fee-for-Service	1205829280	1205829280	1	1	BON CHUL KOO, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	25001 EMERY RD	STE 100	CLEVELAND	OH	44128	0000	00	None	41.43516946	-81.502173	Cuyahoga County
65945	Fee-for-Service	1144325754	1144325754	1	1	BOURNE,JEFFREY R DO	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	7050	41	Internal Medicine	0	In state provider	None	136 HELGREN CT	None	TEMPLETON	CA	93465	9779	40	06079	35.55556027	-120.7274915	San Luis Obispo County
65954	Fee-for-Service	1033691316	1033691316	1	1	BHOSAI, SASINEE J NP	11/26/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
65965	Fee-for-Service	1316410566	1316410566	1	1	BERSOLA, KARINA V AU	5/3/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
65969	Fee-for-Service	1396234126	1396234126	1	1	BUICK, JESSICA PHD	11/15/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	242 HARTNELL AVE	None	REDDING	CA	96002	1844	45	06089	40.56741154	-122.369071	Shasta County
66008	Fee-for-Service	1447420286	1447420286	1	1	BERNHEIMER, DAVID A MD	2/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102738	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
66027	Fee-for-Service	1376074492	1376074492	1	1	BALDWIN, NELL W	12/15/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174382	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
66052	Fee-for-Service	1053398768	1053398768	1	1	BURKY JR, ROBERT E	3/31/1992	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	64034	20	Orthopedic Surgery	0	In state provider	None	969 PLUMAS ST	STE 116	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
66054	Fee-for-Service	1649778358	1649778358	1	1	BRASSER, CORTNEY M CRNA	10/1/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
66055	Fee-for-Service	1073158770	1073158770	1	1	BELLA VISTA HOSPICE CARE INC	10/12/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8700 RESEDA BLVD	STE 205	NORTHRIDGE	CA	91324	6127	19	06037	34.229988	-118.536062	Los Angeles County
66079	Fee-for-Service	1285659490	1285659490	1	1	BAKER, JEFFREY C PT	8/12/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
66105	Fee-for-Service	1134225147	1134225147	1	1	BLECHMAN, BETSY E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39062	18	Ophthalmology	0	In state provider	None	3831 HUGHES AVE	STE 500	CULVER CITY	CA	90232	6854	19	06037	34.02243278	-118.3981492	Los Angeles County
66107	Fee-for-Service	1457665903	1457665903	1	1	BAILEY, YVONNE E MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118442	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
66120	Fee-for-Service	1447912241	1447912241	1	1	BRITTANY WERTZ, DO INC	2/20/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	AL CORPORATION	678 S INDIAN HILL BLVD	STE 200	CLAREMONT	CA	91711	6002	19	06037	34.083495	-117.719192	Los Angeles County
66141	Fee-for-Service	1235213307	1235213307	1	1	BOYERS, MICHAEL J MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80391	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
66195	Fee-for-Service	1417974478	1417974478	1	1	BALIAN, HAROUT R MD	2/22/2009	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	49429	25	Physical Medicine and Rehabilitation	0	In state provider	None	333 N HILL AVE	STE 101	PASADENA	CA	91106	1574	19	06037	34.15148254	-118.1214123	Los Angeles County
66212	Fee-for-Service	1508911892	1508911892	1	12	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
66254	Fee-for-Service	1134144223	1134144223	1	1	BEEVE, GREGORY J MD	4/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61657	41	Internal Medicine	0	In state provider	None	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
66264	Fee-for-Service	1609837954	1609837954	1	1	BOYD SANDRA LO	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	131 RUE DE YOE	STE B	MODESTO	CA	95354	1355	50	06099	37.64434842	-120.9876844	Stanislaus County
66286	Fee-for-Service	1891486619	1891486619	1	1	BROPHY, MIKAYLA PT	5/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1338 MAIN ST	None	RAMONA	CA	92065	0000	37	06073	33.03880322	-116.8742834	San Diego County
66287	Fee-for-Service	1316909773	1316909773	1	1	BOILEAU, MICHEL A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	BEND UROLOGY ASSOCIATES	2090 NE WYATT CT	STE 101	BEND	OR	97701	7691	00	None	44.07132919	-121.2647062	Deschutes County
66297	Fee-for-Service	1982691390	1982691390	1	1	BHATNAGAR, PRABHA MD	3/1/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35003	01	General Practice	0	In state provider	None	2151 SANTA CLARA AVE	None	ALAMEDA	CA	94501	2832	01	06001	37.76756367	-122.2469254	Alameda County
66372	Fee-for-Service	1972140952	1972140952	1	1	BABCHANIK, KENIA G PT	11/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
66393	Fee-for-Service	1538218433	1538218433	1	1	BAYLOR, ANNA L MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	72855	08	Family Practice	0	In state provider	None	499 HUMBOLDT ST	None	SANTA ROSA	CA	95404	4214	49	06097	38.442762	-122.7139875	Sonoma County
66397	Fee-for-Service	1104981125	1104981125	1	1	BOURCIER, JEANINE LMFT	3/14/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
66435	Fee-for-Service	1164451233	1164451233	1	1	BATAH, JIHAD MD	1/31/1994	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	51326	10	Gastroenterology (M.D. only)	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
66438	Fee-for-Service	1831364298	1831364298	1	1	BROOKS, GABRIEL C MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115638	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66449	Fee-for-Service	1760591697	1760591697	1	1	BHASIN, SANGITA MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	67154	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
66462	Fee-for-Service	1740368539	1740368539	1	1	BRADMAN, SANDRA HARIETTE	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80903	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
66477	Fee-for-Service	1750321972	1750321972	1	1	BASNER, LILLIAN CNP	6/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
66484	Fee-for-Service	1417974478	1417974478	1	1	BALIAN, HAROUT R MD	2/22/2009	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	49429	41	Internal Medicine	0	In state provider	None	333 N HILL AVE	STE 101	PASADENA	CA	91106	1574	19	06037	34.15148254	-118.1214123	Los Angeles County
66488	Fee-for-Service	1326216920	1326216920	1	1	BROMS, RYAN C	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
66499	Fee-for-Service	1689706103	1689706103	1	1	BORDEN-MILLER, BETTY	4/1/1996	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3033 DOYNE RD	None	PASADENA	CA	91107	1110	19	06037	34.17363628	-118.0889806	Los Angeles County
66503	Fee-for-Service	1508911892	1508911892	1	12	BAY AREA FOOT CARE, INC	7/29/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
66508	Fee-for-Service	1568474427	1568474427	1	1	BROWN, MICHELLE P MD	7/20/2018	208600000X	NA	General Surgery	026	PHYSICIANS	50090	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
66523	Fee-for-Service	1457431538	1457431538	1	1	BRENNER, MATTHEW MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	48758	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
66526	Fee-for-Service	1538354204	1538354204	1	1	BRADY, JONATHAN P LMFT	11/8/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5855 E NAPLES PLZ	SUITE 213	LONG BEACH	CA	90803	5060	19	06037	33.75591002	-118.119711	Los Angeles County
66551	Fee-for-Service	1154401941	1154401941	1	5	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	1646 E HERNDON AVE	STE 106	FRESNO	CA	93720	3380	10	06019	36.8375595	-119.757339	Fresno County
66566	Fee-for-Service	1497911697	1497911697	1	1	BRADLAW, JANE DO	12/1/2021	207P00000X	NA	Other	026	PHYSICIANS	18845	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
66569	Fee-for-Service	1003265653	1003265653	1	1	BAE, GORDON H MD	4/26/2020	207R00000X	NA	Other	026	PHYSICIANS	150572	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
66593	Fee-for-Service	1427150986	1427150986	1	1	BURKE, JASON MD	10/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
66595	Fee-for-Service	1447243324	1447243324	2	1	BW ONE, INC.	9/3/2010	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	656 N BROADWAY	None	LOS ANGELES	CA	90012	2802	19	06037	34.06019765	-118.2393756	Los Angeles County
66605	Fee-for-Service	1427054493	1427054493	1	1	BOSITIS, CHRISTOPHER M MD	1/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176308	None	None	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
66612	Fee-for-Service	1750445797	1750445797	1	1	BLOOD, TAMARA L LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
66627	Fee-for-Service	1013206036	1013206036	1	1	BEAR, JOSHUA J MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	79	Neurology-Child	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
66652	Fee-for-Service	1730284464	1730284464	1	1	BHARUCHA, PARIMAL T MD	8/1/2010	207R00000X	NA	Other	026	PHYSICIANS	112785	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
66664	Fee-for-Service	1265700900	1265700900	1	1	BOLLINGER, MARK W LMFT	3/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E DAILY DR	210	CAMARILLO	CA	93010	5806	56	06111	34.21906637	-119.0621709	Ventura County
66695	Fee-for-Service	1700855418	1700855418	2	1	BUHARI, SHIRAZ MD	5/24/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	82278	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
66714	Fee-for-Service	1720126600	1720126600	1	1	BEN O OGUNWALE, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	309 S SHARON AMITY RD	None	CHARLOTTE	NC	28211	2978	00	None	35.17443	-80.801595	Mecklenburg County
66721	Fee-for-Service	1316369275	1316369275	1	1	BARNES, SOPHIE E NP	10/23/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
66747	Fee-for-Service	1295415487	1295415487	1	1	BELLFORT SALINAS, SILVIA LC	10/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66750	Fee-for-Service	1265847065	1265847065	1	1	BOESL, CHAD CRNA	1/20/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
66758	Fee-for-Service	1497047377	1497047377	1	1	BIGBEE, KORIE M NP	3/13/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1515 N VERMONT AVE	None	LOS ANGELES	CA	90027	5337	19	06037	34.09851639	-118.2918012	Los Angeles County
66790	Fee-for-Service	1356771430	1356771430	1	2	BRINKLEY, SHAWN L LMFT	12/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ISTIC HEALING	18719 CALVERT ST.	None	TARZANA	CA	91335	6812	19	06037	34.18185024	-118.541135	Los Angeles County
66809	Fee-for-Service	1942254198	1942254198	1	1	BAY AREA RAD MED GRP INC	2/1/1983	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
66837	Fee-for-Service	1154401941	1154401941	1	5	BASS MEDICAL GROUP	2/25/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1646 E HERNDON AVE	STE 106	FRESNO	CA	93720	3380	10	06019	36.8375595	-119.757339	Fresno County
66846	Fee-for-Service	1306916242	1306916242	1	1	BARRIOS, ELAINE A MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52556	40	Pediatrics	0	In state provider	None	3581 PALMER DRIVE	STE 401	CAMERON PARK	CA	95682	8236	09	06017	38.66109103	-120.9649544	El Dorado County
66851	Fee-for-Service	1376781286	1376781286	1	1	BLASCHKO, SARAH D MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106121	34	Urology and Urological Surgery	0	In state provider	None	1001 POTRERO AVENUE	RM 3A20	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
66878	Fee-for-Service	1265637714	1265637714	1	1	BONITA POINT FAMILY	8/16/2012	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY, INC	180 OTAY LAKES RD	SUITE 201	BONITA	CA	91902	2400	37	06073	32.65928608	-117.0304661	San Diego County
66932	Fee-for-Service	1093910663	1093910663	1	1	BAY AREA TRANSPORTATION	12/6/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	335 E NASA	None	WEBSTER	TX	77598	5312	00	None	29.53939806	-95.11595061	Harris County
66939	Fee-for-Service	1730284464	1730284464	1	1	BHARUCHA, PARIMAL T MD	8/1/2010	207R00000X	NA	Other	026	PHYSICIANS	112785	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
66987	Fee-for-Service	1033315288	1033315288	1	1	BURNETTE, VANI LMFT	3/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
66989	Fee-for-Service	1578653317	1578653317	1	1	BLANKENBERG, FRANCIS G	5/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	60767	30	Radiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
66994	Fee-for-Service	1669873055	1669873055	1	1	BOUC, STEPHANIE S PHD	4/24/2023	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	26485 CARMEL RANCHO BLVD	STE 5	CARMEL VALLEY	CA	93923	8706	27	06053	36.53938515	-121.9047851	Monterey County
66996	Fee-for-Service	1326764697	1326764697	1	1	BERNALES MENDEZ, DEZARINA A	2/7/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	OT	9850 GENESEE AVE	510	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
66997	Fee-for-Service	1043265549	1043265549	1	1	BAUTISTA, RAYMOND DPM	10/16/2023	213ES0000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E 28TH ST	STE 111	LONG BEACH	CA	90806	2759	19	06037	33.80803441	-118.1847137	Los Angeles County
67059	Fee-for-Service	1821625062	1821625062	1	1	BRADBURNE, CHRISTOPHER MD	10/31/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180846	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
67066	Fee-for-Service	1841234408	1841234408	1	1	BIERBAUM, TUCKER J MD	11/30/1986	207P00000X	NA	Other	026	PHYSICIANS	54985	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
67111	Fee-for-Service	1144242611	1144242611	1	1	BARTLETT,JOHN D MD	5/24/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74554	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	ROOM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
67144	Fee-for-Service	1962808758	1962808758	1	1	BAUM, PAUL D LCSW	6/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3600 LIME ST	BUILDING 2/SUITE 103	RIVERSIDE	CA	92501	2971	33	06065	33.98276147	-117.3693188	Riverside County
67148	Fee-for-Service	1003824020	1003824020	1	1	BAYLON, PAUL M MD	1/1/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48547	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3118-3120 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5830	19	06037	33.97275861	-118.2115716	Los Angeles County
67150	Fee-for-Service	1023251626	1023251626	1	1	BORST, RICHARD F MD	11/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124511	30	Radiology	0	In state provider	None	411 30TH ST	SUITE 508	OAKLAND	CA	94609	3031	01	06001	37.81903474	-122.2649444	Alameda County
67156	Fee-for-Service	1093115693	1093115693	1	1	BRADFORD, LITSA F LMFT	7/27/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	629 STATE STREET	SUITE 213	SANTA BARBARA	CA	93101	7069	42	06083	34.41837547	-119.6977828	Santa Barbara County
67160	Fee-for-Service	1023054087	1023054087	1	1	BRIGHT, AARON A MD	2/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81565	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
67168	Fee-for-Service	1215957451	1215957451	1	1	BRARA, BIRINDER S MD	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34017	08	Family Practice	0	In state provider	None	3816 WOODRUFF AVE	STE 205	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
67169	Fee-for-Service	1093090011	1093090011	1	1	BRADLEY, NATALIE A MFT	2/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96488	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVENUE	WARD 93, WARD 95	SAN FRANCISCO	CA	94410	3518	38	06075	37.75548534	-122.4065362	San Francisco County
67171	Fee-for-Service	1881233187	1881233187	1	1	BROADWAY PHARMACY CORPORATIO	1/14/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10225 AUSTIN DR	STE. 103	SPRING VALLEY	CA	91978	1500	37	06073	32.73081646	-116.9707735	San Diego County
67211	Fee-for-Service	1457653644	1457653644	1	1	BROWN, JEANNIE PHD	9/4/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
67226	Fee-for-Service	1144416009	1144416009	1	1	BAINS, TARUNPREET MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98809	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
67228	Fee-for-Service	1730284464	1730284464	1	1	BHARUCHA, PARIMAL T MD	8/1/2010	207R00000X	NA	Other	026	PHYSICIANS	112785	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
67230	Fee-for-Service	1255460622	1255460622	1	1	BHANDARI, VIJAY K MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98471	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
67240	Fee-for-Service	1851432652	1851432652	1	1	BOPARAI, VANDANA MD	4/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98473	41	Internal Medicine	0	In state provider	None	637 MERCED ST	None	NEWMAN	CA	95360	9603	50	06099	37.31481158	-121.0162228	Stanislaus County
67278	Fee-for-Service	1386141885	1386141885	1	1	BEROUKHIM AFRAHIMI, SHIELA	5/3/2021	207R00000X	NA	Other	026	PHYSICIANS	163918	None	None	0	In state provider	MD	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
67402	Fee-for-Service	1619022258	1619022258	1	1	BLUMENSTRAUCH, ROY B MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54548	07	Dermatology	0	In state provider	INC	4201 TORRANCE BLVD	SUITE 640	TORRANCE	CA	90503	4524	19	06037	33.8375955	-118.358748	Los Angeles County
67403	Fee-for-Service	1770631624	1770631624	1	1	BOYNTON, ADRIENNA MD	12/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77444	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
67417	Fee-for-Service	1457582918	1457582918	1	1	BABABEYGY, SHIMON R MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115805	18	Ophthalmology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
67453	Fee-for-Service	1003249749	1003249749	1	1	BYRNE, SUSANNA MD	12/27/2022	207L00000X	NA	Other	026	PHYSICIANS	19706	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
67455	Fee-for-Service	1215957451	1215957451	1	1	BRARA, BIRINDER S MD	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34017	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3816 WOODRUFF AVE	STE 205	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
67481	Fee-for-Service	1912226747	1912226747	1	1	BALLONADO, ARDENE C NP	11/2/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67487	Fee-for-Service	1184848871	1184848871	1	1	BROWN, MEREDITH A LMFT	3/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
67489	Fee-for-Service	1396967337	1396967337	1	1	BACH, YVONNE V MD	6/20/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	95383	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
67494	Fee-for-Service	1164851937	1164851937	1	1	BUTLER, KIMBERLY A MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128284	01	General Practice	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
67501	Fee-for-Service	1205326972	1205326972	1	1	BAREFEET PODIATRY INC	4/4/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2345 E 8TH ST	SUITE 105	NATIONAL CITY	CA	91950	2866	37	06073	32.68268563	-117.082682	San Diego County
67502	Fee-for-Service	1154691160	1154691160	1	1	BRITTON, WHITNEY A PT	10/30/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	755 N. LEMOORE AVE.	SUITE C	LEMOORE	CA	93245	9998	16	06031	36.306108	-119.780838	Kings County
67507	Fee-for-Service	1942251384	1942251384	1	1	BUSTOS, JERROLD C MD	1/4/2008	207L00000X	NA	Other	026	PHYSICIANS	85842	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
67551	Fee-for-Service	1639815350	1639815350	1	1	BARRETTO, KARINA TERESA MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	190830	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
67556	Fee-for-Service	1174961908	1174961908	1	1	BETOF WARNER, ALLISON MD	2/24/2023	207RX0202X	NA	Oncology	026	PHYSICIANS	184101	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
67563	Fee-for-Service	1295369064	1295369064	1	1	BOYER, CLARISSA CCC-SLP	4/16/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
67566	Fee-for-Service	1013913102	1013913102	1	1	BANSAL, ANKUSH K MD	5/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110949	41	Internal Medicine	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
67576	Fee-for-Service	1902204449	1902204449	1	1	BHASKAR, SHYAM MD INC	3/9/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1001 VAN DORSTEN AVE	None	CORCORAN	CA	93212	2321	16	06031	36.099531	-119.5635525	Kings County
67590	Fee-for-Service	1538365838	1538365838	1	1	BALELO, KIMBERLY A PT	10/19/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
67652	Fee-for-Service	1083615298	1083615298	1	1	BANDARI, BAHMAN MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47790	41	Internal Medicine	0	In state provider	None	4314 W SLAUSON AVE	None	LOS ANGELES	CA	90043	2854	19	06037	33.98885257	-118.3509655	Los Angeles County
67656	Fee-for-Service	1265644629	1265644629	1	1	BAGGA, PAVANDEEP S MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112605	05	Anesthesiology	0	In state provider	None	995 BLANCO	STE A	SALINAS	CA	93901	0000	27	06053	36.65488958	-121.6372749	Monterey County
67686	Fee-for-Service	1154401941	1154401941	1	26	BASS MEDICAL GROUP	7/25/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	108 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3013	07	06013	37.9124899	-122.0426939	Contra Costa County
67712	Fee-for-Service	1861697211	1861697211	1	1	BANH, KENNY V MD	2/11/2008	207P00000X	NA	Other	026	PHYSICIANS	92874	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
67717	Fee-for-Service	1659876605	1659876605	1	1	BANKS, FAIRVEOLA RN	6/26/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3628 E IMPERIAL HWY	102	LYNWOOD	CA	90262	2643	19	06037	33.93070837	-118.2044557	Los Angeles County
67742	Fee-for-Service	1205867561	1205867561	1	1	BECKMAN, J KEVIN DO	11/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7527	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2030 VIBORG RD	STE 201	SOLVANG	CA	93463	2220	42	06083	34.60247248	-120.1271535	Santa Barbara County
67744	Fee-for-Service	1215957451	1215957451	1	1	BRARA, BIRINDER S MD	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34017	02	General Surgery	0	In state provider	None	3816 WOODRUFF AVE	STE 205	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
67750	Fee-for-Service	1831271857	1831271857	1	1	BARNES, KENNETH MD	5/20/1987	207R00000X	NA	Other	026	PHYSICIANS	23003	08	Family Practice	0	In state provider	None	2517 SAN BRUNO AVE	None	SAN FRANCISCO	CA	94134	1504	38	06075	37.73002273	-122.4045878	San Francisco County
67753	Fee-for-Service	1053341073	1053341073	1	1	BELCADI, MOUNIR MD	4/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	93642	36	Psychiatry	0	In state provider	None	24 W EL ROSE DRIVE	None	PETALUMA	CA	94952	4023	49	06097	38.22308352	-122.646555	Sonoma County
67758	Fee-for-Service	1023351426	1023351426	1	2	BAUTISTA, PORTIA	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133290	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
67760	Fee-for-Service	1386696805	1386696805	1	1	BRUNGARDT, JAMES M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39363	02	General Surgery	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
67823	Fee-for-Service	1518050012	1518050012	1	1	BRANDWENE, ELLIOTT L MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60229	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
67848	Fee-for-Service	1508911892	1508911892	1	35	BAY AREA FOOT CARE, INC	8/23/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2089 VALE RD	STE 12	SAN PABLO	CA	94806	3847	07	06013	37.95396781	-122.3375393	Contra Costa County
67861	Fee-for-Service	1902204449	1902204449	1	1	BHASKAR, SHYAM MD INC	3/9/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1001 VAN DORSTEN AVE	None	CORCORAN	CA	93212	2321	16	06031	36.099531	-119.5635525	Kings County
67865	Fee-for-Service	1740391440	1740391440	1	1	BRUNKHORST, NEAL L CRNA	11/7/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
67891	Fee-for-Service	1649318239	1649318239	1	1	BEYER, YVONNE A LMFT	12/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	166 SANTA CLARA AVE	STE 205	OAKLAND	CA	94610	1323	01	06001	37.820169	-122.250771	Alameda County
67894	Fee-for-Service	1215135777	1215135777	1	1	BROWN, TERESA M	8/30/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3401 S HARBOR BLVD	None	SANTA ANA	CA	92704	7933	30	06059	33.701166	-117.9194305	Orange County
67922	Fee-for-Service	1154406148	1154406148	1	1	BEST-START BIRTH CENTER INC	9/18/2020	No Taxonomy Provided	NA	None	052	ALTERNATIVE BIRTH CENTERS - SPECIALTY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3630 ENTERPRISE STREET	None	SAN DIEGO	CA	92110	3212	37	06073	32.74601586	-117.1985439	San Diego County
67925	Fee-for-Service	1346430279	1346430279	1	1	BELL, DAVID L MD	1/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95720	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
67926	Fee-for-Service	1881772572	1881772572	1	1	BERNAS, ELVIRO M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37731	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
67927	Fee-for-Service	1154612281	1154612281	1	1	BITTENCOURT, CASSIANA E MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143867	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
67938	Fee-for-Service	1467654343	1467654343	1	1	BASU, SOMNATH MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97900	30	Radiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
67940	Fee-for-Service	1083615298	1083615298	1	1	BANDARI, BAHMAN MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47790	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4314 W SLAUSON AVE	None	LOS ANGELES	CA	90043	2854	19	06037	33.98885257	-118.3509655	Los Angeles County
67949	Fee-for-Service	1942542774	1942542774	1	1	BECK, LAUREN N MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148254	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
67951	Fee-for-Service	1508911892	1508911892	1	38	BAY AREA FOOT CARE, INC	10/10/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2500 HOSPITAL DR	BUILDING 1	MOUNTAIN VIEW	CA	94040	4106	43	06085	37.36908	-122.081819	Santa Clara County
67959	Fee-for-Service	1174893358	1174893358	1	1	BAYLIS, CHRISTOPHER M CRNA	8/22/2019	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
67972	Fee-for-Service	1154401941	1154401941	1	26	BASS MEDICAL GROUP	7/25/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	108 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3013	07	06013	37.9124899	-122.0426939	Contra Costa County
67979	Fee-for-Service	1740360304	1740360304	1	1	BROOKS, ROBIN B LCSW	5/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	67495 E PALM CANYON DR	243	CATHEDRAL CITY	CA	92234	5450	33	06065	33.78942449	-116.4839683	Riverside County
67983	Fee-for-Service	1588984058	1588984058	1	1	BRAR, RAVINDER K MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142874	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67992	Fee-for-Service	1932381761	1932381761	1	1	BRUNETTO, JULIE LMFT	6/29/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3575 PERSHING AVE	None	SAN DIEGO	CA	92104	3413	37	06073	32.74353067	-117.1346152	San Diego County
67997	Fee-for-Service	1811428550	1811428550	1	1	BARTHELET, JONATHAN MD	3/5/2020	207R00000X	NA	Other	026	PHYSICIANS	161156	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
68024	Fee-for-Service	1659578813	1659578813	1	1	BRECEDA, VICKI E	10/5/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
68026	Fee-for-Service	1972080752	1972080752	1	3	BORIS SHLOPOV MD PATHOLOGY M	11/14/2022	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	EDICAL CORPORATION	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
68040	Fee-for-Service	1831271857	1831271857	1	1	BARNES, KENNETH MD	5/20/1987	207R00000X	NA	Other	026	PHYSICIANS	23003	41	Internal Medicine	0	In state provider	None	2517 SAN BRUNO AVE	None	SAN FRANCISCO	CA	94134	1504	38	06075	37.73002273	-122.4045878	San Francisco County
68098	Fee-for-Service	1629156294	1629156294	1	1	BUXTON, RICHARD G MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61479	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
68146	Fee-for-Service	1659313633	1659313633	1	1	BROWN, JOHN V MD	11/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62749	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
68165	Fee-for-Service	1023627627	1023627627	1	2	BOYER, PAUL LCSW	5/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	444 34TH ST	SUITE #1	OAKLAND	CA	94609	2816	01	06001	37.82202446	-122.2640524	Alameda County
68169	Fee-for-Service	1619144151	1619144151	1	1	BECK, TIFFANY L MD	8/8/2017	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148151	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
68230	Fee-for-Service	1043910144	1043910144	1	1	BARON, MENACHEM M LCSW	11/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
68232	Fee-for-Service	1972786382	1972786382	1	1	BOHN, OLGA L MD	6/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142203	22	Pathology (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
68240	Fee-for-Service	1235805318	1235805318	1	1	BANDAK, DIANA OD	2/28/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3816 WOODRUFF AVE	STE 100	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
68244	Fee-for-Service	1811056401	1811056401	1	1	BUSH-SMITH, KIMBERLY A	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84777	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
68261	Fee-for-Service	1154401941	1154401941	1	26	BASS MEDICAL GROUP	7/25/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	108 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3013	07	06013	37.9124899	-122.0426939	Contra Costa County
68264	Fee-for-Service	1538385729	1538385729	1	1	BAILEY CARE HOMES, INC	1/16/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9811 S DENKER AVE	None	LOS ANGELES	CA	90047	3965	19	06037	33.946398	-118.3046995	Los Angeles County
68317	Fee-for-Service	1043374473	1043374473	1	1	BEAIRD, CHYLE E MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81865	None	None	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
68351	Fee-for-Service	1942434238	1942434238	1	1	BREEN, ALISON S MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113675	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
68367	Fee-for-Service	1447814116	1447814116	1	1	BIRRING, RAYMON MD	5/18/2022	390200000X	NA	Other	026	PHYSICIANS	176763	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
68374	Fee-for-Service	1215357975	1215357975	1	1	BURBRIDGE, MARK A MD	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129736	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
68402	Fee-for-Service	1508911892	1508911892	1	36	BAY AREA FOOT CARE, INC	8/28/2024	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	12250 HERDAL DR	None	AUBURN	CA	95603	5643	31	06061	38.87851957	-121.0815647	Placer County
68423	Fee-for-Service	1245401819	1245401819	1	2	BARSEGHIAN, NANA	1/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	102005	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
68432	Fee-for-Service	1659313633	1659313633	1	1	BROWN, JOHN V MD	11/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62749	78	Neoplastic Diseases/Oncology	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
68443	Fee-for-Service	1831290469	1831290469	1	1	BARNES, ANNE R MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89559	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
68455	Fee-for-Service	1063556579	1063556579	1	1	BURMER, WILLIAM G	4/1/1989	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	DIAG MED ULTRASOUND SVS	1217 DECESARI AVE	None	MADERA	CA	93637	0000	20	06039	36.96400413	-120.0705806	Madera County
68456	Fee-for-Service	1083123855	1083123855	1	1	BRAMEL, SHAWNA M LCSW	11/8/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
68460	Fee-for-Service	1679768089	1679768089	1	1	BICHENG NAN MD	11/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6508 N BARTLETT AVE	STE D	LAREDO	TX	78041	6446	00	None	27.5624292	-99.46754856	Webb County
68481	Fee-for-Service	1760712814	1760712814	1	1	BACOS, DIMITRI MD	4/7/2020	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	110160	-	NOT APPLICABLE	0	In state provider	None	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	44	06087	36.99276804	-122.0178271	Santa Cruz County
68494	Fee-for-Service	1376811349	1376811349	1	1	BAKER, MALINDA A MD	11/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118183	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
68539	Fee-for-Service	1114247137	1114247137	1	2	BABB, CHERYL J LCSW	7/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
68555	Fee-for-Service	1891779872	1891779872	1	1	BADRUDDOJA, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2450 E RIVER RD	None	TUCSON	AZ	85718	0000	00	None	32.285088	-110.934765	Pima County
68558	Fee-for-Service	1922773159	1922773159	1	1	BRIDGE PHYSICAL THERAPY PROF	11/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ESSIONAL CORPORATION	6301 BEACH BLVD	102	BUENA PARK	CA	90621	2840	30	06059	33.86880928	-117.9983013	Orange County
68579	Fee-for-Service	1538658281	1538658281	1	1	BARRIOLA, HEYLEE	6/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
68606	Fee-for-Service	1700967361	1700967361	1	1	BERMAN, RONALD H MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27773	03	Allergy	0	In state provider	None	2023 VALE RD	STE 110	SAN PABLO	CA	94806	3891	07	06013	37.95369824	-122.3378493	Contra Costa County
68612	Fee-for-Service	1083762975	1083762975	1	1	BERNDT, ANDREA CRNA	6/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
68637	Fee-for-Service	1003221177	1003221177	1	1	BRAH, JEEVEN K MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127575	41	Internal Medicine	0	In state provider	None	3687 MOUNT DIABLO BLVD	200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
68646	Fee-for-Service	1568081750	1568081750	1	1	BRAR, YUDHVEER MD	6/14/2023	207R00000X	NA	Other	026	PHYSICIANS	183813	None	None	0	In state provider	None	520 W I ST	None	LOS BANOS	CA	93635	4211	20	06039	37.06346603	-120.8593647	Merced County
68647	Fee-for-Service	1356401566	1356401566	1	1	BONE BUILDERS MEDICAL CLINIC	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60659	20	Orthopedic Surgery	0	In state provider	None	4510 EXECUTIVE DR	STE 125	SAN DIEGO	CA	92121	3021	37	06073	32.87570943	-117.2100834	San Diego County
68653	Fee-for-Service	1316792799	1316792799	1	1	BRAIN HEALTH USA INC	9/4/2024	251S00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	14541 DELANO ST	None	VAN NUYS	CA	91411	2820	19	06037	34.18266753	-118.4502285	Los Angeles County
68670	Fee-for-Service	1972643872	1972643872	1	1	BRYAN, SYLVESTER J JR MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	28146	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
68689	Fee-for-Service	1508911892	1508911892	1	36	BAY AREA FOOT CARE, INC	8/28/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12250 HERDAL DR	None	AUBURN	CA	95603	5643	31	06061	38.87851957	-121.0815647	Placer County
68702	Fee-for-Service	1548485816	1548485816	1	1	BACON, JEFFREY K MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11715	41	Internal Medicine	0	In state provider	None	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5733	15	06029	35.39412578	-119.0082617	Kern County
68705	Fee-for-Service	1992112478	1992112478	1	1	BAGHAEE, ANITA MD	5/1/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	139102	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
68777	Fee-for-Service	1982013975	1982013975	1	1	BHANDARI, STUTI MD	10/23/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144972	36	Psychiatry	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
68787	Fee-for-Service	1932381761	1932381761	1	2	BRUNETTO, JULIE LMFT	6/14/2023	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
68789	Fee-for-Service	1104299957	1104299957	1	1	BEDI, SARABJIT MD PC	1/21/2016	207L00000X	NA	Other	026	PHYSICIANS	94320	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
68798	Fee-for-Service	1760742134	1760742134	1	1	BHARDWAJ, KARISHMA MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
68818	Fee-for-Service	1134250772	1134250772	1	1	BROWN, MONICA LCSW	11/26/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3769 TIBBETTS ST	None	RIVERSIDE	CA	92506	2638	33	06065	33.94726645	-117.3990645	Riverside County
68843	Fee-for-Service	1891779872	1891779872	1	1	BADRUDDOJA, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2450 E RIVER RD	None	TUCSON	AZ	85718	0000	00	None	32.285088	-110.934765	Pima County
68845	Fee-for-Service	1114367687	1114367687	1	1	BERTOLDO, AMANDA L LCSW	4/12/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
68861	Fee-for-Service	1306367982	1306367982	1	1	BOENING, REBECCA R MD	9/21/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163710	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
68869	Fee-for-Service	1477043206	1477043206	1	1	BRANCH, JANET KATRINA B OT	11/14/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
68882	Fee-for-Service	1295786804	1295786804	1	1	BRONTE-STEWART, HELEN M	7/31/1989	2084N0400X	NA	Neurology	026	PHYSICIANS	63510	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	# A887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68894	Fee-for-Service	1164808770	1164808770	1	1	BERGMAN, JULIE M NP	12/7/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
68897	Fee-for-Service	1700967361	1700967361	1	1	BERMAN, RONALD H MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27773	41	Internal Medicine	0	In state provider	None	2023 VALE RD	STE 110	SAN PABLO	CA	94806	3891	07	06013	37.95369824	-122.3378493	Contra Costa County
68912	Fee-for-Service	1235372905	1235372905	1	1	BARIL, SAVANNAH EG MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138413	18	Ophthalmology	0	In state provider	None	2031 W ALAMEDA AVE	SUITE 300	BURBANK	CA	91506	2960	19	06037	34.15972797	-118.3237055	Los Angeles County
68923	Fee-for-Service	1861543704	1861543704	1	1	BLAKE, GRETCHEN F LCSW	5/18/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
68929	Fee-for-Service	1053360230	1053360230	1	1	BARNETT, KARA W	6/6/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
68933	Fee-for-Service	1134166671	1134166671	1	1	BUGHI, STEFAH MD	3/31/1986	207RE0101X	NA	Endocrinology	026	PHYSICIANS	43274	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
68941	Fee-for-Service	1083121008	1083121008	1	1	BROWN, DAKOTA W LMFT	5/5/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	129663	-	NOT APPLICABLE	0	In state provider	None	426 SAN PEDRO ST	None	LOS ANGELES	CA	90013	2119	19	06037	34.04510882	-118.2433551	Los Angeles County
68956	Fee-for-Service	1972643872	1972643872	1	1	BRYAN, SYLVESTER J JR MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	28146	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
68962	Fee-for-Service	1265710305	1265710305	2	1	BERE, PRAVEEN MD	9/17/2024	208M00000X	NA	Other	026	PHYSICIANS	148829	41	Internal Medicine	0	In state provider	None	1100 N PALM CANYON DR	STE 109	PALM SPRINGS	CA	92262	4418	33	06065	33.838182	-116.546744	Riverside County
68998	Fee-for-Service	1518301688	1518301688	1	1	BAZAROV, IRINA DPM	8/19/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
68999	Fee-for-Service	1295831303	1295831303	1	1	BARNES, TERRA D J OD	5/1/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	24361 EL TORO RD	STE 180	LAGUNA WOODS	CA	92637	2756	30	06059	33.60920657	-117.7320537	Orange County
69008	Fee-for-Service	1518029792	1518029792	1	1	BANKI, NADER N MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	73091	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
69027	Fee-for-Service	1174655393	1174655393	1	1	BEE, MICHELLE D LMFT	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52971	-	NOT APPLICABLE	0	In state provider	None	844 PICO BLVD	None	SANTA MONICA	CA	90405	1325	19	06037	34.01263151	-118.4813759	Los Angeles County
69038	Fee-for-Service	1447692421	1447692421	1	1	BIEN, VENICE M NP	2/5/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
69057	Fee-for-Service	1538365606	1538365606	1	1	BROWN, CRYSTAL M	10/12/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
69082	Fee-for-Service	1376700583	1376700583	1	1	BOPARAI, SANJIWAN	7/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119799	None	None	0	In state provider	None	1320 STANDIFORD AVENUE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
69116	Fee-for-Service	1669998761	1669998761	1	1	BURK, STACEY LMFT	3/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	45	06089	40.57267376	-122.3643496	Shasta County
69123	Fee-for-Service	1538338348	1538338348	1	1	BEVERLY HILLS ANESTHESIA	8/5/2008	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	450 N ROXBURY DRIVE	SUITE 600	BEVERLY HILLS	CA	90210	4321	19	06037	34.06820793	-118.4070317	Los Angeles County
69144	Fee-for-Service	1467469353	1467469353	1	1	BARR, CHARLES R PHD	5/31/1992	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	131 N EL MOLINO AVE	STE 220	PASADENA	CA	91101	1877	19	06037	34.14834	-118.1369375	Los Angeles County
69174	Fee-for-Service	1619358157	1619358157	1	1	BAHAMON, CAMILA MD	5/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162479	15	Obstetrics (D.O. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
69210	Fee-for-Service	1396141107	1396141107	1	1	BEGINES, JOYCE L NP	11/6/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
69222	Fee-for-Service	1407249006	1407249006	1	1	BAHO, SAMMY MD	2/17/2025	207L00000X	NA	Other	026	PHYSICIANS	144188	05	Anesthesiology	0	In state provider	None	995 BLANCO CIR	# A	SALINAS	CA	93901	4447	27	06053	36.65488958	-121.6372749	Monterey County
69235	Fee-for-Service	1346400116	1346400116	1	2	BARRIOS, JOSE L MD	1/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114420	01	General Practice	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
69248	Fee-for-Service	1982829800	1982829800	1	1	BAGHERI, KAVEH MD INC	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8860 CENTER DR	STE 240	LA MESA	CA	91942	7000	37	06073	32.78189749	-117.0075062	San Diego County
69294	Fee-for-Service	1073608576	1073608576	1	1	BULOW, KWI MD	7/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56674	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	STE H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
69299	Fee-for-Service	1376848622	1376848622	1	1	BEST CHOICE PHARMACY &	8/25/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL SUPPLY INC	7148 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2717	19	06037	34.24815369	-118.2876331	Los Angeles County
69312	Fee-for-Service	1548574841	1548574841	1	1	BERUMEN, YOLANDA NP	1/19/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	624703	-	NOT APPLICABLE	0	In state provider	None	125 WEST F STREET	SUITE 101	ONTARIO	CA	91762	3201	36	06071	34.069302	-117.652158	San Bernardino County
69321	Fee-for-Service	1932258704	1932258704	1	1	BULCZYNSKI, ANDRZEJ MD	3/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8904	20	Orthopedic Surgery	0	In state provider	VENTURA COUNTY MED CTR	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
69351	Fee-for-Service	1295094084	1295094084	1	1	BUCHANAN, IAN A MD	5/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136375	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
69364	Fee-for-Service	1902216021	1902216021	1	1	BAUER, MARIANNE T MD	5/13/2021	207R00000X	NA	Other	026	PHYSICIANS	172692	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
69405	Fee-for-Service	1093933251	1093933251	1	1	BERNATSKY, VANIA E NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
69417	Fee-for-Service	1912233644	1912233644	2	1	BRAVO PHARMACY LLC	4/27/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7316 COMPTON AVENUE	None	LOS ANGELES	CA	90001	2532	19	06037	33.973083	-118.2476625	Los Angeles County
69457	Fee-for-Service	1396926200	1396926200	1	1	BELIKOV, SERGEY MD APC	6/6/2008	207L00000X	NA	Other	026	PHYSICIANS	76721	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
69517	Fee-for-Service	1164986766	1164986766	1	1	BROSTOFF, DEBBIE NP	2/18/2025	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
69528	Fee-for-Service	1629235791	1629235791	1	1	BHAMB, NEIL V MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	112761	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
69538	Fee-for-Service	1982829800	1982829800	1	1	BAGHERI, KAVEH MD INC	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8860 CENTER DR	STE 240	LA MESA	CA	91942	7000	37	06073	32.78189749	-117.0075062	San Diego County
69546	Fee-for-Service	1215117544	1215117544	1	1	BATES, CHERYL C MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96568	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
69579	Fee-for-Service	1336587427	1336587427	1	1	BEAMAN, GINA E LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
69606	Fee-for-Service	1770160780	1770160780	1	1	BOUEY, NICOLAS MD	7/17/2024	390200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
69609	Fee-for-Service	1548419674	1548419674	1	1	BEZEMA, ERIK M MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103644	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
69611	Fee-for-Service	1700239530	1700239530	1	1	BUDOFF, GREG E MD	5/22/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168607	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
69634	Fee-for-Service	1760608996	1760608996	1	1	BABYLON ADULT DAY HEALTH	6/19/2003	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	18725 SHERMAN WAY	None	RESEDA	CA	91335	4018	19	06037	34.20119852	-118.5412545	Los Angeles County
69643	Fee-for-Service	1568523348	1568523348	1	1	BALDWIN, TRACEY J	6/20/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
69667	Fee-for-Service	1871679381	1871679381	1	1	BATTAGLIA, KENNETH S MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37116	01	General Practice	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
69669	Fee-for-Service	1912342783	1912342783	1	1	BIXENSTINE, PAUL J MD	9/7/2022	207R00000X	NA	Other	026	PHYSICIANS	145060	None	None	0	In state provider	None	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	30	06059	33.62609529	-117.7293191	Orange County
69696	Fee-for-Service	1700918349	1700918349	1	1	BARTH, REBEKA MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96567	None	None	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
69706	Fee-for-Service	1568585024	1568585024	1	1	BIR, R S MD INC	7/1/2001	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	9792 SIERRA AVE	None	FONTANA	CA	92335	6717	36	06071	34.0757348	-117.4357502	San Bernardino County
69740	Fee-for-Service	1811703051	1811703051	1	1	BAZA, DANIKA L BIRTH DOULA	2/18/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	10	06019	0	0	None
69761	Fee-for-Service	1417486788	1417486788	1	1	BARRIENTOS, JUANITA M LCSW	8/20/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
69794	Fee-for-Service	1710195003	1710195003	1	1	BLALOCK, TRAVIS W MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116875	07	Dermatology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
69798	Fee-for-Service	1841419793	1841419793	1	1	BLACK, ROBIN	2/7/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2077 HARBOR BLVD	STE C	COSTA MESA	CA	92627	2630	30	06059	33.64990963	-117.9190918	Orange County
69837	Fee-for-Service	1306851860	1306851860	1	1	BRILLMAN, JUDITH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
69838	Fee-for-Service	1194066969	1194066969	1	1	BOGIKIAN MEDICAL CORPORATION	4/11/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	84922	08	Family Practice	0	In state provider	None	247 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2951	19	06037	34.15983348	-118.2585375	Los Angeles County
69848	Fee-for-Service	1568858033	1568858033	1	1	BANSAL, DANESH MD	7/8/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172931	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
69865	Fee-for-Service	1518310622	1518310622	1	1	BRAKER, CANDYCE LMFT	8/30/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
69869	Fee-for-Service	1710383070	1710383070	1	1	BIO-MEDICAL APPLICATIONS OF	8/4/2016	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1474 STONE POINT DR	SUITE 105	ROSEVILLE	CA	95661	2839	31	06061	38.75550859	-121.24894	Placer County
69908	Fee-for-Service	1598857765	1598857765	1	1	BADANI, RUPAL V MD	7/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87307	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
69922	Fee-for-Service	1659361798	1659361798	1	1	BARCHAN, OLEXANDER MD	7/5/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79738	41	Internal Medicine	0	In state provider	None	804 HARBOR BLVD	None	WEST SACRAMENTO	CA	95691	2202	57	06113	38.57921959	-121.5490927	Yolo County
70009	Fee-for-Service	1710942560	1710942560	1	1	BRENNER, RICHARD J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31972	30	Radiology	0	In state provider	None	14860 ROSCOE BLVD	STE 100	PANORAMA CITY	CA	91402	4687	19	06037	34.2214515	-118.4573205	Los Angeles County
70010	Fee-for-Service	1295942134	1295942134	1	1	BRIERCHECK, BRADLEY S MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103651	36	Psychiatry	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
70044	Fee-for-Service	1699401414	1699401414	1	1	BADRELDIN, DINA S NP	4/16/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
70075	Fee-for-Service	1053511378	1053511378	1	1	BERT, KARLENE H NP	11/12/2015	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1878 E HATCH ROAD	None	MODESTO	CA	95351	5002	50	06099	37.60918253	-120.9613365	Stanislaus County
70094	Fee-for-Service	1013320738	1013320738	1	1	BUTLER, DANIEL C MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155634	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
70130	Fee-for-Service	1679523260	1679523260	1	2	BARR, JOHN D MD	11/9/2009	2085N0700X	NA	MRI Provider	026	PHYSICIANS	88237	13	Neurology (M.D. only)	0	In state provider	None	10150 SORRENTO VALLEY RD	STE 320	SAN DIEGO	CA	92121	1614	37	06073	32.88901457	-117.2082369	San Diego County
70131	Fee-for-Service	1104887090	1104887090	1	1	BUI, LINH N MD	6/1/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61058	30	Radiology	0	In state provider	None	4200 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2112	19	06037	33.78981346	-118.1439033	Los Angeles County
70153	Fee-for-Service	1922132992	1922132992	1	1	BURNS, TIFFANY M	3/9/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 WEST 6TH STREET	STE 111	LOS ANGELES	CA	90017	1823	19	06037	34.05416748	-118.2622848	Los Angeles County
70175	Fee-for-Service	1265780597	1265780597	1	2	BARTOLOME, ANGELA LCSW	4/9/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
70182	Fee-for-Service	1528006103	1528006103	1	1	BRYAN MEDICAL CENTER	5/1/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1600 S 48TH ST	None	LINCOLN	NE	68506	1227	00	None	40.79662742	-96.65363209	Lancaster County
70198	Fee-for-Service	1376759035	1376759035	1	1	BUSSE, CAROLE S LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
70251	Fee-for-Service	1295814275	1295814275	1	1	BOUGAS, PANAGIOTIS MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84424	None	None	0	In state provider	None	1801 W ROMNEYA DR	STE 308	ANAHEIM	CA	92801	1826	30	06059	33.8506615	-117.946413	Orange County
70278	Fee-for-Service	1912241258	1912241258	1	1	BANJ HEALTH CENTER INC	11/20/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	12954 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	4418	19	06037	33.91447388	-118.3523875	Los Angeles County
70288	Fee-for-Service	1558354993	1558354993	1	1	BELLIG, GREGORY J MD	8/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81822	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
70289	Fee-for-Service	1477717932	1477717932	1	1	BERGER, BRENT L MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103501	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
70297	Fee-for-Service	1356839872	1356839872	1	1	BARSAM GHARAGOZLOU, MD INC.	10/8/2024	261QP2300X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3700 SUNSET LN STE 4	None	ANTIOCH	CA	94509	6123	07	06013	37.98481899	-121.8042927	Contra Costa County
70330	Fee-for-Service	1063629285	1063629285	1	1	BINOYA, EDGARDO G MD INC	2/28/1980	193200000X	NA	Other	026	PHYSICIANS	30593	01	General Practice	0	In state provider	None	10230 ARTESIA BLVD	STE 118	BELLFLOWER	CA	90706	6769	19	06037	33.8728276	-118.1160403	Los Angeles County
70377	Fee-for-Service	1881653954	1881653954	1	1	BERNSTEIN, SETH OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	21520 YORBA LINDA BLVD	STE B	YORBA LINDA	CA	92887	3762	30	06059	33.877629	-117.7516485	Orange County
70383	Fee-for-Service	1023109907	1023109907	1	1	BORNSTEIN, JOHN B MD INC	8/31/1996	193400000X	NA	Other	026	PHYSICIANS	38206	05	Anesthesiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
70418	Fee-for-Service	1679523260	1679523260	1	2	BARR, JOHN D MD	11/9/2009	2085N0700X	NA	MRI Provider	026	PHYSICIANS	88237	30	Radiology	0	In state provider	None	10150 SORRENTO VALLEY RD	STE 320	SAN DIEGO	CA	92121	1614	37	06073	32.88901457	-117.2082369	San Diego County
70419	Fee-for-Service	1104887090	1104887090	1	1	BUI, LINH N MD	6/1/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61058	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4200 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2112	19	06037	33.78981346	-118.1439033	Los Angeles County
70450	Fee-for-Service	1629146600	1629146600	1	1	BROECKEL, PHILIP G MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	37332	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	# &	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
70467	Fee-for-Service	1528006103	1528006103	1	1	BRYAN MEDICAL CENTER	5/1/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1600 S 48TH ST	None	LINCOLN	NE	68506	1227	00	None	40.79662742	-96.65363209	Lancaster County
70479	Fee-for-Service	1780060574	1780060574	1	1	BARTLETT, SARA P LCSW	8/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
70562	Fee-for-Service	1477979821	1477979821	1	1	BELTRAMO, FERNANDO MD	8/1/2017	2080P0203X	NA	Other	026	PHYSICIANS	116484	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
70568	Fee-for-Service	1588661839	1588661839	1	1	BUEHLER, DONALD L MD	7/25/1982	208G00000X	NA	General Surgery	026	PHYSICIANS	19204	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9834 GENESEE AVE	STE 120	LA JOLLA	CA	92037	1225	37	06073	32.884074	-117.225855	San Diego County
70569	Fee-for-Service	1235147950	1235147950	1	1	BARGER, LESLIE W MD	12/31/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	71767	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
70578	Fee-for-Service	1114919495	1114919495	1	1	BRINTON, DANIEL A MD	4/13/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	57682	18	Ophthalmology	0	In state provider	None	3300 TELEGRAPH AVE	None	OAKLAND	CA	94609	3028	01	06001	37.82176506	-122.266417	Alameda County
70579	Fee-for-Service	1760735385	1760735385	1	1	BAGGA, CAROLINA C MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120128	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DRIVE	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
70599	Fee-for-Service	1578701397	1578701397	1	1	BRUNNER-LAM, GERALDINE	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
70604	Fee-for-Service	1760770192	1760770192	1	1	BLACKHURST, MARK PSYD	12/21/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
70606	Fee-for-Service	1366422008	1366422008	1	1	BAILEY, MITCHELL E MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	25349	02	General Surgery	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
70611	Fee-for-Service	1093721938	1093721938	1	1	BISHOP, DOUGLAS S MD	2/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52918	18	Ophthalmology	0	In state provider	None	3105 CEDAR RAVINE RD	STE 103	PLACERVILLE	CA	95667	6561	09	06017	38.72626462	-120.7945035	El Dorado County
70722	Fee-for-Service	1508911892	1508911892	1	39	BAY AREA FOOT CARE, INC	9/1/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	730 16TH ST	None	MODESTO	CA	95354	2519	50	06099	37.64268152	-120.9919817	Stanislaus County
70744	Fee-for-Service	1669745261	1669745261	1	1	BURESCH, ARIN M MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141760	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
70775	Fee-for-Service	1023049111	1023049111	1	1	BARDACH, NAOMI S MD	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91891	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
70784	Fee-for-Service	1376750224	1376750224	1	1	BLAIR S. KRANSON M.D. INC.	10/9/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	7320 WOODLAKE AVE	STE 395	WEST HILLS	CA	91307	1496	19	06037	34.20245266	-118.6321273	Los Angeles County
70794	Fee-for-Service	1740712041	1740712041	1	1	BEN-DAVID, SIVAN DO	9/23/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17201	40	Pediatrics	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
70846	Fee-for-Service	1083788079	1083788079	1	1	BETTER CARE INCORPORATED	3/1/1966	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1267 MERIDIAN AVE	None	SAN JOSE	CA	95125	5210	43	06085	37.302129	-121.913647	Santa Clara County
70856	Fee-for-Service	1588661839	1588661839	1	1	BUEHLER, DONALD L MD	7/25/1982	208G00000X	NA	General Surgery	026	PHYSICIANS	19204	33	Thoracic Surgery	0	In state provider	None	9834 GENESEE AVE	STE 120	LA JOLLA	CA	92037	1225	37	06073	32.884074	-117.225855	San Diego County
70883	Fee-for-Service	1790704211	1790704211	1	1	BARNES, DEBORAH W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
70886	Fee-for-Service	1093787178	1093787178	1	1	BLANCO, LORNA MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	63801	41	Internal Medicine	0	In state provider	None	133 N ALTADENA DR	FL 2	PASADENA	CA	91107	7325	19	06037	34.14843	-118.0986385	Los Angeles County
70901	Fee-for-Service	1174653547	1174653547	1	1	BRUHNHARNEY, NANNETTE LMFT	6/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4535 MISSOURI FLAT ROAD	200D	PLACERVILLE	CA	95667	6808	09	06017	38.69980395	-120.8227032	El Dorado County
70904	Fee-for-Service	1548721897	1548721897	1	1	BARTON, MACKENZIE J DO	5/8/2023	207P00000X	NA	Other	026	PHYSICIANS	20824	None	None	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
70917	Fee-for-Service	1528220571	1528220571	1	1	BALL, JULIE A	12/11/2008	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
70923	Fee-for-Service	1477791218	1477791218	1	1	BULAON-CASTILLO, LUCILLE J	6/13/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
70940	Fee-for-Service	1841685997	1841685997	1	1	BLACKMON, AMANDA L DO	4/16/2021	207RH0000X	NA	Hematology	026	PHYSICIANS	16427	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
71020	Fee-for-Service	1538501218	1538501218	1	1	BADWAL, RANDEEP MD	3/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152193	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
71028	Fee-for-Service	1477128932	1477128932	1	1	BURTON, BENJAMIN	7/25/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
71061	Fee-for-Service	1902387533	1902387533	1	1	BIO-MEDICAL APPLICATIONS OF	2/3/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, INC	16423 SIERRA LAKES PKWY	None	FONTANA	CA	92336	1252	36	06071	34.13788252	-117.4476285	San Bernardino County
71076	Fee-for-Service	1750796215	1750796215	1	1	BABAYAN, ANDREW OD	6/30/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12000 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3319	19	06037	34.18665451	-118.394541	Los Angeles County
71099	Fee-for-Service	1366021164	1366021164	1	1	BATTIKHA, CAROL MD	9/26/2024	207R00000X	NA	Other	026	PHYSICIANS	191803	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
71155	Fee-for-Service	1487706628	1487706628	1	1	BONNIE BRAE CONVALESCENT	11/1/1981	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	420 S BONNIE BRAE ST	None	LOS ANGELES	CA	90057	3010	19	06037	34.06038115	-118.2711852	Los Angeles County
71175	Fee-for-Service	1154308484	1154308484	1	1	BRAR, GAMDUR S MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51065	None	None	0	In state provider	VALLEY PEDIATRICS	2339 W CLEVELAND AVE	STE 101	MADERA	CA	93637	8753	20	06039	36.97466548	-120.085749	Madera County
71184	Fee-for-Service	1740535228	1740535228	1	1	BEABER, BRANDON E MD	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114039	13	Neurology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
71202	Fee-for-Service	1457911984	1457911984	1	1	BAKER, NOLAN CCC-SLP	11/20/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
71210	Fee-for-Service	1063599645	1063599645	3	1	BHARGAV C. PATEL AND RICKY B	3/15/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1120 WEST LA PALMA AVENU	1	ANAHEIM	CA	92801	2801	30	06059	33.84713549	-117.93276	Orange County
71221	Fee-for-Service	1205954898	1205954898	1	1	BURKE,JOHN M PHD	11/26/2008	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVENUE	#230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
71232	Fee-for-Service	1073010757	1073010757	1	1	BESHAY, LAUREN H MD	3/24/2023	207R00000X	NA	Other	026	PHYSICIANS	164711	None	None	0	In state provider	None	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
71233	Fee-for-Service	1245801463	1245801463	1	1	BATTAGLIA, FRANCESCA	6/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
71249	Fee-for-Service	1295721884	1295721884	1	1	BESTOSO, JOHN T MD	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87345	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
71346	Fee-for-Service	1316441793	1316441793	1	1	BROWN, MITCHELL E	2/1/2022	207P00000X	NA	Other	026	PHYSICIANS	174271	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
71424	Fee-for-Service	1972895779	1972895779	1	1	BECKER, SHANNON C MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121997	01	General Practice	0	In state provider	None	2210 DEL PASO RD	None	SACRAMENTO	CA	95834	9671	34	06067	38.655189	-121.5091575	Sacramento County
71539	Fee-for-Service	1427071588	1427071588	1	1	BATMANIS, PAUL S MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70394	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
71557	Fee-for-Service	1790872281	1790872281	1	1	BURROWS, JAMES E MD	7/1/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	79514	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1301 20TH ST	STE 360	SANTA MONICA	CA	90404	2052	19	06037	34.02976782	-118.4812493	Los Angeles County
71572	Fee-for-Service	1518255751	1518255751	1	1	BROCKWELL, MATTHEW J MD	2/15/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	117300	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
71576	Fee-for-Service	1043475627	1043475627	1	1	BARTHELOW, JOEL I MD	8/25/2008	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	114 MISSION RANCH BLVD	STE 50	CHICO	CA	95926	2186	04	06007	39.75356438	-121.8600403	Butte County
71586	Fee-for-Service	1962499277	1962499277	1	1	BERLANSTEIN, BRUCE P MD	11/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
71628	Fee-for-Service	1912962176	1912962176	1	1	BAGHERI, RAMIN MD	1/9/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77608	20	Orthopedic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
71652	Fee-for-Service	1629037361	1629037361	1	1	BALCOMBE,JOAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5475 SOUTH 500 EAST	None	OGDEN	UT	84405	6905	00	None	41.16449014	-111.9686412	Weber County
71683	Fee-for-Service	1457864464	1457864464	1	1	BAWJ MEDICAL SERVICES INC	4/24/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	524 W 4TH ST	B	PERRIS	CA	92570	2016	33	06065	33.78236446	-117.237456	Riverside County
71693	Fee-for-Service	1457764235	1457764235	1	1	BAINS, SHARNDEEP K DO	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14725	01	General Practice	0	In state provider	None	444 PLUMAS BLVD	None	YUBA CITY	CA	95991	5071	51	06101	39.13178911	-121.6141048	Sutter County
71696	Fee-for-Service	1942732797	1942732797	1	1	BURR, REBECCA G MD	10/2/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	187579	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
71760	Fee-for-Service	1184883092	1184883092	1	1	BARKER, RACHEL M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
71782	Fee-for-Service	1689820011	1689820011	1	1	BABALAVI, PARVIZ MD	12/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	51850	01	General Practice	0	In state provider	None	933 N CENTINELA AVE	None	INGLEWOOD	CA	90302	1501	19	06037	33.97609809	-118.356369	Los Angeles County
71803	Fee-for-Service	1134414980	1134414980	1	1	BAXTER, ATEA L LCSW	4/2/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
71830	Fee-for-Service	1629262001	1629262001	1	1	BERNSTEIN, RHEA LCSW	5/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	417 BROAD ST	UNIT D	NEVADA CITY	CA	95959	2444	29	06057	39.26297528	-121.0202977	Nevada County
71837	Fee-for-Service	1346942349	1346942349	1	1	BHATTI ENTERPRISE LLC	3/27/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5405 STOCKDALE HWY	109	BAKERSFIELD	CA	93309	2561	15	06029	35.35415166	-119.0620737	Kern County
71853	Fee-for-Service	1891162152	1891162152	1	1	BRADY, CHRISTINE E PHD	5/16/2020	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
71855	Fee-for-Service	1669091427	1669091427	1	1	BIVER, LAURA M	7/23/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
71883	Fee-for-Service	1700861879	1700861879	1	1	BENTZ, SCOTT D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
71904	Fee-for-Service	1952559825	1952559825	1	1	BONILLA, MELLISSA T LCSW	5/28/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	79897	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	WARD 93, WARD 95 3RD FL	SAN FRANCISCO	CA	94110	3185	38	06075	37.75548534	-122.4065362	San Francisco County
71915	Fee-for-Service	1912962176	1912962176	1	1	BAGHERI, RAMIN MD	1/9/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77608	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
71922	Fee-for-Service	1598961641	1598961641	1	1	BRITTANY MOYER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHNS MEDICAL CENTER	1615 DELAWARE ST	None	LONGVIEW	WA	98632	0000	00	None	46.1309207	-122.9408931	Cowlitz County
71952	Fee-for-Service	1740303247	1740303247	1	1	BIR, R S MD INC	7/1/1998	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11692 CENTRAL AVE	None	CHINO	CA	91710	1923	36	06071	34.0409475	-117.6896806	San Bernardino County
71984	Fee-for-Service	1184087678	1184087678	1	1	BRAUN, HILLARY J MD	7/26/2023	204F00000X	NA	General Surgery	026	PHYSICIANS	152198	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
71990	Fee-for-Service	1811075674	1811075674	1	1	BALDAWALA, TANAAZ B MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	53349	10	Gastroenterology (M.D. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
71991	Fee-for-Service	1669989752	1669989752	1	1	BAGBY, WHITNEY D NP	11/4/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
71994	Fee-for-Service	1255561569	1255561569	1	1	BEWLEY, ABIGAIL M MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125950	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
72031	Fee-for-Service	1073008017	1073008017	1	1	BOONE, CHANTAL B DO	3/16/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6200 LA CHOLLA BLVD	None	TUCSON	AZ	85741	3529	00	None	32.320323	-111.009951	Pima County
72041	Fee-for-Service	1750418042	1750418042	1	1	BAHRO, SONIA A PHD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
72049	Fee-for-Service	1306828702	1306828702	1	1	BEAMON, RICHARD F MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	88869	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 TERMINO AVENUE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
72067	Fee-for-Service	1760444244	1760444244	1	1	BRONNER GONZALEZ, TINA	11/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90271	41	Internal Medicine	0	In state provider	ESTHER	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
72074	Fee-for-Service	1477850022	1477850022	1	1	BERNBECK, DEBRA LMFT	11/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	206 PROVIDENCE MINE RD	STE. 215	NEVADA CITY	CA	95959	2956	29	06057	39.25037109	-121.0307545	Nevada County
72078	Fee-for-Service	1376851428	1376851428	1	1	BERNALES, GEORGE A MD INC	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	47861	01	General Practice	0	In state provider	None	2766 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5747	19	06037	33.97368953	-118.2205748	Los Angeles County
72096	Fee-for-Service	1972786911	1972786911	1	1	BHINDER, HARCHITWANT S MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116485	41	Internal Medicine	0	In state provider	None	2801 K STREET	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
72125	Fee-for-Service	1831343086	1831343086	1	1	BALASUBRAMANYA, SHYAMASUNDAR	2/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122208	33	Thoracic Surgery	0	In state provider	MD	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
72142	Fee-for-Service	1750918769	1750918769	1	1	BUSHEE, FALLON MD	10/27/2023	207P00000X	NA	Other	026	PHYSICIANS	186397	None	None	0	In state provider	None	751 BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
72195	Fee-for-Service	1033209507	1033209507	1	1	BOGER,JAMES E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
72203	Fee-for-Service	1154861359	1154861359	1	1	BLURTON, HELAYNA NP	4/24/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
72206	Fee-for-Service	1174560247	1174560247	1	1	BUCKINGHAM, BRUCE A MD	4/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	25563	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
72210	Fee-for-Service	1568468528	1568468528	1	1	BHAGIA, UMESH T MD	7/9/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	80509	20	Orthopedic Surgery	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
72221	Fee-for-Service	1548659105	1548659105	1	2	BEHAVIORAL HEALTH SERVICES	9/29/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	19	06037	34.01581788	-118.3348506	Los Angeles County
72223	Fee-for-Service	1164452744	1164452744	1	1	BROSE, WILLIAM G MD	1/31/1987	207L00000X	NA	Other	026	PHYSICIANS	55824	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
72227	Fee-for-Service	1437392776	1437392776	1	1	BARI, AUSAF A MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112205	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	SUITE 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
72239	Fee-for-Service	1699807503	1699807503	1	1	BAKERSFIELD RECOVERY	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	708 LINCOLN STREET	None	BAKERSFIELD	CA	93305	3018	15	06029	35.3871307	-118.9884628	Kern County
72248	Fee-for-Service	1144648593	1144648593	1	1	BUENO DEL BOSQUE, ALLEN MD	12/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	149228	08	Family Practice	0	In state provider	None	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	27	06053	36.68590557	-121.8010492	Monterey County
72267	Fee-for-Service	1114528015	1114528015	1	1	BROOKS, RANDEL CRNA	4/21/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
72303	Fee-for-Service	1861881716	1861881716	1	1	BURTON, ELIJAH J MD	3/11/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170948	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
72426	Fee-for-Service	1508911892	1508911892	1	25	BAY AREA FOOT CARE, INC	6/11/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	576 N SUNRISE AVE	STE 230	ROSEVILLE	CA	95661	2841	31	06061	38.75781026	-121.253352	Placer County
72446	Fee-for-Service	1336812692	1336812692	1	1	BOWENS, LATONYA J NP	10/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
72469	Fee-for-Service	1083843619	1083843619	1	1	BHULLAR, GURMANJOT K MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118093	36	Psychiatry	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
72471	Fee-for-Service	1689064347	1689064347	1	1	BONILLA, CRISTINA LCSW	6/14/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8135 S PAINTER AVENUE	SUITE 103	WHITTIER	CA	90602	3171	19	06037	33.965829	-118.032738	Los Angeles County
72497	Fee-for-Service	1174560247	1174560247	1	1	BUCKINGHAM, BRUCE A MD	4/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	25563	67	Endocrinology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
72498	Fee-for-Service	1336176114	1336176114	1	1	BRANSON, DEBRA NP	8/20/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
72503	Fee-for-Service	1841231800	1841231800	1	1	BOXER, ADAM L MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69415	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	# A-887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
72510	Fee-for-Service	1548659105	1548659105	1	2	BEHAVIORAL HEALTH SERVICES	9/29/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	19	06037	34.01581788	-118.3348506	Los Angeles County
72523	Fee-for-Service	1255642120	1255642120	1	1	BENT, CHRISTOPHER K MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117543	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
72529	Fee-for-Service	1841342227	1841342227	1	1	BUTTE CO OFFICE OF ED	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1859 BIRD STREET	None	OROVILLE	CA	95965	4854	04	06007	39.51259228	-121.5566418	Butte County
72535	Fee-for-Service	1033514898	1033514898	1	1	BRODIE, SHAUNA A NP	10/7/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
72549	Fee-for-Service	1952386757	1952386757	1	1	BELLOWS, JASON M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	PO BOX 111719	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
72550	Fee-for-Service	1023137874	1023137874	1	1	BORGES, TOD J	11/27/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	714 W LODI AVE	None	LODI	CA	95240	3429	39	06077	38.1299637	-121.2823792	San Joaquin County
72562	Fee-for-Service	1609925700	1609925700	1	1	BARTELS, MARY G MD	5/20/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178331	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
72568	Fee-for-Service	1407501448	1407501448	1	1	BARKER, RYAN PT	6/21/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
72571	Fee-for-Service	1508911892	1508911892	1	5	BAY AREA FOOT CARE, INC	5/9/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2272 BACON ST	None	CONCORD	CA	94520	0000	38	06075	37.98200856	-122.0347914	Contra Costa County
72696	Fee-for-Service	1326072349	1326072349	1	1	BAE, STEVE S MD	10/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82405	None	None	0	In state provider	None	17170 COLIMA RD	STE D	HACIENDA HEIGHTS	CA	91745	6771	19	06037	33.9907128	-117.9325812	Los Angeles County
72713	Fee-for-Service	1508911892	1508911892	1	25	BAY AREA FOOT CARE, INC	6/11/2024	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	576 N SUNRISE AVE	STE 230	ROSEVILLE	CA	95661	2841	31	06061	38.75781026	-121.253352	Placer County
72716	Fee-for-Service	1104993906	1104993906	1	1	BAROMEDICAL ASSOCIATES INC	9/3/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2000 VALE RD	DEPT OF HYPERBARIC MED	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
72734	Fee-for-Service	1427510775	1427510775	1	1	BAI, MINBO	9/17/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
72738	Fee-for-Service	1487918751	1487918751	1	1	BASKAR, SHANKAR	3/18/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
72760	Fee-for-Service	1629528245	1629528245	1	1	BOLEY, CAROLYN B NP	12/29/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
72772	Fee-for-Service	1730118738	1730118738	1	1	BHALLA, VIVEK MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70125	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
72784	Fee-for-Service	1639113764	1639113764	1	1	BESHONER, MICHAEL M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	79-1019 HAUKAPILA ST	None	KEALAKEKUA	HI	96750	7920	00	None	19.519965	-155.918154	Hawaii County
72794	Fee-for-Service	1811751712	1811751712	1	1	BELTRAN, EMILY NP	7/24/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
72811	Fee-for-Service	1336168814	1336168814	1	1	BURTZO, DAVID M MD	3/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68790	68	Hematology	0	In state provider	None	1043 ELM AVE	STE 104	LONG BEACH	CA	90813	3244	19	06037	33.779655	-118.1880065	Los Angeles County
72819	Fee-for-Service	1841342227	1841342227	1	1	BUTTE CO OFFICE OF ED	3/12/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	1859 BIRD STREET	None	OROVILLE	CA	95965	4854	04	06007	39.51259228	-121.5566418	Butte County
72845	Fee-for-Service	1346446457	1346446457	1	1	BI-BETT	7/29/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	560 LENNON LN	200	WALNUT CREEK	CA	94598	2486	07	06013	37.9294855	-122.0315817	Contra Costa County
72860	Fee-for-Service	1508911892	1508911892	1	5	BAY AREA FOOT CARE, INC	1/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2272 BACON ST	None	CONCORD	CA	94520	0000	38	06075	37.98200856	-122.0347914	Contra Costa County
72870	Fee-for-Service	1346081353	1346081353	1	1	BROADAWAY, HALEY M LMFT	8/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
72884	Fee-for-Service	1245318088	1245318088	1	1	BEHZADNIA, ALI A MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	39541	67	Endocrinology	0	In state provider	None	361 HOSPITAL RD	STE 329	NEWPORT BEACH	CA	92663	3524	30	06059	33.62579141	-117.9299554	Orange County
72903	Fee-for-Service	1871904656	1871904656	1	4	BARSTOW PRIMARY CARE CLINIC	1/5/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16124 KASOTA BLVD	STE B,C	APPLE VALLEY	CA	92307	2232	36	06071	34.54426738	-117.2667469	San Bernardino County
72948	Fee-for-Service	1508547803	1508547803	1	1	BREAZEALE, JUSTIN R CRNA	2/27/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
72961	Fee-for-Service	1801098272	1801098272	1	1	BIO MEDICAL APPLICATIONS	9/26/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	1422 WEST 11TH ST	None	LOS ANGELES	CA	90015	1228	19	06037	34.04676984	-118.2730755	Los Angeles County
72968	Fee-for-Service	1508284316	1508284316	1	1	BINESH, BAHAREH B MD	8/21/2017	207R00000X	NA	Other	026	PHYSICIANS	146831	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
73017	Fee-for-Service	1417118522	1417118522	1	1	BASU, NABANITA MD	9/17/2021	207R00000X	NA	Other	026	PHYSICIANS	118258	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
73040	Fee-for-Service	1831616226	1831616226	1	1	BICOMONG, MARIAH B LCSW	2/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
73057	Fee-for-Service	1982086575	1982086575	1	1	BECK, LINELL DO	7/25/2023	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	8280 W WARM SPRINGS RD	None	LAS VEGAS	NV	89113	3612	00	None	36.057384	-115.2721395	Clark County
73075	Fee-for-Service	1699949404	1699949404	1	1	BAHADORI, AMIR H MD INC	9/9/2008	174400000X	NA	Other	026	PHYSICIANS	65627	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	STE 405	SHERMAN OAKS	CA	91403	1866	19	06037	34.160805	-118.4487295	Los Angeles County
73097	Fee-for-Service	1336168814	1336168814	1	1	BURTZO, DAVID M MD	3/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68790	78	Neoplastic Diseases/Oncology	0	In state provider	None	1043 ELM AVE	STE 104	LONG BEACH	CA	90813	3244	19	06037	33.779655	-118.1880065	Los Angeles County
73140	Fee-for-Service	1164478210	1164478210	1	1	BHATT, APURVA A MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95945	08	Family Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
73171	Fee-for-Service	1245318088	1245318088	1	1	BEHZADNIA, ALI A MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	39541	41	Internal Medicine	0	In state provider	None	361 HOSPITAL RD	STE 329	NEWPORT BEACH	CA	92663	3524	30	06059	33.62579141	-117.9299554	Orange County
73175	Fee-for-Service	1710242789	1710242789	1	1	BERAHO, LORRAINE MD	1/3/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	156809	40	Pediatrics	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6862	24	06047	37.28825369	-120.4963159	Merced County
73206	Fee-for-Service	1801273479	1801273479	1	1	BROGAN, JACQUELINE MD	2/28/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	160890	07	Dermatology	0	In state provider	None	292 AVOCADO AVE	None	EL CAJON	CA	92020	4604	37	06073	32.793039	-116.957649	San Diego County
73213	Fee-for-Service	1972906584	1972906584	1	1	BAJ MANAGEMENT INC	2/10/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	800 PROSPECT AVE	None	SOUTH PASADENA	CA	91030	2420	19	06037	34.116579	-118.158501	Los Angeles County
73265	Fee-for-Service	1174915086	1174915086	1	1	BRODHEAD, CASEY D PYSD	4/17/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
73269	Fee-for-Service	1366580110	1366580110	1	1	BROWN, DANIEL J MD	11/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104513	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
73310	Fee-for-Service	1417441528	1417441528	1	1	BAADH, INDERBIR S MD	8/18/2021	207R00000X	NA	Other	026	PHYSICIANS	173495	None	None	0	In state provider	None	520 W I ST	None	LOS BANOS	CA	93635	4211	20	06039	37.06346603	-120.8593647	Merced County
73326	Fee-for-Service	1942741079	1942741079	1	1	BOYER, WILLIAM A LMFT	7/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	YCHOTHERAPY	1101 CALIFORNIA AVE	STE 100	CORONA	CA	92881	6470	33	06065	33.86171794	-117.5440764	Riverside County
73331	Fee-for-Service	1366607012	1366607012	1	1	BLAIR, CASSIDY F PHD	12/1/2008	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
73337	Fee-for-Service	1821280918	1821280918	1	1	BRENT DAVID TIMPERLEY M.D.	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
73350	Fee-for-Service	1982125332	1982125332	1	1	BALLINGER, SCOTT N PSYD	1/1/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
73397	Fee-for-Service	1013450196	1013450196	1	1	BARGHOUTY, RANA M CCC-SLP	11/4/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
73510	Fee-for-Service	1689839441	1689839441	1	1	BEBEN, TOMASZ MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113430	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
73513	Fee-for-Service	1205059144	1205059144	1	1	BHASIN, SWARANJIT S MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99418	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
73518	Fee-for-Service	1588996003	1588996003	1	1	BRADLEY C MCAFEE, MS, AUDIOL	2/3/2023	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	OGIST	3655 LOMITA BLVD	100	TORRANCE	CA	90505	1905	19	06037	33.81497113	-118.3489779	Los Angeles County
73542	Fee-for-Service	1295762995	1295762995	1	1	BARON, HELEN L MD	6/5/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79314	41	Internal Medicine	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
73545	Fee-for-Service	1982809877	1982809877	1	1	BRAGG, ELIZABETH A MD	8/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134893	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
73548	Fee-for-Service	1164500757	1164500757	1	1	BUI, LINH D MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83597	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
73556	Fee-for-Service	1629159397	1629159397	1	1	BROWN, HOSEA III MD	12/11/2002	207R00000X	NA	Other	026	PHYSICIANS	45164	41	Internal Medicine	0	In state provider	None	4477 W 118TH ST	STE 202	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
73558	Fee-for-Service	1841316213	1841316213	1	1	BLOCK, BRUCE MD	9/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77004	40	Pediatrics	0	In state provider	None	4145 CLARES ST	STE A	CAPITOLA	CA	95010	2053	44	06087	36.97837345	-121.964319	Santa Cruz County
73565	Fee-for-Service	1841392933	1841392933	1	1	BREAKFIELD, LAVAUGHAN L	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	840 S FAIRMONT AVE	STE 5	LODI	CA	95240	5105	39	06077	38.122992	-121.2858225	San Joaquin County
73615	Fee-for-Service	1154484160	1154484160	1	1	BECKER, MARC J PHD	2/26/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
73624	Fee-for-Service	1922269620	1922269620	1	1	BARR, CAMERON R MD	3/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109286	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
73656	Fee-for-Service	1649388257	1649388257	1	1	BAUMGARTEN, JANA M MD	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83172	25	Physical Medicine and Rehabilitation	0	In state provider	None	2080 CENTURY PARK EAST	STE 300	LOS ANGELES	CA	90067	2006	19	06037	34.05887194	-118.4122914	Los Angeles County
73660	Fee-for-Service	1336599638	1336599638	1	1	BT DRUGS INC	10/24/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14262 BEACH BLVD	None	WESTMINSTER	CA	92683	4562	30	06059	33.75494511	-117.9894376	Orange County
73700	Fee-for-Service	1972080752	1972080752	1	1	BORIS SHLOPOV MD PATHOLOGY M	3/28/2019	207ZP0102X	NA	Other	026	PHYSICIANS	None	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	EDICAL CORPORATION	800 S MAIN	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
73733	Fee-for-Service	1477032951	1477032951	1	1	BELL, BRIANA CCC-SLP	1/21/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	227 W D ST.	None	TEHACHAPI	CA	93561	2022	15	06029	35.12927568	-118.4509272	Kern County
73768	Fee-for-Service	1467739342	1467739342	1	1	BUIS, TOD S LCSW	6/25/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
73787	Fee-for-Service	1922271063	1922271063	1	1	BALETTE, ROBERT E MD	4/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48109	01	General Practice	0	In state provider	None	517 N MAIN ST	STE 100	SANTA ANA	CA	92701	4684	30	06059	33.74951945	-117.8675809	Orange County
73795	Fee-for-Service	1558065656	1558065656	1	1	BASTA, ANTONIOUS F DO	1/23/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23384	70	Clinic (mixed specialty)	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
73796	Fee-for-Service	1437380987	1437380987	1	1	BARROW, SANDRA MD	11/14/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	157688	41	Internal Medicine	0	In state provider	None	2301 CIRCADIAN WAY	STE A	SANTA ROSA	CA	95407	5457	49	06097	38.421936	-122.7533895	Sonoma County
73809	Fee-for-Service	1043644511	1043644511	1	1	BRYANT, IMANI R LCSW	1/7/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
73835	Fee-for-Service	1982809877	1982809877	1	1	BRAGG, ELIZABETH A MD	8/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134893	05	Anesthesiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
73846	Fee-for-Service	1629159397	1629159397	1	1	BROWN, HOSEA III MD	12/11/2002	207R00000X	NA	Other	026	PHYSICIANS	45164	08	Family Practice	0	In state provider	None	4477 W 118TH ST	STE 202	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
73865	Fee-for-Service	1063560951	1063560951	1	1	BALLAT, AMAL MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69756	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
73875	Fee-for-Service	1275560914	1275560914	1	1	BROCKMANN, DOUGLAS C MD	10/31/1993	207L00000X	NA	Other	026	PHYSICIANS	41371	05	Anesthesiology	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
73897	Fee-for-Service	1578980637	1578980637	1	1	BLAIR, CHERIE S MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139146	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
73902	Fee-for-Service	1477601300	1477601300	1	1	BRIGGS, NICOLE R OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3420 KENYON ST	None	SAN DIEGO	CA	92110	5001	37	06073	32.74894593	-117.2139252	San Diego County
73915	Fee-for-Service	1992142798	1992142798	1	1	BELL, ELIJAH J III MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143168	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
73972	Fee-for-Service	1225753932	1225753932	1	1	BRIGGS, HOLLY	10/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
73991	Fee-for-Service	1114961539	1114961539	1	1	BASCHARON, RANDA A DO	8/8/2006	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	INC	9280 W SUNSET RD	STE 422	LAS VEGAS	NV	89148	4862	00	None	36.07027746	-115.29495	Clark County
74004	Fee-for-Service	1063639102	1063639102	1	1	BUCHMANN, RYAN D LMFT	8/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	330 RANCHEROS DR	STE 218	SAN MARCOS	CA	92069	2978	37	06073	33.1388667	-117.1563523	San Diego County
74012	Fee-for-Service	1407801046	1407801046	1	1	BULLARD, CECIL H MD	3/18/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33803	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4770 W HERNDON AVE	None	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
74035	Fee-for-Service	1992985154	1992985154	1	1	BOYADJIAN, SARINE	5/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
74045	Fee-for-Service	1154401941	1154401941	1	44	BASS MEDICAL GROUP	6/23/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	350 30TH ST	208 & 210	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
74049	Fee-for-Service	1033485958	1033485958	1	1	BOWMAN, CHELSEA E MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127499	41	Internal Medicine	0	In state provider	None	919 SAN RAMON VALLEY RD	None	SAN RAMON	CA	94526	4050	07	06013	37.80740959	-121.9917956	Contra Costa County
74073	Fee-for-Service	1558065656	1558065656	1	1	BASTA, ANTONIOUS F DO	1/23/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23384	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
74112	Fee-for-Service	1265584924	1265584924	1	2	BENTON, CALVIN B MD	10/5/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	34382	-	NOT APPLICABLE	0	In state provider	None	795 FLETCHER LANE	None	HAYWARD	CA	94544	1008	01	06001	37.66549609	-122.080513	Alameda County
74122	Fee-for-Service	1689667057	1689667057	1	1	BROWN, DEBORAH S MD	7/3/1997	207L00000X	NA	Other	026	PHYSICIANS	62887	05	Anesthesiology	0	In state provider	None	4643 QUAIL LAKES DR	STE 204	STOCKTON	CA	95207	5269	39	06077	37.987092	-121.343391	San Joaquin County
74126	Fee-for-Service	1558381665	1558381665	1	1	BECK, EMILY A CNM	9/2/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
74146	Fee-for-Service	1821622895	1821622895	1	1	BENNETT, JAZMIN J CNP	8/14/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
74154	Fee-for-Service	1710039151	1710039151	1	1	BEYE, ANDREW A CRNA	3/30/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
74160	Fee-for-Service	1396897740	1396897740	1	1	BUEERMANN, DONALD W	12/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3951 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	3620	33	06065	33.92276786	-117.4483793	Riverside County
74161	Fee-for-Service	1104410174	1104410174	1	1	BRITTANY DWAN TAYLOR	3/11/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3557 LA CIOTAT WAY	None	RIVERSIDE	CA	92501	1226	33	06065	34.01483967	-117.3496396	Riverside County
74186	Fee-for-Service	1780755736	1780755736	1	1	BLOOM, BARRY S MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42962	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
74192	Fee-for-Service	1639477136	1639477136	1	1	BEROUKHIM, BEHNOUD MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117510	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
74200	Fee-for-Service	1073161162	1073161162	1	1	BRAND HOME HEALTH CARE INC	1/20/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	127 S BRAND BLVD	STE 208	GLENDALE	CA	91204	1372	19	06037	34.145289	-118.255096	Los Angeles County
74201	Fee-for-Service	1134166614	1134166614	1	1	BOUGHEY, JOAN CNP	3/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	30	06059	33.67620851	-117.7948348	Orange County
74224	Fee-for-Service	1437574092	1437574092	1	1	BEASLEY, JEFFREY S LMFT	7/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
74226	Fee-for-Service	1437592086	1437592086	1	1	BATTIKHI, HUDA S MD	2/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133948	40	Pediatrics	0	In state provider	None	1323 3RD AVE	None	CHULA VISTA	CA	91911	4302	37	06073	32.60538009	-117.0657621	San Diego County
74244	Fee-for-Service	1932234838	1932234838	1	1	BRENTAR, JOHN T PHD	3/14/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
74262	Fee-for-Service	1538246939	1538246939	1	1	BONE, PLACID A MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132534	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
74284	Fee-for-Service	1629192133	1629192133	1	1	BEVERLY, SHEREEN L MD	10/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68251	None	None	0	In state provider	INC	16812 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	3218	19	06037	33.878061	-118.3523735	Los Angeles County
74294	Fee-for-Service	1033689740	1033689740	1	1	BRAICH, ALEX S PT	10/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
74310	Fee-for-Service	1215102512	1215102512	2	1	BRIGHT EXPECTATIONS INC	9/9/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3921 MANCHESTER PLACE	None	RIVERSIDE	CA	92503	4025	33	06065	33.92865088	-117.4370331	Riverside County
74332	Fee-for-Service	1154401941	1154401941	1	44	BASS MEDICAL GROUP	9/1/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	350 30TH ST	208 & 210	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
74341	Fee-for-Service	1265677231	1265677231	1	1	BERGMAN, LYNN L LMFT	7/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	633 CHERRY ST	None	SANTA ROSA	CA	95404	4202	49	06097	38.44485	-122.7159	Sonoma County
74375	Fee-for-Service	1902323827	1902323827	1	1	BAER, RITA T LMFT INC	6/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18917 NORDHOFF ST	STE 18	NORTHRIDGE	CA	91324	4823	19	06037	34.23552853	-118.5456555	Los Angeles County
74399	Fee-for-Service	1265584924	1265584924	1	1	BENTON, CALVIN B MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	34382	02	General Surgery	0	In state provider	None	3031 TELEGRAPH AVE	STE 217	BERKELEY	CA	94705	2053	01	06001	37.85506766	-122.259871	Alameda County
74416	Fee-for-Service	1205914884	1205914884	1	1	BLACKMAN, SPENCER L MD	5/14/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	88542	08	Family Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
74451	Fee-for-Service	1104410174	1104410174	1	1	BRITTANY DWAN TAYLOR	3/11/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3557 LA CIOTAT WAY	None	RIVERSIDE	CA	92501	1226	33	06065	34.01483967	-117.3496396	Riverside County
74466	Fee-for-Service	1134600067	1134600067	1	1	BROWN, ANAIS M CCC-SLP	8/27/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
74480	Fee-for-Service	1972051811	1972051811	1	1	BUCHANAN MARRIAGE AND FAMILY	8/26/2019	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	THERAPY SERVICES, PC	4609 HIGHWAY 49 S	None	MARIPOSA	CA	95338	9701	22	06043	37.46040251	-119.9443914	Mariposa County
74489	Fee-for-Service	1326573015	1326573015	1	1	BURLEY, SELENE LMFT	5/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	73550 ALESSANDRO DR	200	PALM DESERT	CA	92260	3613	33	06065	33.72240897	-116.381407	Riverside County
74522	Fee-for-Service	1730147547	1730147547	1	1	BABBEL, ROBERT W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2314 NW KINGS BLVD	# A	CORVALLIS	OR	97330	3925	00	None	44.59018248	-123.2774548	Benton County
74523	Fee-for-Service	1861566465	1861566465	1	1	BERGOFFEN, JOANN MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76310	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
74525	Fee-for-Service	1134176381	1134176381	1	1	BALUYOT, LESLIE C MD	8/8/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	77685	41	Internal Medicine	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
74549	Fee-for-Service	1033119516	1033119516	1	1	BARNES, NATHANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 BLOSSOM ST	STE 220	WEBSTER	TX	77598	4243	00	None	29.54375473	-95.1259397	Harris County
74561	Fee-for-Service	1245895317	1245895317	1	1	BROYLES, JESSE A DO	7/13/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
74615	Fee-for-Service	1437671757	1437671757	1	1	BROWN, NATASHA MD	7/9/2021	207P00000X	NA	Other	026	PHYSICIANS	171583	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
74622	Fee-for-Service	1154401941	1154401941	1	44	BASS MEDICAL GROUP	6/23/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	350 30TH ST	208 & 210	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
74627	Fee-for-Service	1770913428	1770913428	1	1	BRANDON GREENE	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 KOOTENAI HEALTH WAY	None	COEUR D ALENE	ID	83814	6051	00	None	47.695635	-116.792906	Kootenai County
74629	Fee-for-Service	1952557316	1952557316	1	1	BALEK, MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5645 MAIN ST	None	FLUSHING	NY	11355	5045	00	None	40.746969	-73.825713	Queens County
74656	Fee-for-Service	1235305947	1235305947	1	1	BATENI, CYRUS P MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103267	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
74673	Fee-for-Service	1114962792	1114962792	1	1	BOON, TERI TARABINO MD	6/30/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64151	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
74718	Fee-for-Service	1265584924	1265584924	1	3	BENTON, CALVIN B MD	5/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	34382	-	NOT APPLICABLE	0	In state provider	None	1143 MISSOURI STREET	None	FAIRFIELD	CA	94533	6007	48	06095	38.24811247	-122.048307	Solano County
74753	Fee-for-Service	1851615603	1851615603	1	1	BUTERA, ANNA-MARIA DO	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11928	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
74759	Fee-for-Service	1831956911	1831956911	1	1	BERG, ELLEY TAYLOR LMFT	4/11/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
74786	Fee-for-Service	1093813743	1093813743	1	1	BARUTI SERABE	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	765 W INTERSTATE AVE	None	BISMARCK	ND	58503	1179	00	None	46.832112	-100.8031005	Burleigh County
74787	Fee-for-Service	1851450936	1851450936	1	1	BATCHELDER, ASHLEY L	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
74814	Fee-for-Service	1134176381	1134176381	1	1	BALUYOT, LESLIE C MD	8/8/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	77685	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
74818	Fee-for-Service	1265637227	1265637227	1	1	BANGSUND, PETER J MD	8/22/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	123857	10	Gastroenterology (M.D. only)	0	In state provider	None	111 RALEY BLVD	STE 100	CHICO	CA	95928	8347	04	06007	39.71601447	-121.790817	Butte County
74819	Fee-for-Service	1841726643	1841726643	1	1	BINGHAM, MICHAEL MD	3/26/2020	207L00000X	NA	Other	026	PHYSICIANS	147363	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
74908	Fee-for-Service	1154401941	1154401941	1	44	BASS MEDICAL GROUP	6/23/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	350 30TH ST	208 & 210	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
74929	Fee-for-Service	1427733831	1427733831	1	1	BASKETT, BRIAHNA	10/3/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
74940	Fee-for-Service	1730735853	1730735853	1	1	BOTTING, JULIANA M PT	5/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
74957	Fee-for-Service	1215096540	1215096540	1	1	BURNS, ROBERT J OD	1/1/1982	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5239 PROSPECT RD	None	SAN JOSE	CA	95129	5019	43	06085	37.29208179	-121.9938173	Santa Clara County
74974	Fee-for-Service	1285071894	1285071894	1	1	BANGASH, KAYHAN A MD	6/25/2021	207P00000X	NA	Other	026	PHYSICIANS	170260	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
74980	Fee-for-Service	1619116142	1619116142	1	1	BEADLE, BETH M MD	1/1/2017	2085R0001X	NA	Other	026	PHYSICIANS	143707	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
74984	Fee-for-Service	1518913250	1518913250	1	1	BRET,LINDSAY D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 COMMONS WAY	None	KALISPELL	MT	59901	0000	00	None	48.22137	-114.327819	Flathead County
74992	Fee-for-Service	1730649021	1730649021	1	1	BURCH, ELIZABETH L MD	6/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178711	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
75000	Fee-for-Service	1346779378	1346779378	1	1	BARBE, ROXANNE NP	1/13/2025	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
75044	Fee-for-Service	1467644187	1467644187	1	1	BLUCK, SCOTT L DO	12/26/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9096	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
75054	Fee-for-Service	1902888084	1902888084	1	1	BAUTISTA, ROGER M DO	9/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9319	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3293	10	06019	36.56881144	-119.5985344	Fresno County
75064	Fee-for-Service	1851439053	1851439053	1	1	BAART BEHAVIORAL HEALTH SERV	10/20/1981	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	4920 AVALON BLVD	None	LOS ANGELES	CA	90011	4004	19	06037	33.998157	-118.265212	Los Angeles County
75070	Fee-for-Service	1477272250	1477272250	1	1	BLACKNEY, LINH LMFT	6/6/2024	390200000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	232 W MAIN ST	#103	TUSTIN	CA	92780	7721	30	06059	33.74205326	-117.8256506	Orange County
75074	Fee-for-Service	1730318452	1730318452	1	1	BHARDWAJ, RAHUL MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	110715	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
75099	Fee-for-Service	1578707642	1578707642	1	1	BARKHOUDARIAN, GARNI MD	9/13/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	98984	None	None	0	In state provider	None	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
75107	Fee-for-Service	1265637227	1265637227	1	1	BANGSUND, PETER J MD	8/22/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	123857	41	Internal Medicine	0	In state provider	None	111 RALEY BLVD	STE 100	CHICO	CA	95928	8347	04	06007	39.71601447	-121.790817	Butte County
75158	Fee-for-Service	1124062294	1124062294	1	1	BAILEY, M HUGH MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48435	24	Plastic Surgery	0	In state provider	None	351 HOSPITAL RD	STE 617	NEWPORT BEACH	CA	92663	3508	30	06059	33.62579141	-117.9299554	Orange County
75160	Fee-for-Service	1235201054	1235201054	1	1	BELARDINELLI, DAWN M MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74918	40	Pediatrics	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
75169	Fee-for-Service	1598858896	1598858896	1	1	BROWN, SCOTT L MD APC	3/15/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	8851 CENTER DR	STE 502	LA MESA	CA	91942	3059	37	06073	32.78189749	-117.0075062	San Diego County
75177	Fee-for-Service	1346694411	1346694411	1	1	BASU, ARUNABHA MD	1/16/2023	207L00000X	NA	Other	026	PHYSICIANS	173171	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
75188	Fee-for-Service	1154401941	1154401941	1	10	BASS MEDICAL GROUP	8/15/2022	213ES0103X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2914 W MAIN ST	None	VISALIA	CA	93291	5731	54	06107	36.330075	-119.323458	Tulare County
75194	Fee-for-Service	1154401941	1154401941	1	44	BASS MEDICAL GROUP	8/15/2022	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	350 30TH ST	208 & 210	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
75199	Fee-for-Service	1295761229	1295761229	1	1	BHAT, RAJESH K MD	8/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88819	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
75227	Fee-for-Service	1962457812	1962457812	1	58	BEVERLY RADIOLOGY MEDICAL GR	9/3/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	25395 HANCOCK AVE	#200	MURRIETA	CA	92562	9054	33	06065	33.5591482	-117.185187	Riverside County
75235	Fee-for-Service	1952477432	1952477432	1	1	BANTUG, CONCEPCION MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55561	40	Pediatrics	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
75308	Fee-for-Service	1326185018	1326185018	1	1	BRACHO, PAUL R LCSW	9/2/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
75326	Fee-for-Service	1790855708	1790855708	1	1	BANNAN, BARBARA J MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68640	01	General Practice	0	In state provider	None	9515 SOQUEL DR	STE 100	APTOS	CA	95003	4135	44	06087	36.9753751	-121.8848219	Santa Cruz County
75343	Fee-for-Service	1154880144	1154880144	1	1	BARNHART, JOHN C MD	7/3/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180630	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
75361	Fee-for-Service	1659344471	1659344471	1	1	BOORMAN, DAVID C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	STE 4100	ST GEORGE	UT	84790	2156	00	None	37.097622	-113.553828	Washington County
75372	Fee-for-Service	1205837200	1205837200	1	1	BALLARD JEFFREY L	5/31/1991	208600000X	NA	General Surgery	026	PHYSICIANS	61836	None	None	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
75393	Fee-for-Service	1275692857	1275692857	1	1	BUCCIGROSSI, DAVID E MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60391	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
75397	Fee-for-Service	1437474277	1437474277	1	1	BERGHEIM, MARIANNE MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113464	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
75402	Fee-for-Service	1942445895	1942445895	1	1	BAIRDAIN, SIGRID MD	12/5/2019	208600000X	NA	General Surgery	026	PHYSICIANS	162578	89	Surgery-Traumatic	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
75442	Fee-for-Service	1619594660	1619594660	1	1	BURTS SPECIALTY PHARMACY	7/30/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2628 CONEJO CENTER	None	THOUSAND OAKS	CA	91320	1407	56	06111	34.19915851	-118.9325385	Ventura County
75457	Fee-for-Service	1982018297	1982018297	1	1	BARNES, RICHARD LMFT	12/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
75475	Fee-for-Service	1154401941	1154401941	1	10	BASS MEDICAL GROUP	10/13/2020	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2914 W MAIN ST	None	VISALIA	CA	93291	5731	54	06107	36.330075	-119.323458	Tulare County
75520	Fee-for-Service	1326626516	1326626516	1	1	BRODSKY, KELCIE PT	4/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2335 VISTA WAY	None	OCEANSIDE	CA	92054	5663	37	06073	33.18316476	-117.3365251	San Diego County
75531	Fee-for-Service	1013052513	1013052513	1	1	BHATI, MAHENDRA T MD	12/7/2016	2084P0800X	NA	Psychiatry	026	PHYSICIANS	141001	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75548	Fee-for-Service	1235224593	1235224593	1	1	BODY CENTER PHYSICAL THERAPY	7/7/2023	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RAPY AND PILATES	224 N INDIAN HILL BLVD	None	CLAREMONT	CA	91711	4609	19	06037	34.09607063	-117.7192866	Los Angeles County
75570	Fee-for-Service	1578509113	1578509113	1	1	BELANI, RAJESH MD	6/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77944	78	Neoplastic Diseases/Oncology	0	In state provider	None	3075 HEALTH CENTER DR	STE 102	SAN DIEGO	CA	92123	2773	37	06073	32.79963065	-117.1556197	San Diego County
75577	Fee-for-Service	1275562431	1275562431	1	1	BEN-ARI, RON	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63320	41	Internal Medicine	0	In state provider	None	2775 W PICO BLVD	None	LOS ANGELES	CA	90006	3913	19	06037	34.0472705	-118.299798	Los Angeles County
75583	Fee-for-Service	1598296147	1598296147	1	1	BERG, CHRISTOPHER J	10/11/2022	207R00000X	NA	Other	026	PHYSICIANS	160087	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
75597	Fee-for-Service	1346744588	1346744588	1	1	BLOTTE, CAROLINA MD	11/22/2022	207L00000X	NA	Other	026	PHYSICIANS	177181	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
75602	Fee-for-Service	1700536067	1700536067	1	1	BOURI, NATALIE R MD	3/26/2025	207R00000X	NA	Other	026	PHYSICIANS	188986	41	Internal Medicine	0	In state provider	None	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
75642	Fee-for-Service	1679651590	1679651590	1	1	BEYNET, DAVID P MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95507	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
75690	Fee-for-Service	1073798757	1073798757	1	1	BOGLE,ANGELA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2640	00	None	39.08455286	-94.57578107	Jackson County
75700	Fee-for-Service	1225475882	1225475882	1	1	BENAVIDEZ, CASSANDRA O LMFT	6/16/2022	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
75758	Fee-for-Service	1003094699	1003094699	1	1	BEHRINGER, DEBORAH L MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98033	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
75764	Fee-for-Service	1154401941	1154401941	1	10	BASS MEDICAL GROUP	2/25/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2914 W MAIN ST	None	VISALIA	CA	93291	5731	54	06107	36.330075	-119.323458	Tulare County
75804	Fee-for-Service	1417449786	1417449786	1	1	BOYAJIAN, CHRISTINE DO	10/16/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21768	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
75807	Fee-for-Service	1700974920	1700974920	1	1	BASHIRI, NASRIN MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64418	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
75808	Fee-for-Service	1306941620	1306941620	1	1	BLOOM, ERNEST MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	56359	07	Dermatology	0	In state provider	None	501 S SHORE CENTER WEST	None	ALAMEDA	CA	94501	5701	01	06001	37.75884896	-122.2528366	Alameda County
75834	Fee-for-Service	1508072034	1508072034	1	1	BRAEWOOD HOME HEALTH, INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8215 VAN NUYS BLVD	SUITE 300-301	PANORAMA CITY	CA	91402	4810	19	06037	34.22026244	-118.4488066	Los Angeles County
75845	Fee-for-Service	1063897221	1063897221	1	2	BONITO INPATIENT SERVICES	9/14/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	LLC	2075 EAST FLAMINGO RD	None	LAS VEGAS	NV	89119	5188	00	None	36.112671	-115.1248725	Clark County
75852	Fee-for-Service	1730225418	1730225418	1	1	BENDER, NICOLE M	2/17/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	98184	None	None	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
75855	Fee-for-Service	1245234962	1245234962	1	1	BRUSETT, KENT A	10/4/2010	208600000X	NA	General Surgery	026	PHYSICIANS	86006	None	None	0	In state provider	None	1555 EAST STREET	STE 220	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
75858	Fee-for-Service	1578509113	1578509113	1	1	BELANI, RAJESH MD	6/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77944	68	Hematology	0	In state provider	None	3075 HEALTH CENTER DR	STE 102	SAN DIEGO	CA	92123	2773	37	06073	32.79963065	-117.1556197	San Diego County
75898	Fee-for-Service	1174502009	1174502009	1	1	BOLD, EDWARD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11563	41	Internal Medicine	0	In state provider	None	23451 MADISON ST	STE 280	TORRANCE	CA	90505	4763	19	06037	33.81197627	-118.3478154	Los Angeles County
75919	Fee-for-Service	1790820942	1790820942	1	1	BONNER, JULIE C MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80278	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75963	Fee-for-Service	1982182853	1982182853	1	1	BALEN-GARCIA, DANETTE L LMFT	8/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	VICES	6610 MELBA AVE	None	WEST HILLS	CA	91307	3409	19	06037	34.19020917	-118.6335186	Los Angeles County
76003	Fee-for-Service	1811928484	1811928484	1	1	BARAKAT, SAWSAN N MD	2/28/1989	174400000X	NA	Other	026	PHYSICIANS	43624	None	None	0	In state provider	None	18840 VENTURA BLVD	SUITE216	TARZANA	CA	91356	3301	19	06037	34.17204394	-118.5442921	Los Angeles County
76017	Fee-for-Service	1750762183	1750762183	1	1	BURNS-BENGGON, JENNIFER MD	7/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144180	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
76019	Fee-for-Service	1184946543	1184946543	1	1	BOPARAI, KIRANDEEP K PT	12/12/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1110 CIVIC CENTER BLVD	STE 502	YUBA CITY	CA	95993	3013	51	06101	39.143016	-121.639237	Sutter County
76052	Fee-for-Service	1124124938	1124124938	1	1	BRAUN, BENJAMIN S MD	12/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71979	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
76087	Fee-for-Service	1649267295	1649267295	1	1	BELTRAN, ARMANDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2022 MURCHISON DR	None	EL PASO	TX	79902	3058	00	None	31.78323549	-106.4739825	El Paso County
76112	Fee-for-Service	1629137385	1629137385	1	1	BOST, CONNELL W MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72670	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
76119	Fee-for-Service	1932120235	1932120235	1	1	BIITTNER, MARK MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65830	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
76159	Fee-for-Service	1780669838	1780669838	1	1	BALLECER, RONALDO A MD	2/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34864	05	Anesthesiology	0	In state provider	INC	1383 E HERNDON AVE	STE 105	FRESNO	CA	93720	3302	10	06019	36.83690167	-119.7635813	Fresno County
76171	Fee-for-Service	1548469117	1548469117	1	1	BEREGOVSKAYA, OLGA V MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	93529	41	Internal Medicine	0	In state provider	None	7355 N PALM AVE	STE 100	FRESNO	CA	93711	5770	10	06019	36.84318769	-119.8097047	Fresno County
76176	Fee-for-Service	1083054068	1083054068	1	1	BAKER, SHATAYIA M LCSW	4/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
76188	Fee-for-Service	1174502009	1174502009	1	1	BOLD, EDWARD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11563	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	23451 MADISON ST	STE 280	TORRANCE	CA	90505	4763	19	06037	33.81197627	-118.3478154	Los Angeles County
76197	Fee-for-Service	1124344130	1124344130	1	1	BONGIOVANNI, TASCE R MD	4/24/2018	208600000X	NA	General Surgery	026	PHYSICIANS	119598	89	Surgery-Traumatic	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
76211	Fee-for-Service	1144519497	1144519497	1	1	BERNING, AMBER A MD	1/1/2018	207ZP0102X	NA	Other	026	PHYSICIANS	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
76213	Fee-for-Service	1790780997	1790780997	1	1	BIEDERMAN, BRUCE J MD	6/18/2009	2085B0100X	NA	MRI Provider	026	PHYSICIANS	52940	30	Radiology	0	In state provider	None	3156 VISTA WY	STE 100	OCEANSIDE	CA	92056	3694	37	06073	33.18255249	-117.3250703	San Diego County
76256	Fee-for-Service	1356553564	1356553564	1	1	BRIGHTLIFE INTERNATIONAL	12/22/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	BRIGHTLIFE INTERNATIONAL	11633 S HAWTHORNE BLVD	STE 216	HAWTHORNE	CA	90250	2321	19	06037	33.928488	-118.3527475	Los Angeles County
76259	Fee-for-Service	1184201006	1184201006	1	1	BANUELOS MOTA, ANDREA MD	10/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192199	08	Family Practice	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
76267	Fee-for-Service	1790163863	1790163863	1	1	BROWN, MICHAEL D DO	6/26/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18292	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76268	Fee-for-Service	1619371804	1619371804	1	1	BEST CHOICE HOSPICE INC	3/22/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3111 LOS FELIZ BLVD	SUITE 214	LOS ANGELES	CA	90039	1599	19	06037	34.12432566	-118.2669792	Los Angeles County
76310	Fee-for-Service	1922022078	1922022078	1	1	BRAUN, ARMAND MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137000	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
76324	Fee-for-Service	1356758346	1356758346	1	1	BARLOW, RYAN B DO	7/31/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	14110	None	None	0	In state provider	None	11938 PARAMOUNT BLVD.	None	DOWNEY	CA	90242	2306	19	06037	33.93385032	-118.1444253	Los Angeles County
76351	Fee-for-Service	1053613711	1053613711	1	1	BASHIR, MUHAMMAD H MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115993	None	None	0	In state provider	None	5043 E KINGS CANYON RD	#101	FRESNO	CA	93727	3962	10	06019	36.73599961	-119.725504	Fresno County
76361	Fee-for-Service	1386638153	1386638153	1	1	BURSTEIN, STEVEN MD	8/30/1990	174400000X	NA	Other	026	PHYSICIANS	49626	41	Internal Medicine	0	In state provider	None	1510 SAN PABLO ST	STE 451	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
76376	Fee-for-Service	1962457812	1962457812	1	168	BEVERLY RADIOLOGY MEDICAL GR	1/16/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	NG	18856 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2323	36	06071	34.5378383	-117.2528329	San Bernardino County
76393	Fee-for-Service	1215375712	1215375712	1	1	BEECHER-FLAD, JULIA LMFT	9/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
76400	Fee-for-Service	1720351208	1720351208	1	1	BERNSTEIN, ROBERT F MD AMC	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37476	06	Cardiovascular Disease (M.D. only)	0	In state provider	A MEDICAL CORPORATION	555 E TACHEVAH DRIVE	BLDG 1 WEST STE 202	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
76408	Fee-for-Service	1649303462	1649303462	1	1	BLAKLEY, DAVID C DC	8/24/2018	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 300	DONWEY	CA	90720	3309	19	06037	33.93622932	-118.1311752	Los Angeles County
76428	Fee-for-Service	1326091208	1326091208	1	1	BAEHNER, FREDERICK L MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68894	90	Pathology-Forensic	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
76429	Fee-for-Service	1427250752	1427250752	1	1	BLUM, MARTHA L MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87632	41	Internal Medicine	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	7759	27	06053	36.65911769	-121.6448024	Monterey County
76448	Fee-for-Service	1346702404	1346702404	1	1	BROWN, WHITNEY K NP	9/18/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76466	Fee-for-Service	1295842243	1295842243	1	1	BIERMAN, BERNARD M MD	2/28/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	80589	36	Psychiatry	0	In state provider	None	401 S TUSTIN ST	None	ORANGE	CA	92866	2503	30	06059	33.782094	-117.8357215	Orange County
76473	Fee-for-Service	1003261645	1003261645	1	1	BEHAVIORAL HEALTH SERVICES	12/15/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	514 W PACIFIC COAST HWY	None	LONG BEACH	CA	90806	5237	19	06037	33.78983955	-118.1985075	Los Angeles County
76474	Fee-for-Service	1992267686	1992267686	1	1	BOYLE, MICHAEL J MD	7/21/2023	207P00000X	NA	Other	026	PHYSICIANS	181368	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
76483	Fee-for-Service	1679625891	1679625891	1	1	BARTOS, MICHAEL R MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	39368	36	Psychiatry	0	In state provider	PERMANENTE MEDICAL GROUP	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
76487	Fee-for-Service	1336450436	1336450436	1	1	BASS, MARTHA A	2/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12281 KNOTT ST	STE 103	GARDEN GROVE	CA	92841	3939	30	06059	33.78524517	-118.0112189	Orange County
76508	Fee-for-Service	1437261989	1437261989	1	1	BELANGER, JOSEE MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50315	01	General Practice	0	In state provider	None	1301 MISSION ST	None	SANTA CRUZ	CA	95060	3530	44	06087	36.96817615	-122.0381947	Santa Cruz County
76541	Fee-for-Service	1063768778	1063768778	1	1	BLENGGIO MARTINEZ, TERESA L	6/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
76547	Fee-for-Service	1609602572	1609602572	1	1	BARTOLOME, FAYEMARIE H AU	10/22/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
76555	Fee-for-Service	1619371804	1619371804	1	1	BEST CHOICE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3111 LOS FELIZ BLVD	SUITE 214	LOS ANGELES	CA	90039	1599	19	06037	34.12432566	-118.2669792	Los Angeles County
76588	Fee-for-Service	1801282280	1801282280	1	1	BOYLE, KELLY MD	8/18/2023	208600000X	NA	General Surgery	026	PHYSICIANS	180297	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
76668	Fee-for-Service	1740503416	1740503416	1	1	BRECHEISEN, MARK D JR DO	8/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
76688	Fee-for-Service	1043527211	1043527211	1	1	BIGLARIPOOR, ROSY LMFT	12/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4100 MOORPARK AVE	STE 106	SAN JOSE	CA	95117	1707	43	06085	37.31582653	-121.974174	Santa Clara County
76706	Fee-for-Service	1801428107	1801428107	1	1	BRAVO, STEPHANIE V CNP	2/10/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	36	06071	34.54034956	-117.2645069	San Bernardino County
76714	Fee-for-Service	1326091208	1326091208	1	1	BAEHNER, FREDERICK L MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68894	22	Pathology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
76716	Fee-for-Service	1427250752	1427250752	1	1	BLUM, MARTHA L MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87632	77	Infectious Disease	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	7759	27	06053	36.65911769	-121.6448024	Monterey County
76755	Fee-for-Service	1063679017	1063679017	1	1	BERGER, CHRISTOPHER E	8/24/2018	2084P0015X	NA	Psychiatry	026	PHYSICIANS	113239	None	None	0	In state provider	None	150 E HOLT BLVD	None	ONTARIO	CA	91761	1613	36	06071	34.063164	-117.6502275	San Bernardino County
76757	Fee-for-Service	1609895192	1609895192	1	1	BARAN, JOSEPH JR MD	2/27/2009	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	71723	41	Internal Medicine	0	In state provider	None	5550 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2307	37	06073	32.74809744	-117.0773303	San Diego County
76774	Fee-for-Service	1306341953	1306341953	1	1	BYUN, JAMIE MD	6/22/2022	390200000X	NA	Other	026	PHYSICIANS	178102	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
76848	Fee-for-Service	1609077130	1609077130	1	1	BAHNMILLER, DARLENE K CNM	2/2/2009	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0725	36	06071	34.5406159	-117.2658221	San Bernardino County
76858	Fee-for-Service	1437417276	1437417276	1	1	BUCKEYE UNION SCHOOL	7/1/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5049 ROBERT J MATTHEWS	None	EL DORADO HILLS	CA	95762	0000	09	06017	38.62296065	-121.0583958	El Dorado County
76860	Fee-for-Service	1265567606	1265567606	1	1	BOLINGER, TODD FRANKLIN	8/10/1994	302R00000X	NA	Other	026	PHYSICIANS	79612	36	Psychiatry	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
76864	Fee-for-Service	1811382260	1811382260	1	1	BUI, CANDY LMFT	2/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
76868	Fee-for-Service	1881006955	1881006955	1	1	BOTTA, GREGORY P MD	8/5/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	140495	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
76897	Fee-for-Service	1265483176	1265483176	1	1	BIRNBAUM,JONATHAN R MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66598	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5772 BOLSA AVE	STE 250	HUNTINGTON BEACH	CA	92649	1176	30	06059	33.74435559	-118.0280994	Orange County
76905	Fee-for-Service	1467489435	1467489435	1	1	BRENNER, ANDREW S MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
76924	Fee-for-Service	1215176839	1215176839	1	1	BLASKIEWICZ, DONALD J MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109748	14	Neurological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
76936	Fee-for-Service	1538704812	1538704812	1	1	BASS, LAURA LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1010 N CENTRAL AVE	SUITE 310	GLENDALE	CA	91202	2937	19	06037	34.16012317	-118.2571026	Los Angeles County
76944	Fee-for-Service	1205031077	1205031077	1	1	BOWMAN, ZACHARY S MD	9/3/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	105811	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1625 STOCKTON BLVD	STE 205	SACRAMENTO	CA	95816	7092	34	06067	38.56554	-121.4664615	Sacramento County
76945	Fee-for-Service	1396528931	1396528931	1	1	BLACKWOOD, SANDRA L CD	9/29/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
76954	Fee-for-Service	1659574622	1659574622	1	1	BRATT, MAYA NP	4/26/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
76955	Fee-for-Service	1497996318	1497996318	1	1	BLOCK, DINA R MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136131	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
76984	Fee-for-Service	1518141142	1518141142	1	1	BEATTY, MEGAN MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101174	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
76986	Fee-for-Service	1265921688	1265921688	1	1	BUJNAK, ALYSSA C MD	8/1/2022	390200000X	NA	Other	026	PHYSICIANS	166588	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
76997	Fee-for-Service	1740511682	1740511682	1	1	BEKOWIES, MIRABAI R	12/7/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
77020	Fee-for-Service	1992739692	1992739692	1	1	BAIRD, MICHELLE D CNM	12/27/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
77038	Fee-for-Service	1518461409	1518461409	1	1	BROWN, KELSEY E	7/2/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
77040	Fee-for-Service	1912909912	1912909912	1	1	BRFHH SHREVEPORT LLC	1/17/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1541 KINGS HWY	None	SHREVEPORT	LA	71103	4228	00	None	32.4817527	-93.76189829	Caddo Parish
77047	Fee-for-Service	1609806744	1609806744	1	1	BUI, STEPHANIE K MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54228	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
77061	Fee-for-Service	1427635556	1427635556	1	1	BOBB, BRANDYN MD	11/10/2023	207PE0004X	NA	Other	026	PHYSICIANS	187634	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
77068	Fee-for-Service	1407315534	1407315534	1	1	BAGLEY, SHELLEY R PT	6/6/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
77080	Fee-for-Service	1720197361	1720197361	1	1	BOURGOIN, MICHAEL P OD	7/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1835 NEWPORT BLVD	SUITE A111	COSTA MESA	CA	92627	5032	30	06059	33.64060991	-117.9194274	Orange County
77094	Fee-for-Service	1972080752	1972080752	1	5	BORIS SHLOPOV MD PATHOLOGY M	11/14/2022	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	EDICAL CORPORATION	800 S MAIN	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
77132	Fee-for-Service	1437282936	1437282936	1	1	BAMSHAD, BABAK R MD INC	5/24/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81239	34	Urology and Urological Surgery	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
77133	Fee-for-Service	1861503070	1861503070	1	1	BRINDA DESIRAJU M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	115 1/2 REMSEN STREET	None	BROOKLYN	NY	11201	0000	00	None	40.69393247	-73.99373307	Kings County
77135	Fee-for-Service	1154071447	1154071447	1	1	BECKMAN, JESSICA J OD	2/4/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44139 MONTEREY AVE	A	PALM DESERT	CA	92260	8700	33	06065	33.728004	-116.3912775	Riverside County
77139	Fee-for-Service	1699885350	1699885350	1	1	BEL AIR PAHRMACY #516	2/2/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5100 LAGUNA BLVD	None	ELK GROVE	CA	95758	4159	34	06067	38.422224	-121.445415	Sacramento County
77143	Fee-for-Service	1710608336	1710608336	1	1	BUGBEE, JESSIE	12/6/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	733 CEDAR STREET	None	GARBERVILLE	CA	95542	3201	12	06023	40.10148699	-123.7927018	Humboldt County
77154	Fee-for-Service	1194055640	1194055640	1	1	BABAKHANIAN, ZAREE MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109953	10	Gastroenterology (M.D. only)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
77155	Fee-for-Service	1881006955	1881006955	1	1	BOTTA, GREGORY P MD	8/5/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	140495	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
77159	Fee-for-Service	1700943123	1700943123	1	1	BRANDT, JENNIFER PHD	7/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
77161	Fee-for-Service	1841437399	1841437399	1	1	BLANCAS, CHRISTINA LMFT	7/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	STE 202	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
77188	Fee-for-Service	1548489024	1548489024	1	1	BLOODSOURCE INCORPORATED	1/1/1979	291U00000X	NA	Other	004	BLOOD BANKS	-	-	NOT APPLICABLE	0	In state provider	None	10536 PETER MCCUEN BLVD	None	MATHER	CA	95655	9905	34	06067	38.570805	-121.296537	Sacramento County
77214	Fee-for-Service	1154376283	1154376283	1	1	BAKER, BRADLEY R OD	9/15/1982	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	516 JAY ST	None	COLUSA	CA	95932	2436	06	06011	39.2132737	-122.0087611	Colusa County
77215	Fee-for-Service	1447327739	1447327739	1	1	BLUMBERG, DEAN PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 FILLMORE STREET	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
77221	Fee-for-Service	1588979942	1588979942	1	1	BERG, REGAN J MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113575	02	General Surgery	0	In state provider	None	1510 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
77283	Fee-for-Service	1275903205	1275903205	1	1	BOXER, OREN R PHD A	4/3/2015	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGICAL CORPORATIO	595 E COLORADO BLVD	MEZZANINE	PASADENA	CA	91101	2039	19	06037	34.14588202	-118.1380722	Los Angeles County
77287	Fee-for-Service	1093102279	1093102279	1	1	BUI, CHRISTINE M MD	7/6/2023	208M00000X	NA	Other	026	PHYSICIANS	161697	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
77297	Fee-for-Service	1952412520	1952412520	1	1	BRAYER, TONI J MD	10/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52709	41	Internal Medicine	0	In state provider	None	1375 SUTTER ST	#308	SAN FRANCISCO	CA	94109	5466	38	06075	37.78738239	-122.4229066	San Francisco County
77329	Fee-for-Service	1912909912	1912909912	1	1	BRFHH SHREVEPORT LLC	1/17/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1541 KINGS HWY	None	SHREVEPORT	LA	71103	4228	00	None	32.4817527	-93.76189829	Caddo Parish
77331	Fee-for-Service	1942683396	1942683396	1	1	BRIGEL, FAITH W LCSW	7/28/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	700 E EL CAMINO REAL	SUITE 100	MOUNTAIN VIEW	CA	94040	2805	43	06085	37.37713035	-122.0645303	Santa Clara County
77334	Fee-for-Service	1609806744	1609806744	1	1	BUI, STEPHANIE K MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54228	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
77345	Fee-for-Service	1043390040	1043390040	1	1	BAJWA, SAIF U MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66948	41	Internal Medicine	0	In state provider	-	16800 LAKESHORE DR	SUITE 2	LAKE ELSINORE	CA	92530	4909	33	06065	33.68537076	-117.3679118	Riverside County
77353	Fee-for-Service	1841604436	1841604436	1	1	BLANKENBECKLER, MELISSA C MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124194	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
77359	Fee-for-Service	1558411686	1558411686	1	1	BELZER & GRUNHAUS-BELZER PSY	9/26/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4550 KEARNY VILLA RD.	# 109	SAN DIEGO	CA	92123	1578	37	06073	32.82271596	-117.1441359	San Diego County
77375	Fee-for-Service	1255067690	1255067690	1	1	BATTAR, PALLAVI S CNP	11/30/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
77384	Fee-for-Service	1659459196	1659459196	1	1	BERRANG, JOSEPH A MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51870	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
77401	Fee-for-Service	1871767384	1871767384	1	1	BALLAS, JERASIMOS	7/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112607	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
77421	Fee-for-Service	1437282936	1437282936	1	1	BAMSHAD, BABAK R MD INC	5/24/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81239	02	General Surgery	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
77431	Fee-for-Service	1578227153	1578227153	1	1	BIG VALLEY EYE	10/3/2021	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1680 EAST HERNDON	SUITE 101	FRESNO	CA	93720	3305	10	06019	36.83756052	-119.7571005	Fresno County
77455	Fee-for-Service	1164627436	1164627436	1	1	BADO, AUDRA P	8/31/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
77523	Fee-for-Service	1972635282	1972635282	1	1	BENITEZ, ERMA L MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54356	07	Dermatology	0	In state provider	None	191 S BUENA VISTA ST	STE 235	BURBANK	CA	91505	4563	19	06037	34.15872557	-118.3283863	Los Angeles County
77580	Fee-for-Service	1346773892	1346773892	1	1	BROWN, JEWEL A MD	8/9/2021	390200000X	NA	Other	026	PHYSICIANS	174270	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
77583	Fee-for-Service	1932194339	1932194339	1	1	BUTTERWORTH, KAREN K MD	8/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86991	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
77599	Fee-for-Service	1013459874	1013459874	1	1	BOURANG, SHAMERIN LCSW	10/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
77636	Fee-for-Service	1043390040	1043390040	1	1	BAJWA, SAIF U MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66948	01	General Practice	0	In state provider	-	16800 LAKESHORE DR	SUITE 2	LAKE ELSINORE	CA	92530	4909	33	06065	33.68537076	-117.3679118	Riverside County
77682	Fee-for-Service	1861964983	1861964983	1	1	BARROS, GINGER E	4/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
77700	Fee-for-Service	1588059059	1588059059	1	1	BAGEWADI, SABA MD	8/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169110	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
77711	Fee-for-Service	1689615882	1689615882	1	1	BRETT W WIESLEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2675 W TAYLORSVILLE BLVD	None	TAYLORSVILLE	UT	84129	2208	00	None	40.65438556	-111.9571398	Salt Lake County
77723	Fee-for-Service	1972929438	1972929438	1	1	BAGHOUMIAN, MARINEH OD	8/24/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	STE P-25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
77735	Fee-for-Service	1013515287	1013515287	1	1	BALWIN PARK MEDICAL GROUP, I	12/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	NC.	14652 PACIFIC AVE	None	BALDWIN PARK	CA	91706	5333	19	06037	34.08196186	-117.9561364	Los Angeles County
77750	Fee-for-Service	1538247432	1538247432	1	1	BROWN, THOMAS W DO INC	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	4130	15	Obstetrics (D.O. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
77769	Fee-for-Service	1639814916	1639814916	1	1	BLANDFORD, MONICA R LMFT	6/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
77777	Fee-for-Service	1003989559	1003989559	1	1	BARTIS, STEVEN J OD	3/20/1995	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
77779	Fee-for-Service	1306801766	1306801766	1	1	BULLARD, TIMOTHY C, MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64738	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
77805	Fee-for-Service	1164478160	1164478160	1	1	BAHMANI ANDREWS, AFSANEH MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61989	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
77818	Fee-for-Service	1356480016	1356480016	1	2	BUFFMAN, BARRY R MD	7/22/2020	208800000X	NA	Other	026	PHYSICIANS	82000	08	Family Practice	0	In state provider	None	43847 HEATON AVE	STE D	LANCASTER	CA	93534	4936	19	06037	34.67959105	-118.1457605	Los Angeles County
77822	Fee-for-Service	1962457812	1962457812	1	16	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
77886	Fee-for-Service	1629203831	1629203831	1	1	BUTROS, ALEXANDRA F LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
77896	Fee-for-Service	1255741799	1255741799	1	1	BRUNO, LEAH M MD	5/2/2019	207R00000X	NA	Other	026	PHYSICIANS	157768	41	Internal Medicine	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
77904	Fee-for-Service	1225492382	1225492382	1	1	BHATIA, PRERANA MD	5/31/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	152738	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
77913	Fee-for-Service	1396821153	1396821153	1	1	BULGER, EILEEN METZGER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
77972	Fee-for-Service	1750033890	1750033890	1	1	BROWN, VICTORIA NP	1/4/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
77987	Fee-for-Service	1134356132	1134356132	1	1	BARILLAS, MIRIAM E PSYD	6/19/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
78025	Fee-for-Service	1457360448	1457360448	1	1	BELNAP, BRIAN D DO	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10439	25	Physical Medicine and Rehabilitation	0	In state provider	None	3907 WARING ROAD	SUITE 2	OCEANSIDE	CA	92056	4500	37	06073	33.18780783	-117.2918439	San Diego County
78037	Fee-for-Service	1538247432	1538247432	1	1	BROWN, THOMAS W DO INC	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	4130	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
78065	Fee-for-Service	1336213792	1336213792	1	1	BRACKEN, JOHN D LMFT	2/21/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28626 PONDEROSA ST.	None	CASTAIC	CA	91384	4744	19	06037	34.47298401	-118.6343797	Los Angeles County
78090	Fee-for-Service	1962457812	1962457812	1	125	BEVERLY RADIOLOGY MEDICAL GR	9/17/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6107 N FRESNO STREET	SUITE 101	FRESNO	CA	93710	8617	10	06019	36.8253	-119.7814355	Fresno County
78092	Fee-for-Service	1114139771	1114139771	1	1	BOUNDLESS TRANSPORT	11/19/2007	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1031 CERVANTEZ CRT	None	MILPITAS	CA	95035	3450	43	06085	37.45013037	-121.8874327	Santa Clara County
78093	Fee-for-Service	1700415031	1700415031	1	1	BELANGER, ANN M DO	4/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20830	None	None	0	In state provider	None	2433 CENTRAL AVENUE	SUITE A	ALAMEDA	CA	94501	4564	01	06001	37.76358675	-122.2413153	Alameda County
78107	Fee-for-Service	1710070669	1710070669	1	1	BRENNER, JOHN S CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
78130	Fee-for-Service	1740623966	1740623966	1	1	BURT, ASHLEY M MD	7/2/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	134011	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
78146	Fee-for-Service	1407426620	1407426620	1	1	BRILLIANCE HOME HEALTH INC	8/22/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3206 HONOLULU AVE	None	LA CRESCENTA	CA	91214	3327	19	06037	34.22068785	-118.2491099	Los Angeles County
78149	Fee-for-Service	1891572327	1891572327	1	1	BREATHE & BLOSSOM LLC	9/8/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
78157	Fee-for-Service	1518975705	1518975705	1	1	BIER, ALAN J MD	1/1/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	65842	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
78158	Fee-for-Service	1376671784	1376671784	1	1	BROOKS, KRISTEN B MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92601	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
78164	Fee-for-Service	1952889461	1952889461	1	1	BHANUSHALI, DHAWAL PT	2/23/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2000 W KETTLEMAN LN,	SUITE 106	LODI	CA	95242	4334	39	06077	38.1153755	-121.2971355	San Joaquin County
78185	Fee-for-Service	1386878700	1386878700	1	1	BITENCOURT, NICOLE G MD	9/16/2020	207R00000X	NA	Other	026	PHYSICIANS	168383	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
78197	Fee-for-Service	1154813079	1154813079	1	1	BINDER, JACOB A MD	9/1/2021	207P00000X	NA	Other	026	PHYSICIANS	174373	None	None	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
78258	Fee-for-Service	1467842005	1467842005	1	1	BRANDON, CAROLINE T MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134030	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
78288	Fee-for-Service	1902366305	1902366305	1	1	BAYLOR SCOTT & WHITE MEDICAL	1/20/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - AUSTIN	5245 W HIGHWAY 290	None	AUSTIN	TX	78735	8963	00	None	30.23607462	-97.83527798	Travis County
78293	Fee-for-Service	1891739017	1891739017	1	1	BORTUZZO, CHRISTIANA MD	8/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	1030 W 24TH ST	BLDG H	YUMA	AZ	85364	8384	00	None	32.684121	-114.631578	Yuma County
78297	Fee-for-Service	1609383827	1609383827	1	1	BUTTERS, JANELLE R NP	10/1/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
78318	Fee-for-Service	1669530622	1669530622	1	1	BERG, JENNIFER G PSYD	7/14/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	595 E COLORADO BLVD STE	324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
78322	Fee-for-Service	1437593878	1437593878	1	1	BAUTISTA, JOHN C MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132092	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
78347	Fee-for-Service	1669661849	1669661849	1	1	BECK, SHAWN M MD	5/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96569	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
78354	Fee-for-Service	1235260225	1235260225	1	1	BRIGHT CARE HOME HEALTH	6/16/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDER	9269 UTICA AVE	STE 170	RANCHO CUCAMONGA	CA	91730	5469	36	06071	34.08515881	-117.5714565	San Bernardino County
78356	Fee-for-Service	1124249388	1124249388	1	1	BAHREMAN, AMIR H MD	6/23/2010	207R00000X	NA	Other	026	PHYSICIANS	101955	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
78367	Fee-for-Service	1689776403	1689776403	1	1	BASSETT, JAMES MD	6/30/1987	208800000X	NA	Other	026	PHYSICIANS	49266	34	Urology and Urological Surgery	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
78373	Fee-for-Service	1336199272	1336199272	1	1	BARNETT, STEVEN P MD	5/21/2012	2084P0800X	NA	Psychiatry	026	PHYSICIANS	38029	36	Psychiatry	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
78381	Fee-for-Service	1962457812	1962457812	1	78	BEVERLY RADIOLOGY MEDICAL GR	10/14/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	6485 DAY ST	STE 101	RIVERSIDE	CA	92507	0930	33	06065	33.931809	-117.2789185	Riverside County
78398	Fee-for-Service	1932620812	1932620812	1	1	BAR, IMAN A MD INC	2/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	72354	40	Pediatrics	0	In state provider	None	2077 HARBOR BLVD	UNIT A	COSTA MESA	CA	92627	2630	30	06059	33.64990963	-117.9190918	Orange County
78400	Fee-for-Service	1053642751	1053642751	1	1	BOSLEY, CHRISTINE LCSW	3/7/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
78410	Fee-for-Service	1851367528	1851367528	1	1	BANQUERIGO, ELDINE A MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53530	01	General Practice	0	In state provider	None	10837 LAUREL ST	None	RANCHO CUCAMONGA	CA	91730	7643	36	06071	34.10480629	-117.5685104	San Bernardino County
78414	Fee-for-Service	1336320167	1336320167	1	1	BRON, IGOR M MD INC	5/16/2018	207L00000X	NA	Other	026	PHYSICIANS	64227	05	Anesthesiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
78425	Fee-for-Service	1669640926	1669640926	1	1	BELKO, ANDREA E MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101899	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
78434	Fee-for-Service	1891729281	1891729281	1	1	BROUSSEAU, MICHAEL P MD	8/1/1994	207R00000X	NA	Other	026	PHYSICIANS	81370	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
78445	Fee-for-Service	1427387547	1427387547	1	1	BALAKER, ASHLEY E MD	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	108296	04	Otology, Laryngology, Rhinology	0	In state provider	None	26726 CROWN VALLEY PKWY	STE 200	MISSION VIEJO	CA	92691	8003	30	06059	33.56385623	-117.6639538	Orange County
78471	Fee-for-Service	1386878700	1386878700	1	1	BITENCOURT, NICOLE G MD	9/16/2020	207R00000X	NA	Other	026	PHYSICIANS	168383	83	Rheumatology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
78476	Fee-for-Service	1295255974	1295255974	1	1	BRIGHT STAR SPEECH AND LANGU	7/26/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	AGE SERVICES	1401 N TUSTIN AVE	SUITE 270	SANTA ANA	CA	92705	8656	30	06059	33.757254	-117.8341425	Orange County
78498	Fee-for-Service	1558399311	1558399311	1	1	BOYAPALLI, RENUKA R MD	2/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	56036	41	Internal Medicine	0	In state provider	None	3655 LOMITA BLVD	STE 108	TORRANCE	CA	90505	1902	19	06037	33.81497113	-118.3489779	Los Angeles County
78505	Fee-for-Service	1114944972	1114944972	1	1	BONACINI, MAURIZIO MD	7/31/1992	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	43170	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	FL 2	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
78514	Fee-for-Service	1467615898	1467615898	1	1	BOGARD, SHYRLENA L MD	7/24/2018	261Q00000X	NA	Other	026	PHYSICIANS	149104	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
78515	Fee-for-Service	1134625288	1134625288	1	1	BETCHEL, NICHOLAS T DO	6/28/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17799	None	None	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 401	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
78525	Fee-for-Service	1912274572	1912274572	1	1	BILAL ANWER MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
78538	Fee-for-Service	1649794447	1649794447	1	1	BERGH, JOHANNA PT	8/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
78555	Fee-for-Service	1518252204	1518252204	1	1	BAKER, MATTHEW C MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129608	83	Rheumatology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
78574	Fee-for-Service	1902366305	1902366305	1	1	BAYLOR SCOTT & WHITE MEDICAL	1/20/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - AUSTIN	5245 W HIGHWAY 290	None	AUSTIN	TX	78735	8963	00	None	30.23607462	-97.83527798	Travis County
78589	Fee-for-Service	1770874075	1770874075	1	1	BECERRA, JORGE JR LCSW	5/1/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PKWY	BUILDING C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
78591	Fee-for-Service	1518943687	1518943687	1	1	BOU MERHI, GABRIEL F MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
78596	Fee-for-Service	1841268273	1841268273	1	1	BOWEN, THOMAS A DO	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9097	18	Ophthalmology	0	In state provider	None	2005 COURT ST	STE J	REDDING	CA	96001	1807	45	06089	40.57842204	-122.3936969	Shasta County
78608	Fee-for-Service	1194734384	1194734384	1	1	BANSBACH, STEVEN E MD	6/1/1995	207L00000X	NA	Other	026	PHYSICIANS	35241	05	Anesthesiology	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
78673	Fee-for-Service	1124035076	1124035076	1	1	BASKIN, MARC R MD	3/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36097	03	Allergy	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
78699	Fee-for-Service	1104358571	1104358571	1	1	BAINS, KENNY	10/7/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163717	08	Family Practice	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
78711	Fee-for-Service	1093851743	1093851743	1	1	BREW, CARL R RN	8/25/2003	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5050 ROSEVILLE RD	# 4-5	NORTH HIGHLANDS	CA	95660	5153	34	06067	38.65878	-121.38093	Sacramento County
78726	Fee-for-Service	1477996155	1477996155	1	1	BARRETT, BRANDON W DPM	5/18/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
78732	Fee-for-Service	1851612204	1851612204	1	1	BANG, TAMI J MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
78749	Fee-for-Service	1073619060	1073619060	1	1	BIG VALLEY OB-GYN MEDICAL	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	5298	None	None	0	In state provider	CENTER INC	420 W ACACIA ST	STE 11	STOCKTON	CA	95203	2441	39	06077	37.96135715	-121.2996632	San Joaquin County
78760	Fee-for-Service	1386878700	1386878700	1	1	BITENCOURT, NICOLE G MD	9/16/2020	207R00000X	NA	Other	026	PHYSICIANS	168383	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
78787	Fee-for-Service	1558399311	1558399311	1	1	BOYAPALLI, RENUKA R MD	2/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	56036	67	Endocrinology	0	In state provider	None	3655 LOMITA BLVD	STE 108	TORRANCE	CA	90505	1902	19	06037	33.81497113	-118.3489779	Los Angeles County
78793	Fee-for-Service	1114944972	1114944972	1	1	BONACINI, MAURIZIO MD	7/31/1992	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	43170	10	Gastroenterology (M.D. only)	0	In state provider	None	2340 CLAY ST	FL 2	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
78809	Fee-for-Service	1003096777	1003096777	1	1	BANSAL, RITU S MD	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101750	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
78828	Fee-for-Service	1265939169	1265939169	1	1	BANERJEE, SANKHA MD	7/29/2021	207R00000X	NA	Other	026	PHYSICIANS	174212	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
78829	Fee-for-Service	1619364676	1619364676	1	1	BREWER, STEVEN LMFT	6/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14420 CIVIC DR	STE 6	VICTORVILLE	CA	92392	2384	36	06071	34.51268102	-117.3236867	San Bernardino County
78841	Fee-for-Service	1255893285	1255893285	1	1	BUSH, BRIAN M DO	8/30/2022	207R00000X	NA	Other	026	PHYSICIANS	19520	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
78852	Fee-for-Service	1245207190	1245207190	1	1	BERG, LAMONT S MD	2/1/2022	207L00000X	NA	Other	026	PHYSICIANS	62982	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
78871	Fee-for-Service	1821418542	1821418542	1	1	BARRON, KAVITA MD	8/12/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155596	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
78878	Fee-for-Service	1750367546	1750367546	1	1	BECK, MARK J	11/1/2002	207ZP0102X	NA	Other	026	PHYSICIANS	27503	None	None	0	In state provider	None	600 N HIGHLAND AVENUE	None	BANNING	CA	92220	3090	33	06065	33.9316595	-116.9468639	Riverside County
78915	Fee-for-Service	1356426241	1356426241	1	2	BHASKER, MOHAN W MD	7/24/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34139	None	None	0	In state provider	None	1145 WEST REDONDO BEACH	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
78931	Fee-for-Service	1629004650	1629004650	1	1	BROWN, STACEY L MD	1/31/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54711	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
78933	Fee-for-Service	1528568870	1528568870	1	1	BRIGHT LIGHT HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	303 S GLENOAKS BLVD	STE 14	BURBANK	CA	91502	1319	19	06037	34.18156737	-118.3040137	Los Angeles County
78942	Fee-for-Service	1346703584	1346703584	1	1	BEUTLER, BRYCE D MD	7/12/2023	390200000X	NA	Other	026	PHYSICIANS	180626	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
78960	Fee-for-Service	1124035076	1124035076	1	1	BASKIN, MARC R MD	3/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36097	01	General Practice	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
78998	Fee-for-Service	1336246644	1336246644	1	1	BERKUS, DEAN B MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	34100	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
78999	Fee-for-Service	1093851743	1093851743	1	1	BREW, CARL R RN	6/16/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5050 ROSEVILLE RD	# 4-5	NORTH HIGHLANDS	CA	95660	5153	34	06067	38.65878	-121.38093	Sacramento County
79022	Fee-for-Service	1306208590	1306208590	1	1	BANAGA, JUSTIN L MD	6/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152793	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
79038	Fee-for-Service	1902197569	1902197569	1	1	BAGHERIANNEJAD-ESFAHANT,	8/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126659	41	Internal Medicine	0	In state provider	FATEMEH MD	2335 E KASHIAN LANE	450	FRESNO	CA	93729	8949	10	06019	36.74333844	-119.7831874	Fresno County
79046	Fee-for-Service	1710018551	1710018551	1	1	BLOCH, ORIN MD	4/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103450	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	91432	2202	38	06075	37.76344756	-122.4581992	San Francisco County
79059	Fee-for-Service	1043269491	1043269491	1	1	BRACKETT, BESS E MD	11/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	88618	20	Orthopedic Surgery	0	In state provider	None	555 CAPITOL MALL	STE 260	SACRAMENTO	CA	95814	4503	34	06067	38.579166	-121.500621	Sacramento County
79074	Fee-for-Service	1821720129	1821720129	1	1	BEST, CORLISS A MD	12/20/2022	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	181257	None	None	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
79107	Fee-for-Service	1194339457	1194339457	1	1	BOHANNON, MAYA LCSW	12/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
79141	Fee-for-Service	1073691176	1073691176	1	1	BARONIA, SANGEETA R MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54261	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
79148	Fee-for-Service	1154029080	1154029080	1	1	BEST CHOICE SENIOR CARE INC	4/20/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11159 COHASSET STREET	None	SUN VALLEY	CA	91352	4704	19	06037	34.20664536	-118.3743018	Los Angeles County
79174	Fee-for-Service	1043899081	1043899081	1	1	BEARD, CHARLOTTE L PHD	6/30/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
79175	Fee-for-Service	1316963713	1316963713	1	1	BAHADOR, AFSHIN MD	8/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65396	None	None	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
79184	Fee-for-Service	1689807596	1689807596	1	1	BARTHOLOMEW, AARON E PSYD	7/4/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
79221	Fee-for-Service	1528568870	1528568870	1	1	BRIGHT LIGHT HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	303 S GLENOAKS BLVD	STE 14	BURBANK	CA	91502	1319	19	06037	34.18156737	-118.3040137	Los Angeles County
79250	Fee-for-Service	1699834325	1699834325	1	1	BOTSHEKAN, LATONYA R CNM	2/7/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1843 1/2 S LA CIENEGA BL	None	LOS ANGELES	CA	90035	4603	19	06037	34.04410366	-118.3768223	Los Angeles County
79254	Fee-for-Service	1841510609	1841510609	1	1	BROWNELL, ROBERT C EDD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1305 TOMMYDON STREET	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
79294	Fee-for-Service	1952448854	1952448854	1	1	BAUM, NEIL H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3525 PRYTANIA ST	STE 614	NEW ORLEANS	LA	70115	8102	00	None	29.9263276	-90.09246905	Orleans Parish
79313	Fee-for-Service	1932247251	1932247251	1	1	BERA, AMERISH B MD	7/1/1994	207R00000X	NA	Other	026	PHYSICIANS	76045	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
79329	Fee-for-Service	1205559713	1205559713	1	2	BAY IMAGING CONSULTANTS MEDI	9/10/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CAL GROUP INC	225 N. JACKSON AVE.	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
79404	Fee-for-Service	1881241453	1881241453	1	1	BRYAN YANG MD INC	7/5/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	None	2221 W OLYMPIC BLVD	FL 2	LOS ANGELES	CA	90006	2117	19	06037	34.05226036	-118.2816552	Los Angeles County
79426	Fee-for-Service	1447338512	1447338512	1	1	BIRDSONG, WILLIAM H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75881	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
79454	Fee-for-Service	1720143530	1720143530	1	1	BOSTER, TERI ANN MD	6/1/1996	207P00000X	NA	Other	026	PHYSICIANS	83082	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
79465	Fee-for-Service	1700895174	1700895174	1	1	BERENT, MICHAEL D MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67486	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
79480	Fee-for-Service	1851391684	1851391684	1	1	BROWN, JULIA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST MARYS HOSPITAL	1601 W SAINT MARYS RD	None	TUCSON	AZ	85745	2623	00	None	32.228199	-111.0000825	Pima County
79539	Fee-for-Service	1891992897	1891992897	1	1	BARR, MATTHEW MD	2/28/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	263 FARMINGTON AVE	None	FARMINGTON	CT	06030	0000	00	None	41.730192	-72.7919415	Capitol Planning Region
79541	Fee-for-Service	1790706380	1790706380	1	1	BAE, WON C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33439	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
79543	Fee-for-Service	1831715077	1831715077	1	1	BLOOMING ROSE HOSPICE INC	6/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3089 N LIMA ST	C	BURBANK	CA	91504	2013	19	06037	34.206192	-118.346528	Los Angeles County
79562	Fee-for-Service	1386848679	1386848679	1	1	BECKMAN, RANDI F LCSW	7/2/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
79563	Fee-for-Service	1164438875	1164438875	1	1	BENNETT-GELLERT, ERICA C MD	1/6/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	55835	04	Otology, Laryngology, Rhinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
79571	Fee-for-Service	1053390021	1053390021	1	1	BOLD, JONATHAN W MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74034	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
79620	Fee-for-Service	1932151321	1932151321	1	1	BONNER COUNTY EMS	2/21/2017	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	521 N THIRD AVE	None	SANDPOINT	ID	83864	1506	00	None	48.27795945	-116.5504089	Bonner County
79633	Fee-for-Service	1902049240	1902049240	1	1	BARRERA, CRYSTAL Y	1/6/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
79635	Fee-for-Service	1972573590	1972573590	1	1	BOULAS, H J MD	5/2/2024	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	43264	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
79636	Fee-for-Service	1700896677	1700896677	1	1	BIRD, KATHERINE E NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
79666	Fee-for-Service	1104116243	1104116243	1	1	BHADRIRAJU, SUDHAMAYI MD	6/2/2019	390200000X	NA	Other	026	PHYSICIANS	143153	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
79696	Fee-for-Service	1053340653	1053340653	1	1	BRANDON, KAREN R	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
79704	Fee-for-Service	1972033975	1972033975	1	1	BRAUN, AVERY E DO	6/28/2022	208800000X	NA	Other	026	PHYSICIANS	19700	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
79718	Fee-for-Service	1841583457	1841583457	1	1	BANERJI, GABRIEL P H MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117473	30	Radiology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
79804	Fee-for-Service	1538177977	1538177977	1	1	BENDEBEL, MA VICTORIA	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53352	01	General Practice	0	In state provider	MD INC	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
79815	Fee-for-Service	1194786053	1194786053	1	1	BROWN, H R	9/15/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11226 GOLD EXPRESS DR	STE 202	RANCHO CORDOVA	CA	95670	4411	34	06067	38.622456	-121.264299	Sacramento County
79824	Fee-for-Service	1720493661	1720493661	1	1	BERLIN, ALIA M NP	4/14/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
79836	Fee-for-Service	1831715077	1831715077	1	1	BLOOMING ROSE HOSPICE INC	6/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3089 N LIMA ST	C	BURBANK	CA	91504	2013	19	06037	34.206192	-118.346528	Los Angeles County
79844	Fee-for-Service	1134469026	1134469026	1	1	BAKAS, ANDREA NP	4/21/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
79867	Fee-for-Service	1679827562	1679827562	1	1	BALLETTA, CHRISTINE LMFT	12/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	204 W LAKE ST	STE D	MOUNT SHASTA	CA	96067	2254	47	06093	41.31244838	-122.3134734	Siskiyou County
79891	Fee-for-Service	1962112755	1962112755	1	1	BALK, AUSTIN W	1/17/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
79909	Fee-for-Service	1780388314	1780388314	1	1	BELGARDE, EMILY LPCC	10/9/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
79922	Fee-for-Service	1780777698	1780777698	1	1	BILHORN, JEFFREY J CRNA	10/12/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
79926	Fee-for-Service	1437212453	1437212453	1	1	BLICKENSTAFF, KURT MD	5/31/1989	208600000X	NA	General Surgery	026	PHYSICIANS	57756	02	General Surgery	0	In state provider	None	3901 LAS POSAS RD	STE 204	CAMARILLO	CA	93010	1505	56	06111	34.2415821	-119.0183756	Ventura County
79950	Fee-for-Service	1962479089	1962479089	1	1	BLUMENFELD, THOMAS J MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	75858	20	Orthopedic Surgery	0	In state provider	None	1020 29TH ST	STE 450	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
79951	Fee-for-Service	1104116243	1104116243	1	1	BHADRIRAJU, SUDHAMAYI MD	6/2/2019	390200000X	NA	Other	026	PHYSICIANS	143153	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
79954	Fee-for-Service	1750561973	1750561973	1	1	BRENNER, DANIEL A MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105376	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	131 STONY CIRCLE	STE 1600	SANTA ROSA	CA	95401	9520	49	06097	38.439477	-122.7451095	Sonoma County
79960	Fee-for-Service	1083898597	1083898597	1	2	BRUNSON, WILSON R LMFT	5/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22780	-	NOT APPLICABLE	0	In state provider	None	637 BROADWAY ST	None	KING CITY	CA	93930	3231	27	06053	36.20997663	-121.1314821	Monterey County
79992	Fee-for-Service	1215959077	1215959077	1	2	BERMAN, MADHU MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	47762	None	None	0	In state provider	None	1200 ROSECRANS AVE	#105	MANHATTAN BEACH	CA	90266	2462	19	06037	33.90178953	-118.3931775	Los Angeles County
79993	Fee-for-Service	1982139291	1982139291	1	1	BICKI, ALEXANDRA MD	5/31/2024	2080P0210X	NA	Nephrology	026	PHYSICIANS	172756	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
79999	Fee-for-Service	1619021409	1619021409	1	1	BELL, LISA J	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
80016	Fee-for-Service	1871859389	1871859389	1	1	BLISS, AMY L DO	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89521	3861	00	None	39.52483792	-119.7968314	Washoe County
80025	Fee-for-Service	1194169052	1194169052	1	1	BENHAMOU, ORI-MICHAEL J MD	7/30/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	162956	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
80046	Fee-for-Service	1215646013	1215646013	1	1	BLECHERT, CHRISTOPHER A OT	6/4/2024	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8805 HAVEN AVE	SUITE 110	RANCHO CUCAMONGA	CA	91730	5149	36	06071	34.09424614	-117.5756838	San Bernardino County
80084	Fee-for-Service	1386756799	1386756799	1	1	BOHLMAN, MICHAEL S MD	9/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94482	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
80091	Fee-for-Service	1558470757	1558470757	1	1	BOYLE, ROBERT J LCSW	8/22/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4869 TOPANGA CANYON BLVD	SUITE 6	WOODLAND HILLS	CA	91364	4255	19	06037	34.156404	-118.605838	Los Angeles County
80116	Fee-for-Service	1285008334	1285008334	1	1	BERTAO, MELISSA L	8/8/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
80127	Fee-for-Service	1316353949	1316353949	1	1	BOWERS, MARK W MD	10/5/2020	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	168934	20	Orthopedic Surgery	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
80132	Fee-for-Service	1962457812	1962457812	1	89	BEVERLY RADIOLOGY MEDICAL GR	12/1/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	2620 S BRISTOL ST	None	SANTA ANA	CA	92704	5727	30	06059	33.7119783	-117.8854709	Orange County
80145	Fee-for-Service	1467642025	1467642025	1	1	BENJAMIN OLSSON	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
80156	Fee-for-Service	1225692205	1225692205	1	1	BURLINGAME, CYNTHIA R LMFT	1/29/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107269	-	NOT APPLICABLE	0	In state provider	None	4000 BIRCH ST	SUITE 112A	NEWPORT BEACH	CA	92660	2211	30	06059	33.66463772	-117.8698289	Orange County
80161	Fee-for-Service	1679515324	1679515324	1	1	BOTAS, CARLOS M MD	1/5/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52713	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
80166	Fee-for-Service	1043487267	1043487267	1	1	BEHNAM, SHAHRAD M MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96639	41	Internal Medicine	0	In state provider	None	520 N PROSPECT AVENUE	SUITE 103	REDONDO BEACH	CA	90277	3033	19	06037	33.8529819	-118.3802954	Los Angeles County
80180	Fee-for-Service	1205267549	1205267549	1	2	BANNER HEALTH	4/5/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1680 PAUL BUNYAN ROAD	None	SUSANVILLE	CA	96130	3159	18	06035	40.42141164	-120.6468171	Lassen County
80214	Fee-for-Service	1013027838	1013027838	1	1	BUI, AMY-VAN T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82140	67	Endocrinology	0	In state provider	None	39755 MURRIETA HOT SPRNG	STE E-13O	MURRIETA	CA	92563	0000	33	06065	33.55575954	-117.1627899	Riverside County
80223	Fee-for-Service	1518354661	1518354661	1	1	BENJAMIN, BRIAN S DO	7/15/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18598	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
80244	Fee-for-Service	1700964202	1700964202	1	1	BI, LUKE C MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73340	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
80278	Fee-for-Service	1891773412	1891773412	1	1	BOLES, KRISTI A MD	8/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS ROAD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
80304	Fee-for-Service	1245314582	1245314582	1	1	BARRERA, JENNIFER KAREN NP	2/8/2015	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	475 29TH STREET	None	OAKLAND	CA	94609	3510	01	06001	37.81797518	-122.2663391	Alameda County
80318	Fee-for-Service	1750900825	1750900825	1	1	BEAUTIFUL JOURNEY RECOVERY C	11/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ENTER A CALIFORNIA PROFE	15928 VENTURA BLVD	207	ENCINO	CA	91436	4400	19	06037	34.15585301	-118.4801465	Los Angeles County
80354	Fee-for-Service	1881803047	1881803047	1	1	BROOKS, MICHAEL P DPM	1/1/1979	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	19682 HESPERIAN BLVD	SUITE 101A	HAYWARD	CA	94541	4752	01	06001	37.66812177	-122.1194688	Alameda County
80367	Fee-for-Service	1912433673	1912433673	1	1	BALBI, KATE DO	8/9/2021	207L00000X	NA	Other	026	PHYSICIANS	18859	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
80382	Fee-for-Service	1013966621	1013966621	1	1	BAINS,JAGDEEP K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13927 W GRAND AVE	SUITE # 401	SURPRISE	AZ	85374	0000	00	None	33.647229	-112.362138	Maricopa County
80388	Fee-for-Service	1407913361	1407913361	1	1	BALLENGER, JAMES F PHD	10/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
80390	Fee-for-Service	1962457812	1962457812	1	71	BEVERLY RADIOLOGY MEDICAL GR	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8805 HAVEN AVE	STE 120	RANCHO CUCAMONGA	CA	91730	5149	36	06071	34.09424614	-117.5756838	San Bernardino County
80410	Fee-for-Service	1215968060	1215968060	1	1	BAKER, AARON G MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70132	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
80413	Fee-for-Service	1245658210	1245658210	1	1	BLACK, JORDAN M MD	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141974	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
80417	Fee-for-Service	1962457812	1962457812	1	152	BEVERLY RADIOLOGY MEDICAL GR	10/29/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	38925 TRADE CENTER DR	UNIT E	PALMDALE	CA	93551	3653	19	06037	34.59028112	-118.1433053	Los Angeles County
80424	Fee-for-Service	1699063172	1699063172	1	1	BOYCE, SHANIKA A MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122847	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
80428	Fee-for-Service	1083090773	1083090773	1	1	BELEKANICH, ANTHONY M OD	11/9/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
80438	Fee-for-Service	1295773422	1295773422	1	1	BANERJEE, SANJOY MD	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90939	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
80448	Fee-for-Service	1245541564	1245541564	1	1	BARBOZA, RICHARD M MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130044	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
80504	Fee-for-Service	1013027838	1013027838	1	1	BUI, AMY-VAN T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82140	41	Internal Medicine	0	In state provider	None	39755 MURRIETA HOT SPRNG	STE E-13O	MURRIETA	CA	92563	0000	33	06065	33.55575954	-117.1627899	Riverside County
80509	Fee-for-Service	1033564356	1033564356	1	1	BRAHMBHATT, AKSHAAR N MD	6/11/2024	2085R0204X	NA	Other	026	PHYSICIANS	185253	30	Radiology	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
80511	Fee-for-Service	1235318056	1235318056	1	1	BOURJI, NAJI MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119913	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3838 SAN DIMAS ST	STE B201	BAKERSFIELD	CA	93301	2285	15	06029	35.3946385	-119.008203	Kern County
80518	Fee-for-Service	1760594105	1760594105	1	1	BHULLAR, SANTOKH S MD	8/4/2008	207R00000X	NA	Other	026	PHYSICIANS	61798	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
80541	Fee-for-Service	1225657414	1225657414	1	1	BROWN, CHRISTA D MD	12/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185069	None	None	0	In state provider	None	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
80543	Fee-for-Service	1043443765	1043443765	1	1	BRASH, MELISSA L LCSW	10/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
80588	Fee-for-Service	1922592377	1922592377	1	1	BHASKARABHATLA, SANTOSH MD	8/27/2023	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	186787	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
80593	Fee-for-Service	1003390329	1003390329	1	1	BEKAERT, JOSEPH A PT	10/20/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
80631	Fee-for-Service	1649620824	1649620824	1	1	BADE, RYAN MD	1/22/2021	207P00000X	NA	Other	026	PHYSICIANS	18422	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
80659	Fee-for-Service	1225293111	1225293111	1	1	BARRY, PENNAN M MD	4/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92150	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
80676	Fee-for-Service	1962457812	1962457812	1	148	BEVERLY RADIOLOGY MEDICAL GR	4/3/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	SUITE 100	MARINA DEL REY	CA	90292	6621	19	06037	33.98120707	-118.4409729	Los Angeles County
80747	Fee-for-Service	1487841177	1487841177	1	1	BILLE, BRIAN MD	4/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94359	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
80755	Fee-for-Service	1609929900	1609929900	1	1	BERGSTROM, VIRGINIA M LMFT	10/26/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5588 N PALM AVE	None	FRESNO	CA	93704	1913	10	06019	36.818874	-119.8082415	Fresno County
80771	Fee-for-Service	1407575160	1407575160	1	1	BRIAN KANG MD INC	8/25/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	345 S. HALCYON RD	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
80775	Fee-for-Service	1912379231	1912379231	1	1	BUTTONS ELDERLY CARE	3/18/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1448 BUTTONS CT	None	OAKLEY	CA	94561	3238	07	06013	37.99525846	-121.721022	Contra Costa County
80840	Fee-for-Service	1265473581	1265473581	1	1	BENJAMIN, RAMSIS MD	8/21/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60405	41	Internal Medicine	0	In state provider	None	1818 S WESTERN AVE	STE 401	LOS ANGELES	CA	90006	5860	19	06037	34.0412168	-118.3089894	Los Angeles County
80842	Fee-for-Service	1770899346	1770899346	1	1	BERMON, DAVID J MD	10/16/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	120408	-	NOT APPLICABLE	0	In state provider	None	5850 S MAIN ST	RM 1078, 2010, 2017	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
80876	Fee-for-Service	1801889399	1801889399	1	1	BRETT ANDRES	11/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11782 SW BARNES RD	STE 300	PORTLAND	OR	97225	5933	00	None	45.51755652	-122.797636	Washington County
80884	Fee-for-Service	1770684219	1770684219	1	1	BAKSHANDEH, HALEH MD	10/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89344	07	Dermatology	0	In state provider	None	11600 INDIAN HILL ROAD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
80886	Fee-for-Service	1821326380	1821326380	1	1	BASA, JOHANNA V MD	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136671	02	General Surgery	0	In state provider	None	1940 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07889352	-117.7478982	Los Angeles County
80926	Fee-for-Service	1134306236	1134306236	1	1	BROWN, CHARLES F MD	1/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102416	None	None	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
80931	Fee-for-Service	1124106703	1124106703	1	1	BENJAMINE, LEO L MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81688	40	Pediatrics	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
80935	Fee-for-Service	1447680376	1447680376	1	1	BELL, DALE E LMFT	12/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3755 ALHAMBRA AVE	SUITE 8	MARTINEZ	CA	94553	3833	07	06013	37.99744727	-122.1323154	Contra Costa County
80948	Fee-for-Service	1225293111	1225293111	1	1	BARRY, PENNAN M MD	4/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92150	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
80954	Fee-for-Service	1831271378	1831271378	1	1	BARAJAS, RAYMOND A INC	5/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	75499	None	None	0	In state provider	None	11028 LOWER AZUSA RD	None	EL MONTE	CA	91731	1440	19	06037	34.09193387	-118.0251713	Los Angeles County
81011	Fee-for-Service	1902408875	1902408875	1	1	BARLAAN, MAFE A NP	1/1/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
81034	Fee-for-Service	1669931887	1669931887	1	1	BATES, KATHERINE S MD	9/5/2023	390200000X	NA	Other	026	PHYSICIANS	180138	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
81088	Fee-for-Service	1316012834	1316012834	2	1	BOYER, KENNETH OD INC	10/29/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2443 FOOTHILL BLVD	None	LA VERNE	CA	91750	3028	19	06037	34.11136123	-117.7588874	Los Angeles County
81097	Fee-for-Service	1316965247	1316965247	1	1	BEEDE, ALLEN L OD	9/1/1999	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	240 MERIDIAN AVE	STE 3	SAN JOSE	CA	95126	2927	43	06085	37.32468731	-121.9137566	Santa Clara County
81115	Fee-for-Service	1760428577	1760428577	1	1	BENZEEVI, YORAI S MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
81161	Fee-for-Service	1821366287	1821366287	2	1	BROWN, ADDIE L LMFT	5/9/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	465 34TH STREET	None	OAKLAND	CA	94609	2815	01	06001	37.82207411	-122.2647332	Alameda County
81182	Fee-for-Service	1710918008	1710918008	1	1	BLAIR, SARAH L MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85042	02	General Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
81189	Fee-for-Service	1316655871	1316655871	1	1	BRIDGEWATER BAY HOLDINGS LLC	12/21/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2828 MEADOWLARK DR	None	SAN DIEGO	CA	92123	2710	37	06073	32.794011	-117.1543465	San Diego County
81198	Fee-for-Service	1275714016	1275714016	1	1	BRUUN, ALEXANDRA A LCSW	9/8/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6393 SKYWAY	SUITE 7	PARADISE	CA	95969	4543	04	06007	39.75819028	-121.6248459	Butte County
81205	Fee-for-Service	1821481805	1821481805	1	1	BRINKMAN, LORIE OT	9/26/2019	225XN1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 STEIN PLAZA	STE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
81230	Fee-for-Service	1194879254	1194879254	1	1	BLAKEMORE, JAMES G DC	10/1/2001	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	BLAKEMORE CA CHP OFC INC	159 N RAYMOND AVE	None	FULLERTON	CA	92831	4609	30	06059	33.871968	-117.9070185	Orange County
81281	Fee-for-Service	1780099549	1780099549	1	1	BORDIA, NIKHIL N MD	12/1/2017	390200000X	NA	Other	026	PHYSICIANS	141339	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
81288	Fee-for-Service	1992823330	1992823330	1	1	BERNSTEIN, STACEY J MD	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89725	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
81289	Fee-for-Service	1720347461	1720347461	1	1	BROWN, RENEE L DO	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14666	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 FOURTH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
81312	Fee-for-Service	1245429968	1245429968	1	1	BARZAGA HAZRATI, NAILE MD	7/28/2017	207R00000X	NA	Other	026	PHYSICIANS	134032	41	Internal Medicine	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
81355	Fee-for-Service	1083077549	1083077549	1	1	BREEGGEMANN, MATTHEW C MD	6/5/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	168104	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
81359	Fee-for-Service	1295736916	1295736916	1	1	BOYER, DAVID S MD	12/4/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	25107	18	Ophthalmology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
81371	Fee-for-Service	1124269246	1124269246	1	1	BAEZ, MARITZA PHD	7/8/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
81386	Fee-for-Service	1952175820	1952175820	1	1	BLAAUW, HAYLEY A PT	1/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2051 STATHAM BLVD	None	OXNARD	CA	93033	3901	56	06111	34.17967669	-119.1655477	Ventura County
81399	Fee-for-Service	1033133210	1033133210	1	1	BROWN, KAREN S MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55045	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
81426	Fee-for-Service	1649646738	1649646738	1	1	BERNAL, BRENDA CNP	4/6/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2505 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2011	19	06037	34.03287856	-118.4748782	Los Angeles County
81433	Fee-for-Service	1801801295	1801801295	1	1	BORGQUIST, SUZANNE J PT	3/8/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7921 PROFESSIONAL CIR	None	HUNTINGTON BEACH	CA	92648	1901	30	06059	33.69178835	-117.990149	Orange County
81451	Fee-for-Service	1952353963	1952353963	1	1	BRICKER, MICHELLE D MD	10/30/1991	207R00000X	NA	Other	026	PHYSICIANS	73679	01	General Practice	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
81456	Fee-for-Service	1710046339	1710046339	1	1	BROWNE-BAKER, CHERYL L	1/1/1989	207R00000X	NA	Other	026	PHYSICIANS	64899	41	Internal Medicine	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
81471	Fee-for-Service	1710918008	1710918008	1	1	BLAIR, SARAH L MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85042	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
81476	Fee-for-Service	1194907352	1194907352	1	1	BIRTH CENTER, A NURSING	7/17/2000	No Taxonomy Provided	NA	None	052	ALTERNATIVE BIRTH CENTERS - SPECIALTY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CORP	5440 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3106	34	06067	38.661714	-121.337991	Sacramento County
81480	Fee-for-Service	1841466430	1841466430	1	1	BLONDER, DAVID MD	9/18/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	188288	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
81485	Fee-for-Service	1285626515	1285626515	1	1	BASOVICH, LEONID B	6/1/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	13731	12	Manipulative Therapy (D.O. only)	0	In state provider	None	975 S FAIRMONT AVENUE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
81496	Fee-for-Service	1821677329	1821677329	1	1	BRANSKY, NATALIE P MD	5/28/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
81566	Fee-for-Service	1801542618	1801542618	1	1	BODY AND SOUL HEALTH CENTER	6/6/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	A PROFESSIONAL NURSING C	2551 GILBERT AVE	None	CORONA	CA	92881	3622	33	06065	33.84600755	-117.5485499	Riverside County
81573	Fee-for-Service	1720009152	1720009152	1	1	BARNES-BLANKS, CAROL MD	4/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	46666	08	Family Practice	0	In state provider	None	441 NORTH LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
81582	Fee-for-Service	1043735939	1043735939	1	1	BEHROOJ, MARIA NP	2/4/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
81605	Fee-for-Service	1992812945	1992812945	1	1	BARRIO, LORENA M MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65399	36	Psychiatry	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
81621	Fee-for-Service	1801978432	1801978432	1	1	BUONCRISTIANI, AMY C MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62545	08	Family Practice	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
81636	Fee-for-Service	1245041847	1245041847	1	1	BAJWA, ROSE P NP	3/6/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	428 J ST	STE 400	SACRAMENTO	CA	95814	2394	34	06067	38.581839	-121.500522	Sacramento County
81653	Fee-for-Service	1528376514	1528376514	1	1	BARRERA, JOSE L LCSW	12/8/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
81659	Fee-for-Service	1174539423	1174539423	1	1	BUCHANAN, DANA L DO	7/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9469	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
81707	Fee-for-Service	1235689910	1235689910	1	1	BLOMMER, BELISSA E LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44943	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
81740	Fee-for-Service	1447712286	1447712286	1	1	BANASHEK, LAURA MD	11/4/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
81753	Fee-for-Service	1114936390	1114936390	1	1	BOROVIC, JOSIF MD INC	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70254	05	Anesthesiology	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
81781	Fee-for-Service	1811906894	1811906894	1	1	BUHARI, FRAM MD INC	10/5/1994	207R00000X	NA	Other	026	PHYSICIANS	29927	41	Internal Medicine	0	In state provider	None	2800 N CALIFORNIA ST	STE 14	STOCKTON	CA	95204	3759	39	06077	37.97782434	-121.2919633	San Joaquin County
81787	Fee-for-Service	1053468439	1053468439	1	1	BREAM, CORY R OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORY BREAM & ASSOCIATES	7095 MARKET PLACE DR	None	GOLETA	CA	93117	5905	42	06083	34.42799696	-119.873532	Santa Barbara County
81792	Fee-for-Service	1942342530	1942342530	1	1	BROWN, CHARLES H MD	8/9/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
81811	Fee-for-Service	1730147265	1730147265	1	1	BALODIMAS, JAMES MD	8/17/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	73090	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
81819	Fee-for-Service	1245897982	1245897982	1	1	BRUNING, KRISTIN M CCC-SLP	12/1/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST	SUITE 108 AND 109	FOUNTAIN VALLEY	CA	92708	7301	30	06059	33.68919119	-117.9542204	Orange County
81830	Fee-for-Service	1912066648	1912066648	1	1	BAKIRIAN-MILLER, SEVIM J OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5330 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2952	36	06071	34.0776965	-117.688707	San Bernardino County
81835	Fee-for-Service	1639950991	1639950991	1	1	BIERA, ELLEN RCP	12/8/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
81843	Fee-for-Service	1467526905	1467526905	1	1	BARONA FIRE DEPARTMENT	10/1/1998	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1112 BARONA RD	None	LAKESIDE	CA	92040	1540	37	06073	32.94246038	-116.8522659	San Diego County
81854	Fee-for-Service	1225366099	1225366099	1	1	BRANDT, JEFFREY J MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123194	01	General Practice	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
81869	Fee-for-Service	1437198348	1437198348	1	1	BUCCELLATO, LEONARD MD	3/22/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	171049	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
81887	Fee-for-Service	1609988401	1609988401	1	1	BIO MEDICAL APPLICATIONS	9/15/2004	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	1221 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	2931	19	06037	33.78970725	-118.2983104	Los Angeles County
81912	Fee-for-Service	1972149466	1972149466	1	1	BRIMFIELD DIALYSIS LLC	3/12/2021	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	20359 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5309	01	06001	37.69591482	-122.0867676	Alameda County
81944	Fee-for-Service	1881601607	1881601607	1	1	BECKER, STEVEN A MD	3/24/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	40334	20	Orthopedic Surgery	0	In state provider	None	16300 SAND CANYON AVE	STE 511	IRVINE	CA	92618	3705	30	06059	33.66115075	-117.7742405	Orange County
82002	Fee-for-Service	1992706220	1992706220	1	1	BONNER, ROBERT G OD	3/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	BONNER ROBERT OD PC	14595 OLYMPIC DR	None	CLEARLAKE	CA	95422	9100	17	06033	38.96183448	-122.63994	Lake County
82020	Fee-for-Service	1568597615	1568597615	1	1	BISCHOFF, ERIKA LCSW	6/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 S SEPULVEDA BLVD	305	LOS ANGELES	CA	90049	3536	19	06037	34.06573968	-118.4598268	Los Angeles County
82023	Fee-for-Service	1689625337	1689625337	1	1	BELLINGER, RAYE LYNN MD	2/20/1988	207R00000X	NA	Other	026	PHYSICIANS	44408	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6527	34	06067	38.568402	-121.418019	Sacramento County
82051	Fee-for-Service	1104873033	1104873033	1	1	BECK, WALTER D PHD	10/1/2001	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	13922 SEAL BEACH BLVD	STE B	SEAL BEACH	CA	90740	5377	30	06059	33.76132389	-118.0777961	Orange County
82060	Fee-for-Service	1417537150	1417537150	1	1	BROOKS, WENDY LMFT	1/30/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
82063	Fee-for-Service	1689967564	1689967564	1	1	BURGENER, ELIZABETH B MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122040	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
82064	Fee-for-Service	1437381126	1437381126	1	1	BARMANN, CHRISTOPHER M PHD	9/26/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
82065	Fee-for-Service	1770554693	1770554693	1	1	BASKIN, BRIAN D MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83581	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
82066	Fee-for-Service	1730682097	1730682097	1	1	BARLOW, JESSICA A MD	7/8/2023	207P00000X	NA	Other	026	PHYSICIANS	186015	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
82086	Fee-for-Service	1104388180	1104388180	1	1	BOMANI, ABASI MD	2/4/2024	261QU0200X	NA	Other	026	PHYSICIANS	180702	None	None	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
82091	Fee-for-Service	1366448854	1366448854	1	1	BRUCK, RICHARD L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30560	41	Internal Medicine	0	In state provider	None	591 N 13TH AVE	STE 3	UPLAND	CA	91786	4968	36	06071	34.10081218	-117.6336095	San Bernardino County
82106	Fee-for-Service	1073564423	1073564423	1	1	BRASEL, KAREN J MD	1/18/2021	2086S0127X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
82131	Fee-for-Service	1235224593	1235224593	1	2	BODY CENTER PHYSICAL THERAPY	3/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RAPY AND PILATES	224 INDIAN HILL BLVD	None	CLAREMONT	CA	91711	4609	19	06037	34.09607063	-117.7192866	Los Angeles County
82141	Fee-for-Service	1346438819	1346438819	1	1	BALDWIN, HARLAN L CO	4/1/1995	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	6863 BROCKTON AVE	None	RIVERSIDE	CA	92506	3811	33	06065	33.949107	-117.3967785	Riverside County
82146	Fee-for-Service	1265988661	1265988661	1	1	BENISANO, SHANNEL LMFT	8/3/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	409 13TH	STE 1900	OAKLAND	CA	94612	2605	01	06001	37.80326679	-122.2707988	Alameda County
82158	Fee-for-Service	1679734990	1679734990	1	1	BRUNENGRABER, DANIEL MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129461	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
82192	Fee-for-Service	1427351535	1427351535	1	1	BRIAN O'CARROLL, D.P.M., INC	3/25/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	911 OAK PARK BLVD	STE 106	PISMO BEACH	CA	93449	3406	40	06079	35.13435006	-120.6051746	San Luis Obispo County
82201	Fee-for-Service	1992889067	1992889067	1	1	BERNSTEIN, ALLAN L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22090	13	Neurology (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
82203	Fee-for-Service	1285054759	1285054759	1	1	BYRNE, SANDRA S MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63156	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2614	43	06085	37.313433	-121.9318385	Santa Clara County
82240	Fee-for-Service	1194326645	1194326645	1	1	BRACCO, JAMIE LMFT	5/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
82267	Fee-for-Service	1851398671	1851398671	1	1	BERGNER, GREGORY W MD	10/27/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34890	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1090 3RD ST	STE 1	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
82282	Fee-for-Service	1225455330	1225455330	1	1	BLAIR, KATHERINE MD	3/26/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167953	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
82308	Fee-for-Service	1518168806	1518168806	1	1	BADER, LUCAS J MD	1/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112030	20	Orthopedic Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
82313	Fee-for-Service	1699368365	1699368365	1	1	BELIEVE HOSPICE CARE INC	7/9/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 306A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
82343	Fee-for-Service	1760664866	1760664866	1	1	BEERS, LENORA A LCSW	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15823	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1010	01	06001	37.79926205	-122.2314248	Alameda County
82355	Fee-for-Service	1770554693	1770554693	1	1	BASKIN, BRIAN D MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83581	41	Internal Medicine	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
82364	Fee-for-Service	1013968072	1013968072	1	1	BRANDON N ONG	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SWEDISH HOSPITAL CHERRY	500 17TH AVE	None	SEATTLE	WA	98122	5711	00	None	47.60689769	-122.3102467	King County
82372	Fee-for-Service	1487801817	1487801817	1	1	BRODERICK, KRISTY R	5/25/2010	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	STE 8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
82387	Fee-for-Service	1174880389	1174880389	1	1	BURNS, KEVIN MD	11/21/2018	2085R0204X	NA	Other	026	PHYSICIANS	152119	30	Radiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
82394	Fee-for-Service	1902840838	1902840838	1	1	BARNETT,PAUL R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MARK REED HOSPITAL	322 S BIRCH STREET	None	MCCLEARY	WA	98557	0000	00	None	47.05560381	-123.2607785	Grays Harbor County
82407	Fee-for-Service	1790875904	1790875904	1	1	BANERJEE, ANURADHA MD	4/22/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53262	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	RM A808	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82408	Fee-for-Service	1407387475	1407387475	1	1	BECKERMAN, SAMUEL R MD	5/14/2021	207P00000X	NA	Other	026	PHYSICIANS	157860	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
82409	Fee-for-Service	1962457812	1962457812	1	93	BEVERLY RADIOLOGY MEDICAL GR	6/8/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	11525 BROOKSHIRE AVE	STE 111	DOWNEY	CA	90241	4982	19	06037	33.93544635	-118.1318321	Los Angeles County
82420	Fee-for-Service	1689713604	1689713604	1	1	BRIGHT MEDICAL ASSOC INC	1/6/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	13330 BLOOMFIELD AVE	STE A	NORWALK	CA	90650	3254	19	06037	33.90988905	-118.0644875	Los Angeles County
82457	Fee-for-Service	1326199134	1326199134	1	1	BAER, TIFFANY MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67112	41	Internal Medicine	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
82476	Fee-for-Service	1518946664	1518946664	1	1	BRANDT, RYAN D MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64343	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
82484	Fee-for-Service	1447323951	1447323951	1	1	BEDROSIAN, DIANE HELENE	2/4/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70705	40	Pediatrics	0	In state provider	None	2067 W VISTA WAY	STE 100	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
82502	Fee-for-Service	1184836611	1184836611	1	1	BATOR, MARTA Z MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118961	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
82513	Fee-for-Service	1801842406	1801842406	1	1	BRUCE HORWOOD, M.D.	7/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
82557	Fee-for-Service	1780918201	1780918201	1	1	BURNS, TRACY L MD	8/17/2020	207L00000X	NA	Other	026	PHYSICIANS	130345	05	Anesthesiology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
82559	Fee-for-Service	1851398671	1851398671	1	1	BERGNER, GREGORY W MD	10/27/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34890	08	Family Practice	0	In state provider	None	1090 3RD ST	STE 1	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
82565	Fee-for-Service	1235181033	1235181033	1	1	BRITT, WILLIAM G III PHD	8/2/1982	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11262 CAMPUS ST	None	LOMA LINDA	CA	92354	3204	36	06071	34.0491957	-117.2656796	San Bernardino County
82600	Fee-for-Service	1699368365	1699368365	1	1	BELIEVE HOSPICE CARE INC	7/9/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 306A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
82653	Fee-for-Service	1285945998	1285945998	1	1	BROWN, STEVEN A DO	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11961	20	Orthopedic Surgery	0	In state provider	None	4510 BROCKTON AVE	SUITE 175	RIVERSIDE	CA	92501	4020	33	06065	33.97675372	-117.3850798	Riverside County
82688	Fee-for-Service	1023229432	1023229432	1	1	BARUTI, SALMAN LCSW	9/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
82692	Fee-for-Service	1063822138	1063822138	1	1	BRETTLER, TALYA J MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141576	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
82693	Fee-for-Service	1790875904	1790875904	1	1	BANERJEE, ANURADHA MD	4/22/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53262	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	RM A808	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82700	Fee-for-Service	1962457812	1962457812	1	68	BEVERLY RADIOLOGY MEDICAL GR	10/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	25455 MEDICAL CENTER DR	#210	MURRIETA	CA	92562	5963	33	06065	33.55689911	-117.1863428	Riverside County
82797	Fee-for-Service	1245405422	1245405422	1	1	BOND, ANDREW R MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134324	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
82798	Fee-for-Service	1205814837	1205814837	1	1	BOROUJERDI-RAD, HASSAN	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55053	45	Nephrology (Renal-Kidney)	0	In state provider	MD INC	9209 COLIMA RD	STE 4600	WHITTIER	CA	90605	1824	19	06037	33.9505367	-118.0054552	Los Angeles County
82807	Fee-for-Service	1114488806	1114488806	1	1	BURTON, BRITTANY N MD	5/31/2023	207L00000X	NA	Other	026	PHYSICIANS	181527	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
82846	Fee-for-Service	1780918201	1780918201	1	1	BURNS, TRACY L MD	8/17/2020	207L00000X	NA	Other	026	PHYSICIANS	130345	40	Pediatrics	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
82868	Fee-for-Service	1972681575	1972681575	1	1	BUNDY, ROBERT D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24590	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
82873	Fee-for-Service	1033301726	1033301726	1	1	BOSKOVITZ, ABRAHAM MD	10/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56060	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
82937	Fee-for-Service	1295710390	1295710390	1	1	BIAS, JOHN G MD	12/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49062	08	Family Practice	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
82959	Fee-for-Service	1447612940	1447612940	1	1	BOCK, MEREDITH MD	6/16/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	152951	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82975	Fee-for-Service	1861569568	1861569568	1	1	BUSH, ONA CRNA	8/13/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
82984	Fee-for-Service	1790875904	1790875904	1	1	BANERJEE, ANURADHA MD	4/22/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53262	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	RM A808	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82987	Fee-for-Service	1962457812	1962457812	1	109	BEVERLY RADIOLOGY MEDICAL GR	8/17/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	1918 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	3957	19	06037	34.02023731	-118.1199715	Los Angeles County
82993	Fee-for-Service	1083644710	1083644710	1	1	BECKER, OLGA V MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72614	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83012	Fee-for-Service	1467031260	1467031260	1	1	BURKE, SARAH K NP	8/16/2022	363A00000X	NA	Physician Assistant	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
83017	Fee-for-Service	1437699774	1437699774	1	1	BUERGER, ANASTASIA E DO	6/29/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15187	None	None	0	In state provider	None	1600 S GAFFEY ST	None	SAN PEDRO	CA	90731	4628	19	06037	33.729498	-118.292351	Los Angeles County
83025	Fee-for-Service	1366476624	1366476624	1	1	BAJPAI, ANITA MD	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78368	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
83042	Fee-for-Service	1861085672	1861085672	1	1	BAY AREA THERAPY GROUP A MAR	12/21/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS RD	600	CONCORD	CA	94520	5292	07	06013	37.96879608	-122.0519798	Contra Costa County
83086	Fee-for-Service	1205814837	1205814837	1	1	BOROUJERDI-RAD, HASSAN	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55053	41	Internal Medicine	0	In state provider	MD INC	9209 COLIMA RD	STE 4600	WHITTIER	CA	90605	1824	19	06037	33.9505367	-118.0054552	Los Angeles County
83120	Fee-for-Service	1467482216	1467482216	1	1	BANDARI, DANIEL S MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84350	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
83150	Fee-for-Service	1891709853	1891709853	1	1	BEAM,DONALD T MD	5/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COOK CHILDREN'S PHY NET-	WORK	801 SEVENTH AVENUE	FORT WORTH	TX	76001	0000	00	None	32.75675006	-97.21256836	Tarrant County
83166	Fee-for-Service	1740224310	1740224310	1	1	BRENT D NELSON, M.D.	2/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
83184	Fee-for-Service	1427065846	1427065846	1	1	BALL, RANDALL L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
83185	Fee-for-Service	1417066234	1417066234	1	1	BRATTON, MARK A	7/1/1996	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3520 E SHIELDS AVE	STE 102	FRESNO	CA	93726	6923	10	06019	36.77947947	-119.765781	Fresno County
83202	Fee-for-Service	1831399070	1831399070	1	1	BROWNELL, APRIL A PSYD	2/26/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
83203	Fee-for-Service	1205512829	1205512829	1	2	BEVERLY ORTHOPEDIC PHYSICAL	7/31/2024	225XE1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY CENTER INC.	2623 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2309	19	06037	34.02103446	-118.1316423	Los Angeles County
83282	Fee-for-Service	1548280480	1548280480	1	1	BRIGHT HORIZONS HOME	11/27/1996	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH SERVICE	1601 PACIFIC COAST HWY	STE 290 ROOM E250	HERMOSA BEACH	CA	90254	3283	19	06037	33.86699096	-118.3936813	Los Angeles County
83303	Fee-for-Service	1457767154	1457767154	1	1	BRYDONE-JACK, MICHAEL J MD	5/6/2021	390200000X	NA	Other	026	PHYSICIANS	172034	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
83319	Fee-for-Service	1093796583	1093796583	1	1	BETH A SWANSON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 SETON PKWY	None	ROUND ROCK	TX	78665	0000	00	None	30.568167	-97.6511115	Williamson County
83334	Fee-for-Service	1861085672	1861085672	1	1	BAY AREA THERAPY GROUP A MAR	7/30/2024	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS RD	600	CONCORD	CA	94520	5292	07	06013	37.96879608	-122.0519798	Contra Costa County
83381	Fee-for-Service	1568424463	1568424463	1	1	BULLOCH, ROBERT B MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
83387	Fee-for-Service	1760416648	1760416648	1	1	BENNETT, RICHARD G MD	9/30/1982	207N00000X	NA	Dermatology	026	PHYSICIANS	50297	07	Dermatology	0	In state provider	None	200 MED PLAZA 465	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
83394	Fee-for-Service	1306146568	1306146568	1	1	BERNSTEIN, CAROLYN J NP	10/15/2018	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
83407	Fee-for-Service	1306493101	1306493101	1	1	BOMBANE, ERIN B CNP	3/12/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 S BALDWIN AVE	None	ARCADIA	CA	91007	7922	19	06037	34.12357479	-118.0551359	Los Angeles County
83411	Fee-for-Service	1326507385	1326507385	1	1	BLUMBERG, MAX J MD	7/15/2024	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	180291	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
83414	Fee-for-Service	1306980271	1306980271	1	1	BENJAMIN S GMELCH MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
83429	Fee-for-Service	1275563355	1275563355	1	1	BANKS, DALIA A MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83786	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
83445	Fee-for-Service	1750332920	1750332920	1	1	BAJWA, NARINDER S MD	10/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	43906	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	330 H ST	STE B	MARYSVILLE	CA	95901	5815	58	06115	39.13851535	-121.5948969	Yuba County
83452	Fee-for-Service	1679781231	1679781231	1	1	BURKE, JENNIFER R CRNA	12/27/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
83457	Fee-for-Service	1427042050	1427042050	1	1	BRAUNSTEIN, SCOTT A MD	3/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76114	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
83483	Fee-for-Service	1841234747	1841234747	1	1	BASS, SAMUAL P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
83490	Fee-for-Service	1205512829	1205512829	1	2	BEVERLY ORTHOPEDIC PHYSICAL	7/31/2024	225XE1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	THERAPY CENTER INC.	2623 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2309	19	06037	34.02103446	-118.1316423	Los Angeles County
83497	Fee-for-Service	1336555218	1336555218	1	1	BALE, SHIRAH M PSYD	6/16/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
83499	Fee-for-Service	1700433604	1700433604	1	1	BAILEY, KARLA NP	10/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
83512	Fee-for-Service	1043392962	1043392962	1	1	BANSAL, JAGAN N MD INC	5/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5540 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4120	19	06037	34.10855455	-118.1948437	Los Angeles County
83544	Fee-for-Service	1073582649	1073582649	1	1	BLATZ, DOUGLAS J MD	11/1/1982	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	30769	01	General Practice	0	In state provider	None	221 E HACIENDA AVE	STE C	CAMPBELL	CA	95008	6625	43	06085	37.26835997	-121.9544052	Santa Clara County
83545	Fee-for-Service	1760565840	1760565840	1	1	BUDAYR, ANNA E MD	3/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79992	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
83547	Fee-for-Service	1407929961	1407929961	1	1	BOZNER, RICHARD P OD	8/1/1984	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	DR BOZNERS VISION LAB	OPTOMETRY	4212 MARKET ST	RIVERSIDE	CA	92501	3516	33	06065	0	0	None
83577	Fee-for-Service	1043394505	1043394505	1	1	BASTA, FAWZY S MD	9/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42961	36	Psychiatry	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1285	19	06037	34.27904453	-118.459944	Los Angeles County
83578	Fee-for-Service	1083763544	1083763544	1	1	BODE, AMY E CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
83588	Fee-for-Service	1154451243	1154451243	1	1	BYERS, HUGH R MD	5/29/2009	207ND0900X	NA	Dermatology	026	PHYSICIANS	88468	22	Pathology (M.D. only)	0	In state provider	None	3701 S HIGUERA ST	STE 200	SAN LUIS OBISPO	CA	93401	7462	40	06079	35.2507845	-120.6712168	San Luis Obispo County
83589	Fee-for-Service	1649274986	1649274986	1	1	BENTZ, JEROME W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 E 7TH ST	STE 3	PLATTE	SD	57369	2123	00	None	43.38423094	-98.83619802	Charles Mix County
83595	Fee-for-Service	1902863210	1902863210	1	1	BOUKHMAN, MILANA P MD	12/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	93116	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
83602	Fee-for-Service	1669095782	1669095782	1	1	BARLOW, REBECCA R CNM	2/7/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
83607	Fee-for-Service	1619930211	1619930211	1	1	BARSOTTI, MICHAEL MD	9/30/1987	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	62616	01	General Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
83623	Fee-for-Service	1861085672	1861085672	1	1	BAY AREA THERAPY GROUP A MAR	7/9/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS RD	600	CONCORD	CA	94520	5292	07	06013	37.96879608	-122.0519798	Contra Costa County
83635	Fee-for-Service	1881981207	1881981207	1	1	BEVERLY HILLS VASCULAR	3/18/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ACCESS CENTER INC	8750 WILSHIRE BLVD	STE 150	BEVERLY HILLS	CA	90211	2703	19	06037	34.06685846	-118.3829408	Los Angeles County
83636	Fee-for-Service	1457402497	1457402497	1	1	BROADWAY MEDICAL SERVICE AND	1/1/1979	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLY INC	1034 BROADWAY ST	None	EUREKA	CA	95501	0126	12	06023	40.79683498	-124.1753848	Humboldt County
83637	Fee-for-Service	1669531398	1669531398	1	1	BURNO, RHONDA L NP	5/22/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
83668	Fee-for-Service	1568424463	1568424463	1	1	BULLOCH, ROBERT B MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
83692	Fee-for-Service	1427870252	1427870252	1	2	BRAD BARROWS, INC	4/29/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	S	1306 MARICOPA HWY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
83704	Fee-for-Service	1104349869	1104349869	1	1	BELTRAN, AARON CNP	6/27/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
83725	Fee-for-Service	1750911731	1750911731	1	1	BREJEYEH, MUNA LMFT	5/2/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	131356	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
83733	Fee-for-Service	1750332920	1750332920	1	1	BAJWA, NARINDER S MD	10/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	43906	01	General Practice	0	In state provider	None	330 H ST	STE B	MARYSVILLE	CA	95901	5815	58	06115	39.13851535	-121.5948969	Yuba County
83743	Fee-for-Service	1427042050	1427042050	1	1	BRAUNSTEIN, SCOTT A MD	3/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76114	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
83759	Fee-for-Service	1447215751	1447215751	1	1	BALL, ROBERT MD	2/28/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48284	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
83825	Fee-for-Service	1942296488	1942296488	2	1	BARROW HOME LLC	11/26/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2225 BARROW ST	None	SAN LEANDRO	CA	94577	3217	01	06001	37.70544912	-122.1813042	Alameda County
83838	Fee-for-Service	1043483167	1043483167	1	1	BENTON-LAWSON, CANDACE V	11/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	60543	-	NOT APPLICABLE	0	In state provider	LCSW	2180 WEST VALLEY BLVD	None	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
83858	Fee-for-Service	1295765261	1295765261	1	1	BERKSHIRE MEDICAL CENTER	11/29/2005	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	725 NORTH ST	None	PITTSFIELD	MA	01201	4109	00	None	42.459417	-73.2494295	Berkshire County
83859	Fee-for-Service	1285711036	1285711036	1	1	BERGUER, RAMON MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74078	10	Gastroenterology (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
83862	Fee-for-Service	1205892544	1205892544	1	1	BARGER, KHAMISAH M MD	8/11/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72692	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
83871	Fee-for-Service	1841372836	1841372836	1	1	BARTOS, IAN J MD	4/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74967	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
83874	Fee-for-Service	1154451243	1154451243	1	1	BYERS, HUGH R MD	5/29/2009	207ND0900X	NA	Dermatology	026	PHYSICIANS	88468	07	Dermatology	0	In state provider	None	3701 S HIGUERA ST	STE 200	SAN LUIS OBISPO	CA	93401	7462	40	06079	35.2507845	-120.6712168	San Luis Obispo County
83879	Fee-for-Service	1568482792	1568482792	1	1	BARBOUR, JACK MD	9/15/2024	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	40995	-	NOT APPLICABLE	0	In state provider	None	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	19	06037	34.01581788	-118.3348506	Los Angeles County
83886	Fee-for-Service	1437655990	1437655990	1	1	BURROUGH, WILLIAM B MD	6/16/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163624	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
83913	Fee-for-Service	1093158891	1093158891	1	1	BUTTAN, ANSHU K MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136452	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1737	19	06037	34.07671715	-118.3799413	Los Angeles County
83922	Fee-for-Service	1881981207	1881981207	1	1	BEVERLY HILLS VASCULAR	3/18/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ACCESS CENTER INC	8750 WILSHIRE BLVD	STE 150	BEVERLY HILLS	CA	90211	2703	19	06037	34.06685846	-118.3829408	Los Angeles County
83926	Fee-for-Service	1710114061	1710114061	1	1	BOTELLO, STELLA LCSW	1/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
83935	Fee-for-Service	1568533537	1568533537	1	1	BURKHART, GARY D MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56067	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
83980	Fee-for-Service	1588728422	1588728422	1	1	BOLAJI, ELIZABETH J CNM	11/26/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
84001	Fee-for-Service	1740398148	1740398148	1	1	BENZL, JERRY S MD INC	11/30/1986	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34016	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	26902 OSO PKWY	STE 180	MISSION VIEJO	CA	92691	5801	30	06059	33.58325322	-117.6607886	Orange County
84003	Fee-for-Service	1447679741	1447679741	1	1	BUI, NGUYEN MD	7/19/2018	207L00000X	NA	Other	026	PHYSICIANS	154483	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
84017	Fee-for-Service	1427228600	1427228600	1	1	BROWN, PERCY N LMFT	11/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
84027	Fee-for-Service	1083033146	1083033146	1	1	BENNINK, JUSTIN M MD	3/5/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138477	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84057	Fee-for-Service	1699956821	1699956821	1	1	BAUTISTA, EDDIE LMFT	4/22/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	368 SAN JUAN GRADE RD.	None	SALINAS	CA	93906	4150	27	06053	36.73674347	-121.6354761	Monterey County
84062	Fee-for-Service	1437461233	1437461233	1	1	BYRNE, ALLISON M DO	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11850	01	General Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
84070	Fee-for-Service	1841250073	1841250073	1	1	BEDNAR & DEMERSSEMAN	1/31/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL ASSOCIATES	555 E TACHEVAH DR	# 201W	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
84089	Fee-for-Service	1205213337	1205213337	1	1	BERKERY, DOMINICK A CRNA	2/24/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
84096	Fee-for-Service	1053488056	1053488056	1	1	BLAU, ERIC M MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27617	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84100	Fee-for-Service	1164425245	1164425245	1	1	BRYANT, TIMOTHY G MD	9/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	53185	02	General Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
84110	Fee-for-Service	1194390955	1194390955	1	1	BLACK, DANELL T LPCC	12/8/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	575 LOCUST AVE	SUITE 101	FRESNO	CA	93720	2928	10	06019	36.83923036	-119.7758855	Fresno County
84120	Fee-for-Service	1295815371	1295815371	1	1	BERMAN, MICHAEL L MD	2/1/1977	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21754	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
84151	Fee-for-Service	1295765261	1295765261	1	1	BERKSHIRE MEDICAL CENTER	11/29/2005	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	725 NORTH ST	None	PITTSFIELD	MA	01201	4109	00	None	42.459417	-73.2494295	Berkshire County
84214	Fee-for-Service	1265630156	1265630156	1	1	BLANCHARD, SUMNER L	1/13/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
84215	Fee-for-Service	1467414615	1467414615	1	1	BEY LOVIE D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4701 MONTGOMERY BLVD NE	None	ALBUQUERQUE	NM	87109	1219	00	None	35.13107363	-106.5908411	Bernalillo County
84221	Fee-for-Service	1568533537	1568533537	1	1	BURKHART, GARY D MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56067	77	Infectious Disease	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
84232	Fee-for-Service	1841609096	1841609096	1	1	BAJE, NELSON J	11/6/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2295 S VINEYARD	BUILDING A	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
84253	Fee-for-Service	1851516124	1851516124	1	1	BERNSTEIN, JUDITH LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
84296	Fee-for-Service	1134124233	1134124233	1	1	BEST, REKHA C OT	12/28/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
84298	Fee-for-Service	1508519612	1508519612	1	1	BEST PATHWAYS HOME HEALTH LL	4/22/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9198 GREENBACK LANE	SUITE 216	ORANGEVALE	CA	95662	5901	34	06067	38.677905	-121.2122655	Sacramento County
84304	Fee-for-Service	1437617164	1437617164	1	1	BABAEI, FARAHNAZ CNM	8/11/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
84315	Fee-for-Service	1093798720	1093798720	1	1	BLACK, RICHARD R DO	6/10/2022	207U00000X	NA	Other	026	PHYSICIANS	11117	None	None	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
84351	Fee-for-Service	1437461233	1437461233	1	1	BYRNE, ALLISON M DO	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11850	08	Family Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
84406	Fee-for-Service	1972030104	1972030104	1	1	BOKHARI, ANJUM DO	12/27/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	19451	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
84409	Fee-for-Service	1295815371	1295815371	1	1	BERMAN, MICHAEL L MD	2/1/1977	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21754	78	Neoplastic Diseases/Oncology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
84417	Fee-for-Service	1316982515	1316982515	1	1	BOUTENEFF, ALEX C MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158137	04	Otology, Laryngology, Rhinology	0	In state provider	None	2350 BUHNE STREET	SUITE B & C	EUREKA	CA	95501	3205	12	06023	40.78592523	-124.1422103	Humboldt County
84426	Fee-for-Service	1427088426	1427088426	1	1	BRESSMAN, PAUL C MD	8/31/1989	2086S0129X	NA	General Surgery	026	PHYSICIANS	22968	02	General Surgery	0	In state provider	None	7974 HAVEN AVE	STE 250	RANHCO CUCAMONGA	CA	91730	3063	36	06071	34.10875445	-117.5759905	San Bernardino County
84475	Fee-for-Service	1144513805	1144513805	2	1	BAY AREA OPHTHALMIC MEDICAL	5/13/2015	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	276 DOLORES AVE	None	SAN LEANDRO	CA	94577	4908	01	06001	37.72304518	-122.1521022	Alameda County
84506	Fee-for-Service	1750485777	1750485777	1	1	BERNSTEIN, RICHARD A MD	2/8/2015	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	6688	25	Physical Medicine and Rehabilitation	0	In state provider	None	36 SEASCAPE VLG	None	APTOS	CA	95003	6109	44	06087	36.95231135	-121.8789966	Santa Cruz County
84510	Fee-for-Service	1568533537	1568533537	1	1	BURKHART, GARY D MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56067	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
84555	Fee-for-Service	1710908983	1710908983	1	1	BUHLER, DANIEL	12/31/1991	207P00000X	NA	Other	026	PHYSICIANS	30892	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
84587	Fee-for-Service	1578257473	1578257473	1	1	BARBIC, ELIZABETH	1/17/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
84597	Fee-for-Service	1295902492	1295902492	1	1	BRIGGS, DUSTIN T MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124871	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
84604	Fee-for-Service	1588746515	1588746515	1	1	BADBERG, AMY M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	118 N 7TH AVE	None	SHELDON	IA	51201	1235	00	None	43.18701949	-95.84720824	O'Brien County
84615	Fee-for-Service	1932441706	1932441706	1	1	BERG, DAVID M MD	1/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5774	00	None	36.03815706	-114.9842287	Clark County
84617	Fee-for-Service	1952861304	1952861304	1	1	BENNETT-HORNE, CHRISTINA LM	3/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	2395 BECHELLI LN	B	REDDING	CA	96002	0120	45	06089	40.57229298	-122.3627512	Shasta County
84633	Fee-for-Service	1366748519	1366748519	1	1	BUI, VIVIAN T MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129076	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
84654	Fee-for-Service	1720695455	1720695455	1	1	BARANDIARAN, MARIO CRNA	4/15/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
84683	Fee-for-Service	1326571472	1326571472	1	1	BRIDGE, SARAH I MD	7/26/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173119	None	None	0	In state provider	None	1701 CESAR CHAVEZ AVENUE	STE 200 225	LOS ANGELES	CA	90033	6720	19	06037	34.05112725	-118.2173921	Los Angeles County
84780	Fee-for-Service	1831289909	1831289909	1	1	BEN-EZER, DORIT G MD	3/30/1991	2080P0210X	NA	Nephrology	026	PHYSICIANS	39755	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
84798	Fee-for-Service	1982066551	1982066551	1	1	BURKE, CHELSEY M MD	2/5/2025	2080P0207X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
84800	Fee-for-Service	1437131067	1437131067	1	1	BARAKAT, GEORGE H MD	12/31/1983	193400000X	NA	Other	026	PHYSICIANS	42411	20	Orthopedic Surgery	0	In state provider	None	555 ASH ST	None	SUSANVILLE	CA	96130	3711	18	06035	40.42111494	-120.6465913	Lassen County
84805	Fee-for-Service	1508137555	1508137555	1	1	BLAU, NATHAN MD	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	34173	01	General Practice	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
84821	Fee-for-Service	1700979127	1700979127	1	1	BOTTCHER, MARGARET S	10/1/1998	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	01	General Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
84838	Fee-for-Service	1275769887	1275769887	1	1	BATEMAN, ASHLEY R MD	6/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120827	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
84857	Fee-for-Service	1134127749	1134127749	1	1	BAYLOR MEDICAL CENTER AT	11/1/1993	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	GARLAND	2300 MARIE CURIE DR	None	GARLAND	TX	75042	5706	00	None	32.91860847	-96.661962	Dallas County
84862	Fee-for-Service	1851439053	1851439053	1	2	BAART BEHAVIORAL HEALTH SERV	3/4/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	4920 AVALON BLVD	None	LOS ANGELES	CA	90011	4004	19	06037	33.998157	-118.265212	Los Angeles County
84883	Fee-for-Service	1891489639	1891489639	1	1	BENNETT, MONIQUE OD	6/26/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4051 LONE TREE WAY STE E	None	ANTIOCH	CA	94531	6204	07	06013	37.97536168	-121.8003374	Contra Costa County
84887	Fee-for-Service	1629531629	1629531629	1	1	BALMAGES, AMANDA A DO	3/31/2022	207P00000X	NA	Other	026	PHYSICIANS	19355	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
84893	Fee-for-Service	1447321328	1447321328	1	1	BIGLEY, JOHN M MD	3/31/1986	207R00000X	NA	Other	026	PHYSICIANS	41119	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
84930	Fee-for-Service	1295391712	1295391712	1	1	BAGHERPOUR INC	10/22/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	70077 RAMON RD	SUITE 1	RANCHO MIRAGE	CA	92270	5201	33	06065	33.81587854	-116.4396933	Riverside County
84963	Fee-for-Service	1013982602	1013982602	1	1	BRAR, PAMILA K MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62754	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
84981	Fee-for-Service	1063583565	1063583565	1	1	BIGGERS JR AND HOLLY MDS	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	A PROF CORP	1414 S GRAND AVE	STE 410	LOS ANGELES	CA	90015	3078	19	06037	34.03661142	-118.2657227	Los Angeles County
85000	Fee-for-Service	1689623589	1689623589	1	1	BUTT, WILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	960 JFH PKWY	None	CARTERSVILLE	GA	30120	2494	00	None	34.20007679	-84.80347966	Bartow County
85013	Fee-for-Service	1508409665	1508409665	1	1	BARNETT, ANNA K LMFT	2/25/2022	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
85025	Fee-for-Service	1518540996	1518540996	1	1	BRUNSON, LEESHA LMFT	11/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
85084	Fee-for-Service	1982066551	1982066551	1	1	BURKE, CHELSEY M MD	2/5/2025	2080P0207X	NA	Hematology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
85085	Fee-for-Service	1437131067	1437131067	1	1	BARAKAT, GEORGE H MD	12/31/1983	193400000X	NA	Other	026	PHYSICIANS	42411	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 ASH ST	None	SUSANVILLE	CA	96130	3711	18	06035	40.42111494	-120.6465913	Lassen County
85088	Fee-for-Service	1194982462	1194982462	1	1	BONDYASHEVA, ANTONINA MD	12/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106395	41	Internal Medicine	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
85108	Fee-for-Service	1700979127	1700979127	1	1	BOTTCHER, MARGARET S	10/1/1998	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
85146	Fee-for-Service	1134127749	1134127749	1	1	BAYLOR MEDICAL CENTER AT	1/1/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	GARLAND	2300 MARIE CURIE DR	None	GARLAND	TX	75042	5706	00	None	32.91860847	-96.661962	Dallas County
85147	Fee-for-Service	1295113116	1295113116	1	1	BASSAL, FREDERICK DO	9/20/2023	2084N0402X	NA	Neurology	026	PHYSICIANS	21310	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
85153	Fee-for-Service	1972732873	1972732873	1	1	BUTCHER, PATRICK D MD	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120240	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91773	3219	19	06037	34.20289797	-118.6294006	Los Angeles County
85158	Fee-for-Service	1891977740	1891977740	1	1	BECERRA, ROGELIA E LMFT	5/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
85177	Fee-for-Service	1861944316	1861944316	1	1	BURBANK, CHRISTINA M	12/20/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
85180	Fee-for-Service	1518941632	1518941632	1	1	BUSSE, RAYDEEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
85199	Fee-for-Service	1982211264	1982211264	1	1	BROWN, ALLISON E PT	12/16/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
85233	Fee-for-Service	1689736043	1689736043	1	1	BHARDWAJ, JATINDER MD	2/25/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	161299	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
85258	Fee-for-Service	1043522345	1043522345	1	1	BANG, JASON B MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103344	05	Anesthesiology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
85306	Fee-for-Service	1992898845	1992898845	1	1	BROOMAND, BEHROUZ MD	11/21/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43704	01	General Practice	0	In state provider	LANKERSHIM MED CLINIC	6056 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91606	4806	19	06037	34.18110115	-118.3843592	Los Angeles County
85313	Fee-for-Service	1497205678	1497205678	1	1	BEACH, APRIL M NP	9/21/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
85344	Fee-for-Service	1043258619	1043258619	1	1	BALCERAK, THESESA NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3101 E. STATE ST	None	EAGLE	ID	83616	0000	00	None	43.68295931	-116.315383	Ada County
85367	Fee-for-Service	1083608392	1083608392	1	1	BELT, THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 ALBANY ST	STE 9066	BEECH GROVE	IN	46107	1555	00	None	39.7235553	-86.09943399	Marion County
85377	Fee-for-Service	1053912519	1053912519	1	1	BRIGHT NIGHT HOSPICE	2/19/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13647 VANOWEN ST	SUITE A	VAN NUYS	CA	91405	4262	19	06037	34.19397151	-118.4303925	Los Angeles County
85390	Fee-for-Service	1881655363	1881655363	1	1	BRITZ, MARIE B MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33754	07	Dermatology	0	In state provider	None	2074 FOREST AVE	STE 1	SAN JOSE	CA	95128	4811	43	06085	37.32704107	-121.9355734	Santa Clara County
85421	Fee-for-Service	1780270694	1780270694	1	1	BLANCO, RITCHIE	2/19/2025	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	14911 NATIONAL AVE	STE 2	LOS GATOS	CA	95032	2632	43	06085	37.25172742	-121.951483	Santa Clara County
85463	Fee-for-Service	1548372899	1548372899	1	1	BEALS, STEVEN A CRNA	10/10/2001	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
85466	Fee-for-Service	1174537575	1174537575	1	1	BERKE, GERALD S. MD	6/1/1984	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	40243	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
85497	Fee-for-Service	1689069940	1689069940	1	1	BODMER, NATALIE J MD	11/3/2021	207L00000X	NA	Other	026	PHYSICIANS	143834	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
85500	Fee-for-Service	1093030736	1093030736	1	1	BEHMANESH, BEHNAZ DO	5/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11885	None	None	0	In state provider	None	2701 W ALAMEDA AVE	604	BURBANK	CA	91505	4402	19	06037	34.15751343	-118.3303715	Los Angeles County
85507	Fee-for-Service	1629291158	1629291158	1	1	BEHNIA, NAZLY	6/28/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
85524	Fee-for-Service	1689736043	1689736043	1	1	BHARDWAJ, JATINDER MD	2/25/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	161299	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
85528	Fee-for-Service	1427066497	1427066497	1	1	BOGUE, ROBERT K DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	104 W ALEXANDER AVE	None	MERCED	CA	95348	3410	24	06047	37.31496818	-120.4711392	Merced County
85569	Fee-for-Service	1871781286	1871781286	1	1	BECKER, ROBERT J MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104625	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
85581	Fee-for-Service	1023445822	1023445822	1	1	BURNS, KATHLEEN G	12/22/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
85594	Fee-for-Service	1992898845	1992898845	1	1	BROOMAND, BEHROUZ MD	11/21/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43704	02	General Surgery	0	In state provider	LANKERSHIM MED CLINIC	6056 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91606	4806	19	06037	34.18110115	-118.3843592	Los Angeles County
85606	Fee-for-Service	1962457812	1962457812	1	162	BEVERLY RADIOLOGY MEDICAL GR	1/14/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ENTER	630 RAYMOND AVE	SUITE 201	PASADENA	CA	91105	3278	19	06037	34.13505223	-118.1487761	Los Angeles County
85608	Fee-for-Service	1053789271	1053789271	1	1	BAYLON, PAUL M MD INC	1/5/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48547	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3118 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5830	19	06037	33.97275861	-118.2115716	Los Angeles County
85644	Fee-for-Service	1063513604	1063513604	1	1	BILLOW, DAKANE A MD	9/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96256	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
85653	Fee-for-Service	1316059116	1316059116	1	1	BIO-MEDICAL APPS OF CALIF	2/5/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SANTA ROSA NORTH	487 AVIATION BLVD	STE 110	SANTA ROSA	CA	95403	1069	49	06097	38.51741311	-122.7933335	Sonoma County
85664	Fee-for-Service	1053912519	1053912519	1	1	BRIGHT NIGHT HOSPICE	2/19/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13647 VANOWEN ST	SUITE A	VAN NUYS	CA	91405	4262	19	06037	34.19397151	-118.4303925	Los Angeles County
85667	Fee-for-Service	1538188529	1538188529	1	1	BRUNNER, SCOTT D MD	7/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57856	08	Family Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
85671	Fee-for-Service	1518595123	1518595123	1	1	BHAGAT, ANKUR DO	4/20/2024	207R00000X	NA	Other	026	PHYSICIANS	20760	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
85672	Fee-for-Service	1326844168	1326844168	1	1	BOJORQUEZ, MAXIMILIANO PT	2/23/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2091 W FLORIDA AVE	STE 210	HEMET	CA	92545	4800	33	06065	33.7473485	-116.9931105	Riverside County
85729	Fee-for-Service	1386136257	1386136257	1	1	BERTAINA, ALICE MD	7/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
85734	Fee-for-Service	1952913634	1952913634	1	1	BEANS, HONEY B CNP	10/13/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
85761	Fee-for-Service	1386303642	1386303642	1	1	BUTLER, KIMBERLEE L PT	3/24/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
85822	Fee-for-Service	1700142726	1700142726	1	1	BAIDYA, NISHANTA B MD	2/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167672	None	None	0	In state provider	None	12602 AMARGOSA RD	STE F	VICTORVILLE	CA	92392	7640	36	06071	34.47936072	-117.3397257	San Bernardino County
85841	Fee-for-Service	1386358711	1386358711	1	1	BELKNAP, DELPHIN WANJIKU	6/7/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1542 W CRYSTAL AVE	None	VISALIA	CA	93291	2458	54	06107	36.350775	-119.3088285	Tulare County
85845	Fee-for-Service	1851703946	1851703946	1	1	BARAKAT, SUZANNE MD	1/8/2018	208M00000X	NA	Other	026	PHYSICIANS	140932	08	Family Practice	0	In state provider	None	350 30TH ST	100	OAKLAND	CA	94609	3422	01	06001	37.81892183	-122.2640154	Alameda County
85900	Fee-for-Service	1962457812	1962457812	1	88	BEVERLY RADIOLOGY MEDICAL GR	12/1/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	14150 CULVER DR	STE 101	IRVINE	CA	92604	0322	30	06059	33.70834263	-117.7839373	Orange County
85913	Fee-for-Service	1942391586	1942391586	1	1	BENDER, MICHAEL D MD	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	18410	10	Gastroenterology (M.D. only)	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
85917	Fee-for-Service	1174366090	1174366090	1	1	BOTRUS, JOSEPH	1/27/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND ST	STE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
85928	Fee-for-Service	1093847733	1093847733	1	1	BAKER, GARY R	12/11/2012	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1150 W ORANGEBURG AVE	None	MODESTO	CA	95350	4042	50	06099	37.66396236	-121.0095829	Stanislaus County
85932	Fee-for-Service	1982182226	1982182226	1	1	BERGMAN, CHERYL Z RCP	8/31/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
85940	Fee-for-Service	1265913735	1265913735	1	1	BROXTON, NANCY LMFT	11/25/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	335 E LAKE AVE	None	WATSONVILLE	CA	95076	4826	44	06087	36.91590197	-121.7525812	Santa Cruz County
85961	Fee-for-Service	1275732869	1275732869	1	1	BREWER, STEPHEN PSYD	10/19/2017	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3356 2ND AVE	SUITE G	SAN DIEGO	CA	92103	5636	37	06073	32.74048649	-117.1631499	San Diego County
85972	Fee-for-Service	1912268996	1912268996	1	1	BERGMAN, MICA Y MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131235	18	Ophthalmology	0	In state provider	None	1513 S GRAND AVE	STE 200	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
85979	Fee-for-Service	1598714818	1598714818	1	1	BAILEY, THOMAS S JR MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22648	None	None	0	In state provider	None	27800 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6410	30	06059	33.55952733	-117.6645199	Orange County
85986	Fee-for-Service	1982778775	1982778775	1	1	BERTRAND, SCOTT T, CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2120 FOOTHILL BLVD	STE 213	LA VERNE	CA	91750	2950	19	06037	34.1128457	-117.7639454	Los Angeles County
85999	Fee-for-Service	1306200563	1306200563	1	1	BEDRAN, ASAD DO	7/22/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15895	08	Family Practice	0	In state provider	None	27231 LA PAZ RD	STE A	LAGUNA NIGUEL	CA	92677	3627	30	06059	33.56889655	-117.7077443	Orange County
86011	Fee-for-Service	1851700132	1851700132	1	1	BOLOURIAN KASHI, KIOUMARS M	3/1/2020	207R00000X	NA	Other	026	PHYSICIANS	150087	41	Internal Medicine	0	In state provider	D	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
86031	Fee-for-Service	1760541403	1760541403	1	1	BAUTISTA, CHRISTINE G NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17046 MARYGOLD AVE	None	FONTANA	CA	92335	1722	36	06071	34.07488008	-117.4335119	San Bernardino County
86131	Fee-for-Service	1386358711	1386358711	1	1	BELKNAP, DELPHIN WANJIKU	6/7/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1542 W CRYSTAL AVE	None	VISALIA	CA	93291	2458	54	06107	36.350775	-119.3088285	Tulare County
86147	Fee-for-Service	1033606934	1033606934	1	1	BAILEY, CELESTE V MD	9/1/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	175289	None	None	0	In state provider	None	1665 ESPLANADE	None	CHICO	CA	95926	3312	04	06007	39.74388808	-121.8503372	Butte County
86155	Fee-for-Service	1487186698	1487186698	1	1	BURR, TUCKER V MD	5/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176487	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
86161	Fee-for-Service	1285784207	1285784207	1	1	BENTLEY, EDWARD MD	12/10/1998	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	39573	10	Gastroenterology (M.D. only)	0	In state provider	None	601 E ARRELLAGA ST	STE 102	SANTA BARBARA	CA	93103	4233	42	06083	34.43383593	-119.7024663	Santa Barbara County
86165	Fee-for-Service	1285690180	1285690180	1	1	BLOOM, NANCY S LCSW	10/1/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	135 COURT ST	None	AUBURN	CA	95603	5003	31	06061	38.89618708	-121.0774255	Placer County
86170	Fee-for-Service	1558844019	1558844019	1	1	BIRDJANDI, FARSCHAD MD INC	12/19/2018	207R00000X	NA	Other	026	PHYSICIANS	89932	41	Internal Medicine	0	In state provider	None	6655 ALVARDO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
86173	Fee-for-Service	1205891793	1205891793	1	1	BHANOT, PUNAM MD	6/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51922	22	Pathology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
86225	Fee-for-Service	1982060174	1982060174	1	1	BALDONADO, ANALIZA NP	7/9/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
86267	Fee-for-Service	1881013589	1881013589	1	1	BINDAL, DEEPU MD	12/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129500	01	General Practice	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
86270	Fee-for-Service	1881286052	1881286052	1	1	BAXTER, KATHRYN B CNP	11/12/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
86289	Fee-for-Service	1033573100	1033573100	1	1	BISSADA, MARINA N DO	1/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17458	08	Family Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
86305	Fee-for-Service	1669700183	1669700183	1	1	BROCKMAN, HARVEY PT	8/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
86314	Fee-for-Service	1407484298	1407484298	1	1	BARTOLETTI, JOSEPH J MD	1/8/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	188426	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
86316	Fee-for-Service	1649369109	1649369109	1	1	BAGGOT, PADDY JIM MD PC	7/21/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84916	None	None	0	In state provider	None	500 S VIRGIL AVE	204	LOS ANGELES	CA	90020	1446	19	06037	34.064964	-118.2870335	Los Angeles County
86340	Fee-for-Service	1275756017	1275756017	1	1	BRENNECKE, BERNADETTE L LCSW	3/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4574 LIVE OAK CANYON RD	None	LA VERNE	CA	91750	2312	19	06037	34.128486	-117.7449615	Los Angeles County
86352	Fee-for-Service	1366677197	1366677197	1	1	BROWN, JOACHIM M DO	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10787	08	Family Practice	0	In state provider	None	400 NORTH PEPPER AVE	None	COLTON	CA	92324	1914	36	06071	34.073505	-117.3505995	San Bernardino County
86379	Fee-for-Service	1265794754	1265794754	1	1	BARRETT, IAN J MD	3/3/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	147622	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
86383	Fee-for-Service	1538377023	1538377023	1	1	BAPAT, ROOPALI V MD	4/9/2017	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
86399	Fee-for-Service	1245377514	1245377514	1	1	BAKEL, LEIGH A MD	7/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
86424	Fee-for-Service	1558748061	1558748061	1	1	BELL, MARILEE G	5/14/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	621 W MICHELTORENA	STE B	SANTA BARBARA	CA	93101	4195	42	06083	34.41914194	-119.7157341	Santa Barbara County
86441	Fee-for-Service	1215356548	1215356548	1	2	BONKOWSKI, LAURIE E MD	11/27/2017	390200000X	NA	Other	026	PHYSICIANS	138069	40	Pediatrics	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
86442	Fee-for-Service	1558777029	1558777029	1	1	BOHAN, TIMOTHY D CRNA	4/20/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
86454	Fee-for-Service	1144777491	1144777491	1	1	BENNETT, REBECCA Z MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	151075	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
86468	Fee-for-Service	1740267426	1740267426	1	1	BEDDOE, RANDY A MD	7/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	57182	08	Family Practice	0	In state provider	None	2950 SYCAMORE DR	STE 300	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
86470	Fee-for-Service	1578602272	1578602272	1	1	BALEN, PAUL F MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60521	30	Radiology	0	In state provider	None	355 E GRAND AVE	STE 3	ESCONDIDO	CA	92025	3313	37	06073	33.12354429	-117.0775982	San Diego County
86490	Fee-for-Service	1528497096	1528497096	1	1	BONAR, MICHAEL N LCSW	7/29/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 BROADWAY	SUITE 14	BURLINGAME	CA	94010	3458	41	06081	37.5846779	-122.3658869	San Mateo County
86493	Fee-for-Service	1083887442	1083887442	1	1	BAUTISTA-QUACH, MARNELLI A M	7/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109074	22	Pathology (M.D. only)	0	In state provider	None	2625 COFFEE RD	SUITE S	MODESTO	CA	95355	2050	50	06099	37.67888506	-120.9759048	Stanislaus County
86508	Fee-for-Service	1629898275	1629898275	1	1	BOCTOR, SANDRA PT	3/13/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
86591	Fee-for-Service	1225470990	1225470990	1	1	BOURNE, ERIC T MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134579	05	Anesthesiology	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
86605	Fee-for-Service	1043423874	1043423874	1	1	BANGALORE, SAMIR S MD	1/23/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
86619	Fee-for-Service	1962457812	1962457812	1	128	BEVERLY RADIOLOGY MEDICAL GR	8/14/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	612 W. DUARTE ROAD	SUITE 101	ARCADIA	CA	91007	7602	19	06037	34.12647805	-118.051994	Los Angeles County
86649	Fee-for-Service	1992190797	1992190797	1	1	BHANSALI, ASHITOSH MD	8/7/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	149283	40	Pediatrics	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
86669	Fee-for-Service	1518977685	1518977685	1	1	BHANDARKAR, SUNIL G MD	3/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91354	18	Ophthalmology	0	In state provider	None	433 N 4TH ST	STE 214	MONTEBELLO	CA	90640	4309	19	06037	34.01561115	-118.1019888	Los Angeles County
86674	Fee-for-Service	1841550399	1841550399	1	1	BYUN, JAE SUNG LAC	1/13/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7212 ORANGETHORPE AVE	STE 6	BUENA PARK	CA	90621	3341	30	06059	33.85890953	-118.007244	Orange County
86677	Fee-for-Service	1093791006	1093791006	1	1	BAZHENOVA, LYUDMILA A MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76755	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
86700	Fee-for-Service	1487778007	1487778007	1	1	BENZING, JULIE A PT	9/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
86723	Fee-for-Service	1528383429	1528383429	1	1	BURTON, REBECCA E DO	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
86741	Fee-for-Service	1588657456	1588657456	1	1	BENJAMIN L BLEND M.D.	6/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	931 HIGHLAND BLVD 3220	None	BOSEMAN	MT	59715	0000	00	None	45.66951	-111.0209265	Gallatin County
86744	Fee-for-Service	1386891208	1386891208	1	1	BECERRA, JILLY LMFT	5/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13601 WHITTIER BLVD	STE 208	WHITTIER	CA	90605	1955	19	06037	33.96101144	-118.0289736	Los Angeles County
86762	Fee-for-Service	1871988055	1871988055	1	1	BLIZE HEALTHCARE CALIFORNIA	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	750 ALFRED NOBEL DR	SUITE 202	HERCULES	CA	94547	1837	07	06013	38.02012843	-122.2751657	Contra Costa County
86782	Fee-for-Service	1942232368	1942232368	1	1	BALAREZO, CARLOS MD	9/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	31315	02	General Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
86792	Fee-for-Service	1407811623	1407811623	1	1	BHARGAVA, RISHI MD	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82900	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
86796	Fee-for-Service	1124388962	1124388962	1	1	BAILEY, ERICA L MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129636	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
86817	Fee-for-Service	1770585721	1770585721	1	1	BROWN, MARK G MD	4/2/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159917	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
86849	Fee-for-Service	1699843128	1699843128	1	1	BRAR, INIRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HENRY FORD HEALTH SYSTEM	2799 W GRAND BLVD	None	DETROIT	MI	48202	2608	00	None	42.36645079	-83.08385497	Wayne County
86871	Fee-for-Service	1528293677	1528293677	1	1	BACKHUS, LEAH M MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77191	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
86874	Fee-for-Service	1245224831	1245224831	1	1	BONDOC, TERESA R MD INC	12/17/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49027	40	Pediatrics	0	In state provider	None	2700 N BELLFLOWER BLVD	STE 115	LONG BEACH	CA	90815	1100	19	06037	33.805692	-118.1251805	Los Angeles County
86878	Fee-for-Service	1922556695	1922556695	1	1	BOYER, VICTORIA MSW LCSW	10/9/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2221 LINCOLN PARK	None	LOS ANGELES	CA	90031	2920	19	06037	34.07105982	-118.202527	Los Angeles County
86881	Fee-for-Service	1518938661	1518938661	1	1	BARON, KATHLEEN A MD	9/5/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31933	08	Family Practice	0	In state provider	None	255 W BULLARD AVE	STE 124	CLOVIS	CA	93612	0861	10	06019	36.82308345	-119.714949	Fresno County
86883	Fee-for-Service	1366907685	1366907685	1	1	BIG HEARTS HOSPICE CARE	1/3/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9812 OLD WINERY PLACE	STE 4	SACRAMENTO	CA	95827	1732	34	06067	38.573559	-121.331043	Sacramento County
86888	Fee-for-Service	1508252883	1508252883	1	1	BUI, STEVEN DO	7/29/2019	207L00000X	NA	Other	026	PHYSICIANS	17128	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
86895	Fee-for-Service	1891884904	1891884904	1	1	BEHESHTI, MANIE MD	9/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86233	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
86909	Fee-for-Service	1962457812	1962457812	1	92	BEVERLY RADIOLOGY MEDICAL GR	12/14/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	FORBES	27882 FORBES RD	STE 120	LAGUNA NIGUEL	CA	92677	1267	30	06059	33.5574382	-117.6760079	Orange County
86910	Fee-for-Service	1619418043	1619418043	1	1	BHAMBI, NEIL MD	7/27/2020	207R00000X	NA	Other	026	PHYSICIANS	158440	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
86919	Fee-for-Service	1730272527	1730272527	1	1	BRUTON, BARBARA A MD	6/20/2005	207R00000X	NA	Other	026	PHYSICIANS	45856	41	Internal Medicine	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
86921	Fee-for-Service	1083998371	1083998371	1	1	BANKS, KAREN D DO	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13479	41	Internal Medicine	0	In state provider	None	820 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
86926	Fee-for-Service	1962457812	1962457812	1	77	BEVERLY RADIOLOGY MEDICAL GR	10/14/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	2250 S MAIN ST	STE 103	CORONA	CA	92882	2534	33	06065	33.8550661	-117.5695499	Riverside County
86947	Fee-for-Service	1508146721	1508146721	1	1	BASHO, REVA K MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119414	68	Hematology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
86969	Fee-for-Service	1336569300	1336569300	1	1	BUI, ANTIEM T DO	1/22/2020	207R00000X	NA	Other	026	PHYSICIANS	15461	41	Internal Medicine	0	In state provider	None	3300 E SOUTH ST	STE 308	LONG BEACH	CA	90805	4598	19	06037	33.86018093	-118.1537163	Los Angeles County
86978	Fee-for-Service	1922101336	1922101336	1	1	BLUM-JOHNSTON, RICHARD PT	11/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	224 N RIVERSIDE AVE	SUITE A	RIALTO	CA	92376	5968	36	06071	34.10345211	-117.3705328	San Bernardino County
87032	Fee-for-Service	1003345026	1003345026	1	1	BRIDGEWATER HEALTH SUPPLIES	4/6/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	LLC	116A SOUTH ST	None	OYSTER BAY	NY	11771	2221	00	None	40.87187373	-73.53092447	Nassau County
87052	Fee-for-Service	1871988055	1871988055	1	1	BLIZE HEALTHCARE CALIFORNIA	11/25/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	750 ALFRED NOBEL DR	SUITE 202	HERCULES	CA	94547	1837	07	06013	38.02012843	-122.2751657	Contra Costa County
87069	Fee-for-Service	1114168507	1114168507	1	1	BROWN, GWENDELYON G NP	6/22/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
87085	Fee-for-Service	1770680852	1770680852	1	1	BANKS, STEPHEN J MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80561	78	Neoplastic Diseases/Oncology	0	In state provider	None	3555 ROUND BARN CIRCLE	#100	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
87089	Fee-for-Service	1295295194	1295295194	1	1	BARSEGHIAN, BARSEGH	1/9/2025	2084P0805X	NA	Psychiatry	026	PHYSICIANS	186516	38	Geriatrics	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
87103	Fee-for-Service	1801345665	1801345665	1	1	BAKST, DANIEL	11/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
87116	Fee-for-Service	1962580688	1962580688	1	1	BUCHANAN, JON A MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84692	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
87131	Fee-for-Service	1972739431	1972739431	1	1	BOOK, ZACHARY R MD	1/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	123923	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
87140	Fee-for-Service	1104211176	1104211176	1	1	BUSSEL, ANI MD	7/9/2019	208M00000X	NA	Other	026	PHYSICIANS	161118	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
87172	Fee-for-Service	1366907685	1366907685	1	1	BIG HEARTS HOSPICE CARE	1/3/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9812 OLD WINERY PLACE	STE 4	SACRAMENTO	CA	95827	1732	34	06067	38.573559	-121.331043	Sacramento County
87183	Fee-for-Service	1659304830	1659304830	1	1	BOXER, REBECCA S MD	5/17/2023	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	68213	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
87191	Fee-for-Service	1033315114	1033315114	1	1	BERENJI, MANIJEH MD	11/11/2021	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	121725	None	None	0	In state provider	None	16300 ROSCOE BLVD	STE 1-A	VAN NUYS	CA	91406	1258	19	06037	34.22128033	-118.4884471	Los Angeles County
87234	Fee-for-Service	1508146721	1508146721	1	1	BASHO, REVA K MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119414	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
87238	Fee-for-Service	1235525882	1235525882	1	1	BLAUFUSS, GREGORY S MD	7/28/2023	207L00000X	NA	Other	026	PHYSICIANS	183519	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
87244	Fee-for-Service	1194331314	1194331314	1	1	BENSTEAD, MADISON	3/18/2025	174N00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
87245	Fee-for-Service	1104998921	1104998921	1	1	BROX, WILLIAM T MD	3/4/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49158	20	Orthopedic Surgery	0	In state provider	None	470 GREENFIELD AVE	# 35	HANFORD	CA	93230	3513	16	06031	36.32996137	-119.6580167	Kings County
87247	Fee-for-Service	1518970086	1518970086	2	1	BAILEY, WILLIAM L MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	65522	41	Internal Medicine	0	In state provider	None	191 S BUENA VISTA ST	STE 220	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
87255	Fee-for-Service	1245694587	1245694587	1	1	BIRCKHEAD, BRANDON J MD	7/29/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158921	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87260	Fee-for-Service	1083177372	1083177372	1	1	BESSETTE-CASTRO, JESSICA CN	12/21/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	13171 MINDANAO WAY	None	MARINA DEL REY	CA	90292	6307	19	06037	33.98421001	-118.4377644	Los Angeles County
87282	Fee-for-Service	1275162976	1275162976	1	1	BIRGER, MAXWELL MD	8/15/2023	207R00000X	NA	Other	026	PHYSICIANS	186574	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
87309	Fee-for-Service	1588754113	1588754113	1	1	BENTZ, JOEL MD	1/16/2024	207ZP0102X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1350 STARDUST ST	STE D	RENO	NV	89503	4264	00	None	39.52858204	-119.8347915	Washoe County
87326	Fee-for-Service	1891029468	1891029468	1	1	BARELA, SANDRA A MFT	11/3/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	460 E CARSON PLAZA DR	215	CARSON	CA	90746	3206	19	06037	33.84594175	-118.2663997	Los Angeles County
87351	Fee-for-Service	1821056565	1821056565	1	1	BLISS, GARY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	80 68TH ST SE	None	GRAND RAPIDS	MI	49548	6980	00	None	42.84065955	-85.662657	Kent County
87384	Fee-for-Service	1972522704	1972522704	1	1	BERGER, KEVIN W MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53406	41	Internal Medicine	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
87396	Fee-for-Service	1093274193	1093274193	1	1	BOLES, SHEA MD	2/7/2025	207P00000X	NA	Other	026	PHYSICIANS	179202	66	Emergency Medicine (Urgent Care)	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
87416	Fee-for-Service	1033299177	1033299177	1	1	BARASCH, EUGENE F MD	6/17/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	80932	None	None	0	In state provider	None	8219 CRYSTAL WALK CIR	None	ELK GROVE	CA	95758	8081	34	06067	38.417454	-121.4079615	Sacramento County
87427	Fee-for-Service	1407375538	1407375538	1	1	BLANCHARD, DREW C PT	4/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24671 MONROE AVE	#101C	MURRIETA	CA	92562	2527	33	06065	33.56694181	-117.2021151	Riverside County
87444	Fee-for-Service	1154407674	1154407674	1	1	BLAUROCK, MADELINE C	5/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81508	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
87471	Fee-for-Service	1013009067	1013009067	1	1	BAINS, BHUPINDER MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62063	41	Internal Medicine	0	In state provider	None	216 N AZUSA AVE	None	AZUSA	CA	91702	3524	19	06037	34.12510326	-117.9075517	Los Angeles County
87480	Fee-for-Service	1265503700	1265503700	1	1	BADSHAH, NUR	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	310 S 2ND ST	None	TUCUMCARI	NM	88401	2858	00	None	35.176653	-103.726112	Quay County
87507	Fee-for-Service	1639366586	1639366586	1	1	BONNEAU, RAYMOND MD APC	12/31/1986	174400000X	NA	Other	026	PHYSICIANS	30247	20	Orthopedic Surgery	0	In state provider	None	165 ROWLAND WY	STE 100	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
87512	Fee-for-Service	1962457812	1962457812	1	60	BEVERLY RADIOLOGY MEDICAL GR	9/8/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3655 ALAMO ST	STE 101	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
87523	Fee-for-Service	1093893802	1093893802	1	1	BHASKAR, SHREE L MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85303	26	Psychiatry (child)	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
87524	Fee-for-Service	1508146721	1508146721	1	1	BASHO, REVA K MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119414	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
87537	Fee-for-Service	1518970086	1518970086	2	1	BAILEY, WILLIAM L MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	65522	01	General Practice	0	In state provider	None	191 S BUENA VISTA ST	STE 220	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
87583	Fee-for-Service	1689736415	1689736415	1	1	BEACH, MARY A PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
87597	Fee-for-Service	1275593154	1275593154	1	1	BULKIN, ANATOLY J	9/14/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79826	02	General Surgery	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
87598	Fee-for-Service	1962457812	1962457812	1	104	BEVERLY RADIOLOGY MEDICAL GR	5/13/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	12276 HESPERIA ROAD	STE 5	VICTORVILLE	CA	92395	5838	36	06071	34.47424926	-117.2915621	San Bernardino County
87599	Fee-for-Service	1558396077	1558396077	1	1	BADALYAN, SEDA MD	11/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100925	41	Internal Medicine	0	In state provider	None	435 ARDEN AVENUE	SUITE 450	GLENDALE	CA	91203	4024	19	06037	34.15848148	-118.2628845	Los Angeles County
87609	Fee-for-Service	1972715365	1972715365	1	1	BATEMAN, ALISON PHD	12/8/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
87615	Fee-for-Service	1235240490	1235240490	1	1	BOYD, KENDAL C PHD	9/6/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11130 ANDERSON ST	STE 117	LOMA LINDA	CA	92354	2802	36	06071	34.05167746	-117.2614612	San Bernardino County
87624	Fee-for-Service	1629332341	1629332341	1	1	BEY, LOVEVASIA NP	4/14/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6120 N VINELAND AVE	None	NORTH HOLLYWOOD	CA	91606	4914	19	06037	34.1819583	-118.3702737	Los Angeles County
87664	Fee-for-Service	1568458966	1568458966	1	1	BARTELL, LINDA D MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	83134	41	Internal Medicine	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
87715	Fee-for-Service	1689716003	1689716003	1	1	BASAVIAH, PREETHA MD	8/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72829	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87736	Fee-for-Service	1063615102	1063615102	1	1	BANSAL, MANEESH A MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100339	01	General Practice	0	In state provider	None	5540 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4120	19	06037	34.10855455	-118.1948437	Los Angeles County
87744	Fee-for-Service	1972790863	1972790863	1	2	BUI, HAO D MD INC	12/1/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4901 CENTENNIAL PLAZA WY	None	BAKERSFIELD	CA	93312	2011	15	06029	35.40400955	-119.0934945	Kern County
87745	Fee-for-Service	1659729341	1659729341	1	1	BROOKS, KATHERINE C MD	9/4/2019	207R00000X	NA	Other	026	PHYSICIANS	160970	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
87755	Fee-for-Service	1447997077	1447997077	1	1	BURNEY, BRAEANNE M NP	5/23/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
87811	Fee-for-Service	1851427595	1851427595	1	1	BARAN, JOHANNA L	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117062	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
87814	Fee-for-Service	1508415779	1508415779	1	1	BARRAMEDA, MONICA LMFT	8/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
87818	Fee-for-Service	1982077475	1982077475	1	1	BEARDSLEY, KATHERINE LMFT	7/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 E ST	STE 316	SANTA ROSA	CA	95404	4607	49	06097	38.441016	-122.7097035	Sonoma County
87848	Fee-for-Service	1043240682	1043240682	1	1	BAPTIST HEALTH MEDICAL CTR	11/23/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 INTERSTATE 630	EXIT 7	LITTLE ROCK	AR	72205	7202	00	None	34.74576577	-92.35934231	Pulaski County
87859	Fee-for-Service	1831129824	1831129824	1	2	BEST CARE MED EQUIP INC	6/26/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SEAL'S HEALTHCARE	2131 PLACENTIA AVE	None	COSTA MESA	CA	92627	3301	30	06059	33.651594	-117.932116	Orange County
87889	Fee-for-Service	1487784567	1487784567	1	1	BONACCI, CHRISTINE A MD	5/31/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	72222	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3290 PROFESSIONAL DR	STE C	AUBURN	CA	95602	2490	31	06061	38.94408	-121.100762	Placer County
87952	Fee-for-Service	1104925205	1104925205	1	1	BUTERA, MICHAEL L	11/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70238	77	Infectious Disease	0	In state provider	None	6699 ALVARADO RD	STE 2308	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
87983	Fee-for-Service	1003351719	1003351719	1	1	BURNLEY, TARA A LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH RD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
87985	Fee-for-Service	1003979188	1003979188	1	1	BLISS, LINDLEY T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
87986	Fee-for-Service	1467802934	1467802934	1	1	BERRYHILL, BETHANY M NP	11/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
88013	Fee-for-Service	1922043314	1922043314	1	1	BEYERSDORF, HEIDI M	3/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
88014	Fee-for-Service	1497095905	1497095905	1	1	BOHAMA DIALYSIS LLC	1/23/2014	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8219 ROCHESTER AVE	STE 120	RANCHO CUCAMONGA	CA	91730	0722	36	06071	34.104249	-117.5431815	San Bernardino County
88016	Fee-for-Service	1487694014	1487694014	1	1	BARBICK, BRIAN C MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90159	02	General Surgery	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
88030	Fee-for-Service	1003163809	1003163809	1	1	BACIO, SOFIA LCSW	4/7/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	73836	-	NOT APPLICABLE	0	In state provider	None	7515 VAN NUYS BLVD	URGENT CARE ROOMS 122,12	VAN NUYS	CA	91405	1949	19	06037	34.207344	-118.4487995	Los Angeles County
88034	Fee-for-Service	1972790863	1972790863	1	2	BUI, HAO D MD INC	11/18/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4901 CENTENNIAL PLAZA WY	None	BAKERSFIELD	CA	93312	2011	15	06029	35.40400955	-119.0934945	Kern County
88049	Fee-for-Service	1750182945	1750182945	1	1	BYRNES, ELWANDA E	4/29/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	24	06047	0	0	None
88062	Fee-for-Service	1588313662	1588313662	1	1	BENNETT, ALEXANDRA LCSW	9/18/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
88063	Fee-for-Service	1841240215	1841240215	1	1	BELBEL, ROGER DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EL PASO HEART VASCULAR	CLINIC, PA	7430 REMCON BLDG B 110	EL PASO	TX	79912	3519	00	None	0	0	None
88101	Fee-for-Service	1922516889	1922516889	1	1	BACALLAO, MICHAEL A LCSW	9/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	382 N MCKELVY AVE	202	CLOVIS	CA	93611	2410	10	06019	36.836442	-119.668488	Fresno County
88131	Fee-for-Service	1841750080	1841750080	1	1	BLEU, GWENDOLYN LMFT	2/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
88163	Fee-for-Service	1124003793	1124003793	1	1	BROWN, EDWARD W MD	4/30/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	38495	None	None	0	In state provider	None	3750 CONVOY ST	STE 301	SAN DIEGO	CA	92111	3741	37	06073	32.81201122	-117.1531108	San Diego County
88174	Fee-for-Service	1093179319	1093179319	1	1	BUCHFUHRER, JULIA E DO	11/1/2022	207RR0500X	NA	Other	026	PHYSICIANS	15806	None	None	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 108	DOWNEY	CA	90241	5020	19	06037	33.93622932	-118.1311752	Los Angeles County
88180	Fee-for-Service	1497999262	1497999262	1	1	BERK, FATMA MD	7/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162672	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
88181	Fee-for-Service	1548939689	1548939689	1	1	BRANDES, DIANA NP	8/12/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
88213	Fee-for-Service	1922100908	1922100908	1	1	BEISSNER, IRENE A MD	10/27/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42256	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1617 BROADWAY ST	None	VALLEJO	CA	94590	2406	48	06095	38.12454745	-122.2499877	Solano County
88214	Fee-for-Service	1194889410	1194889410	1	1	BANSAL, VISHAL MD	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94958	None	None	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2108	37	06073	32.75034388	-117.161023	San Diego County
88215	Fee-for-Service	1376930784	1376930784	1	1	BALLARD, DANIEL P	10/8/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	172930	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
88219	Fee-for-Service	1740784669	1740784669	1	1	BOOTH, BRITTANY I MD	3/11/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166199	None	None	0	In state provider	None	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
88223	Fee-for-Service	1245551621	1245551621	1	1	BOICE, BRADEN W MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140826	30	Radiology	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2116	34	06067	38.602089	-121.3925895	Sacramento County
88230	Fee-for-Service	1043744774	1043744774	1	1	BUFANO, COLLIN DO	7/11/2020	207P00000X	NA	Other	026	PHYSICIANS	17848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
88236	Fee-for-Service	1639258247	1639258247	1	1	BENNETT, BARBARA A MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1010 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1417	21	06041	37.95619826	-122.5481605	Marin County
88242	Fee-for-Service	1104925205	1104925205	1	1	BUTERA, MICHAEL L	11/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6699 ALVARADO RD	STE 2308	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
88253	Fee-for-Service	1104001718	1104001718	1	1	BRAR, AMARPALI MD	9/25/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	154027	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
88308	Fee-for-Service	1255764346	1255764346	1	1	BIAN, SHELLY X MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129334	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
88321	Fee-for-Service	1972790863	1972790863	1	2	BUI, HAO D MD INC	8/10/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4901 CENTENNIAL PLAZA WY	None	BAKERSFIELD	CA	93312	2011	15	06029	35.40400955	-119.0934945	Kern County
88351	Fee-for-Service	1962457812	1962457812	1	80	BEVERLY RADIOLOGY MEDICAL GR	2/9/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	9191 WESTMINSTER AVE	SUITE 105	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
88352	Fee-for-Service	1558471219	1558471219	1	1	BEL AIR MARKET INC.	2/18/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1039 SUNRISE AVE	None	ROSEVILLE	CA	95661	7004	31	06061	38.72858731	-121.2720515	Placer County
88359	Fee-for-Service	1376774943	1376774943	1	1	BARKER, CATHERINE F PHD	10/19/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	919 N SUNSET AVENUE	None	WEST COVINA	CA	91790	1244	19	06037	34.08746233	-117.9341836	Los Angeles County
88392	Fee-for-Service	1487632725	1487632725	1	1	BALDWIN, MATTHEW T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST PAUL RADIOLOGY	166 4TH ST E	None	ST PAUL	MN	55101	1421	00	None	44.94748068	-93.08830943	Ramsey County
88405	Fee-for-Service	1922265586	1922265586	1	1	BAKER HICKS INC	5/20/2009	385HR2060X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4747 NORTH 1ST ST	#181	FRESNO	CA	93726	0517	10	06019	36.803385	-119.7724465	Fresno County
88433	Fee-for-Service	1346711686	1346711686	1	1	BLUE MOON HOME HEALTH	7/3/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	260 SOUTH LOS ROBLES AVE	SUITE 114	PASADENA	CA	91101	2869	19	06037	34.141437	-118.1413435	Los Angeles County
88456	Fee-for-Service	1215072962	1215072962	1	1	BURNS, MARK F LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	29926	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
88484	Fee-for-Service	1124053939	1124053939	1	1	BURR, MICHAEL F MD	8/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91751	05	Anesthesiology	0	In state provider	None	43830 10TH ST W	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
88512	Fee-for-Service	1942244108	1942244108	1	1	BURT, DONALD W MD	9/26/2024	207YX0602X	NA	ENT/Otolaryngology	026	PHYSICIANS	40654	04	Otology, Laryngology, Rhinology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
88516	Fee-for-Service	1508002775	1508002775	1	1	BEIERMEISTER, KEITH A MD	11/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125321	02	General Surgery	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
88523	Fee-for-Service	1861438392	1861438392	1	1	BRUNK, VICKIE F	7/11/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
88530	Fee-for-Service	1013143718	1013143718	1	1	BLANKENSHIP, CRYSTAL B MD	2/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121992	01	General Practice	0	In state provider	None	2020 SUTTER PLACE	None	DAVIS	CA	95616	6213	57	06113	38.56287659	-121.7715536	Yolo County
88547	Fee-for-Service	1306257324	1306257324	1	1	BENEVOLENCE INDUSTRIES INC	7/31/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	934 ATLANTIC AVE	None	LONG BEACH	CA	90813	4515	19	06037	33.778395	-118.1850225	Los Angeles County
88556	Fee-for-Service	1487766283	1487766283	1	1	BIO-MEDICAL APPLICATIONS	5/29/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	351 E BIRCH STREET	None	CALEXICO	CA	92231	4350	13	06025	32.67929272	-115.4940817	Imperial County
88584	Fee-for-Service	1235332966	1235332966	1	1	BURNETT, MITZE PSYD	5/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3419 VALLE VERDE DR	None	NAPA	CA	94558	2414	28	06055	38.32542048	-122.292335	Napa County
88597	Fee-for-Service	1083683031	1083683031	1	1	BRODERKICK, LYNN S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 S PARK ST	None	MADISON	WI	53715	1507	00	None	43.0654364	-89.40092987	Dane County
88628	Fee-for-Service	1164459913	1164459913	1	1	BLUMENFELD, ANDREW M MD	12/18/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47863	13	Neurology (M.D. only)	0	In state provider	None	3907 WARING RD	None	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
88635	Fee-for-Service	1164913687	1164913687	1	1	BELLA VITA HOME HEALTH CARE	1/8/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1915 W GLENOAKS BLVD	UNIT 200	GLENDALE	CA	91201	4387	19	06037	34.17444751	-118.2940603	Los Angeles County
88645	Fee-for-Service	1588607410	1588607410	1	1	BELL, MARK R MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80340	None	None	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
88661	Fee-for-Service	1215102165	1215102165	1	1	BOWLER, ELIZABETH D MD	5/5/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	35056	-	NOT APPLICABLE	0	In state provider	None	212 I STREET	None	DAVIS	CA	95616	4213	57	06113	38.54444712	-121.7367031	Yolo County
88671	Fee-for-Service	1558400259	1558400259	1	1	BEAUBRUN, GABRIELLE F MD	12/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67116	36	Psychiatry	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
88687	Fee-for-Service	1376621961	1376621961	1	1	BENET, JOHN I	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61790	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
88706	Fee-for-Service	1225081789	1225081789	1	1	BACHIR, GHASSAN S	7/25/2011	208600000X	NA	General Surgery	026	PHYSICIANS	42006	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
88712	Fee-for-Service	1629488358	1629488358	1	1	BEHDIN, NINA MD	2/4/2025	208600000X	NA	General Surgery	026	PHYSICIANS	138587	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
88718	Fee-for-Service	1346711686	1346711686	1	1	BLUE MOON HOME HEALTH	7/3/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	260 SOUTH LOS ROBLES AVE	SUITE 114	PASADENA	CA	91101	2869	19	06037	34.141437	-118.1413435	Los Angeles County
88733	Fee-for-Service	1972284958	1972284958	1	1	BREAKING CYCLES COUNSELING	8/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12139 MOUNT VERNON AVE	STE 105	GRAND TERRACE	CA	92313	5500	36	06071	34.033185	-117.313583	San Bernardino County
88758	Fee-for-Service	1669550372	1669550372	1	1	BANK, DANIEL D MD	7/31/1991	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1700 ADAMS AVE	None	COSTA MESA	CA	92626	4865	30	06059	33.6727595	-117.9257945	Orange County
88761	Fee-for-Service	1871026245	1871026245	1	1	BYRNE, LAUREN R MD	7/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157354	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
88762	Fee-for-Service	1194801100	1194801100	1	1	BRUCE, NOAH G PSYD	4/30/2018	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	355 ABBOTT ST STE 201	STE 201	SALINAS	CA	93901	4483	27	06053	36.66552031	-121.6439174	Monterey County
88766	Fee-for-Service	1770655300	1770655300	1	1	BURRS, DEMETRA L MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81711	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
88767	Fee-for-Service	1669584462	1669584462	1	1	BIO-MEDICAL APPLICATIONS	5/1/1996	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	OF ARIZONA LLC	2650 MIRACLE MILE	None	BULLHEAD CITY	AZ	86442	5170	00	None	35.090145	-114.595848	Mohave County
88776	Fee-for-Service	1023774718	1023774718	1	1	BALL, JAMEE P NP	2/7/2024	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
88783	Fee-for-Service	1043496334	1043496334	1	1	BLAZADO, EVELYN R MD INC	4/4/2008	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	PARADISE VALLEY INC	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2098	37	06073	32.68637926	-117.0828839	San Diego County
88797	Fee-for-Service	1750440244	1750440244	1	1	BAYER, KELLEY L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
88812	Fee-for-Service	1710431960	1710431960	1	1	BONGGA, JOHN J L CRNA	1/20/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	2ND FL	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
88836	Fee-for-Service	1306257324	1306257324	1	1	BENEVOLENCE INDUSTRIES INC	7/31/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	934 ATLANTIC AVE	None	LONG BEACH	CA	90813	4515	19	06037	33.778395	-118.1850225	Los Angeles County
88857	Fee-for-Service	1720406002	1720406002	1	1	BROOKS, KATHERINE M DO	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14712	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
88865	Fee-for-Service	1154825834	1154825834	1	1	BASH, JASPER C MD	3/30/2023	208800000X	NA	Other	026	PHYSICIANS	183451	None	None	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
88873	Fee-for-Service	1114989951	1114989951	1	1	BLUSTEIN, ARNOLD J MD	9/21/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33522	40	Pediatrics	0	In state provider	None	1235 HARRISON ST	None	SAN LEANDRO	CA	94577	4515	01	06001	37.72577467	-122.1544541	Alameda County
88886	Fee-for-Service	1598968992	1598968992	1	1	BAI, SHUTING MD	6/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147071	22	Pathology (M.D. only)	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
88887	Fee-for-Service	1639173289	1639173289	1	1	BENZIAN, LURLEEN M MD	9/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82200	07	Dermatology	0	In state provider	None	334 S PATTERSON AVE	STE 105	SANTA BARBARA	CA	93111	2475	42	06083	34.43376368	-119.8092445	Santa Barbara County
88888	Fee-for-Service	1982950572	1982950572	1	1	BAREKATAIN, ARMIN MD	1/3/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161144	None	None	0	In state provider	None	23521 PASEO DE VALENCIA	SUITE 303	LAGUNA HILLS	CA	92653	3102	30	06059	33.61113028	-117.7126684	Orange County
88892	Fee-for-Service	1952845364	1952845364	1	1	BRANDT, DAVID NP	4/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
88897	Fee-for-Service	1689057002	1689057002	1	1	BALLAN, ALEX LCSW	9/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18000 STUDEBAKER RD	700	CERRITOS	CA	90703	2679	19	06037	33.86863289	-118.0988933	Los Angeles County
88913	Fee-for-Service	1164459913	1164459913	1	1	BLUMENFELD, ANDREW M MD	12/18/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47863	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3907 WARING RD	None	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
88974	Fee-for-Service	1063677508	1063677508	1	1	BAGGA-MALHOTRA, SHAGUN MD	3/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119796	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
89007	Fee-for-Service	1922046598	1922046598	1	1	BHUTA, SUNITA M MD	8/1/1998	207ZP0101X	NA	Other	026	PHYSICIANS	32014	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
89023	Fee-for-Service	1043347495	1043347495	1	1	BAIN, LISA C MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108858	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
89037	Fee-for-Service	1245370147	1245370147	1	1	BAYER, MATTHEW MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76944	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
89047	Fee-for-Service	1619008380	1619008380	1	1	BEHAVIORAL HEALTH SERVICES	8/31/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC.	12917 CERISE AVE.	None	HAWTHORNE	CA	90250	5520	19	06037	33.914835	-118.3325365	Los Angeles County
89084	Fee-for-Service	1457630113	1457630113	1	1	BELAGAVI, AMULYA C MD	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	151661	41	Internal Medicine	0	In state provider	None	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
89086	Fee-for-Service	1699840728	1699840728	1	1	BUTTAN, VINAY K MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33656	41	Internal Medicine	0	In state provider	None	166 N VILLA ST	None	PORTERVILLE	CA	93257	3218	54	06107	36.06885992	-119.0306664	Tulare County
89103	Fee-for-Service	1215905633	1215905633	1	1	BISLA, TAJINDER S MD	3/31/2020	207ZP0102X	NA	Other	026	PHYSICIANS	62287	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	1900	15	06029	35.38291587	-119.0199632	Kern County
89145	Fee-for-Service	1679620868	1679620868	1	1	BALBOA PARK INTERNAL	12/14/2014	207R00000X	NA	Other	026	PHYSICIANS	54031	41	Internal Medicine	0	In state provider	MEDICINE MED ASSOC, INC	2970 5TH AVE	STE 140	SAN DIEGO	CA	92103	5995	37	06073	32.736375	-117.160368	San Diego County
89174	Fee-for-Service	1063585016	1063585016	1	1	BUNDROS, YANI LMFT	7/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
89218	Fee-for-Service	1477889962	1477889962	1	1	BAXI, SANJIV M MD	2/11/2021	207R00000X	NA	Other	026	PHYSICIANS	114670	None	None	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
89233	Fee-for-Service	1003265562	1003265562	1	1	BECK, GEOFFREY T MD	12/30/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158623	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
89260	Fee-for-Service	1245398676	1245398676	1	1	BUTTE COUNTY PSYCH HLTH FAC	7/1/2009	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	592 RIO LINDA AVE	None	CHICO	CA	95926	1817	04	06007	39.75427022	-121.8482553	Butte County
89288	Fee-for-Service	1427101369	1427101369	1	1	BENACARE MEDICAL CTR INC	2/23/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	984 W FOOTHILL BLVD	None	UPLAND	CA	91786	3700	36	06071	34.10650049	-117.6651668	San Bernardino County
89290	Fee-for-Service	1184043051	1184043051	1	1	BOJEDLA, SUNDEEP DO	5/28/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	18130	13	Neurology (M.D. only)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
89323	Fee-for-Service	1760894190	1760894190	1	1	BARKODAR, LINDA MD INC APC	7/30/2014	261QP2300X	NA	Other	026	PHYSICIANS	107742	41	Internal Medicine	0	In state provider	None	2809 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5538	19	06037	33.94599284	-118.2211199	Los Angeles County
89327	Fee-for-Service	1245370147	1245370147	1	1	BAYER, MATTHEW MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76944	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
89329	Fee-for-Service	1568809259	1568809259	1	1	BRUNSING, RYAN L MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134578	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89332	Fee-for-Service	1699719708	1699719708	1	1	BOURNS, SCOTT G DO	5/20/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9042	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
89339	Fee-for-Service	1356360705	1356360705	1	1	BOYLE, CATHY M RN	2/1/2002	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
89357	Fee-for-Service	1245268317	1245268317	1	1	BAAS, DONALD R RPT	3/1/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	116 S LASSEN ST	None	WILLOWS	CA	95988	3009	11	06021	39.52027795	-122.1995617	Glenn County
89363	Fee-for-Service	1003109448	1003109448	1	1	BUDATI, GOKUL MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156322	01	General Practice	0	In state provider	None	400 PLUMAS BLVD	STE 200	YUBA CITY	CA	95991	6200	51	06101	39.12993077	-121.6147217	Sutter County
89379	Fee-for-Service	1962428896	1962428896	1	1	BARASH, MUNI M MD	1/1/1982	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	45243	41	Internal Medicine	0	In state provider	None	2557 MOWRY AVE	STE 12	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
89389	Fee-for-Service	1326087750	1326087750	1	1	BROCK-UTNE, ARNE J MD	6/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72943	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
89420	Fee-for-Service	1881733608	1881733608	1	1	BERGMAN, DAVID A MD	12/11/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	26747	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
89459	Fee-for-Service	1093219578	1093219578	1	1	BISHARA, CYNTHIA MD	1/12/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179953	None	None	0	In state provider	None	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	19	06037	33.80432955	-118.1594295	Los Angeles County
89477	Fee-for-Service	1487634317	1487634317	1	1	BAUTISTA MEDICAL GROUP	4/1/1993	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2505 MERCED ST	None	FRESNO	CA	93721	1811	10	06019	36.74081939	-119.7879808	Fresno County
89484	Fee-for-Service	1326310129	1326310129	1	1	BULOS, JONATHAN	6/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
89491	Fee-for-Service	1770677247	1770677247	1	1	BOHUN, THERESA ROSE MD	7/31/1995	207R00000X	NA	Other	026	PHYSICIANS	77440	41	Internal Medicine	0	In state provider	None	3260 3RD AVE	None	SAN DIEGO	CA	92103	5616	37	06073	32.73949839	-117.1622444	San Diego County
89544	Fee-for-Service	1821076639	1821076639	1	1	BUNNAPRADIST, SUPHAMAI	4/1/2000	174400000X	NA	Other	026	PHYSICIANS	65633	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
89546	Fee-for-Service	1366606055	1366606055	1	1	BOISVERT, CHANTAL MD	8/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104628	18	Ophthalmology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
89550	Fee-for-Service	1982686333	1982686333	1	1	BARON, JONATHAN A MD	2/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	82045	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
89552	Fee-for-Service	1255548103	1255548103	1	1	BALASUNDARAM, MALATHI MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98983	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
89594	Fee-for-Service	1134291677	1134291677	1	1	BORREGO, RODOLFO LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1106 N CHINOWTH ST	None	VISALIA	CA	93291	4113	54	06107	36.33858	-119.3352705	Tulare County
89611	Fee-for-Service	1962457812	1962457812	1	98	BEVERLY RADIOLOGY MEDICAL GR	6/29/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	2679 ZOE AVE	None	HUNTINGTON PARK	CA	90255	4144	19	06037	33.9793143	-118.2229961	Los Angeles County
89621	Fee-for-Service	1164860854	1164860854	1	1	BONNEY, CAITLIN F MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
89625	Fee-for-Service	1568612729	1568612729	1	1	BUTTERFIELD, KENJI MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107102	05	Anesthesiology	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
89661	Fee-for-Service	1295773232	1295773232	1	1	BANTZ, JODY L PHD	6/13/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
89662	Fee-for-Service	1912511601	1912511601	1	1	BEST CHANCE HOME HEALTH	9/30/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY CARE INC	5311 TOPANGA CANYON BLVD	SUITE 307	WOODLAND HILLS	CA	91364	1754	19	06037	34.166313	-118.6059365	Los Angeles County
89674	Fee-for-Service	1093107625	1093107625	1	1	BARBA, KARLA F LMFT	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
89685	Fee-for-Service	1548659105	1548659105	1	1	BEHAVIORAL HEALTH SERVICES	9/4/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INC	2501 W EL SEGUNDO BLVD	SUITE B	HAWTHORNE	CA	90250	3317	19	06037	33.91648148	-118.3206645	Los Angeles County
89687	Fee-for-Service	1629039664	1629039664	1	1	BRAR, RAJIVINDER S DO	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9567	08	Family Practice	0	In state provider	None	360 E MISSION BLVD	None	POMONA	CA	91766	1847	19	06037	34.05514856	-117.7475076	Los Angeles County
89691	Fee-for-Service	1780732644	1780732644	1	1	BEDROS, ANI MD	7/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74846	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
89711	Fee-for-Service	1669402327	1669402327	1	1	BIDDISON, THOMAS D MD	10/1/1998	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	55699	01	General Practice	0	In state provider	None	1300 N VERMONT AVE	STE 407	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
89739	Fee-for-Service	1124345137	1124345137	1	1	BELL FAMILY THERAPY AND HEAL	6/27/2020	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	TH SOLUTIONS, A PROFESSI	327 NORTH SAN MATEO DR	10	SAN MATEO	CA	94401	2543	41	06081	37.57156972	-122.3318678	San Mateo County
89747	Fee-for-Service	1689974610	1689974610	1	2	BORBERG FRANCESCHI,	2/21/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139961	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CHRISTIAN J MD	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
89763	Fee-for-Service	1548219348	1548219348	1	1	BORSKY, TOMAS	10/31/1991	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PRACTICE TOMAS BORSKY OD	154 HUGHES ROAD	STE 3	GRASS VALLEY	CA	95945	5630	29	06057	39.22846954	-121.0536958	Nevada County
89771	Fee-for-Service	1508903873	1508903873	1	1	BEST,ALAN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	PO BOX 111719	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
89781	Fee-for-Service	1285705244	1285705244	1	1	BOBBA, NAVEENA R MD	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77404	03	Allergy	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
89789	Fee-for-Service	1346372661	1346372661	1	2	BRETT V CURTIS MD A PROFESSI	2/24/2024	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	979 SAN PABLO AVE	None	ALBANY	CA	94706	2009	01	06001	37.88748052	-122.2980472	Alameda County
89810	Fee-for-Service	1467496919	1467496919	1	1	BROWN, MONICA L MD	2/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84923	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18TH AVE & HWY 53	None	CLEARLAKE	CA	95422	0000	17	06033	38.936934	-122.6222415	Lake County
89817	Fee-for-Service	1962457812	1962457812	1	147	BEVERLY RADIOLOGY MEDICAL GR	4/3/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8436 3RD ST	SUITE 600 & 801	LOS ANGELES	CA	90048	4163	19	06037	34.07313096	-118.3745151	Los Angeles County
89820	Fee-for-Service	1396037537	1396037537	1	1	BOONYASAMPANT, MARK MD	11/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126158	22	Pathology (M.D. only)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
89830	Fee-for-Service	1619437779	1619437779	1	1	BOURNE, MATTHEW DO	1/22/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23003	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
89833	Fee-for-Service	1821076639	1821076639	1	1	BUNNAPRADIST, SUPHAMAI	4/1/2000	174400000X	NA	Other	026	PHYSICIANS	65633	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
89867	Fee-for-Service	1144254806	1144254806	1	1	BHAGAVAT, APARNA M MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111299	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
89869	Fee-for-Service	1700032034	1700032034	1	1	BUTLER, MARY M LMFT	5/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3130 WEST MAIN ST	STE C	VISALIA	CA	93291	5765	54	06107	36.328122	-119.325447	Tulare County
89886	Fee-for-Service	1548211899	1548211899	1	1	BARSEGYAN, ARSINE	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84731	None	None	0	In state provider	None	1202 S CENTRAL AVE	None	GLENDALE	CA	91204	2504	19	06037	34.1320219	-118.2577528	Los Angeles County
89903	Fee-for-Service	1962457812	1962457812	1	59	BEVERLY RADIOLOGY MEDICAL GR	9/9/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	230 S MAIN ST	STE 100	ORANGE	CA	92868	3851	30	06059	33.785154	-117.867318	Orange County
89929	Fee-for-Service	1457389082	1457389082	1	1	BUNNELL, WILLIAM P MD	6/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60773	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	# 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
89949	Fee-for-Service	1912408527	1912408527	1	1	BLAIS, JEAN-FREDERICK CRNA	3/15/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
89971	Fee-for-Service	1548659105	1548659105	1	1	BEHAVIORAL HEALTH SERVICES	6/15/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INC	2501 W EL SEGUNDO BLVD	SUITE B	HAWTHORNE	CA	90250	3317	19	06037	33.91648148	-118.3206645	Los Angeles County
89977	Fee-for-Service	1467452235	1467452235	1	1	BORGES, MICHAEL F MD	6/9/2016	207L00000X	NA	Other	026	PHYSICIANS	72319	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
90015	Fee-for-Service	1033267836	1033267836	1	1	BARTOS, BRADLEY R MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76191	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
90046	Fee-for-Service	1811256027	1811256027	1	1	BASSETT, DUSTIN J DO	6/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12953	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
90073	Fee-for-Service	1285705244	1285705244	1	1	BOBBA, NAVEENA R MD	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77404	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
90080	Fee-for-Service	1629128442	1629128442	1	1	BATCHU, SATISH MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60985	08	Family Practice	0	In state provider	None	500 DOYLE PARK DR	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
90107	Fee-for-Service	1568609030	1568609030	1	1	BRILL, ELLIOTT R MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115806	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
90120	Fee-for-Service	1821076639	1821076639	1	1	BUNNAPRADIST, SUPHAMAI	4/1/2000	174400000X	NA	Other	026	PHYSICIANS	65633	45	Nephrology (Renal-Kidney)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
90127	Fee-for-Service	1447681317	1447681317	1	1	BROOKS, NICOLE M LMFT	5/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	190 SIERRA CT	SUITE A310	PALMDALE	CA	93550	7607	19	06037	34.64013337	-118.1280539	Los Angeles County
90144	Fee-for-Service	1326373937	1326373937	1	1	BARAGHOUSH, AFSHAN MD	4/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116483	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
90171	Fee-for-Service	1942646583	1942646583	1	1	BARAHONA, CLEA C LMFT	8/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
90182	Fee-for-Service	1780252213	1780252213	1	1	BOGA, NIKHIL DPM	12/24/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1100 LAUREL ST	STE E	SAN CARLOS	CA	94070	5000	41	06081	37.49983088	-122.2532086	San Mateo County
90210	Fee-for-Service	1477589786	1477589786	1	1	BRADLEE, PETER M PH.D	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	125 N LINCOLN ST	STE H	DIXON	CA	95620	3260	48	06095	38.44614779	-121.8364229	Solano County
90236	Fee-for-Service	1851478358	1851478358	1	1	BRUCE PARK MD A PROFESSIONAL	8/16/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	CORPORATION	1966 E CHAPMAN AVE	SUITE G	FULLERTON	CA	92831	4142	30	06059	33.87415051	-117.896427	Orange County
90260	Fee-for-Service	1548659105	1548659105	1	1	BEHAVIORAL HEALTH SERVICES	6/15/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INC	2501 W EL SEGUNDO BLVD	SUITE B	HAWTHORNE	CA	90250	3317	19	06037	33.91648148	-118.3206645	Los Angeles County
90264	Fee-for-Service	1174950091	1174950091	1	1	BURNS, TYLER R LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
90267	Fee-for-Service	1669714176	1669714176	1	1	BORGOHAIN, PREETI MD	5/25/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	159174	40	Pediatrics	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
90294	Fee-for-Service	1588659718	1588659718	1	1	BERQUIST, RICHARD J. MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	42513	08	Family Practice	0	In state provider	None	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
90295	Fee-for-Service	1972537462	1972537462	1	1	BAX, STACY J MD	5/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99111	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
90307	Fee-for-Service	1306565239	1306565239	1	1	BEATRICE, SHAINA CCC-SLP	10/18/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4675 VIA LOS SANTOS	None	SANTA BARBARA	CA	93111	1346	42	06083	34.4561269	-119.7851783	Santa Barbara County
90321	Fee-for-Service	1497281265	1497281265	1	1	BARLOW, MEGAN M MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	157716	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
90325	Fee-for-Service	1891342440	1891342440	1	1	BARAY, RACHEL A CRNA	3/14/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
90336	Fee-for-Service	1861487100	1861487100	1	1	BORRILLO, JESUS L MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78255	18	Ophthalmology	0	In state provider	None	901 CAMPUS DR	STE 215	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
90366	Fee-for-Service	1578649000	1578649000	1	1	BINDIGER, ALAN MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56519	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
90424	Fee-for-Service	1659691897	1659691897	1	1	BROWN, KENDRA N MD	2/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131212	25	Physical Medicine and Rehabilitation	0	In state provider	None	2362 NORTH OXNARD BLVD	STE 104	OXNARD	CA	93036	2053	56	06111	34.22843959	-119.1778933	Ventura County
90426	Fee-for-Service	1881688505	1881688505	1	1	BARTON, CHARLES D JR MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53918	36	Psychiatry	0	In state provider	None	39650 LIBERTY STREET	SUITE 310	FREMONT	CA	94538	2227	01	06001	37.54662058	-121.9736002	Alameda County
90431	Fee-for-Service	1972679538	1972679538	1	1	BONETTE, JESSICA K LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
90463	Fee-for-Service	1144393299	1144393299	1	1	BIO-MED APPLICATIONS OF CA	1/1/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2031 W ALAMEDA AVE	STE 202	BURBANK	CA	91506	2959	19	06037	34.15972797	-118.3237055	Los Angeles County
90477	Fee-for-Service	1316260953	1316260953	1	1	BARRETT, DANIEL M MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110166	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
90482	Fee-for-Service	1902634678	1902634678	1	1	BIRTHING PURPOSE DOULA SERVI	3/6/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
90498	Fee-for-Service	1932117462	1932117462	1	2	BLISS, DAVID W MD	1/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83234	02	General Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
90520	Fee-for-Service	1760822738	1760822738	1	1	BATLAHALLY VENKATARAYAPPA, S	8/9/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	UNIL KUMAR MD	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
90526	Fee-for-Service	1730726563	1730726563	1	1	BOTTA, LAUREN M NP	2/7/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
90535	Fee-for-Service	1962457812	1962457812	1	21	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8327 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4620	19	06037	34.221699	-118.5360985	Los Angeles County
90565	Fee-for-Service	1154320794	1154320794	1	1	BYERS, JOHN J. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	255 N 30TH ST	None	LARAMIE	WY	82072	5140	00	None	41.31237665	-105.5574851	Albany County
90579	Fee-for-Service	1750454708	1750454708	1	1	BRYANT, JAMES G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	22330	02	General Surgery	0	In state provider	None	13847 E 14TH ST	STE 110	SAN LEANDRO	CA	94578	2625	01	06001	37.71457844	-122.1418551	Alameda County
90581	Fee-for-Service	1588659718	1588659718	1	1	BERQUIST, RICHARD J. MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	42513	01	General Practice	0	In state provider	None	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
90616	Fee-for-Service	1639736077	1639736077	1	1	BRADFORD, LAURA	11/27/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	600 NUT TREE RD	STE 250	VACAVILLE	CA	95687	4686	48	06095	38.36133624	-121.9496789	Solano County
90636	Fee-for-Service	1245339340	1245339340	1	1	BRAZINSKY, SHARI A MD	5/31/1993	207RP1001X	NA	Pulmonology	026	PHYSICIANS	70525	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6699 ALVARADO RD	STE 2308	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
90678	Fee-for-Service	1871612853	1871612853	1	1	BELKIN, TAMARA L CNM	12/11/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
90683	Fee-for-Service	1871219717	1871219717	1	1	BE WELL SENIOR LIVING II INC	1/12/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5711 BECKFORD AVE	None	TARZANA	CA	91356	1139	19	06037	34.1747031	-118.5514778	Los Angeles County
90694	Fee-for-Service	1851590137	1851590137	1	1	BARTLETT, KRISTINE PHD	3/17/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
90704	Fee-for-Service	1982854626	1982854626	1	1	BASMAJIAN, HRAYR G MD	9/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105584	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
90713	Fee-for-Service	1164803094	1164803094	1	1	BUI, DAT H OD	3/21/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1575 B STREET	None	HAYWARD	CA	94541	3017	01	06001	37.67905755	-122.072805	Alameda County
90731	Fee-for-Service	1205826849	1205826849	1	1	BABAKNIA, ARFA MD	3/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45197	08	Family Practice	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
90743	Fee-for-Service	1518668920	1518668920	1	1	BARRAGAN, JUAN J OT	11/19/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4010 ORANGE AVE	None	LONG BEACH	CA	90807	3717	19	06037	33.831612	-118.176291	Los Angeles County
90745	Fee-for-Service	1215264387	1215264387	1	1	BUECHLER, ROSE A	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
90763	Fee-for-Service	1154492569	1154492569	1	1	BASRAON, JAGROOP S DO	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1313 E HERNDON AVE	SUITE 203	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
90768	Fee-for-Service	1710340138	1710340138	1	1	BAUER, LEAH MD	7/28/2020	207P00000X	NA	Other	026	PHYSICIANS	151434	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
90787	Fee-for-Service	1578763207	1578763207	1	1	BENEVOLENCE INDUSTRIES INC	1/2/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3631 CRENSHAW BLVD	SUITE 109	LOS ANGELES	CA	90016	4869	19	06037	34.023177	-118.3351475	Los Angeles County
90788	Fee-for-Service	1932117462	1932117462	1	2	BLISS, DAVID W MD	1/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83234	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
90814	Fee-for-Service	1780692632	1780692632	1	2	BERKELEY EMERG MED GRP	5/1/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP INC	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
90838	Fee-for-Service	1962457812	1962457812	1	145	BEVERLY RADIOLOGY MEDICAL GR	3/20/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	835 N HIGHLAND SPRINGS A	SUITE 100	BEAUMONT	CA	92223	5771	33	06065	33.93245893	-116.9469871	Riverside County
90897	Fee-for-Service	1154865459	1154865459	1	1	BLISSFUL HEALTHCARE SERVICES	1/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2829 W BURBANK BLVD	STE 200B	BURBANK	CA	91505	2300	19	06037	34.17733959	-118.3423681	Los Angeles County
90901	Fee-for-Service	1326108713	1326108713	1	1	BAUGHMAN, SHERILYN MD	7/1/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	48323	07	Dermatology	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
90925	Fee-for-Service	1245339340	1245339340	1	1	BRAZINSKY, SHARI A MD	5/31/1993	207RP1001X	NA	Pulmonology	026	PHYSICIANS	70525	41	Internal Medicine	0	In state provider	None	6699 ALVARADO RD	STE 2308	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
90940	Fee-for-Service	1962457812	1962457812	1	97	BEVERLY RADIOLOGY MEDICAL GR	12/1/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1100 N TUSTIN AVE	UNIT A	SANTA ANA	CA	92705	3505	30	06059	33.754707	-117.8342455	Orange County
91019	Fee-for-Service	1891140885	1891140885	1	1	BENSADIGH, BRIAN MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137767	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
91026	Fee-for-Service	1164872289	1164872289	1	1	BURNS, JAZMIN L PSYD	6/1/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1550 HARBOR BLVD	200	WEST SACRAMENTO	CA	95691	3828	57	06113	38.56976322	-121.5493138	Yolo County
91077	Fee-for-Service	1578763207	1578763207	1	1	BENEVOLENCE INDUSTRIES INC	1/2/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3631 CRENSHAW BLVD	SUITE 109	LOS ANGELES	CA	90016	4869	19	06037	34.023177	-118.3351475	Los Angeles County
91078	Fee-for-Service	1285720961	1285720961	1	1	BENNETT, AYANNA S MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82086	40	Pediatrics	0	In state provider	None	4180 PARK BLVD	None	OAKLAND	CA	94602	1207	01	06001	37.80705678	-122.2229335	Alameda County
91088	Fee-for-Service	1962457812	1962457812	1	29	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3320 LOS COYOTES DIAGONA	#120	LONG BEACH	CA	90808	3936	19	06037	33.8173793	-118.1104908	Los Angeles County
91135	Fee-for-Service	1568460087	1568460087	1	1	BRAGER, ROBERT J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5875 BREMO RD	None	RICHMOND	VA	23226	1934	00	None	37.58393668	-77.51374124	Henrico County
91149	Fee-for-Service	1285171751	1285171751	1	1	BADHESHA, UPKAR K	3/31/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3751 E SHIELDS AVE	None	FRESNO	CA	93726	0000	10	06019	36.7796958	-119.7618088	Fresno County
91159	Fee-for-Service	1891741047	1891741047	1	1	BAY AREA PULMONARY &	6/30/1993	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	MED ASSOC, INC	350 30TH ST	STE 520	OAKLAND	CA	94609	3426	01	06001	37.81892183	-122.2640154	Alameda County
91187	Fee-for-Service	1982319299	1982319299	1	1	BRANCH, ELLEN A DO PC	1/26/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
91188	Fee-for-Service	1437613718	1437613718	1	1	BUTTERWORTH, SHALIN	2/27/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
91225	Fee-for-Service	1962457812	1962457812	1	157	BEVERLY RADIOLOGY MEDICAL GR	1/9/2025	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2001 SOLAR DR	SUITE 135	OXNARD	CA	93036	2645	56	06111	34.22025454	-119.1449192	Ventura County
91243	Fee-for-Service	1114982048	1114982048	1	1	BRIGNONI, CATHERINE MD	12/24/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	96802	13	Neurology (M.D. only)	0	In state provider	None	72670 FRED WARING DR	STE 202	PALM DESERT	CA	92260	5013	33	06065	33.72875096	-116.3969499	Riverside County
91297	Fee-for-Service	1225123979	1225123979	1	1	BEARMAN, ROBERT M MD INC	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	25432	22	Pathology (M.D. only)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
91300	Fee-for-Service	1386808624	1386808624	1	1	BRISON, DANIEL I MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107310	34	Urology and Urological Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
91331	Fee-for-Service	1225017684	1225017684	1	1	BARNES, BRENDA K DPM	7/8/1988	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2227 19TH ST	None	BAKERSFIELD	CA	93301	3608	15	06029	35.37622172	-119.0279016	Kern County
91334	Fee-for-Service	1336378702	1336378702	1	1	BAKHDA, KRISTIN A CNM	3/12/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
91345	Fee-for-Service	1437537305	1437537305	1	1	BADERY, SHAMLA MD	4/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	235 W 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
91364	Fee-for-Service	1578763207	1578763207	1	1	BENEVOLENCE INDUSTRIES INC	1/2/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3631 CRENSHAW BLVD	SUITE 109	LOS ANGELES	CA	90016	4869	19	06037	34.023177	-118.3351475	Los Angeles County
91370	Fee-for-Service	1992851968	1992851968	1	1	BUHRMANN, ERICA M MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48948	40	Pediatrics	0	In state provider	None	1235 HARRISON ST	None	SAN LEANDRO	CA	94577	4515	01	06001	37.72577467	-122.1544541	Alameda County
91371	Fee-for-Service	1962457812	1962457812	1	126	BEVERLY RADIOLOGY MEDICAL GR	2/20/2019	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	999 N TUSTIN AVENUE	SUITE S	SANTA ANA	CA	92705	3530	30	06059	33.754167	-117.834191	Orange County
91372	Fee-for-Service	1124022538	1124022538	1	1	BURNHAM, DAVID MD	6/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88988	02	General Surgery	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
91410	Fee-for-Service	1093077802	1093077802	1	1	BACA, NICOLE M MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136037	68	Hematology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
91434	Fee-for-Service	1174083323	1174083323	1	1	BEKAL, SUNDEEP DO	11/14/2022	207R00000X	NA	Other	026	PHYSICIANS	19590	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
91444	Fee-for-Service	1205994936	1205994936	1	1	BALAJI, RAMA MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141408	36	Psychiatry	0	In state provider	None	1305 TOMMYDON STREET	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
91450	Fee-for-Service	1366463218	1366463218	1	1	BAYNE, CARY GRESHAM MD	12/16/1988	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	48422	01	General Practice	0	In state provider	HOME MEDICAL GROUP INC	3410 TRUMBULL ST	None	SAN DIEGO	CA	92106	2425	37	06073	32.72331986	-117.2388599	San Diego County
91458	Fee-for-Service	1518057199	1518057199	2	1	BRIEKE, ANDREAS MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
91472	Fee-for-Service	1699235093	1699235093	1	1	BEYDER, MIRIAM MD	4/12/2024	208M00000X	NA	Other	026	PHYSICIANS	178662	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
91476	Fee-for-Service	1487040911	1487040911	1	1	BIEN, JEFFREY MD	9/3/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	161700	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
91485	Fee-for-Service	1407813843	1407813843	1	1	BOBIS, RICHARD A MD	9/20/2007	207R00000X	NA	Other	026	PHYSICIANS	26712	41	Internal Medicine	0	In state provider	None	15215 NATIONAL AVE	STE 200	LOS GATOS	CA	95032	2425	43	06085	37.24705784	-121.9502302	Santa Clara County
91506	Fee-for-Service	1073141412	1073141412	1	1	BEST EARS AHEAD,INC.	10/6/2022	261QH0700X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	7090 PARKWAY DR STE B	SUITE B	LA MESA	CA	91942	1596	37	06073	32.77342457	-117.043671	San Diego County
91523	Fee-for-Service	1407292972	1407292972	1	1	BAIROS, RENE M	1/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
91543	Fee-for-Service	1962457812	1962457812	1	25	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	300 LOMBARD ST	None	THOUSAND OAKS	CA	91360	5808	56	06111	34.17792105	-118.8709907	Ventura County
91560	Fee-for-Service	1053410241	1053410241	1	1	BAINS, MANINDER P S MD	2/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104391	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1162 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528873	-121.6208232	Sutter County
91580	Fee-for-Service	1184791998	1184791998	1	4	BAY AREA COMMUNITY HEALTH	5/22/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE - INTERMITTENT	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
91581	Fee-for-Service	1457401267	1457401267	1	1	BUENVIAJE, BENEDICT	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78760	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
91587	Fee-for-Service	1568406312	1568406312	1	1	BARROZO, FIL D MD	2/1/1982	207P00000X	NA	Other	026	PHYSICIANS	38588	08	Family Practice	0	In state provider	None	4440 N 1ST ST	# 111	FRESNO	CA	93726	2304	10	06019	36.79900426	-119.7722187	Fresno County
91595	Fee-for-Service	1205287687	1205287687	1	2	BURGESS, CATHERINE E	5/3/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
91622	Fee-for-Service	1326493800	1326493800	1	1	BARR, TYLER MD	4/10/2019	390200000X	NA	Other	026	PHYSICIANS	156275	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
91638	Fee-for-Service	1427092089	1427092089	1	1	BLACKLEDGE, AARON V MD	7/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80152	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1450 MEDICAL CENTER DR	None	ROHNERT PARK	CA	94928	2924	49	06097	38.34758366	-122.6816633	Sonoma County
91640	Fee-for-Service	1033631486	1033631486	1	1	BLANSIT, DIONE E CRNA	4/28/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
91658	Fee-for-Service	1467451302	1467451302	1	1	BERENSTAIN, LAURA MD	5/31/2022	207LP3000X	NA	Other	026	PHYSICIANS	174942	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
91666	Fee-for-Service	1033241096	1033241096	1	1	BIGBEE, CYNTHIA M MSW LCSW	4/6/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	84355	-	NOT APPLICABLE	0	In state provider	None	12183 LOCKSLEY LANE	SUITE 101, 102, 103, 104	AUBURN	CA	95603	2004	31	06061	38.9503293	-121.0966898	Placer County
91696	Fee-for-Service	1093077802	1093077802	1	1	BACA, NICOLE M MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136037	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
91698	Fee-for-Service	1730247974	1730247974	1	1	BUI, JONATHAN D MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96574	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
91713	Fee-for-Service	1528131059	1528131059	1	1	BUI, THANH K MD INC	9/2/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	43130	15	Obstetrics (D.O. only)	0	In state provider	None	650 INTERNATIONAL BLVD	STE B	OAKLAND	CA	94606	2987	01	06001	37.79445123	-122.2523248	Alameda County
91737	Fee-for-Service	1346394939	1346394939	1	1	BRAICA, ALEXANDRINA CRNA	4/6/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
91745	Fee-for-Service	1093887838	1093887838	1	1	BURKES, JODY B MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68381	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
91748	Fee-for-Service	1518057199	1518057199	2	1	BRIEKE, ANDREAS MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
91790	Fee-for-Service	1639480585	1639480585	1	1	BHAT, ANITHA MD	4/7/2020	207R00000X	NA	Other	026	PHYSICIANS	165143	38	Geriatrics	0	In state provider	None	19015 TOWN CENTER DR	STE 101	APPLE VALLEY	CA	92308	8995	36	06071	34.46573792	-117.2485123	San Bernardino County
91819	Fee-for-Service	1578818787	1578818787	2	1	BUGHIO, SARA QASIM	10/30/2024	207R00000X	NA	Other	026	PHYSICIANS	152300	41	Internal Medicine	0	In state provider	None	1790 MUIR ROAD	None	MARTINEZ	CA	94553	4718	07	06013	37.99034921	-122.0908844	Contra Costa County
91827	Fee-for-Service	1699882589	1699882589	1	1	BARNETT, PETER C MD	3/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110165	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 EAST 13TH STREET	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
91850	Fee-for-Service	1619480662	1619480662	1	1	BOBADILLA, STEPHANIE M LCSW	7/19/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4433 VILLAGE RD	STE G	LONG BEACH	CA	90808	1505	19	06037	33.83397238	-118.1408189	Los Angeles County
91855	Fee-for-Service	1487106886	1487106886	1	1	BAMEL, KASEY	5/22/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
91867	Fee-for-Service	1184791998	1184791998	1	4	BAY AREA COMMUNITY HEALTH	5/22/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE - INTERMITTENT	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
91875	Fee-for-Service	1568406312	1568406312	1	1	BARROZO, FIL D MD	2/1/1982	207P00000X	NA	Other	026	PHYSICIANS	38588	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4440 N 1ST ST	# 111	FRESNO	CA	93726	2304	10	06019	36.79900426	-119.7722187	Fresno County
91927	Fee-for-Service	1568642197	1568642197	1	1	BEVERLY INTERNAL MEDICINE	8/31/2009	207R00000X	NA	Other	026	PHYSICIANS	53499	None	None	0	In state provider	None	2614 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2310	19	06037	34.02109305	-118.1311317	Los Angeles County
91956	Fee-for-Service	1619036514	1619036514	1	5	BORREGO COMM HLTH FNDTN	2/11/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	43500 MONTEREY AVE	None	PALM DESERT	CA	92260	9399	33	06065	33.72975	-116.391054	Riverside County
91985	Fee-for-Service	1093077802	1093077802	1	1	BACA, NICOLE M MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136037	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
91996	Fee-for-Service	1528131059	1528131059	1	1	BUI, THANH K MD INC	9/2/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	43130	08	Family Practice	0	In state provider	None	650 INTERNATIONAL BLVD	STE B	OAKLAND	CA	94606	2987	01	06001	37.79445123	-122.2523248	Alameda County
92006	Fee-for-Service	1619169984	1619169984	1	1	BONILLA, CAROLINA J MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104077	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	SUITE 160	SACRAMENTO	CA	95834	2309	34	06067	38.647737	-121.510467	Sacramento County
92035	Fee-for-Service	1639564974	1639564974	1	1	BULLEIT, ERIN E MD	8/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170205	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
92083	Fee-for-Service	1366809915	1366809915	1	1	BRISCO, TIA LMFT	1/29/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
92087	Fee-for-Service	1285723148	1285723148	1	1	BINDER, PERRY S MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	19082	18	Ophthalmology	0	In state provider	None	8910 UNIVERSITY CENTER L	STE 800	SAN DIEGO	CA	92122	1031	37	06073	32.87053963	-117.226785	San Diego County
92091	Fee-for-Service	1952551954	1952551954	1	1	BROADUS, KAREN A LMFT	2/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
92092	Fee-for-Service	1437218633	1437218633	1	1	BARNICLE, CYNTHIA A CRNA	9/11/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
92114	Fee-for-Service	1487686838	1487686838	1	1	BINSTOCK, PETER D MD	8/27/1997	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	48118	66	Emergency Medicine (Urgent Care)	0	In state provider	None	365 LENNON LN	STE 200	WALNUT CREEK	CA	94598	5912	07	06013	37.92784983	-122.0301444	Contra Costa County
92171	Fee-for-Service	1326212051	1326212051	1	1	BI-BETT	7/4/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL COUNSEL	419 PENNSYLVANIA	None	VALLEJO	CA	94590	6933	48	06095	38.09809128	-122.2544646	Solano County
92173	Fee-for-Service	1588367668	1588367668	1	1	BROWER, MICHELLE NP	2/27/2025	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10538 MISSION GORGE RD	100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
92174	Fee-for-Service	1437207347	1437207347	1	1	BURKE, EDMUND C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46319	78	Neoplastic Diseases/Oncology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
92194	Fee-for-Service	1982836466	1982836466	1	1	BARSEGHIAN EL-FARRA, AILIN	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111623	41	Internal Medicine	0	In state provider	MD	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
92243	Fee-for-Service	1619036514	1619036514	1	5	BORREGO COMM HLTH FNDTN	2/11/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	43500 MONTEREY AVE	None	PALM DESERT	CA	92260	9399	33	06065	33.72975	-116.391054	Riverside County
92263	Fee-for-Service	1598053928	1598053928	1	1	BROMLEY, GEORGE W LMFT	7/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
92294	Fee-for-Service	1780097170	1780097170	1	1	BAIG, MUHAMMAD MD	7/16/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	172092	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
92295	Fee-for-Service	1851356398	1851356398	1	1	BERTIZ, AUGUSTO C JR MD	10/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96510	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
92321	Fee-for-Service	1598813438	1598813438	1	1	BAHER, CAMBIZ C MD	6/30/1988	207R00000X	NA	Other	026	PHYSICIANS	63620	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
92328	Fee-for-Service	1336982552	1336982552	1	1	BERG, NICHOLAS NP	12/10/2024	163WP0200X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92340	Fee-for-Service	1699116327	1699116327	1	1	BAKKEN-MARTIN, ASHLEY MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129131	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
92379	Fee-for-Service	1912071085	1912071085	1	1	BANTA, DANTE A MD	7/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44079	01	General Practice	0	In state provider	None	875 N WESTERN AVE	None	LOS ANGELES	CA	90029	3759	19	06037	34.086141	-118.3091865	Los Angeles County
92388	Fee-for-Service	1417028184	1417028184	1	1	BHARADWAJ, PARAG MD	4/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79755	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
92395	Fee-for-Service	1508333618	1508333618	1	1	BERGSTROM, JESSICA	9/23/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
92396	Fee-for-Service	1376839217	1376839217	1	1	BERKENSTOCK, MEGHAN K MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137193	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
92402	Fee-for-Service	1487686838	1487686838	1	1	BINSTOCK, PETER D MD	8/27/1997	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	48118	77	Infectious Disease	0	In state provider	None	365 LENNON LN	STE 200	WALNUT CREEK	CA	94598	5912	07	06013	37.92784983	-122.0301444	Contra Costa County
92404	Fee-for-Service	1700965753	1700965753	1	1	BRIONES, CARMEN C MD	6/18/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	171954	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
92410	Fee-for-Service	1962457812	1962457812	1	114	BEVERLY RADIOLOGY MEDICAL GR	4/23/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	18785 BROOKHURST ST	STE 102	FOUNTAIN VALLEY	CA	92708	7300	30	06059	33.68987636	-117.9542321	Orange County
92413	Fee-for-Service	1689310195	1689310195	1	1	BUI, NINI H	8/1/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
92422	Fee-for-Service	1700934759	1700934759	1	1	BASIAGO, GREGORY J MD	2/21/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61943	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
92461	Fee-for-Service	1437207347	1437207347	1	1	BURKE, EDMUND C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46319	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
92462	Fee-for-Service	1992230197	1992230197	1	1	BHAREL, SONIA MD	9/3/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
92463	Fee-for-Service	1043310030	1043310030	1	1	BLUM, RICHARD I	8/31/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	550 WASHINGTON ST	SUITE 641	SAN DIEGO	CA	92103	2229	37	06073	32.75003652	-117.1603431	San Diego County
92469	Fee-for-Service	1447504121	1447504121	1	1	BAKER, JENNIFER L MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	120237	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
92499	Fee-for-Service	1710365689	1710365689	1	1	BRUMAND, AZADEH DO	8/11/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	18771	None	None	0	In state provider	None	1139 THIRD ST	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
92521	Fee-for-Service	1780356279	1780356279	1	2	BODNARUK, MARTA I NP	10/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
92551	Fee-for-Service	1649656224	1649656224	1	1	BARRY, BARBARA LMFT	1/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	69930 HIGHWAY 111	SUITE 204A	RANCHO MIRAGE	CA	92270	2850	33	06065	33.76779913	-116.445333	Riverside County
92563	Fee-for-Service	1871568899	1871568899	1	1	BENNETT, BERNARD L MD	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	42114	41	Internal Medicine	0	In state provider	None	508 WESTLINE DR	None	ALAMEDA	CA	94501	5847	01	06001	37.76518099	-122.2715282	Alameda County
92565	Fee-for-Service	1982267464	1982267464	1	1	BREITLING, MAY MD	8/25/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
92591	Fee-for-Service	1508325903	1508325903	1	1	BENNETT, NICHOLAS K PHD	2/3/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
92614	Fee-for-Service	1346484714	1346484714	1	1	BORUCKI, AMBER N MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150008	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92627	Fee-for-Service	1205994753	1205994753	1	1	BEHBAHANI, SOHRAB MD INC	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	32669	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2626 EDITH AVE	STE B	REDDING	CA	96001	3056	45	06089	40.57103976	-122.3974622	Shasta County
92642	Fee-for-Service	1457433906	1457433906	1	1	BAE, WANJUN	5/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85159	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
92646	Fee-for-Service	1922205046	1922205046	1	1	BI-BETT	7/29/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2090 COMMERCE AVE	None	CONCORD	CA	94520	4902	07	06013	37.97551151	-122.0468477	Contra Costa County
92676	Fee-for-Service	1831281419	1831281419	1	1	BHATIA, PARUL MD	6/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65630	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92688	Fee-for-Service	1073956579	1073956579	1	1	BAR ZIV, DANIT MD	9/4/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	131644	36	Psychiatry	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
92699	Fee-for-Service	1588000863	1588000863	1	1	BARTLETT, TARA C DO	8/1/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14991	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK	STE 103	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
92710	Fee-for-Service	1700934759	1700934759	1	1	BASIAGO, GREGORY J MD	2/21/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61943	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
92721	Fee-for-Service	1861949190	1861949190	1	1	BOWEN, JOHN D PHD	9/17/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	950 S EUCLID AVE	None	SAN DIEGO	CA	92113	6201	37	06073	32.696181	-117.085139	San Diego County
92755	Fee-for-Service	1043310030	1043310030	1	1	BLUM, RICHARD I	8/31/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53758	41	Internal Medicine	0	In state provider	None	550 WASHINGTON ST	SUITE 641	SAN DIEGO	CA	92103	2229	37	06073	32.75003652	-117.1603431	San Diego County
92780	Fee-for-Service	1164443727	1164443727	1	1	BUSIGO, JASON P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
92789	Fee-for-Service	1407200215	1407200215	1	1	BRAR, RAZLEEN MD	6/17/2019	390200000X	NA	Other	026	PHYSICIANS	152523	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92843	Fee-for-Service	1871546291	1871546291	1	1	BURKE, BRUCE L MD INC	3/27/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	23436	14	Neurological Surgery	0	In state provider	None	253 COHASSET RD	None	CHICO	CA	95926	2209	04	06007	39.75181864	-121.8526095	Butte County
92850	Fee-for-Service	1467620575	1467620575	1	1	BUI, KIMMIE L MD	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106946	30	Radiology	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
92864	Fee-for-Service	1730335605	1730335605	1	1	BAY IMAGING CONSULTANTS	5/9/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	2400 BALFOUR RD	None	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
92935	Fee-for-Service	1205382355	1205382355	1	1	BROWN, SHERITA N LMFT	6/30/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
92936	Fee-for-Service	1790997690	1790997690	1	1	BRUNET, RUSSELL T DO	4/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11614	08	Family Practice	0	In state provider	None	355 ABBOTT ST	STE 100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
92940	Fee-for-Service	1548822349	1548822349	1	1	BERNAL SUAREZ, MARA NP	2/25/2025	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
92948	Fee-for-Service	1043257314	1043257314	1	1	BRAVO, FERNANDO B MD INC	2/4/2009	261Q00000X	NA	Other	026	PHYSICIANS	72360	41	Internal Medicine	0	In state provider	None	3110 LATTE LN	None	BAKERSFIELD	CA	93312	2154	15	06029	35.38808359	-119.0952314	Kern County
92957	Fee-for-Service	1760464226	1760464226	1	1	BAIG, SYEDA	2/23/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	71834	36	Psychiatry	0	In state provider	None	13141 CENTRAL AVE	SUITE H	CHINO	CA	91710	4100	36	06071	34.0146573	-117.6891329	San Bernardino County
92961	Fee-for-Service	1760681258	1760681258	1	1	BUBALO, JOSIPA MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100926	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
92964	Fee-for-Service	1205297702	1205297702	2	1	BENJAMIN HEALTHCARE INC	12/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	127 HOSPITAL DR	STE 202	VALLEJO	CA	94589	2500	48	06095	38.13103371	-122.2387342	Solano County
92980	Fee-for-Service	1144455635	1144455635	1	1	BARELA, DEBORAH S LMFT	12/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 W FLORIDA AVE	SUITE C	HEMET	CA	92543	4628	33	06065	33.74755149	-116.98533	Riverside County
92988	Fee-for-Service	1093810616	1093810616	1	1	BLAKEY, JOHN D MD	4/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71650	22	Pathology (M.D. only)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
92997	Fee-for-Service	1649405630	1649405630	1	1	BERGENSTAL, JOHN MD	9/30/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	4300 MARKETPOINTE DRIVE	SUITE 100	MINNEAPOLIS	MN	55435	5435	00	None	44.8612569	-93.33472789	Hennepin County
93012	Fee-for-Service	1275364861	1275364861	1	1	BAKERSFIELD RESCUE MISSION	5/14/2025	No Taxonomy Provided	NA	None	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	821 E 21ST ST	None	BAKERSFIELD	CA	93305	5242	15	06029	35.37523736	-118.9907956	Kern County
93052	Fee-for-Service	1518363787	1518363787	1	1	BUTLER-OZORE, MISHAY S LMFT	8/19/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	623 N MAIN STREET	SUITES D9, D10, D11, 12	CORONA	CA	92880	1407	33	06065	33.88859597	-117.5642232	Riverside County
93064	Fee-for-Service	1235135575	1235135575	1	1	BEATY, CHRISTOPHER D MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88317	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
93097	Fee-for-Service	1619159563	1619159563	1	1	BECKER, STEPHANIE L LCSW	5/7/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	31897 DEL OBISPO	STE 250	SAN JUAN CAPISTRA	CA	92675	0000	30	06059	33.49808161	-117.6644372	Orange County
93110	Fee-for-Service	1033501168	1033501168	1	1	BIG RIVER EMERGENCY	3/1/2015	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS INC	911 SUNSET DR	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
93123	Fee-for-Service	1962457812	1962457812	1	85	BEVERLY RADIOLOGY MEDICAL GR	8/19/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
93130	Fee-for-Service	1003843558	1003843558	1	1	BEMRICK, ROBERT J II MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84454	30	Radiology	0	In state provider	None	2110 PROFESSIONAL DR	STE 100	ROSEVILLE	CA	95661	3752	31	06061	38.74234873	-121.2521259	Placer County
93170	Fee-for-Service	1437181989	1437181989	1	1	BOFFMAN, HARRY R JR MD	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	25822	20	Orthopedic Surgery	0	In state provider	None	655 EUCLID AVE	STE 301	NATIONAL CITY	CA	91950	2972	37	06073	32.68353398	-117.082625	San Diego County
93176	Fee-for-Service	1639125982	1639125982	1	1	BLANKS, RICHARD H MD	1/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81571	20	Orthopedic Surgery	0	In state provider	None	8405 N FRESNO ST	STE 110	FRESNO	CA	93720	1538	10	06019	36.85627034	-119.7842442	Fresno County
93195	Fee-for-Service	1932312022	1932312022	1	1	BICKELL, KIMBERLY W MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	94225	30	Radiology	0	In state provider	None	12393 WASHINGTON BLVD	None	WHITTIER	CA	90606	2502	19	06037	33.96719187	-118.0496563	Los Angeles County
93217	Fee-for-Service	1467626911	1467626911	1	1	BAKERSFIELD FOOT & ANKLE	8/5/2008	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	SRGNS A PODIATRY GRP INC	4000 STOCKDALE HWY	STE C	BAKERSFIELD	CA	93309	2059	15	06029	35.35429352	-119.0531115	Kern County
93252	Fee-for-Service	1639483498	1639483498	1	1	BALTRUSHES, ROBIN J MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113237	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
93303	Fee-for-Service	1992832232	1992832232	1	1	BOLBOLAN, SHAHLA A MD	8/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90021	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
93306	Fee-for-Service	1083190839	1083190839	1	1	BABOO, RAKESH MD	9/30/2021	207R00000X	NA	Other	026	PHYSICIANS	173931	None	None	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
93320	Fee-for-Service	1346204146	1346204146	1	1	BASSE, MICHAEL E MD	4/30/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68641	None	None	0	In state provider	None	515 E ROMIE LN	None	SALINAS	CA	93901	4018	27	06053	36.65992397	-121.6459411	Monterey County
93339	Fee-for-Service	1801873575	1801873575	1	1	BRASCH, ANDREW J MD	3/31/1986	2084N0400X	NA	Neurology	026	PHYSICIANS	42540	13	Neurology (M.D. only)	0	In state provider	None	6283 CLARK RD	STE 16	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
93349	Fee-for-Service	1992821375	1992821375	1	1	BARBARA, JOSEPH C MD INC	5/1/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	28075	01	General Practice	0	In state provider	None	7880 WREN AVE	STE C133	GILROY	CA	95020	7801	43	06085	37.00983795	-121.5870382	Santa Clara County
93356	Fee-for-Service	1104403476	1104403476	1	1	BLESS CARE HOSPICE INC	1/10/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	726 W BROADWAY	UNIT B	GLENDALE	CA	91204	1054	19	06037	34.14673522	-118.2708954	Los Angeles County
93363	Fee-for-Service	1952338063	1952338063	1	1	BHAKTA, KUSHAL Y MD	5/20/2010	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	92563	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
93370	Fee-for-Service	1053567768	1053567768	1	1	BELTRAN, LORI M DO	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10403	08	Family Practice	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
93372	Fee-for-Service	1316175110	1316175110	1	1	BENOWITZ KOREN, ELIZABETH A	1/15/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	OT	92 ARGONAUT	SUITE 170	ALISO VIEJO	CA	92656	0000	30	06059	33.59217762	-117.7242901	Orange County
93392	Fee-for-Service	1629816095	1629816095	1	1	BARRIENTOS-CERRILLOS, LIZETT	12/2/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	E NP	500 OLD RIVER RD	110	BAKERSFIELD	CA	93311	9504	15	06029	35.35127492	-119.1142991	Kern County
93442	Fee-for-Service	1467575654	1467575654	1	1	BERGESON, JEFFREY M DO	7/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9815	None	None	0	In state provider	None	3133 PROFESSIONAL DR	STE 20	AUBURN	CA	95603	2463	31	06061	38.9412	-121.100888	Placer County
93454	Fee-for-Service	1467730895	1467730895	1	1	BAGAVATHY, KAVITHA MD	12/3/2020	207RC0200X	NA	Other	026	PHYSICIANS	131330	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
93459	Fee-for-Service	1437181989	1437181989	1	1	BOFFMAN, HARRY R JR MD	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	25822	66	Emergency Medicine (Urgent Care)	0	In state provider	None	655 EUCLID AVE	STE 301	NATIONAL CITY	CA	91950	2972	37	06073	32.68353398	-117.082625	San Diego County
93490	Fee-for-Service	1679685739	1679685739	1	1	BOJORQUEZ, DIANA I MD	7/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86235	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
93528	Fee-for-Service	1629470703	1629470703	1	1	BHATT, MONICA OD	6/12/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
93534	Fee-for-Service	1639483498	1639483498	1	1	BALTRUSHES, ROBIN J MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113237	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
93549	Fee-for-Service	1609927193	1609927193	1	1	BARNARD, SUSAN P MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42850	08	Family Practice	0	In state provider	None	240 E 13TH ST	None	MERCED	CA	95340	6234	24	06047	37.2929228	-120.4743925	Merced County
93601	Fee-for-Service	1972569531	1972569531	1	1	BOAKES, JENNETTE MD	7/31/1990	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	70017	20	Orthopedic Surgery	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
93612	Fee-for-Service	1558553669	1558553669	1	1	BODNAR, GINA M LMFT	1/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
93635	Fee-for-Service	1992821375	1992821375	1	1	BARBARA, JOSEPH C MD INC	11/8/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	7880 WREN AVE	STE C133	GILROY	CA	95020	7801	43	06085	37.00983795	-121.5870382	Santa Clara County
93645	Fee-for-Service	1104403476	1104403476	1	1	BLESS CARE HOSPICE INC	1/10/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	726 W BROADWAY	UNIT B	GLENDALE	CA	91204	1054	19	06037	34.14673522	-118.2708954	Los Angeles County
93651	Fee-for-Service	1952338063	1952338063	1	1	BHAKTA, KUSHAL Y MD	5/20/2010	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	92563	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
93652	Fee-for-Service	1750635371	1750635371	1	1	BEVERLY INOCENCIO	12/22/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
93694	Fee-for-Service	1669496964	1669496964	1	1	BLACKWELL, KEITH E MD	8/1/1995	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	68815	84	Surgery-Head and Neck	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
93708	Fee-for-Service	1467838441	1467838441	1	1	BORIKAR, MADHURA MD	1/3/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	183136	None	None	0	In state provider	None	1020 29TH ST	#550	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
93711	Fee-for-Service	1154534873	1154534873	1	1	BERARD, THOMAS M MD	4/30/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	39411	02	General Surgery	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
93732	Fee-for-Service	1447250253	1447250253	1	1	BAYLOR UNIVERSITY MED CT	9/5/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3500 GASTON AVE	None	DALLAS	TX	75246	2017	00	None	32.790276	-96.78114927	Dallas County
93736	Fee-for-Service	1609910033	1609910033	1	1	BHOLA, RAHUL MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144757	18	Ophthalmology	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
93767	Fee-for-Service	1841302643	1841302643	1	1	BIO MEDICAL APPLICATIONS	8/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	4567 TELEPHONE RD	STE 101	VENTURA	CA	93003	5665	56	06111	34.25596177	-119.2350082	Ventura County
93768	Fee-for-Service	1376538256	1376538256	1	1	BVCV OPERATING COMPANY	4/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	802 BUENA VISTA ST	None	DUARTE	CA	91010	1702	19	06037	34.14318601	-117.9774793	Los Angeles County
93771	Fee-for-Service	1750452983	1750452983	1	1	BENEDETTO,WILLIAMS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	310 SUNNYVIEW LANE	None	KALISPELL	MT	59901	0000	00	None	48.214773	-114.3236925	Flathead County
93806	Fee-for-Service	1437132560	1437132560	1	1	BECKLEY, DENNIS J MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	22814	13	Neurology (M.D. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
93829	Fee-for-Service	1952390437	1952390437	1	1	BRADY, PATRICIA H MD	1/29/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53121	08	Family Practice	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
93833	Fee-for-Service	1649774175	1649774175	1	1	BEDROSSIAN, NORA L MD	7/21/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	164894	None	None	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
93834	Fee-for-Service	1013074996	1013074996	1	1	BEACH EMERGENCY MEDICAL ASSO	10/30/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CIATES	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
93865	Fee-for-Service	1700941408	1700941408	1	1	BALAKUMAR, GITAKRISHNA MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54690	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
93871	Fee-for-Service	1154577963	1154577963	1	1	BASSI, SEPIDEH H CP	2/25/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2200 PACIFIC COAST HWY	STE 102	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
93879	Fee-for-Service	1558490326	1558490326	1	1	BITNER, ROBIN L MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92243	36	Psychiatry	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
93898	Fee-for-Service	1831500628	1831500628	1	1	BRODER, NOAM Z MD	8/3/2021	207R00000X	NA	Other	026	PHYSICIANS	164383	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
93906	Fee-for-Service	1184618753	1184618753	1	1	BELFORT, MICHAEL A MD	6/1/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
93946	Fee-for-Service	1558336834	1558336834	1	1	BABUSIS, ALGIS V MD	2/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	73088	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
93975	Fee-for-Service	1245264589	1245264589	1	1	BOTEZAN, DIANA M MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87854	36	Psychiatry	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
93997	Fee-for-Service	1538453196	1538453196	1	1	BAZARGAN-LARI, ARDALAN MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137418	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
94003	Fee-for-Service	1518132794	1518132794	1	1	BOWSER, LEAH MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109990	41	Internal Medicine	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
94012	Fee-for-Service	1962847921	1962847921	1	1	BARKER, JANAE A DO	9/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13773	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	SC05	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
94019	Fee-for-Service	1447250253	1447250253	1	1	BAYLOR UNIVERSITY MED CT	9/5/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3500 GASTON AVE	None	DALLAS	TX	75246	2017	00	None	32.790276	-96.78114927	Dallas County
94031	Fee-for-Service	1629343710	1629343710	1	1	BAHADORANI, BOBBY B DO	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14691	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
94062	Fee-for-Service	1891849550	1891849550	1	1	BERENA, JELENA MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48158	22	Pathology (M.D. only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
94065	Fee-for-Service	1083668347	1083668347	1	1	BEATTY, MATTHEW PAUL MD	7/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91351	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
94076	Fee-for-Service	1730574518	1730574518	1	1	BORKOWSKI, CAITLIN S MD	3/13/2019	207PP0204X	NA	Other	026	PHYSICIANS	156300	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
94088	Fee-for-Service	1710982608	1710982608	1	1	BRAR, NIRMAL S MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73984	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
94095	Fee-for-Service	1356605737	1356605737	1	1	BURNS, ERIC M LMFT	11/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
94139	Fee-for-Service	1063723369	1063723369	1	1	BREWER, SHAYE LCSW	4/24/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
94168	Fee-for-Service	1396711644	1396711644	1	1	BLANDO, ELLEN A MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65631	01	General Practice	0	In state provider	None	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	37	06073	32.7011883	-117.1261025	San Diego County
94209	Fee-for-Service	1083808604	1083808604	1	1	BAIER, NICOLE M MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99660	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
94224	Fee-for-Service	1386727816	1386727816	1	1	BIHRLE, SUSAN E PHD	9/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
94236	Fee-for-Service	1033435300	1033435300	1	1	BARRAGAN, HUMBERTO DO	8/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10994	08	Family Practice	0	In state provider	None	220 E 13TH STREET	None	MERCED	CA	95341	6250	24	06047	37.29309532	-120.4748791	Merced County
94248	Fee-for-Service	1346590437	1346590437	1	1	BEREZOVSKAYA, ANASTASIA	6/13/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25 EDWARDS COURT	SUITE101	BURLINGAME	CA	94010	5182	41	06081	37.59253631	-122.3680236	San Mateo County
94264	Fee-for-Service	1326812280	1326812280	1	1	BEACH CITY WELLNESS INC	9/13/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1633 LONG BEACH BLVD	None	LONG BEACH	CA	90813	1929	19	06037	33.78770019	-118.1895116	Los Angeles County
94274	Fee-for-Service	1841315835	1841315835	1	1	BURKE, SHANNON LMFT	4/11/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
94283	Fee-for-Service	1306994231	1306994231	1	1	BRICCO, DIANE D MD	10/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91857	30	Radiology	0	In state provider	MGA OFFICE	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
94297	Fee-for-Service	1942795935	1942795935	1	1	BEHNIWAL, NEILINDER S MD	11/14/2021	207R00000X	NA	Other	026	PHYSICIANS	173625	None	None	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
94298	Fee-for-Service	1528175528	1528175528	1	2	BERMAN SKIN INSTITUTE MEDICA	7/17/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	ENTO	1792 TRIBUTE RD	200	SACRAMENTO	CA	95815	4305	34	06067	38.598219	-121.445964	Sacramento County
94334	Fee-for-Service	1093208910	1093208910	1	1	BRAR, NAVPREET LCSW	3/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
94346	Fee-for-Service	1851520621	1851520621	1	1	BAYHEALTH INCORPORATED	7/3/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	30 UNION AVE	SUITE 126	CAMPBELL	CA	95008	3168	43	06085	37.28653576	-121.9353543	Santa Clara County
94355	Fee-for-Service	1811593106	1811593106	1	1	BEER, SHAINA L NP	1/21/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1625 PINE STREET	SUITE 102	REDDING	CA	96001	1018	45	06089	40.58321511	-122.388937	Shasta County
94388	Fee-for-Service	1063771350	1063771350	1	1	BANKS, SHIMEKA L MD	2/1/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152896	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
94428	Fee-for-Service	1477628881	1477628881	1	1	BAKER, JILL G NP	1/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BOULEVARD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
94430	Fee-for-Service	1255547493	1255547493	1	1	BILDZUKEWICZ, NIKOLAI A MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	82509	02	General Surgery	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
94454	Fee-for-Service	1396711644	1396711644	1	1	BLANDO, ELLEN A MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65631	08	Family Practice	0	In state provider	None	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	37	06073	32.7011883	-117.1261025	San Diego County
94456	Fee-for-Service	1487124871	1487124871	1	1	BEST TRUST HOME HEALTH INC	10/9/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12509 OXNARD ST	STE 204	NORTH HOLLYWOOD	CA	91606	4443	19	06037	34.17943548	-118.405683	Los Angeles County
94467	Fee-for-Service	1487742425	1487742425	1	1	BAILEY, SUSAN A	4/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	29612	None	None	0	In state provider	None	1580 VALENCIA STREET	201	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
94470	Fee-for-Service	1558749242	1558749242	1	1	BARNES, LAURA A MD	9/4/2018	208M00000X	NA	Other	026	PHYSICIANS	149960	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
94493	Fee-for-Service	1508154469	1508154469	1	1	BATTLE, REGINA D LMFT	9/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	928 4TH ST	STE B	LOS BANOS	CA	93635	4146	24	06047	37.06197394	-120.8509019	Merced County
94497	Fee-for-Service	1083808604	1083808604	1	1	BAIER, NICOLE M MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99660	40	Pediatrics	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
94505	Fee-for-Service	1497288294	1497288294	1	1	BARTOLOZZI, ARTHUR R MD	4/15/2024	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	157325	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
94531	Fee-for-Service	1932108867	1932108867	1	1	BUSH, JAMES E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34666	04	Otology, Laryngology, Rhinology	0	In state provider	None	3805 FRONT ST	None	SAN DIEGO	CA	92103	3019	37	06073	32.74717961	-117.1650049	San Diego County
94544	Fee-for-Service	1366554164	1366554164	1	1	BIO MEDICAL APPLICATIONS	12/9/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	1801 W VALLEY BLVD	STE 204	ALHAMBRA	CA	91803	2300	19	06037	34.07741913	-118.1432981	Los Angeles County
94605	Fee-for-Service	1255808572	1255808572	1	1	BASUBAS, ABIGAIL J PT	1/22/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	685 TWELVE BRIDGES DR	None	LINCOLN	CA	95648	8689	31	06061	38.85108687	-121.2886018	Placer County
94621	Fee-for-Service	1518077312	1518077312	1	1	BALL, NINA	7/25/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	414 N BOYLE AVE	STE 1520	LOS ANGELES	CA	90033	2410	19	06037	34.05043205	-118.2180396	Los Angeles County
94640	Fee-for-Service	1245542901	1245542901	1	1	BANGASH, MUHAMMAD F MD	8/12/2022	207RC0200X	NA	Other	026	PHYSICIANS	150002	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
94641	Fee-for-Service	1508499393	1508499393	1	1	BRIO CLINICAL INC	10/13/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1910 S ARCHIBALD AVE	SUITE U	ONTARIO	CA	91761	8502	36	06071	34.038603	-117.5935995	San Bernardino County
94646	Fee-for-Service	1538245931	1538245931	1	1	BRAUNINGER, ANDREA L MD	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	25034	01	General Practice	0	In state provider	None	1 GRAND AVE	BLDG 27	SAN LUIS OBISPO	CA	93407	9000	40	06079	35.30048884	-120.6580985	San Luis Obispo County
94652	Fee-for-Service	1952509135	1952509135	1	1	BRIGGS-MALONSON, MEDELL	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101101	66	Emergency Medicine (Urgent Care)	0	In state provider	K MD	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
94658	Fee-for-Service	1760552863	1760552863	1	1	BLOCK, JEFFREY P MD APC	3/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	36760	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2220 LYNN RD	STE 302	THOUSAND OAKS	CA	91360	8004	56	06111	34.20863046	-118.8852156	Ventura County
94672	Fee-for-Service	1073850350	1073850350	1	1	BREWER, JENNIFER M MD	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123445	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
94700	Fee-for-Service	1982760310	1982760310	2	1	BARNISKE, DONALD OD	3/2/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 MAIN STREET	None	BRAWLEY	CA	92227	2351	13	06025	32.97860352	-115.5380805	Imperial County
94703	Fee-for-Service	1013935857	1013935857	1	1	BERG, BARBARA A LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	26465 CARMEL RNCH BL #5	PO BOX 223123	None	CARMEL	CA	93922	3123	27	06053	0	0	None
94707	Fee-for-Service	1932519394	1932519394	1	1	BLOMSETH, MITCHELL J LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
94712	Fee-for-Service	1053567545	1053567545	1	1	BAI, WEI MD	2/20/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	166101	68	Hematology	0	In state provider	None	1745 N BROADWAY	101	SANTA MARIA	CA	93454	1927	42	06083	34.971759	-120.4356175	Santa Barbara County
94724	Fee-for-Service	1902069578	1902069578	1	1	BALGUMA, FREDRIC D DO	11/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9975	08	Family Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
94791	Fee-for-Service	1942314224	1942314224	2	1	BRADEN PARTNERS LP	9/25/2018	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	20 S LINDEN AVE	STE 5B	S SAN FRANCISCO	CA	94080	6424	41	06081	37.6513149	-122.4114938	San Mateo County
94808	Fee-for-Service	1093597510	1093597510	1	1	BLACK, SHANEQUA LCSW	10/24/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4401 SEPULVEDA BLVD	210	SHERMAN OAKS	CA	91403	3934	19	06037	34.150356	-118.467397	Los Angeles County
94819	Fee-for-Service	1932108867	1932108867	1	1	BUSH, JAMES E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34666	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3805 FRONT ST	None	SAN DIEGO	CA	92103	3019	37	06073	32.74717961	-117.1650049	San Diego County
94832	Fee-for-Service	1063564284	1063564284	1	1	BUCHANAN, JAMES J DO	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	7870	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
94866	Fee-for-Service	1538200860	1538200860	1	1	BARUA, SOMA	7/18/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	100376	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
94869	Fee-for-Service	1336481605	1336481605	1	1	BARRES, LAUREN G MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134192	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
94894	Fee-for-Service	1154310860	1154310860	1	1	BATES, NERIDA T MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	60403	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
94899	Fee-for-Service	1164086534	1164086534	1	1	BYER, LENNOX E MD	6/2/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	180924	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
94947	Fee-for-Service	1174614986	1174614986	1	1	BUDDE,JAMES C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	407 ULUNIU STREET	4TH FLOOR	KAILUA	HI	96734	0000	00	None	21.39646318	-157.7434882	Honolulu County
94971	Fee-for-Service	1326717679	1326717679	1	1	BUTTERS, DAVID R LMFT	4/18/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	42630 CAMELOT RD	None	TEMECULA	CA	92592	8005	33	06065	33.50021086	-117.0871564	Riverside County
94979	Fee-for-Service	1669415303	1669415303	1	1	BOLTWOOD, CHESTER M MD	11/27/1985	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35042	41	Internal Medicine	0	In state provider	UCLA CTR F/T HLTH SCIENC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
94981	Fee-for-Service	1316471451	1316471451	1	1	BELOVARSKI, IOAN B MD	9/27/2021	207P00000X	NA	Other	026	PHYSICIANS	157748	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
94984	Fee-for-Service	1669442596	1669442596	1	1	BITONTE, ROBERT A MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	27616	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
95014	Fee-for-Service	1659994903	1659994903	1	1	BIO-MEDICAL APPLICATIONS OF	6/1/2022	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1287 N HACIENDA BLVD	None	LA PUENTE	CA	91744	1631	19	06037	34.04434276	-117.9494025	Los Angeles County
95023	Fee-for-Service	1700087681	1700087681	1	1	BERGER, JOSHUA J MD	12/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78995	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
95033	Fee-for-Service	1205973708	1205973708	1	1	BADROSSADAT MADANI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14701 179TH AVE SE	None	MONROE	WA	98272	0000	00	None	47.86409054	-121.990689	Snohomish County
95052	Fee-for-Service	1336104207	1336104207	1	1	BELOGORSKY, JAMES MD INC	10/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	33103	41	Internal Medicine	0	In state provider	None	1617 N CALIFORNIA ST	STE D	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
95089	Fee-for-Service	1942999131	1942999131	1	1	BOM VICHAE PHYSICAL THERAPY	8/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PROFESSIONAL CORPORATI	1401 S BROOKHURST RD	113	FULLERTON	CA	92833	4471	30	06059	33.85761255	-117.9593114	Orange County
95103	Fee-for-Service	1437254075	1437254075	1	1	BRENNER, ROBERT A MD	5/9/2011	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	51139	10	Gastroenterology (M.D. only)	0	In state provider	None	8860 CENTER DRIVE	STE 420	LA MESA	CA	91942	7001	37	06073	32.78189749	-117.0075062	San Diego County
95104	Fee-for-Service	1518158997	1518158997	1	1	BEHRENS, KELLY J PHD	4/23/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
95123	Fee-for-Service	1982654976	1982654976	1	1	BAEZ, PAUL A MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56045	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
95127	Fee-for-Service	1326437468	1326437468	1	1	BHINDER, PRABHJOT MD	11/20/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	148148	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
95142	Fee-for-Service	1962457812	1962457812	1	164	BEVERLY RADIOLOGY MEDICAL GR	1/17/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1901 OUTLET CENTER DR	SUITE 250	OXNARD	CA	93036	0663	56	06111	34.21965581	-119.1491337	Ventura County
95151	Fee-for-Service	1104300540	1104300540	1	1	BANH, WILSON RCP	9/3/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
95163	Fee-for-Service	1588894307	1588894307	1	1	BROCHERT-SAKER, LINDA E LMFT	2/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	1200 AVIATION BLVD.	SUITE 102	REDONDO BEACH	CA	90278	4063	19	06037	33.86558294	-118.386439	Los Angeles County
95170	Fee-for-Service	1528299716	1528299716	1	1	BOTTO, NINA C MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124946	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
95209	Fee-for-Service	1003876590	1003876590	1	1	BLOOM, STUART	1/1/1989	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
95215	Fee-for-Service	1851321889	1851321889	1	1	BRAHMA, ANURADHA MD	6/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94640	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
95234	Fee-for-Service	1043583875	1043583875	1	1	BARRAGAN, ALFONSO L MD INC	3/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29368	02	General Surgery	0	In state provider	None	850 S ATLANTIC BLVD	SUITE 305	MONTEREY PARK	CA	91754	6714	19	06037	34.05097684	-118.1379979	Los Angeles County
95265	Fee-for-Service	1972569432	1972569432	1	1	BROWN, HEATHER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10123 SE MARKET ST	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
95285	Fee-for-Service	1760452874	1760452874	1	1	BARENCHI, RYAN A MD	7/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	96453	08	Family Practice	0	In state provider	None	310 SANTA FE DR	None	ENCINITAS	CA	92024	5110	37	06073	33.038406	-117.285354	San Diego County
95321	Fee-for-Service	1336227990	1336227990	1	1	BLUMBERG, ROBERT S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30999	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
95333	Fee-for-Service	1629543616	1629543616	1	1	BEYOND HOME CARE INC	7/23/2020	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	225 EAST BROADWAY	SUITE 305B	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
95356	Fee-for-Service	1235324070	1235324070	1	1	BERRUECOS, DIANA P LCSW	11/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
95359	Fee-for-Service	1376596213	1376596213	1	1	BAINTON, ROLAND J MD	6/1/1998	207L00000X	NA	Other	026	PHYSICIANS	83133	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
95365	Fee-for-Service	1972744969	1972744969	1	1	BURTON, PATRICK D	1/15/1984	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	13922 SEAL BEACH BLVD	# 13	SEAL BEACH	CA	90740	5387	30	06059	33.76132389	-118.0777961	Orange County
95381	Fee-for-Service	1780604835	1780604835	1	1	BRIAN SULLIVAN M.D.	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
95385	Fee-for-Service	1063874139	1063874139	1	1	BROOKMAN, MYLES I MD	7/31/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	169569	None	None	0	In state provider	None	5991 E SPRING ST	None	LONG BEACH	CA	90808	3752	19	06037	33.81062147	-118.1154555	Los Angeles County
95408	Fee-for-Service	1962457812	1962457812	1	73	BEVERLY RADIOLOGY MEDICAL GR	6/5/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	14860 ROSCOE BLVD	STE 101	PANORAMA CITY	CA	91402	4681	19	06037	34.2214515	-118.4573205	Los Angeles County
95412	Fee-for-Service	1114260007	1114260007	1	1	BERKOVICH, JENNIFER V DO	9/3/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	22624	40	Pediatrics	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
95426	Fee-for-Service	1013424217	1013424217	1	1	BAY AREA PEDIATRIC PRIMARY C	4/27/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	ARE INC.	2360 MCKEE RD	SUITE 4	SAN JOSE	CA	95116	1604	43	06085	37.36657971	-121.8479925	Santa Clara County
95467	Fee-for-Service	1477383859	1477383859	1	1	BIDDLE, JUSTIN T NP	11/5/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
95487	Fee-for-Service	1497241780	1497241780	1	1	BARNETT, CYNTHIA LMFT	1/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29995 TECHNOLOGY DR	101	MURRIETA	CA	92563	2633	33	06065	33.56041691	-117.1370428	Riverside County
95517	Fee-for-Service	1477522746	1477522746	1	1	BARR, PHILIP MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50828	41	Internal Medicine	0	In state provider	None	345 HALCYON RD	None	ARROYO GRANDE	CA	93420	0000	40	06079	35.113419	-120.5915945	San Luis Obispo County
95531	Fee-for-Service	1497789648	1497789648	1	3	BARRY & TAFFY, INC	11/4/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10801 NATIONAL BLVD	SUITE 330	LOS ANGELES	CA	90064	4139	19	06037	34.03101398	-118.4202342	Los Angeles County
95582	Fee-for-Service	1730656679	1730656679	1	1	BEAMES, MICHELLE C LCSW	10/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
95607	Fee-for-Service	1790945756	1790945756	1	1	BUTTS, MELISSA S DO	6/15/2018	207R00000X	NA	Other	026	PHYSICIANS	16394	83	Rheumatology	0	In state provider	None	2510 DOUGLAS BLVD	#300	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
95616	Fee-for-Service	1205360575	1205360575	1	1	BURNEY, PAMELA LMFT	4/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
95617	Fee-for-Service	1811958341	1811958341	1	1	BARTOLOME, BERNARD T MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
95619	Fee-for-Service	1962457812	1962457812	1	116	BEVERLY RADIOLOGY MEDICAL GR	4/23/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	280 NEWPORT CENTER DR	STE 100	NEWPORT BEACH	CA	92660	7541	30	06059	33.610266	-117.8727975	Orange County
95650	Fee-for-Service	1750404729	1750404729	1	1	BISWAL, ANITA MD	6/23/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68631	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
95666	Fee-for-Service	1639164007	1639164007	1	1	BREWSTER, GREGORY S MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61173	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
95674	Fee-for-Service	1720461619	1720461619	1	1	BROOKS, KINDRA	3/1/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10162 PARADA COURT	None	ELK GROVE	CA	95757	5901	34	06067	38.388213	-121.4181765	Sacramento County
95684	Fee-for-Service	1891849386	1891849386	1	1	BOKOLES, JERRY C PSYD	11/18/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	13410	-	NOT APPLICABLE	0	In state provider	None	625 E MAIN ST	None	SANTA PAULA	CA	93060	2608	56	06111	34.35196586	-119.0663619	Ventura County
95695	Fee-for-Service	1164840872	1164840872	1	1	BILEK, ARIELLE E MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148791	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
95730	Fee-for-Service	1841293677	1841293677	1	1	BASSETT, RALPH E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13949 W MEEKER BLVD	STE C	SUN CITY WEST	AZ	85375	4436	00	None	33.658992	-112.361004	Maricopa County
95734	Fee-for-Service	1790289981	1790289981	1	1	BUNNEY, GABRIELLE I MD	7/20/2022	207P00000X	NA	Other	026	PHYSICIANS	180261	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
95763	Fee-for-Service	1831373851	1831373851	1	1	BRENNER, MEGAN L MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	91284	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92350	4018	36	06071	34.047153	-117.2611485	San Bernardino County
95773	Fee-for-Service	1245727809	1245727809	1	1	BAIRD, SUMMER K MD	8/9/2021	207R00000X	NA	Other	026	PHYSICIANS	173497	None	None	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
95805	Fee-for-Service	1518990050	1518990050	1	1	BLUESCOPE HEALTH PROF	3/4/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	BLUESCOPE MED & SUPPLIE	18051 CRENSHAW BLVD	STE B	TORRANCE	CA	90504	5138	19	06037	33.866523	-118.3265185	Los Angeles County
95817	Fee-for-Service	1700566262	1700566262	1	1	BOOMERS MEDICAL TRANSPORTATI	7/28/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON, INC.	165 ODDSTAD DR	APT 68	VALLEJO	CA	94589	3425	48	06095	38.13166333	-122.242538	Solano County
95819	Fee-for-Service	1326178930	1326178930	1	1	BIBERGAL, ANNA L CRNA	5/23/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
95830	Fee-for-Service	1275899130	1275899130	1	1	BAGGA, MANDEEP S MD	11/15/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	140647	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
95870	Fee-for-Service	1275828162	1275828162	1	1	BHAWAY, SANYOGEETA M MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126974	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK DR	SUITE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
95881	Fee-for-Service	1750846143	1750846143	1	1	BUENA VISTA MANOR ARF INC	6/25/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11126 VISTA DEL VALLE DR	None	BAKERSFIELD	CA	93311	4211	15	06029	35.3075726	-119.1267496	Kern County
95882	Fee-for-Service	1568470706	1568470706	1	1	BROOM, JOHN EDWARD MD	4/30/1988	207R00000X	NA	Other	026	PHYSICIANS	48242	41	Internal Medicine	0	In state provider	SHARP REES-STEALY CORP	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
95905	Fee-for-Service	1245442821	1245442821	1	1	BHANJA, ANKUR MD	12/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138176	38	Geriatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
95932	Fee-for-Service	1841635968	1841635968	1	1	BROOKS, BONNIE A MD	6/25/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	134425	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
95955	Fee-for-Service	1639164007	1639164007	1	1	BREWSTER, GREGORY S MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61173	41	Internal Medicine	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
95960	Fee-for-Service	1720461619	1720461619	1	1	BROOKS, KINDRA	3/1/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10162 PARADA COURT	None	ELK GROVE	CA	95757	5901	34	06067	38.388213	-121.4181765	Sacramento County
95991	Fee-for-Service	1851366843	1851366843	1	1	BUSH, RONALD B MD	4/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	53069	41	Internal Medicine	0	In state provider	INC	45280 CLUB DR	None	INDIAN WELLS	CA	92210	8860	33	06065	33.719688	-116.3267435	Riverside County
95992	Fee-for-Service	1881896751	1881896751	1	1	BERNAS, MARIA-ELOISA S MD	8/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110713	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
95998	Fee-for-Service	1740363167	1740363167	1	1	BLOCH,JOY S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61796	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
96011	Fee-for-Service	1962457812	1962457812	1	153	BEVERLY RADIOLOGY MEDICAL GR	9/25/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	OUP	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
96077	Fee-for-Service	1033294624	1033294624	1	1	BRAY, SUZETTE L LMFT	9/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4405 W RIVERSIDE DR	SUITE 203	BURBANK	CA	91505	4072	19	06037	34.15222929	-118.3480509	Los Angeles County
96124	Fee-for-Service	1982634242	1982634242	1	1	BASTIAN, ROLAND E MD	10/31/1995	207P00000X	NA	Other	026	PHYSICIANS	83563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
96178	Fee-for-Service	1043246903	1043246903	1	1	BRIZZOLARA, CARLO C MD	7/31/1993	207P00000X	NA	Other	026	PHYSICIANS	38498	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
96180	Fee-for-Service	1275911679	1275911679	1	1	BECK, TINA PT	2/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
96204	Fee-for-Service	1255975546	1255975546	1	1	BULACLAC, CAMILLE M LCSW	6/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
96222	Fee-for-Service	1578556742	1578556742	1	1	BOLLMANN, WONSIK Y DPM	1/4/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	HIGH DESERT FOOT & ANKLE	15366 11TH ST	STE A	VICTORVILLE	CA	92395	3726	36	06071	34.530156	-117.292539	San Bernardino County
96223	Fee-for-Service	1689404022	1689404022	1	1	BOECKLER, CAROLYN A NP	10/8/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
96255	Fee-for-Service	1942684493	1942684493	1	1	BAKER, ABIGAIL NP	5/23/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
96260	Fee-for-Service	1548859341	1548859341	1	1	BEER, SCOTT CRNA	2/11/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	444 BRUCE STREET	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
96298	Fee-for-Service	1962457812	1962457812	1	134	BEVERLY RADIOLOGY MEDICAL GR	8/9/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	26161 MARGUERITE PKWY	SUITE A	MISSION VIEJO	CA	92692	3120	30	06059	33.58257724	-117.6585555	Orange County
96322	Fee-for-Service	1356473078	1356473078	1	1	BRUBAKER, SHAWN M MD	12/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9922	20	Orthopedic Surgery	0	In state provider	None	1238 WEST ST	None	REDDING	CA	96001	0415	45	06089	40.58551548	-122.3983748	Shasta County
96328	Fee-for-Service	1407116718	1407116718	1	1	BERGEN, MICHAEL A MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149282	30	Radiology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
96394	Fee-for-Service	1083031298	1083031298	1	1	BROWN, KATHERINE S MD	5/10/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	141065	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
96420	Fee-for-Service	1740069152	1740069152	1	1	BAEZA JIMENEZ, ROXANN K CCC-	11/30/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SLP	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
96439	Fee-for-Service	1982760104	1982760104	1	1	BUENA PARK ELEM SD	2/12/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	6885 ORANGETHORPE AVE	None	BUENA PARK	CA	90620	1348	30	06059	33.85891414	-118.0139031	Orange County
96446	Fee-for-Service	1790965309	1790965309	1	1	BAINS, MANPREET K MD	4/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116724	40	Pediatrics	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
96462	Fee-for-Service	1215105580	1215105580	1	1	BENAVIDES, MARTHA E NP	1/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
96465	Fee-for-Service	1992755052	1992755052	1	1	BOWAR, C JON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1406 6TH AVE N	None	ST CLOUD	MN	56303	0000	00	None	45.5746739	-94.17010435	Stearns County
96507	Fee-for-Service	1497789648	1497789648	1	2	BARRY & TAFFY, INC	10/14/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	572 E GREEN STREET	STE 300	PASADENA	CA	91101	2079	19	06037	34.1445435	-118.1386313	Los Angeles County
96561	Fee-for-Service	1447605068	1447605068	1	1	BELAY, RUTH E MD	7/18/2022	208800000X	NA	Other	026	PHYSICIANS	150789	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
96600	Fee-for-Service	1003836545	1003836545	1	1	BUENA VISTA FAMILY MEDICAL	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56329	40	Pediatrics	0	In state provider	BUEN VIS FAM MED CTR INC	719 N A ST	None	OXNARD	CA	93030	4309	56	06111	34.209189	-119.1784995	Ventura County
96620	Fee-for-Service	1538777586	1538777586	1	1	BROZICK, ALEXA	1/20/2025	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	421 N BROOKHURST ST	STE 119	ANAHEIM	CA	92801	5618	30	06059	33.83743497	-117.9590498	Orange County
96654	Fee-for-Service	1871904656	1871904656	1	3	BARSTOW PRIMARY CARE CLINIC	1/5/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	500 S 7TH AVE	STE A	BARSTOW	CA	92311	3057	36	06071	34.894449	-117.019677	San Bernardino County
96676	Fee-for-Service	1942208608	1942208608	1	1	BLOCK, GEOFFREY D MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131448	10	Gastroenterology (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
96682	Fee-for-Service	1710340948	1710340948	1	1	BALAKUMAR, JONATHAN	7/10/2019	207P00000X	NA	Other	026	PHYSICIANS	157935	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6696	19	06037	34.05682871	-118.360716	Los Angeles County
96706	Fee-for-Service	1821454554	1821454554	1	1	BEVERLY HILLS APOTHECARY LLC	11/4/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	432 N BEDFORD DR	None	BEVERLY HILLS	CA	90210	4301	19	06037	34.06854148	-118.4056233	Los Angeles County
96742	Fee-for-Service	1851392351	1851392351	1	1	BLACK, ANDREW W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1125 N PORTER AVE	STE 301	NORMAN	OK	73071	6443	00	None	35.23216454	-97.4410739	Cleveland County
96782	Fee-for-Service	1477636843	1477636843	1	1	BERDJIS, FARHOUCH MD	3/4/2005	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	MEDICAL CORPORATION	1010 W LA VETA	STE 575	ORANGE	CA	92868	4305	30	06059	33.78028244	-117.8635552	Orange County
96801	Fee-for-Service	1609883131	1609883131	1	1	BURAK, CHRISTOPHER R MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82607	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
96820	Fee-for-Service	1558339176	1558339176	1	1	BONANNO, JOSEPH A MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	15782	01	General Practice	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
96830	Fee-for-Service	1801807540	1801807540	1	1	BARRETT, JOI MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71059	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
96848	Fee-for-Service	1174899512	1174899512	1	1	BILLAKOTA, SANTOSHI MD	5/5/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	150153	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
96889	Fee-for-Service	1003836545	1003836545	1	1	BUENA VISTA FAMILY MEDICAL	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56329	41	Internal Medicine	0	In state provider	BUEN VIS FAM MED CTR INC	719 N A ST	None	OXNARD	CA	93030	4309	56	06111	34.209189	-119.1784995	Ventura County
96907	Fee-for-Service	1467038935	1467038935	1	1	BELTRAN GUTIERREZ, EMMANUEL	8/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	MD	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
96912	Fee-for-Service	1710035696	1710035696	1	1	BENITEZ, OSCAR MD	10/17/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	36740	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
96925	Fee-for-Service	1356607444	1356607444	1	1	BERRY, RYAN S MD	6/10/2020	207ZP0102X	NA	Other	026	PHYSICIANS	155238	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	3440 EMPRESA DR	SUITE B	SAN LUIS OBISPO	CA	93401	7345	40	06079	35.253333	-120.667047	San Luis Obispo County
96935	Fee-for-Service	1700147659	1700147659	1	1	BAKER, MEGAN E MD	2/21/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	126428	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
96957	Fee-for-Service	1497763445	1497763445	1	1	BRONANDER, KIRK A MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
96985	Fee-for-Service	1497809990	1497809990	1	1	BRONZO, BRIAN K MD	7/1/2012	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55257	None	None	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
97038	Fee-for-Service	1952551186	1952551186	1	1	BEVERLY HILLS PULMONARY	8/23/2016	193200000X	NA	Other	026	PHYSICIANS	83139	None	None	0	In state provider	ASSOCIATES CORPORATION	150 N ROBERTSON BLVD	STE 150	BEVERLY HILLS	CA	90211	2171	19	06037	34.06812722	-118.3837146	Los Angeles County
97047	Fee-for-Service	1861498115	1861498115	1	1	BEIDLE, THOMAS R MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	5250 NEIL RD	STE 103	RENO	NV	89502	6546	00	None	39.47416458	-119.7784756	Washoe County
97049	Fee-for-Service	1801855028	1801855028	1	1	BOUN, SINGH A MD APC	9/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	79658	08	Family Practice	0	In state provider	None	809 N HILL ST	STE K	LOS ANGELES	CA	90012	2394	19	06037	34.06312917	-118.2394531	Los Angeles County
97073	Fee-for-Service	1083024111	1083024111	1	1	BARRY-HOLSON, KEEGAN Q MD	8/6/2019	207ZP0102X	NA	Other	026	PHYSICIANS	138063	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
97074	Fee-for-Service	1740752203	1740752203	1	1	BUTHENUTH, WILLIAM A RCP	1/11/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
97082	Fee-for-Service	1730274697	1730274697	1	1	BURKEY, NANCY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66070	36	Psychiatry	0	In state provider	None	509 7TH ST	None	SANTA ROSA	CA	95401	5265	49	06097	38.442258	-122.717124	Sonoma County
97107	Fee-for-Service	1558339176	1558339176	1	1	BONANNO, JOSEPH A MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	15782	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
97128	Fee-for-Service	1962457812	1962457812	1	65	BEVERLY RADIOLOGY MEDICAL GR	4/19/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1901 N RICE AVENUE	SUITE 140, 145 & 155	OXNARD	CA	93030	7912	56	06111	34.21960355	-119.1421345	Ventura County
97133	Fee-for-Service	1912173212	1912173212	1	1	BENJAMIN ECKHARDT, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
97145	Fee-for-Service	1275918013	1275918013	1	1	BORNA, DEVIN F DO	11/3/2020	207L00000X	NA	Other	026	PHYSICIANS	17111	None	None	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
97190	Fee-for-Service	1245692946	1245692946	1	1	BRINLEY RAJAGOPAL, ALAINA A	2/19/2020	207P00000X	NA	Other	026	PHYSICIANS	153217	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
97203	Fee-for-Service	1760530794	1760530794	1	1	BOYDKING, AYANA J DO	6/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9004	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
97224	Fee-for-Service	1790214195	1790214195	1	1	BEHRENS, JONATHAN P MD	6/24/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	178753	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
97230	Fee-for-Service	1578022547	1578022547	1	1	BACK, DIANA MD	8/2/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	185242	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
97232	Fee-for-Service	1962933929	1962933929	1	1	BISHARAT-KERNIZAN, JUMANA M	8/22/2023	2085R0204X	NA	Other	026	PHYSICIANS	187232	None	None	0	In state provider	MD	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	31	06061	38.74953449	-121.2601832	Placer County
97243	Fee-for-Service	1235135427	1235135427	1	1	BASSO, TRACY L DPM	1/27/2021	213E00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	635 ANDERSON RD STE 19	None	DAVIS	CA	95616	3505	57	06113	38.54876426	-121.7587542	Yolo County
97251	Fee-for-Service	1265580203	1265580203	1	1	BLACKHAM, DAVID MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57498	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
97258	Fee-for-Service	1639257538	1639257538	1	1	BALLESCA, MANUEL A MD	4/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52229	41	Internal Medicine	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
97284	Fee-for-Service	1740900786	1740900786	1	1	BRENNER, AMY	1/17/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
97321	Fee-for-Service	1417190455	1417190455	1	1	BURT, TREVOR D MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92602	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
97351	Fee-for-Service	1982122016	1982122016	1	1	BASSI, SIMRANJIT S CRNA	5/8/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
97361	Fee-for-Service	1386360790	1386360790	1	1	BRODSTON, MELVIN CRNA	4/15/2023	163WC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
97364	Fee-for-Service	1629298740	1629298740	1	1	BANKS, RICHARD A MD	6/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52604	01	General Practice	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
97394	Fee-for-Service	1558339176	1558339176	1	1	BONANNO, JOSEPH A MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	15782	66	Emergency Medicine (Urgent Care)	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
97395	Fee-for-Service	1851599328	1851599328	1	1	BAKER, MARSHA B MD	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90841	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1127 WILSHIRE BOULEVARD	SUITE 1414	LOS ANGELES	CA	90017	4000	19	06037	34.05270508	-118.2641005	Los Angeles County
97417	Fee-for-Service	1578750261	1578750261	1	1	BUI, ALEXANDER T MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90640	18	Ophthalmology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
97418	Fee-for-Service	1962457812	1962457812	1	66	BEVERLY RADIOLOGY MEDICAL GR	10/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	510 N PROSPECT AVE	#101	REDONDO BEACH	CA	90277	3030	19	06037	33.85259344	-118.379739	Los Angeles County
97456	Fee-for-Service	1013053669	1013053669	1	1	BONNES, BENJAMIN J MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104449	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
97463	Fee-for-Service	1619198801	1619198801	1	1	BARNEY DANIEL STOUTAMIRE M.D	5/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1210 W 18TH ST	None	SIOUX FALLS	SD	57104	4647	00	None	43.537329	-96.743223	Minnehaha County
97464	Fee-for-Service	1295778157	1295778157	1	1	BUSCH, BENJAMIN A MD	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
97489	Fee-for-Service	1760530794	1760530794	1	1	BOYDKING, AYANA J DO	6/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9004	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
97521	Fee-for-Service	1508077280	1508077280	1	1	BYNUM, FRANCINE D MD	1/8/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	95209	40	Pediatrics	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
97534	Fee-for-Service	1699883785	1699883785	1	1	BREAZEALE, BRETTON H MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2900 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	7101	00	None	42.2526295	-121.788099	Klamath County
97563	Fee-for-Service	1164471215	1164471215	1	1	BARSTOW SURGICAL INC	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	32782	02	General Surgery	0	In state provider	None	705 E VIRGINIA WAY	STE B	BARSTOW	CA	92311	3955	36	06071	34.88815781	-117.018543	San Bernardino County
97570	Fee-for-Service	1790145530	1790145530	1	1	BARTLETT, LAURA NP	12/1/2023	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
97602	Fee-for-Service	1013468131	1013468131	1	1	BUTLER, ELIZABETH LMFT	8/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
97606	Fee-for-Service	1508172404	1508172404	1	1	BEJJANI, BASSAM K MD AMC	1/31/1982	193400000X	NA	Other	026	PHYSICIANS	33388	34	Urology and Urological Surgery	0	In state provider	None	14860 ROSCOE BLVD	STE 308	PANORAMA CITY	CA	91402	4698	19	06037	34.2214515	-118.4573205	Los Angeles County
97624	Fee-for-Service	1982781159	1982781159	1	7	BAART COMMUNITY HEALTHCARE	1/26/2005	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ADDICTION RESRCH & TREAT	3707 SUNSET LN	None	ANTIOCH	CA	94509	6101	07	06013	37.98459755	-121.8042179	Contra Costa County
97626	Fee-for-Service	1710311337	1710311337	1	1	BRADLEY, MARINA M NP	10/16/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
97634	Fee-for-Service	1982781159	1982781159	1	2	BAART COMMUNITY HEALTHCARE	11/20/2001	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SOUTHEAST CLINIC	4920 AVALON BLVD	None	LOS ANGELES	CA	90011	4004	19	06037	33.998157	-118.265212	Los Angeles County
97649	Fee-for-Service	1841483815	1841483815	1	1	BRANDON, THERESA C LMFT	6/20/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4344 LATHAM ST	110	RIVERSIDE	CA	92501	0400	33	06065	34.00198519	-117.3739252	Riverside County
97653	Fee-for-Service	1629298740	1629298740	1	1	BANKS, RICHARD A MD	6/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52604	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
97658	Fee-for-Service	1235592445	1235592445	1	1	BURCKHARD, BRADEN A MD	12/4/2020	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	168668	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
97676	Fee-for-Service	1093820276	1093820276	1	1	BREDING, SARAH M LCSW	4/1/2001	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3150 EL CAMINO REAL	STE E	CARLSBAD	CA	92008	2110	37	06073	33.17209501	-117.3227345	San Diego County
97705	Fee-for-Service	1962457812	1962457812	1	138	BEVERLY RADIOLOGY MEDICAL GR	8/9/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	25150 HANCOCK AVE	SUITE 105	MURRIETA	CA	92562	5987	33	06065	33.56635084	-117.1823956	Riverside County
97711	Fee-for-Service	1962457812	1962457812	1	151	BEVERLY RADIOLOGY MEDICAL GR	10/29/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	44105 15TH ST W	SUITE 100	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
97751	Fee-for-Service	1215084116	1215084116	1	1	BARRIE-LAKE, NAOMI LCSW	5/15/2007	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2031 29TH ST	None	SAN DIEGO	CA	92104	5503	37	06073	32.72710626	-117.1319789	San Diego County
97791	Fee-for-Service	1851368369	1851368369	1	1	BARLOW RESPIRATORY HOSP	4/1/1983	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
97799	Fee-for-Service	1174782270	1174782270	1	1	BRAND, JORDAN E MD	2/29/2024	207L00000X	NA	Other	026	PHYSICIANS	121993	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
97854	Fee-for-Service	1528048808	1528048808	1	1	BLACK-DAVIS PAMELA K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	630 N ALVERNON WAY	STE 171	TUCSON	AZ	85711	0000	00	None	32.2299	-110.909205	Pima County
97859	Fee-for-Service	1992377360	1992377360	1	1	BRADFORD, KENDALL A LCSW	4/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
97868	Fee-for-Service	1407870322	1407870322	1	1	BERRY, GLENN W MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	54546	05	Anesthesiology	0	In state provider	None	13 YANKEE BEACH WAY	None	CARMEL	CA	93923	9733	27	06053	36.48945871	-121.9408921	Monterey County
97898	Fee-for-Service	1265437396	1265437396	1	1	BEHZADI, KAMBIZ MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	85552	20	Orthopedic Surgery	0	In state provider	None	5601 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
97901	Fee-for-Service	1710145719	1710145719	1	1	BRUSO, JESSICA R DO	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10587	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
97905	Fee-for-Service	1639643364	1639643364	1	1	BARBARA BARRY, A MARRIAGE AN	1/6/2020	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	69930 HIGHWAY 111	SUITE 204A	RANCHO MIRAGE	CA	92270	2850	33	06065	33.76779913	-116.445333	Riverside County
97927	Fee-for-Service	1366544363	1366544363	1	2	BEKHTEL, IRENA OD	9/24/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ST	10355 TRINITY PKWY	None	STOCKTON	CA	95219	7243	39	06077	38.05026767	-121.3750074	San Joaquin County
97940	Fee-for-Service	1174696405	1174696405	1	1	BAZAN, SARA B LMFT	2/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	822 EAST CANON PERDIDO	#2	SANTA BARBARA	CA	93103	3058	42	06083	34.42963106	-119.6908523	Santa Barbara County
97992	Fee-for-Service	1730877259	1730877259	1	1	BRILLON, ANSELMO LPCC	10/20/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
97995	Fee-for-Service	1861874612	1861874612	1	1	BUTLER, TYRONE MD	2/27/2020	208M00000X	NA	Other	026	PHYSICIANS	163995	41	Internal Medicine	0	In state provider	None	15248 ELEVENTH ST	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
98006	Fee-for-Service	1013623636	1013623636	1	1	BAYLINER TRANSIT L.L.C	10/1/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	701 HIGH ST	226	AUBURN	CA	95603	4735	31	06061	38.90214664	-121.0682262	Placer County
98007	Fee-for-Service	1962457812	1962457812	1	117	BEVERLY RADIOLOGY MEDICAL GR	4/24/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CA	4050 BARRANCA PKWY	STE 160	IRVINE	CA	92604	4785	30	06059	33.68293726	-117.8067799	Orange County
98014	Fee-for-Service	1376717330	1376717330	1	1	BUSH, ERROL L MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111911	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
98026	Fee-for-Service	1770748360	1770748360	1	1	BOWER, MEGAN E CNM	11/27/2017	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
98053	Fee-for-Service	1285712174	1285712174	1	1	BATEMAN, JASON MD	6/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74845	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
98057	Fee-for-Service	1073587887	1073587887	1	1	BLACK, JASON A MD	6/10/2019	207R00000X	NA	Other	026	PHYSICIANS	63632	41	Internal Medicine	0	In state provider	None	24680 JEFFERSON AVE	STE A	MURRIETA	CA	92562	9023	33	06065	33.56056523	-117.2098454	Riverside County
98127	Fee-for-Service	1457392938	1457392938	1	1	BLAKE, GERALD A MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	32432	67	Endocrinology	0	In state provider	None	1738 N D ST	None	SAN BERNARDINO	CA	92405	4418	36	06071	34.13061121	-117.2919772	San Bernardino County
98132	Fee-for-Service	1740482405	1740482405	1	1	BURT, MARLENE D NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
98134	Fee-for-Service	1780760280	1780760280	1	1	BUI, STEVE-KHOI K MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83563	18	Ophthalmology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
98177	Fee-for-Service	1649496597	1649496597	1	1	BURGOS, GENY B MD INC	9/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53610	40	Pediatrics	0	In state provider	None	1801 E MARCH LN	STE C340	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
98213	Fee-for-Service	1760408173	1760408173	1	1	BALLON, SAMUEL C MD	5/31/1995	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21751	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 WELCH RD	STE 300	PALO ALTO	CA	94304	1800	43	06085	37.43619156	-122.1779694	Santa Clara County
98233	Fee-for-Service	1962441501	1962441501	1	1	BLUE, MICHAEL S MD	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87766	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 E LOCUST ST	None	LONE PINE	CA	93545	1009	14	06027	36.60839814	-118.0579394	Inyo County
98244	Fee-for-Service	1265401327	1265401327	1	1	BETRA, RESHAM MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55890	40	Pediatrics	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
98245	Fee-for-Service	1205823929	1205823929	1	1	BIRDJANDI, FARSCHAD MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89932	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
98302	Fee-for-Service	1376717330	1376717330	1	1	BUSH, ERROL L MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111911	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
98303	Fee-for-Service	1962457812	1962457812	1	81	BEVERLY RADIOLOGY MEDICAL GR	5/29/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	9191 WESTMINSTER AVE	STE 210	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
98309	Fee-for-Service	1689670432	1689670432	1	1	BERRY, MICHAEL C MD	11/1/1999	207ZP0102X	NA	Other	026	PHYSICIANS	61350	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
98310	Fee-for-Service	1427106491	1427106491	1	1	BOEHMER, CHRISTIAN G MD	12/1/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83985	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
98323	Fee-for-Service	1518970755	1518970755	1	1	BISWAS, MIMI S MD	9/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66654	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3770 ELIZABETH ST	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
98337	Fee-for-Service	1295988319	1295988319	1	1	BRYSON, JARED L LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
98343	Fee-for-Service	1003952037	1003952037	1	1	BROOKSHIRE PARTNERS	2/24/2006	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11500 DOLAN AVE	None	DOWNEY	CA	90241	4900	19	06037	33.93646634	-118.133428	Los Angeles County
98365	Fee-for-Service	1972080752	1972080752	1	4	BORIS SHLOPOV MD PATHOLOGY M	11/14/2022	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	EDICAL CORPORATION	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
98395	Fee-for-Service	1942314083	1942314083	1	1	BARON, NORMAN E MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	26743	02	General Surgery	0	In state provider	None	628 G ST	None	BRAWLEY	CA	92227	2544	13	06025	32.97749348	-115.531407	Imperial County
98412	Fee-for-Service	1457392938	1457392938	1	1	BLAKE, GERALD A MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	32432	41	Internal Medicine	0	In state provider	None	1738 N D ST	None	SAN BERNARDINO	CA	92405	4418	36	06071	34.13061121	-117.2919772	San Bernardino County
98424	Fee-for-Service	1003081209	1003081209	1	1	BUHAY-MAGLUNOG, MARIA S	10/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	42390	83	Rheumatology	0	In state provider	MD INC	1250 S SUNSET AVE	STE 201	WEST COVINA	CA	91790	3963	19	06037	34.0610671	-117.9463685	Los Angeles County
98453	Fee-for-Service	1700388733	1700388733	1	1	BOARDWAY, KATHRYN A LMFT	11/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
98565	Fee-for-Service	1063550549	1063550549	1	2	B & F HOME HEALTH INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1638 E ARTESIA BLVD	None	LONG BEACH	CA	90805	1623	19	06037	33.87454047	-118.172187	Los Angeles County
98585	Fee-for-Service	1932461803	1932461803	1	1	BRIGGS, BENJAMIN J MD	7/9/2019	207R00000X	NA	Other	026	PHYSICIANS	142695	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
98602	Fee-for-Service	1720155666	1720155666	1	1	BROTMAN, STEVEN C MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53753	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
98605	Fee-for-Service	1477916013	1477916013	1	1	BLOCKER, DANIEL J LMFT	2/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
98613	Fee-for-Service	1518970755	1518970755	1	1	BISWAS, MIMI S MD	9/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66654	41	Internal Medicine	0	In state provider	None	3770 ELIZABETH ST	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
98645	Fee-for-Service	1699903617	1699903617	1	1	BEKELE, WOSEN M MD	7/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111297	30	Radiology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
98711	Fee-for-Service	1003081209	1003081209	1	1	BUHAY-MAGLUNOG, MARIA S	10/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	42390	41	Internal Medicine	0	In state provider	MD INC	1250 S SUNSET AVE	STE 201	WEST COVINA	CA	91790	3963	19	06037	34.0610671	-117.9463685	Los Angeles County
98723	Fee-for-Service	1134464852	1134464852	1	1	BOTELLO, MYRA P LMFT	4/8/2020	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
98738	Fee-for-Service	1205042165	1205042165	1	1	BANKS, NORMAN L MD	9/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91480	25	Physical Medicine and Rehabilitation	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
98759	Fee-for-Service	1437964756	1437964756	1	1	BUCK, TAMARA	2/28/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
98836	Fee-for-Service	1699903492	1699903492	1	1	BEH II, GORDON MD	3/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122532	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
98853	Fee-for-Service	1073809810	1073809810	1	1	BAKEY, CATHERINE O MD	11/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126119	40	Pediatrics	0	In state provider	None	650 HOWE AVE	SUITE 100	SACRAMENTO	CA	95825	4732	34	06067	38.577294	-121.4146395	Sacramento County
98869	Fee-for-Service	1932461803	1932461803	1	1	BRIGGS, BENJAMIN J MD	7/9/2019	207R00000X	NA	Other	026	PHYSICIANS	142695	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
98871	Fee-for-Service	1972739001	1972739001	1	1	BLACK, MICHELLE T MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113466	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
98873	Fee-for-Service	1962457812	1962457812	1	107	BEVERLY RADIOLOGY MEDICAL GR	2/22/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ED	23441 MADISON STREET	SUITE 100	TORRANCE	CA	90505	4734	19	06037	33.81240248	-118.3477463	Los Angeles County
98881	Fee-for-Service	1962457812	1962457812	1	141	BEVERLY RADIOLOGY MEDICAL GR	9/28/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MAGING	65 N MADISON AVE	None	PASADENA	CA	91101	2035	19	06037	34.14705803	-118.1384317	Los Angeles County
98889	Fee-for-Service	1720155666	1720155666	1	1	BROTMAN, STEVEN C MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53753	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
98892	Fee-for-Service	1831207422	1831207422	1	1	BLAND, VANESSA L LMFT	1/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W GRAND AVE	STE 7	EL SEGUNDO	CA	90245	5112	19	06037	33.91893152	-118.4187035	Los Angeles County
98902	Fee-for-Service	1043672702	1043672702	1	1	BENTZLEY, JESSICA K MD	8/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	150850	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
98904	Fee-for-Service	1992853774	1992853774	1	1	BATHALA, RAMA D MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81988	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
98905	Fee-for-Service	1750887790	1750887790	1	1	BARKSDALE, MONICA LYNN OT	4/16/2020	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7737 MEANY AVE	B5-7	BAKERSFIELD	CA	93308	5266	15	06029	35.39423549	-119.0882835	Kern County
98949	Fee-for-Service	1639241474	1639241474	1	1	BHARDWAJ, ANUPAMA MD	12/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53905	05	Anesthesiology	0	In state provider	None	27400 HESPERIA BLVD	None	HAYWARD	CA	94545	0000	01	06001	37.63011596	-122.0960694	Alameda County
98954	Fee-for-Service	1790801553	1790801553	1	1	BASSETT UNIF SCHOOL DIST	5/8/2008	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	904 N WILLOW AVE	None	LA PUENTE	CA	91746	1615	19	06037	34.05300097	-117.9717721	Los Angeles County
98958	Fee-for-Service	1346565934	1346565934	1	1	BALDUZZI, MICHAEL C MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135460	01	General Practice	0	In state provider	None	4628 GEORGETOWN PL	None	STOCKTON	CA	95207	6204	39	06077	37.9893781	-121.313486	San Joaquin County
99000	Fee-for-Service	1942654892	1942654892	1	1	BOLIVAR, KIMBERLY E MD	8/22/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160850	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
99001	Fee-for-Service	1780214403	1780214403	1	3	BATES, GARY A	6/2/2020	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	5730 PACKARD AVENUE	SUITE 500	MARYSVILLE	CA	95901	7119	58	06115	39.12014523	-121.5659991	Yuba County
99071	Fee-for-Service	1568472298	1568472298	1	1	BARNARD, ISABELLE C MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51122	10	Gastroenterology (M.D. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
99076	Fee-for-Service	1679012041	1679012041	1	1	BURRIS, MICHAEL L NP	9/21/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2237 W BALL RD	None	ANAHEIM	CA	92804	5314	30	06059	33.817798	-117.9610599	Orange County
99095	Fee-for-Service	1588728422	1588728422	1	2	BOLAJI, ELIZABETH J CNM	5/17/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
99110	Fee-for-Service	1376523498	1376523498	1	1	BLACK, HUGH B MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78881	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
99122	Fee-for-Service	1427644038	1427644038	1	1	BRYANT HEALTH, P.C.	9/23/2021	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	23653 EL TORO RD	STE B	LAKE FOREST	CA	92630	8614	30	06059	33.617891	-117.7039747	Orange County
99157	Fee-for-Service	1396795472	1396795472	1	1	BALLARD, DANIEL J. MD	9/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
99172	Fee-for-Service	1205064722	1205064722	1	1	BARBA, DAVID MD	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135899	20	Orthopedic Surgery	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 408	LOS ANGELES	CA	90017	3905	19	06037	34.05270508	-118.2641005	Los Angeles County
99187	Fee-for-Service	1497959332	1497959332	1	1	BIRO, NICOLAS G MD	9/22/2021	207WX0200X	NA	Ophthalmology	026	PHYSICIANS	172433	None	None	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
99242	Fee-for-Service	1871041780	1871041780	1	1	BHATNAGAR, RISHI MD	12/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151689	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
99254	Fee-for-Service	1609139591	1609139591	1	1	BALFOUR, STEPHEN A MD	10/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156014	30	Radiology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8762	20	06039	36.88437894	-119.8003484	Madera County
99263	Fee-for-Service	1295976819	1295976819	1	1	BEIZAI, POUNEH MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	78205	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1732	19	06037	34.06373445	-118.443537	Los Angeles County
99309	Fee-for-Service	1053375576	1053375576	1	1	BAPTIST MEMORIAL HOSP	8/2/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2301 S LAMAR BLVD	None	OXFORD	MS	38655	5373	00	None	34.34892102	-89.52070927	Lafayette County
99320	Fee-for-Service	1366751547	1366751547	1	1	BRIGHT, CHARLEEN S LCSW	11/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
99327	Fee-for-Service	1811520018	1811520018	1	1	BEAVER, BRIANNA DO	8/27/2023	390200000X	NA	Other	026	PHYSICIANS	20511	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
99348	Fee-for-Service	1184756603	1184756603	1	1	BRIAN D CLOTHIER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST	None	SALEM	OR	97301	3919	00	None	44.933211	-123.0355125	Marion County
99350	Fee-for-Service	1710201025	1710201025	1	1	BERES, SHANNON J MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115406	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99358	Fee-for-Service	1982651915	1982651915	1	1	BONYADLOU, SHAHRAM	7/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80028	30	Radiology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
99361	Fee-for-Service	1568472298	1568472298	1	1	BARNARD, ISABELLE C MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51122	41	Internal Medicine	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
99376	Fee-for-Service	1215315213	1215315213	1	1	BRANDLEY, JAIMIE DO	7/1/2018	390200000X	NA	Other	026	PHYSICIANS	15496	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
99379	Fee-for-Service	1275939092	1275939092	1	1	BROWN, NICHOLAS P DO	2/16/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18162	None	None	0	In state provider	None	419 CHESTNUT ST	APT 3	MOUNT SHASTA	CA	96067	2918	47	06093	41.31492405	-122.3131185	Siskiyou County
99390	Fee-for-Service	1457770752	1457770752	1	1	BUCUR, PHILIP L MD	8/19/2019	208800000X	NA	Other	026	PHYSICIANS	139381	34	Urology and Urological Surgery	0	In state provider	None	11180 WARNER AVE	SUITE 167	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.71632048	-117.9334575	Orange County
99394	Fee-for-Service	1225011422	1225011422	1	1	BODONY, RICHARD MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67219	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
99397	Fee-for-Service	1376523498	1376523498	1	1	BLACK, HUGH B MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78881	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
99406	Fee-for-Service	1184069239	1184069239	1	1	BAJWA, ERUM I MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135570	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
99413	Fee-for-Service	1679906564	1679906564	1	1	BROWN, KEVIN W	4/17/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
99414	Fee-for-Service	1366953259	1366953259	1	1	BAZZAZI, MARJAN	2/21/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
99438	Fee-for-Service	1215093208	1215093208	1	1	BREES, THERESA L LCSW	3/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
99467	Fee-for-Service	1326571407	1326571407	1	1	BOWMAN, KATE E MD	3/5/2019	390200000X	NA	Other	026	PHYSICIANS	159693	15	Obstetrics (D.O. only)	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
99489	Fee-for-Service	1366441180	1366441180	1	1	BALICH, SUSAN M. MD	2/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
99506	Fee-for-Service	1063897221	1063897221	1	1	BONITO INPATIENT SERVICES	11/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	6900 N DURANGO DR	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
99518	Fee-for-Service	1053499822	1053499822	1	1	BREEDEN, JAMES H MD	4/18/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27619	41	Internal Medicine	0	In state provider	None	3043 SUMMIT ST	None	OAKLAND	CA	94609	3408	01	06001	37.81991034	-122.2644496	Alameda County
99525	Fee-for-Service	1376623389	1376623389	1	1	BABAEE, IRAJ	8/1/1995	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	DBA ADVANCE HEARING SYS	4125 MOHR AVE	STE I	PLEASANTON	CA	94566	4749	01	06001	37.68196048	-121.8733965	Alameda County
99550	Fee-for-Service	1265993059	1265993059	1	1	BERSHAD, ANYA K MD	9/11/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180915	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
99594	Fee-for-Service	1174014229	1174014229	1	1	BEAN, HEIDI A MD	3/24/2021	207L00000X	NA	Other	026	PHYSICIANS	159931	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
99595	Fee-for-Service	1053375576	1053375576	1	1	BAPTIST MEMORIAL HOSP	8/2/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2301 S LAMAR BLVD	None	OXFORD	MS	38655	5373	00	None	34.34892102	-89.52070927	Lafayette County
99601	Fee-for-Service	1508818253	1508818253	1	1	BADR, AHMED I E MD	4/1/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	46393	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8701 E CLOUDVIEW WAY	None	ANAHEIM	CA	92808	1658	30	06059	33.85883254	-117.7240202	Orange County
99637	Fee-for-Service	1710201025	1710201025	1	1	BERES, SHANNON J MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115406	79	Neurology-Child	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99649	Fee-for-Service	1568472298	1568472298	1	1	BARNARD, ISABELLE C MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51122	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
99683	Fee-for-Service	1225011422	1225011422	1	1	BODONY, RICHARD MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67219	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
99684	Fee-for-Service	1821594086	1821594086	1	1	BERNARDO, STACEY K DO	1/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17734	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
99689	Fee-for-Service	1710413356	1710413356	1	1	BANUELOS, MARTHA P LMFT	12/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
99699	Fee-for-Service	1700863719	1700863719	1	1	BENTLEY, CHRISTIAN D MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68137	20	Orthopedic Surgery	0	In state provider	None	3998 VISTA WAY	STE B	OCEANSIDE	CA	92056	4514	37	06073	33.18370179	-117.292963	San Diego County
99700	Fee-for-Service	1972841872	1972841872	1	1	BIOLOGIC INFUSION INC	3/27/2014	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8851 WATSON STREET	None	CYPRESS	CA	90630	2243	30	06059	33.83388859	-118.0392784	Orange County
99707	Fee-for-Service	1427066976	1427066976	1	1	BRENNAN, KIMBERLY A NP	2/8/2015	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3098	00	None	45.49936609	-122.6856232	Multnomah County
99710	Fee-for-Service	1801182308	1801182308	1	1	BULLER, RYAN I DO	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12712	01	General Practice	0	In state provider	None	555 TECHEVAH DR	STE 3W105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
99723	Fee-for-Service	1477844405	1477844405	1	1	BUDER, BRIAN C MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127794	01	General Practice	0	In state provider	None	1619 E EDINGER AVE	None	SANTA ANA	CA	92705	5001	30	06059	33.72684629	-117.846511	Orange County
99730	Fee-for-Service	1184744880	1184744880	1	1	BRATCHER, NINA V LCSW	6/18/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
99732	Fee-for-Service	1003948654	1003948654	1	1	BRADBOURNE HEALTHCARE INC	4/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1109 W SAN BERNARDINO RD	SUITE 230	COVINA	CA	91722	4166	19	06037	34.0887369	-117.9124702	Los Angeles County
99742	Fee-for-Service	1669440574	1669440574	1	1	BARCLAY-WHITE, JASON M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10401 W THUNDERBIRD BLVD	None	SUN CITY	AZ	85351	3004	00	None	33.603885	-112.2831765	Maricopa County
99785	Fee-for-Service	1851535504	1851535504	1	1	BAZAN, JOSE G MD	11/30/2022	2085R0001X	NA	Other	026	PHYSICIANS	110291	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
99786	Fee-for-Service	1346411543	1346411543	1	1	BURNEY, PHILLIP A	12/1/1996	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 E TACHEVAH DR	# 3W	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
99804	Fee-for-Service	1053499822	1053499822	1	1	BREEDEN, JAMES H MD	4/18/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27619	78	Neoplastic Diseases/Oncology	0	In state provider	None	3043 SUMMIT ST	None	OAKLAND	CA	94609	3408	01	06001	37.81991034	-122.2644496	Alameda County
99835	Fee-for-Service	1841367240	1841367240	1	1	BATES, ANDREA R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71770	01	General Practice	0	In state provider	None	8001 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2329	34	06067	38.4669	-121.417101	Sacramento County
99844	Fee-for-Service	1316173552	1316173552	1	1	BORGSCHULTE, GITTE M MD	11/25/2009	207R00000X	NA	Other	026	PHYSICIANS	105451	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	3608	37	06073	33.1857	-117.290538	San Diego County
99849	Fee-for-Service	1982618682	1982618682	2	1	BLAS, MICHELLE C OD	9/1/2000	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 UNION ST	STE 300	SAN FRANCISCO	CA	94123	4108	38	06075	37.7974427	-122.432532	San Francisco County
99890	Fee-for-Service	1063476331	1063476331	1	1	BEHLING, CYNTHIA ANN MD	10/31/1991	207ZC0500X	NA	Other	026	PHYSICIANS	73887	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
99891	Fee-for-Service	1508818253	1508818253	1	1	BADR, AHMED I E MD	4/1/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	46393	41	Internal Medicine	0	In state provider	None	8701 E CLOUDVIEW WAY	None	ANAHEIM	CA	92808	1658	30	06059	33.85883254	-117.7240202	Orange County
99941	Fee-for-Service	1891736757	1891736757	1	1	BLANK, JULIA R MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83790	41	Internal Medicine	0	In state provider	None	1920 COLORADO BLVD	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
99942	Fee-for-Service	1245305168	1245305168	1	1	BRANDSTETTER, KEVIN D MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102074	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
100004	Fee-for-Service	1376561936	1376561936	1	1	BAKER, CATHERINE M DO	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16643	02	General Surgery	0	In state provider	None	3 MEDICAL PLAZA DRIVE	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
100005	Fee-for-Service	1922182211	1922182211	1	1	BAUTISTA, ALEJANDRO A	2/20/1996	2080P0006X	NA	Psychiatry	026	PHYSICIANS	70233	40	Pediatrics	0	In state provider	None	78150 CALLE TAMPICO	APT 4	LA QUINTA	CA	92253	2907	33	06065	33.67817382	-116.30003	Riverside County
100019	Fee-for-Service	1821469263	1821469263	1	1	BENEVOLENCE INDUSTRIES	12/1/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	920 N LONG BEACH BLVD	SUITE 1, 2, 3	COMPTON	CA	90221	2259	19	06037	33.90236003	-118.2082841	Los Angeles County
100083	Fee-for-Service	1538250766	1538250766	1	1	BORNHEIMER, JOSEPH F MD	8/31/1982	174400000X	NA	Other	026	PHYSICIANS	32890	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1560 E CHEVY CHASE DR	STE 310	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
100134	Fee-for-Service	1487811907	1487811907	1	1	BENSCOTER, DAN T DO	7/10/2019	2080P0214X	NA	Pulmonology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
100158	Fee-for-Service	1902890023	1902890023	1	1	BUTANI, LAVJAY MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67266	41	Internal Medicine	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
100163	Fee-for-Service	1295756237	1295756237	1	1	BUESE, JAMES V MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	39589	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
100181	Fee-for-Service	1952485427	1952485427	1	1	BELAJIC, ROBERT D OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3211 FORTUNE CT	STE A	AUBURN	CA	95602	9245	31	06061	38.94234896	-121.1015805	Placer County
100184	Fee-for-Service	1740832880	1740832880	1	1	BOBER, HAILEY M PT	5/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
100209	Fee-for-Service	1366462830	1366462830	1	1	BOCK, ALLAN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66928	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
100250	Fee-for-Service	1881846582	1881846582	1	1	BAHRAMI, SIMIN MD	3/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98982	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	8344	19	06037	34.06373445	-118.443537	Los Angeles County
100268	Fee-for-Service	1679341093	1679341093	1	1	BENOIT, RIKAYAH K DOULA	1/23/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
100295	Fee-for-Service	1922182211	1922182211	1	1	BAUTISTA, ALEJANDRO A	2/20/1996	2080P0006X	NA	Psychiatry	026	PHYSICIANS	70233	01	General Practice	0	In state provider	None	78150 CALLE TAMPICO	APT 4	LA QUINTA	CA	92253	2907	33	06065	33.67817382	-116.30003	Riverside County
100308	Fee-for-Service	1821469263	1821469263	1	1	BENEVOLENCE INDUSTRIES	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	920 N LONG BEACH BLVD	SUITE 1, 2, 3	COMPTON	CA	90221	2259	19	06037	33.90236003	-118.2082841	Los Angeles County
100317	Fee-for-Service	1962457812	1962457812	1	51	BEVERLY RADIOLOGY MEDICAL GR	5/30/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	SANTA CLARITA IMAGING	25775 W MCBEAN PARKWY	STE 100	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
100319	Fee-for-Service	1942299342	1942299342	1	1	BROUETTE, RICHARD J MD	5/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69457	08	Family Practice	0	In state provider	None	1215 PLUMAS ST	STE 1400	YUBA CITY	CA	95991	3455	51	06101	39.14709336	-121.6175316	Sutter County
100325	Fee-for-Service	1194145912	1194145912	1	1	BATES, NICHOLAS S MD	6/10/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160395	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
100329	Fee-for-Service	1972625986	1972625986	1	1	BEAN, GARY E MD INC	9/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	4180 PARK BLVD	None	OAKLAND	CA	94602	1207	01	06001	37.80705678	-122.2229335	Alameda County
100347	Fee-for-Service	1245335991	1245335991	1	1	BEACH CITIES EMERG PHYS	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MED GROUP INC	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
100354	Fee-for-Service	1124161740	1124161740	1	1	BOHLMAN, JAIME H MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94481	40	Pediatrics	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
100389	Fee-for-Service	1982226791	1982226791	1	1	BUENDIA, MARISSA DO	8/27/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22810	09	Gynecology (D.O. only)	0	In state provider	None	1401 SPANOS CT	STE 125	MODESTO	CA	95355	2814	50	06099	37.66975543	-120.9724048	Stanislaus County
100395	Fee-for-Service	1821101924	1821101924	1	1	BENSON, ANNA LEE PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30240 HWY 78	None	SANTA YSABEL	CA	92070	0000	37	06073	33.10894332	-116.6750407	San Diego County
100427	Fee-for-Service	1699501247	1699501247	1	1	BETTER IN PERSON INC	1/15/2025	171M00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	3534 E STATE HWY 20	STE 2	NICE	CA	95464	8573	17	06033	39.12306043	-122.8450956	Lake County
100433	Fee-for-Service	1841751856	1841751856	1	1	BP PHARMACY, INC.	5/31/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6726 BEACH BLVD	None	BUENA PARK	CA	90621	3410	30	06059	33.862743	-117.9980205	Orange County
100447	Fee-for-Service	1902890023	1902890023	1	1	BUTANI, LAVJAY MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67266	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
100448	Fee-for-Service	1073539474	1073539474	1	1	BREED, IVAN L MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31294	41	Internal Medicine	0	In state provider	None	475 W BADILLO ST	None	COVINA	CA	91723	1834	19	06037	34.08634352	-117.8986545	Los Angeles County
100449	Fee-for-Service	1558832824	1558832824	1	1	BROWN, RYAN F CRNA	2/19/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
100456	Fee-for-Service	1255549184	1255549184	1	1	BOGHAIRI, ANOUSH MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33832	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 115	LA MESA	CA	91942	3021	37	06073	32.77978322	-117.0094766	San Diego County
100464	Fee-for-Service	1164759916	1164759916	1	1	BLUMENTHAL, ELIZABETH A MD	6/3/2010	390200000X	NA	Other	026	PHYSICIANS	107191	41	Internal Medicine	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
100476	Fee-for-Service	1639227614	1639227614	1	1	BLUESTONE, GARY L DO	10/31/1993	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	6516	None	None	0	In state provider	None	327 CHESTER AVE	None	BAKERSFIELD	CA	93301	5413	15	06029	35.36002269	-119.0189312	Kern County
100481	Fee-for-Service	1255412664	1255412664	1	1	BENDER, RICHARD A MD	7/31/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	24222	68	Hematology	0	In state provider	None	26732 CROWN VALLEY PKWY	STE 271	MISSION VIEJO	CA	92691	8520	30	06059	33.56347704	-117.66546	Orange County
100484	Fee-for-Service	1023608825	1023608825	1	1	BOLDEN, SIMONE	10/7/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
100512	Fee-for-Service	1508866203	1508866203	1	1	BRIAR ERTZ-BERGER MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2875 NW STUCKI AVE	None	HILLSBORO	OR	97124	5806	00	None	45.53895516	-122.8762898	Washington County
100523	Fee-for-Service	1932240447	1932240447	1	1	BORSODY, LISA M PT	10/22/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1430 ESPLANADE	STE 8	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
100549	Fee-for-Service	1629605381	1629605381	1	1	BAXLEY, SAMANTHA MD	7/9/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
100556	Fee-for-Service	1033177803	1033177803	1	1	BOUVET, MICHAEL MD	8/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	69035	02	General Surgery	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
100573	Fee-for-Service	1053425330	1053425330	1	1	BAQUERIZO, ANGELES MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	79395	02	General Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
100648	Fee-for-Service	1568056968	1568056968	1	1	BEST CHOICE HOME HEALTH	9/16/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	5311 TOPANGA CANYON BLVD	STE 315	WOODLAND HILLS	CA	91364	1754	19	06037	34.166313	-118.6059365	Los Angeles County
100666	Fee-for-Service	1386093714	1386093714	1	1	BAY NATION HOME HEALTH	1/15/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	39675 CEDAR BLVD	SUITE 235	NEWARK	CA	94560	5490	01	06001	37.52050519	-121.9962032	Alameda County
100681	Fee-for-Service	1982226791	1982226791	1	1	BUENDIA, MARISSA DO	8/27/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22810	15	Obstetrics (D.O. only)	0	In state provider	None	1401 SPANOS CT	STE 125	MODESTO	CA	95355	2814	50	06099	37.66975543	-120.9724048	Stanislaus County
100701	Fee-for-Service	1275856700	1275856700	1	1	BYINGTON, KRISTIN D PHD	8/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
100717	Fee-for-Service	1548548688	1548548688	1	1	BROADWAY MEDICAL SERVICE AND	9/1/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	123 COMMERCE CIR	SUITE B	SACRAMENTO	CA	95815	4201	34	06067	38.597616	-121.4597295	Sacramento County
100743	Fee-for-Service	1205090867	1205090867	1	1	BADRTALEI-SHAH, SHIRIN DO	10/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11639	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100747	Fee-for-Service	1255549184	1255549184	1	1	BOGHAIRI, ANOUSH MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33832	41	Internal Medicine	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 115	LA MESA	CA	91942	3021	37	06073	32.77978322	-117.0094766	San Diego County
100749	Fee-for-Service	1295882819	1295882819	1	1	BIGGS GRIDLEY MEM HOSP	7/5/2002	275N00000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	240 SPRUCE ST	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
100775	Fee-for-Service	1730175977	1730175977	1	1	BENTZ, SHELBY L MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	80199	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
100784	Fee-for-Service	1619621497	1619621497	1	2	BZD LABS LLC	11/1/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	512 N LARCHMONT BLVD	None	LOS ANGELES	CA	90004	1306	19	06037	34.07937446	-118.3236235	Los Angeles County
100791	Fee-for-Service	1053664649	1053664649	1	1	BASALONE, JANET C LMFT	10/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	515 E 1ST ST	SUITE D	TUSTIN	CA	92780	3335	30	06059	33.74583051	-117.8188245	Orange County
100818	Fee-for-Service	1518028943	1518028943	1	1	BURGOYNE, KARL S MD	10/1/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	67828	36	Psychiatry	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
100839	Fee-for-Service	1457057960	1457057960	1	2	BAY SPEECH AND PLAY, A SPEEC	2/5/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7550 ALTURA PL	None	OAKLAND	CA	94605	3108	01	06001	37.77604948	-122.1575596	Alameda County
100849	Fee-for-Service	1114292976	1114292976	1	1	BUCKOWSKI, AMY MD	12/12/2018	207P00000X	NA	Other	026	PHYSICIANS	144971	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
100873	Fee-for-Service	1497719892	1497719892	1	1	BABIKIAN, GREGORY P MD	9/5/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79610	41	Internal Medicine	0	In state provider	None	535 ENCINITAS BLVD	STE 102	ENCINITAS	CA	92024	3742	37	06073	33.04694241	-117.2801797	San Diego County
100875	Fee-for-Service	1043322944	1043322944	1	1	BIO MEDICAL APPLICATIONS	3/1/1989	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF LOS GATOS INC	14651 S BASCOM AVE	STE 100	LOS GATOS	CA	95032	2014	43	06085	37.25556684	-121.9504578	Santa Clara County
100922	Fee-for-Service	1821159310	1821159310	1	1	BIRNBAUMER, DIANE M MD	2/28/1988	207P00000X	NA	Other	026	PHYSICIANS	57338	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
100954	Fee-for-Service	1861091712	1861091712	1	1	BRIGHT STAR HOSPICE CARE	4/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10817 SANTA MONICA BLVD	STE 100	LOS ANGELES	CA	90025	4690	19	06037	34.05031409	-118.4356182	Los Angeles County
100969	Fee-for-Service	1154448256	1154448256	1	1	BARTOLI, ADRIAN G	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	61455	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
101004	Fee-for-Service	1457313413	1457313413	1	1	BRULL, JAMES DO	4/29/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	8903	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
101031	Fee-for-Service	1255549184	1255549184	1	1	BOGHAIRI, ANOUSH MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33832	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 115	LA MESA	CA	91942	3021	37	06073	32.77978322	-117.0094766	San Diego County
101046	Fee-for-Service	1063465219	1063465219	1	1	BAKER, LORI L MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	62517	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
101048	Fee-for-Service	1093337784	1093337784	1	1	BRIGHT SOURCE HOSPICE LLC	3/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22024 LASSEN ST	OFC 113	CHATSWORTH	CA	91311	3600	19	06037	34.2499425	-118.6069365	Los Angeles County
101095	Fee-for-Service	1821149667	1821149667	1	1	BENEDICT, HUGH M MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96911	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
101097	Fee-for-Service	1013943414	1013943414	1	1	BLAKE SMITH	12/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE EMERGENCY GROUP	1301 PUNCHBOWL STREET	None	HONOLULU	HI	96813	0000	00	None	21.30800017	-157.8550765	Honolulu County
101100	Fee-for-Service	1861577967	1861577967	1	1	BENNETT, CATHERINE V LMFT	8/20/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5480 BALTIMORE DR	STE 201	LA MESA	CA	91942	2068	37	06073	32.77981091	-117.0323467	San Diego County
101114	Fee-for-Service	1750342465	1750342465	1	1	BONZANI, MATTHEW R MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87852	01	General Practice	0	In state provider	None	1800 NORTH CALIFORNIA	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
101127	Fee-for-Service	1770737017	1770737017	1	1	BEZRUKOV, NIKITA MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111624	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
101148	Fee-for-Service	1770200529	1770200529	1	1	BERDAHL, JAMES A CRNA	1/1/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
101241	Fee-for-Service	1861091712	1861091712	1	1	BRIGHT STAR HOSPICE CARE	4/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10817 SANTA MONICA BLVD	STE 100	LOS ANGELES	CA	90025	4690	19	06037	34.05031409	-118.4356182	Los Angeles County
101243	Fee-for-Service	1497843940	1497843940	1	1	BAPTIST HEALTHSYSTEM INC	7/4/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3400 HIGHWAY 78 E	None	JASPER	AL	35501	8907	00	None	33.84107187	-87.23654673	Walker County
101267	Fee-for-Service	1437886215	1437886215	1	1	BAKER, LORI A	9/1/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
101272	Fee-for-Service	1962411272	1962411272	1	1	BYRNE, MARK G MD	1/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74388	41	Internal Medicine	0	In state provider	None	30 BRENNAN ST	None	WATSONVILLE	CA	95076	4303	44	06087	36.91346025	-121.7577455	Santa Cruz County
101288	Fee-for-Service	1295979144	1295979144	1	1	BILHARTZ, PATTY M MD	2/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123970	25	Physical Medicine and Rehabilitation	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
101294	Fee-for-Service	1639503824	1639503824	1	1	BRYANT, LAURA M CRNA	6/27/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
101316	Fee-for-Service	1629054630	1629054630	1	1	BARRERA, JOSEPH E MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64643	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
101319	Fee-for-Service	1265592539	1265592539	1	1	BUI, MINH Q MD APC	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35218	08	Family Practice	0	In state provider	None	631 COOPER RD	None	OXNARD	CA	93030	5427	56	06111	34.20454837	-119.1719737	Ventura County
101336	Fee-for-Service	1093337784	1093337784	1	1	BRIGHT SOURCE HOSPICE LLC	3/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22024 LASSEN ST	OFC 113	CHATSWORTH	CA	91311	3600	19	06037	34.2499425	-118.6069365	Los Angeles County
101350	Fee-for-Service	1316930225	1316930225	1	1	BROWNE, DEBRA K NP	4/18/2017	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
101480	Fee-for-Service	1235107947	1235107947	1	1	BURTON, HAROLD G MD	1/15/1989	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	35484	01	General Practice	0	In state provider	None	729 SUNRISE AVE	STE 603	ROSEVILLE	CA	95661	4542	31	06061	38.73444822	-121.2720033	Placer County
101481	Fee-for-Service	1144848748	1144848748	1	1	BUCHBINDER, AARON G	10/19/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	91695	-	NOT APPLICABLE	0	In state provider	None	1563 MISSION ST	1ST & 3RD FL	SAN FRANCISCO	CA	94103	2543	38	06075	37.77327874	-122.4183559	San Francisco County
101487	Fee-for-Service	1881875896	1881875896	1	1	BRIGHT, STEVEN D MD	6/13/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
101490	Fee-for-Service	1174614754	1174614754	1	1	BENITZ, WILLIAM E MD	1/1/1982	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	39571	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
101512	Fee-for-Service	1801873575	1801873575	1	2	BRASCH, ANDREW J MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	42540	13	Neurology (M.D. only)	0	In state provider	None	2721 OLIVE HWY	STE 7	OROVILLE	CA	95966	6115	04	06007	39.50452062	-121.5420592	Butte County
101516	Fee-for-Service	1952765026	1952765026	1	1	BUKIRI, HEATHER E MD	4/26/2021	207RR0500X	NA	Other	026	PHYSICIANS	162780	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
101530	Fee-for-Service	1497843940	1497843940	1	1	BAPTIST HEALTHSYSTEM INC	7/4/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3400 HIGHWAY 78 E	None	JASPER	AL	35501	8907	00	None	33.84107187	-87.23654673	Walker County
101550	Fee-for-Service	1467771402	1467771402	1	1	BERNARD, NEERALI S DO	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13208	13	Neurology (M.D. only)	0	In state provider	None	2030 SUTTER PLACE	SUITE 1000	DAVIS	CA	95616	6215	57	06113	38.56292466	-121.7715423	Yolo County
101561	Fee-for-Service	1962411272	1962411272	1	1	BYRNE, MARK G MD	1/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74388	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	30 BRENNAN ST	None	WATSONVILLE	CA	95076	4303	44	06087	36.91346025	-121.7577455	Santa Cruz County
101581	Fee-for-Service	1649245226	1649245226	1	1	BORDIN, GERALD M MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	29450	70	Clinic (mixed specialty)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
101582	Fee-for-Service	1376267971	1376267971	1	1	BRAGASIN, MARINA M NP	2/10/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43944 15TH ST	201	LANCASTER	CA	93534	5207	19	06037	34.681626	-118.1566845	Los Angeles County
101602	Fee-for-Service	1629054630	1629054630	1	1	BARRERA, JOSEPH E MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64643	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
101632	Fee-for-Service	1801391990	1801391990	1	1	BOWMAN, MAX S MD	8/16/2024	208800000X	NA	Other	026	PHYSICIANS	163544	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
101634	Fee-for-Service	1780214403	1780214403	1	1	BATES, GARY A	2/13/2020	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	120 INDEPENDENCE CIR	None	CHICO	CA	95973	4925	04	06007	39.77238185	-121.8739834	Butte County
101649	Fee-for-Service	1750469409	1750469409	1	1	BELKO, JOHN MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86967	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
101678	Fee-for-Service	1740919398	1740919398	1	1	BUI, MICHAEL NP	1/17/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23961 CALLE DE LA MAGDAL	500	LAGUNA HILLS	CA	92653	7622	30	06059	33.60999658	-117.7126577	Orange County
101696	Fee-for-Service	1154930667	1154930667	1	1	BUSTAMANTE, JENNIFER M NP	10/12/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
101737	Fee-for-Service	1285966283	1285966283	1	1	BENNETT, JON DO INC	2/18/2010	207L00000X	NA	Other	026	PHYSICIANS	7453	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
101739	Fee-for-Service	1295756336	1295756336	2	1	BAI, HUA	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	026	PHYSICIANS	94357	40	Pediatrics	0	In state provider	None	15944 LOS SERRANOS COUNT	STE 160	CHINO HILLS	CA	91709	3990	36	06071	33.9635227	-117.695881	San Bernardino County
101740	Fee-for-Service	1477530715	1477530715	1	1	BETONI, JAMES S DO	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14306	None	None	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
101770	Fee-for-Service	1235107947	1235107947	1	1	BURTON, HAROLD G MD	1/15/1989	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	35484	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	729 SUNRISE AVE	STE 603	ROSEVILLE	CA	95661	4542	31	06061	38.73444822	-121.2720033	Placer County
101817	Fee-for-Service	1174103501	1174103501	1	1	BERA, KEVIN R MD	1/2/2025	207R00000X	NA	Other	026	PHYSICIANS	184951	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
101821	Fee-for-Service	1225532633	1225532633	1	1	BAINIWAL, JASSIMRAN S MD	7/26/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	164352	70	Clinic (mixed specialty)	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
101828	Fee-for-Service	1104908623	1104908623	2	1	BELL, GARY R OD	4/28/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	807 W GRAND BLVD	SUITE A	CORONA	CA	92882	3272	33	06065	33.87379603	-117.5737828	Riverside County
101834	Fee-for-Service	1396204608	1396204608	1	1	BARRY, ROBERT H MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	177458	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
101837	Fee-for-Service	1235101122	1235101122	1	1	BECK, DAVID J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	53625	08	Family Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
101849	Fee-for-Service	1336584325	1336584325	1	1	BRERETON, SREYAH S DO	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13611	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
101852	Fee-for-Service	1780094755	1780094755	1	1	BONENFANT, JEFFREY DO	12/3/2021	207RC0200X	NA	Other	026	PHYSICIANS	14615	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
101855	Fee-for-Service	1861787236	1861787236	1	1	BRILL, SARAH A DO	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13935	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
101861	Fee-for-Service	1649272808	1649272808	1	1	BLAKE,KATHELEEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	504 ELM STREET NE	None	ALBUQUERQUE	NM	87102	2512	00	None	35.08789405	-106.6375843	Bernalillo County
101864	Fee-for-Service	1437275286	1437275286	1	1	BUCKMAN, CATHERINE A	4/12/2017	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
101869	Fee-for-Service	1396862504	1396862504	1	1	BIVONA, CANDACE A PHD	9/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8033 VENTURA CANYON AVE	None	PANORAMA CITY	CA	91402	6312	19	06037	34.21667196	-118.4288005	Los Angeles County
101882	Fee-for-Service	1477626984	1477626984	1	1	BARRON, ROBERT H JR MD	10/15/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46582	08	Family Practice	0	In state provider	None	2095 W VISTA WAY	STE 106	VISTA	CA	92083	6028	37	06073	33.18438885	-117.2876725	San Diego County
101916	Fee-for-Service	1295063527	1295063527	1	1	BLAINE J ALLEN NP	11/14/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
101933	Fee-for-Service	1609024397	1609024397	1	1	BYRAM HEALTHCARE CENTERS INC	12/29/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	BYRAM HEALTHCARE	15110 NE 95TH ST	#101	REMOND	WA	98052	2516	00	None	47.68588352	-122.139153	King County
101984	Fee-for-Service	1902840937	1902840937	1	1	BARTON, ERIK D MD	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	77820	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
101996	Fee-for-Service	1952706830	1952706830	1	1	BILSKY, SHARON LCSW	2/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
101998	Fee-for-Service	1477507416	1477507416	1	1	BHATIA, SAMEER MD	1/22/2022	2085R0204X	NA	Other	026	PHYSICIANS	53510	None	None	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
102021	Fee-for-Service	1275165102	1275165102	1	1	BOROOAH, SHYAMANGA R MD	6/16/2020	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
102036	Fee-for-Service	1518939354	1518939354	1	1	BANUELOS, LYDIA R MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65937	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
102059	Fee-for-Service	1245790344	1245790344	1	1	BRAH, HARNEEL S MD	3/13/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
102075	Fee-for-Service	1841216306	1841216306	1	1	BONE, SAMUEL	3/22/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
102096	Fee-for-Service	1770543373	1770543373	1	1	BOCCHICCHIO, MARK C MD	9/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63687	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
102108	Fee-for-Service	1225532633	1225532633	1	1	BAINIWAL, JASSIMRAN S MD	7/26/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	164352	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
102122	Fee-for-Service	1164938742	1164938742	1	1	BEACH, KATHRYN L OT	5/25/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3009 STRATOFORTRESS AVE	B	ATWATER	CA	95301	5170	24	06047	37.36164294	-120.5703841	Merced County
102140	Fee-for-Service	1477531291	1477531291	1	1	BAUGHN,MELANIE R DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT ER PHYSICIANS	3033 S PARKER RD STE 800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
102143	Fee-for-Service	1861020711	1861020711	1	1	BADRI, NADER W MD	7/25/2023	207P00000X	NA	Other	026	PHYSICIANS	176946	None	None	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
102145	Fee-for-Service	1861439267	1861439267	1	1	BASTIAN, CAROL E MD	10/30/1990	207P00000X	NA	Other	026	PHYSICIANS	72298	None	None	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
102156	Fee-for-Service	1891476958	1891476958	1	1	BECERRA, AZUCENA	4/16/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
102187	Fee-for-Service	1760573638	1760573638	1	1	BUCHMANN,ROBERT F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 MARSHALL STREET	STE#653	LITTLE ROCK	AR	72202	0000	00	None	34.74346583	-92.29154425	Pulaski County
102204	Fee-for-Service	1295001493	1295001493	1	1	BAGHERPOUR, REZA MD	10/22/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	156323	25	Physical Medicine and Rehabilitation	0	In state provider	None	70077 RAMON RD	SUITE 1	RANCHO MIRAGE	CA	92270	5201	33	06065	33.81587854	-116.4396933	Riverside County
102208	Fee-for-Service	1356785356	1356785356	1	1	BREAUX, BARRY E JR MD	9/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145209	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102222	Fee-for-Service	1932233954	1932233954	1	1	BANAITIS, DANIEL J LMFT	7/22/2022	103K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11620 WILSHIRE BLVD	900	LOS ANGELES	CA	90025	7140	19	06037	34.05024415	-118.4598908	Los Angeles County
102224	Fee-for-Service	1073853073	1073853073	1	1	BANKSTON, CRISSY A PHD	7/9/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
102228	Fee-for-Service	1972529816	1972529816	1	1	BLANKMAN, STEVEN M PHD	3/15/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21 11TH STREET	None	ARCATA	CA	95521	5902	12	06023	40.86885918	-124.0781549	Humboldt County
102250	Fee-for-Service	1275746455	1275746455	1	1	BRACAMONTES-WOOLLEY,	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103276	01	General Practice	0	In state provider	ERIKA MD	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
102262	Fee-for-Service	1336195122	1336195122	1	1	BALDWIN, DANIEL G MD	5/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
102265	Fee-for-Service	1255456752	1255456752	1	1	BANTOLO, NOVO F	10/12/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
102297	Fee-for-Service	1871025742	1871025742	1	1	BAJKOWSKI, REBECCA A MD	2/9/2021	207P00000X	NA	Other	026	PHYSICIANS	169605	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
102298	Fee-for-Service	1982781159	1982781159	1	9	BAART COMMUNITY HEALTHCARE	2/4/2009	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	E STREET CLINIC	1235 E STREET	None	FRESNO	CA	93706	2024	10	06019	36.73272329	-119.7993386	Fresno County
102309	Fee-for-Service	1558479352	1558479352	1	1	BRADLEY, KENNETH S MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	82005	None	None	0	In state provider	None	2888 EUREKA WAY	STE 200	REDDING	CA	96001	0210	45	06089	40.58556034	-122.4159705	Shasta County
102316	Fee-for-Service	1164918819	1164918819	1	1	BRUNTON, ALYSSA V LMFT	7/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3625 E THOUSAND OAKS BLV	106	WESTLAKE VILLAGE	CA	91362	3551	19	06037	34.16480359	-118.8299997	Ventura County
102350	Fee-for-Service	1962457812	1962457812	1	18	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	11441 HEACOCK ST	#E	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
102363	Fee-for-Service	1255490819	1255490819	1	1	BORREGO COMM HLTH FNDTN	3/20/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO OASIS	88775 AVE 76	STE 1	THERMAL	CA	92274	9681	33	06065	33.49887952	-116.115372	Riverside County
102390	Fee-for-Service	1619386042	1619386042	1	1	BAKERSFIELD PEDIATRICS	11/2/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL GROUP	300 OLD RIVER ROAD	SUITE 105	BAKERSFIELD	CA	93311	9503	15	06029	35.352648	-119.1122505	Kern County
102402	Fee-for-Service	1871904656	1871904656	1	2	BARSTOW PRIMARY CARE CLINIC	1/5/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	15065 VISTA RD	UNIT 7, BUILDING B	HELENDALE	CA	92342	7717	36	06071	34.74457244	-117.3354533	San Bernardino County
102408	Fee-for-Service	1295153799	1295153799	1	1	BLUHM, DAVID C MD	3/4/2023	207L00000X	NA	Other	026	PHYSICIANS	144882	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
102430	Fee-for-Service	1801988977	1801988977	1	1	BORIS, LILY H MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62064	41	Internal Medicine	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
102443	Fee-for-Service	1588656151	1588656151	1	1	BOECK, CARL A OD	9/15/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9621 MISSION GORGE RD	STE 105A	SANTEE	CA	92071	3802	37	06073	32.83859252	-116.988093	San Diego County
102480	Fee-for-Service	1851315774	1851315774	1	1	BARCHUK, ALEX MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	42890	25	Physical Medicine and Rehabilitation	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
102511	Fee-for-Service	1114362175	1114362175	1	1	BLACKSHEAR, CHARLES P MD	4/24/2020	261QU0200X	NA	Other	026	PHYSICIANS	145515	39	Preventive (M.D. only)	0	In state provider	None	13939 14TH	STE 200	SAN LEANDRO	CA	94578	2601	01	06001	37.71377536	-122.1407447	Alameda County
102524	Fee-for-Service	1053421719	1053421719	1	1	BEL AIR PHARMACY #521	6/21/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1286 STABLER LN	None	YUBA CITY	CA	95993	2620	51	06101	39.14758273	-121.6456663	Sutter County
102573	Fee-for-Service	1003339581	1003339581	2	1	BEST RX PHARMACY SERVICES LL	3/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	308 W 6TH ST	107	CORONA	CA	92882	3349	33	06065	33.874497	-117.569682	Riverside County
102576	Fee-for-Service	1952805582	1952805582	1	1	BALTONADO, JULET O DO	12/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17798	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
102598	Fee-for-Service	1316485402	1316485402	1	1	BURNS, AIMEE L LCSW	5/15/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
102603	Fee-for-Service	1023301991	1023301991	1	1	BARMAN, PRANAB M MD	10/8/2019	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	162554	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
102620	Fee-for-Service	1750674503	1750674503	1	1	BROOKS, ALICIA S CRNA	6/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
102621	Fee-for-Service	1619173291	1619173291	1	1	BOURELLE, JANINE NP	6/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1801 16TH ST A	None	BAKERSFIELD	CA	93301	5002	15	06029	35.37230451	-119.0228175	Kern County
102638	Fee-for-Service	1962457812	1962457812	1	160	BEVERLY RADIOLOGY MEDICAL GR	2/11/2025	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4553 GLENCOE AVE	SUITE 120	MARINA DEL REY	CA	90292	7906	19	06037	33.98427168	-118.4328564	Los Angeles County
102650	Fee-for-Service	1255490819	1255490819	1	1	BORREGO COMM HLTH FNDTN	5/22/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO OASIS	88775 AVE 76	STE 1	THERMAL	CA	92274	9681	33	06065	33.49887952	-116.115372	Riverside County
102654	Fee-for-Service	1639673478	1639673478	1	1	BUI, AILEEN MD	4/9/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	165723	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102667	Fee-for-Service	1932268547	1932268547	1	1	BURDEN, LAWRENCE R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31614	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
102691	Fee-for-Service	1871904656	1871904656	1	2	BARSTOW PRIMARY CARE CLINIC	1/5/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15065 VISTA RD	UNIT 7, BUILDING B	HELENDALE	CA	92342	7717	36	06071	34.74457244	-117.3354533	San Bernardino County
102743	Fee-for-Service	1053425207	1053425207	1	1	BRUMMER, CRAIG S MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108672	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
102747	Fee-for-Service	1316932965	1316932965	1	1	BUADU, ERIC O MD	10/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76164	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
102754	Fee-for-Service	1356889596	1356889596	1	1	BRASSETT, KIMBERLY LMFT	8/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23832 ROCKFIELD BLVD	STE 120	LAKE FOREST	CA	92630	2805	30	06059	33.6263651	-117.7142932	Orange County
102779	Fee-for-Service	1033641659	1033641659	1	1	BHARGAVA, GAURAV MD	8/8/2022	207P00000X	NA	Other	026	PHYSICIANS	176298	None	None	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3482	19	06037	34.04810648	-118.0424794	Los Angeles County
102793	Fee-for-Service	1851321715	1851321715	1	1	BINMOELLER, KENNETH F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49767	10	Gastroenterology (M.D. only)	0	In state provider	None	2333 BUCHANAN ST	FL 5	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
102817	Fee-for-Service	1033565544	1033565544	1	1	BRERETON, PHILIP J CO	7/28/2016	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1707 MCHENRY AVENUE	BUILDING B	MODESTO	CA	95350	4352	50	06099	37.669248	-120.9940175	Stanislaus County
102829	Fee-for-Service	1770757528	1770757528	1	1	BANERJI, ANAMIKA I MD	6/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135671	40	Pediatrics	0	In state provider	None	25845 BARTON RD	SUITE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
102877	Fee-for-Service	1861478281	1861478281	1	1	BARASH, ACE A MD	6/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42757	41	Internal Medicine	0	In state provider	None	115 HOSPITAL DRIVE	None	UKIAH	CA	95482	4591	23	06045	39.15095011	-123.2032368	Mendocino County
102909	Fee-for-Service	1740412972	1740412972	1	1	BENNETT, ANNE MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123419	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
102923	Fee-for-Service	1942218474	1942218474	1	1	BELSHAW, NANCEE LMFT	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11600 WASHINGTON PL	STE 110	LOS ANGELES	CA	90066	5000	19	06037	34.00465708	-118.4208535	Los Angeles County
102926	Fee-for-Service	1356771430	1356771430	1	1	BRINKLEY, SHAWN L LMFT	10/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2676	19	06037	34.17245599	-118.5633517	Los Angeles County
102928	Fee-for-Service	1376047456	1376047456	1	1	BULLARD VOLTARELLI, LISA MD	3/13/2024	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	183742	None	None	0	In state provider	None	1001 POTRERO AVE RM 5H22	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
102935	Fee-for-Service	1912948472	1912948472	1	1	BRONSTON, PAUL MD	2/28/1986	207P00000X	NA	Other	026	PHYSICIANS	41120	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
102940	Fee-for-Service	1255490819	1255490819	1	1	BORREGO COMM HLTH FNDTN	3/28/2008	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO OASIS	88775 AVE 76	STE 1	THERMAL	CA	92274	9681	33	06065	33.49887952	-116.115372	Riverside County
102941	Fee-for-Service	1639673478	1639673478	1	1	BUI, AILEEN MD	4/9/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	165723	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102969	Fee-for-Service	1710155916	1710155916	1	1	BUCKLEY, WILLIAM J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ROANOKE AVE	None	RIVERHEAD	NY	11901	2031	00	None	40.934223	-72.673587	Suffolk County
102979	Fee-for-Service	1871904656	1871904656	1	2	BARSTOW PRIMARY CARE CLINIC	1/5/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15065 VISTA RD	UNIT 7, BUILDING B	HELENDALE	CA	92342	7717	36	06071	34.74457244	-117.3354533	San Bernardino County
102990	Fee-for-Service	1497011308	1497011308	1	1	BENJAMIN D CHUNG MD INC	4/11/2013	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4244 RIVERWALK PKWY	SUITE 210	RIVERSIDE	CA	92505	3372	33	06065	33.90336622	-117.49394	Riverside County
103009	Fee-for-Service	1982781159	1982781159	1	1	BAART COMMUNITY HEALTHCARE	6/19/2008	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	433 TURK ST	None	SAN FRANCISCO	CA	94102	3329	38	06075	37.78247225	-122.4163506	San Francisco County
103017	Fee-for-Service	1518132844	1518132844	1	1	BRIGHT EXPECTATIONS, INC	12/4/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1970 LONGMONT ST	None	RIVERSIDE	CA	92506	3542	33	06065	33.9461456	-117.3512675	Riverside County
103019	Fee-for-Service	1063701324	1063701324	1	1	BAHMANPOUR, KAMYAR MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132460	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
103033	Fee-for-Service	1780889972	1780889972	1	1	BANK, ANNE LMFT	1/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
103072	Fee-for-Service	1932277217	1932277217	1	1	BAKER, TAMMIE M RN	2/1/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
103080	Fee-for-Service	1851321715	1851321715	1	1	BINMOELLER, KENNETH F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49767	01	General Practice	0	In state provider	None	2333 BUCHANAN ST	FL 5	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
103084	Fee-for-Service	1356453153	1356453153	1	1	BIO MEDICAL APPLICATIONS	6/26/2000	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	2020 E 1ST ST	STE 110	SANTA ANA	CA	92705	4029	30	06059	33.74487	-117.8371195	Orange County
103128	Fee-for-Service	1184122673	1184122673	1	1	BARBA JR, FERNANDO LCSW	10/25/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
103153	Fee-for-Service	1215915707	1215915707	1	1	BURCH, MIGUEL A MD	3/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87397	02	General Surgery	0	In state provider	None	200 NORTH ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
103155	Fee-for-Service	1841285277	1841285277	1	1	BHATTI, LAVEEZA MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54090	41	Internal Medicine	0	In state provider	None	1414 S GRAND AVE	None	LOS ANGELES	CA	90015	3067	19	06037	34.03661142	-118.2657227	Los Angeles County
103197	Fee-for-Service	1831276690	1831276690	1	1	BOWMAN, WILLIAM E JR MD	6/6/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	34592	20	Orthopedic Surgery	0	In state provider	None	8008 FROST ST	STE 300	SAN DIEGO	CA	92123	2776	37	06073	32.80027859	-117.1524832	San Diego County
103199	Fee-for-Service	1164652269	1164652269	1	1	BASHIR, DALIA A MD	6/1/2020	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
103200	Fee-for-Service	1578973798	1578973798	1	1	BABOUJIAN, SHANT R LAC	5/17/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	411 N CENTRAL AVE	SUITE 350	GLENDALE	CA	91203	2081	19	06037	34.15248444	-118.2579448	Los Angeles County
103226	Fee-for-Service	1255490819	1255490819	1	1	BORREGO COMM HLTH FNDTN	3/20/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO OASIS	88775 AVE 76	STE 1	THERMAL	CA	92274	9681	33	06065	33.49887952	-116.115372	Riverside County
103230	Fee-for-Service	1508065749	1508065749	1	1	BHARTIA, SANJAY M MD	5/26/2020	207R00000X	NA	Other	026	PHYSICIANS	115634	41	Internal Medicine	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
103266	Fee-for-Service	1871904656	1871904656	1	2	BARSTOW PRIMARY CARE CLINIC	2/9/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	15065 VISTA RD	UNIT 7, BUILDING B	HELENDALE	CA	92342	7717	36	06071	34.74457244	-117.3354533	San Bernardino County
103276	Fee-for-Service	1053516625	1053516625	1	1	BOVE, RILEY M MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138800	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
103294	Fee-for-Service	1992224836	1992224836	1	1	BARRINGTON, ELIZABETH P MD	6/8/2023	2080P0006X	NA	Psychiatry	026	PHYSICIANS	168514	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
103296	Fee-for-Service	1134116775	1134116775	1	1	BRUCE OLIN	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	33 9TH ST W	None	DICKINSON	ND	58601	3950	00	None	46.88874767	-102.7851034	Stark County
103297	Fee-for-Service	1326578527	1326578527	1	1	BINETTI, PATRICK J MD	8/19/2022	207L00000X	NA	Other	026	PHYSICIANS	173975	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
103302	Fee-for-Service	1871851923	1871851923	1	1	BEDROOD, SAHAR MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124192	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
103306	Fee-for-Service	1063701324	1063701324	1	1	BAHMANPOUR, KAMYAR MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132460	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
103310	Fee-for-Service	1073652327	1073652327	1	1	BLOOM-GENEVITZ, JACQUELINE L	3/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	12340 SANTA MONICA BLVD	214	LOS ANGELES	CA	90025	7522	19	06037	34.03928164	-118.4661237	Los Angeles County
103348	Fee-for-Service	1639399280	1639399280	1	1	BOSTANJIAN, DAVID MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97613	08	Family Practice	0	In state provider	None	5250 SANTA MONICA BLVD	STE 310	LOS ANGELES	CA	90029	1255	19	06037	34.09077051	-118.3046976	Los Angeles County
103364	Fee-for-Service	1124097431	1124097431	1	1	BRUNER, DAWN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42631	40	Pediatrics	0	In state provider	None	1401 N TUSTIN AVE	STE 360	SANTA ANA	CA	92705	8684	30	06059	33.757254	-117.8341425	Orange County
103406	Fee-for-Service	1770044505	1770044505	1	1	BIALOS, AUDREY K DO	12/12/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19592	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
103408	Fee-for-Service	1679271399	1679271399	1	1	BOGNER, RACHEL LCSW	5/31/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
103420	Fee-for-Service	1447873070	1447873070	1	1	BROWN-AIJALA, LAILA M OD	6/2/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	82227 US HWY 111	STE B2	INDIO	CA	92201	5668	33	06065	33.71471443	-116.2312195	Riverside County
103426	Fee-for-Service	1710567896	1710567896	1	1	BANKS, SARAH C PT	12/20/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	291 MAIN ST.	D, E	LOS GATOS	CA	95030	6137	43	06085	37.22109751	-121.9747502	Santa Clara County
103471	Fee-for-Service	1508123118	1508123118	1	1	BALLATORE-WEINFELD, MELANIE	7/24/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
103512	Fee-for-Service	1750986808	1750986808	1	1	BRADLEY, MARCAS LPCC	9/1/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
103539	Fee-for-Service	1609950153	1609950153	1	1	BRAND, LILAH R PT	7/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
103567	Fee-for-Service	1891875472	1891875472	1	1	BHOWN, NIVEDITA MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56156	05	Anesthesiology	0	In state provider	ANESTHESIOLOGIST INC	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
103568	Fee-for-Service	1265938724	1265938724	1	1	BECERRA SONGOLO, TOSHA D MD	6/29/2022	207L00000X	NA	Other	026	PHYSICIANS	165875	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103576	Fee-for-Service	1972798791	1972798791	1	1	BORGHEI, PEYMAN MD	4/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125731	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
103577	Fee-for-Service	1073579736	1073579736	1	1	BEHFOROUZ, HEIDI L MD	10/16/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	137537	-	NOT APPLICABLE	0	In state provider	None	12021 WILMINGTON AVE	STE 1003	LOS ANGELES	CA	90059	3019	19	06037	33.922863	-118.2431655	Los Angeles County
103580	Fee-for-Service	1326380221	1326380221	1	1	BASKIND, HEATHER A MD	1/11/2019	207R00000X	NA	Other	026	PHYSICIANS	155159	41	Internal Medicine	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
103595	Fee-for-Service	1043368947	1043368947	1	1	BROOKS, KELLIE J NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2075 PALOS VERDES DR N	None	LOMITA	CA	90717	3724	19	06037	33.77602431	-118.3163591	Los Angeles County
103619	Fee-for-Service	1255794814	1255794814	1	1	BONSMITH, KATHLEEN D MD	9/13/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174817	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
103643	Fee-for-Service	1093057648	1093057648	1	1	BAMGBOSE, OLUSINMI M MD	10/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132059	36	Psychiatry	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
103658	Fee-for-Service	1861856684	1861856684	1	1	BEAUVAIS, JOSEF R	9/20/2019	207P00000X	NA	Other	026	PHYSICIANS	161791	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2594	48	06095	38.13070051	-122.237307	Solano County
103661	Fee-for-Service	1861443228	1861443228	1	1	BHAT, ADARSH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69494	41	Internal Medicine	0	In state provider	None	151 N SUNRISE AVE	STE 613	ROSEVILLE	CA	95661	2926	31	06061	38.74746043	-121.2655348	Placer County
103681	Fee-for-Service	1124156591	1124156591	1	1	BENITEZ, CHRISTOPHER T	12/5/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	88540	36	Psychiatry	0	In state provider	MD	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
103704	Fee-for-Service	1013097401	1013097401	1	1	BARNES, JOHN E MD	11/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	22446	13	Neurology (M.D. only)	0	In state provider	None	105 SOUTH DR	STE C	MOUNTAIN VIEW	CA	94040	4311	43	06085	37.36723851	-122.0782528	Santa Clara County
103743	Fee-for-Service	1730267527	1730267527	1	1	BRENEMAN, ERICA V MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79287	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
103766	Fee-for-Service	1669671814	1669671814	1	1	BENJAMIN WILL DARBRO	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
103781	Fee-for-Service	1538585120	1538585120	1	1	BAGWELL, MELISSA PSYD	10/11/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
103790	Fee-for-Service	1841367737	1841367737	1	1	BERNSTEIN, PAUL E MD	1/1/1982	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	32497	04	Otology, Laryngology, Rhinology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
103835	Fee-for-Service	1790889863	1790889863	1	1	BRANDON, ANTONIUS D PHD	9/13/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
103851	Fee-for-Service	1972118974	1972118974	1	1	BRIGHTER FUTURE PSYCHOLOGICA	1/26/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	L SERVICES INC.	15456 VENTURA BLVD STE 5	None	SHERMAN OAKS	CA	91403	3023	19	06037	34.15453193	-118.4706426	Los Angeles County
103859	Fee-for-Service	1447594965	1447594965	1	1	BAILEY, ALANA A NP	6/30/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
103890	Fee-for-Service	1699780494	1699780494	1	1	BHAGYA, NAKKA MD	9/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96356	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
103895	Fee-for-Service	1194037325	1194037325	1	1	BRAR, SUKHJIT S MD	10/26/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	123032	-	NOT APPLICABLE	0	In state provider	None	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	10	06019	36.777735	-119.7815105	Fresno County
103901	Fee-for-Service	1568458438	1568458438	1	1	BANERJEE, BHASKAR MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
103917	Fee-for-Service	1619601341	1619601341	1	1	BAL, SAMEERA K NP	3/15/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4821 PANAMA LN	STE A-C	BAKERSFIELD	CA	93313	3480	15	06029	35.29587848	-119.056005	Kern County
103920	Fee-for-Service	1649618851	1649618851	1	1	BABAIDORABAD, NASIM MD	9/29/2020	207ZP0102X	NA	Other	026	PHYSICIANS	139214	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	0000	19	06037	34.10243051	-118.105902	Los Angeles County
103929	Fee-for-Service	1114190782	1114190782	1	1	BARAKAT, OMAR MD	4/11/2025	2085R0204X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
103936	Fee-for-Service	1700923893	1700923893	1	1	BHANSALI, NEHA H MD	6/25/2012	207R00000X	NA	Other	026	PHYSICIANS	96139	41	Internal Medicine	0	In state provider	None	3300 E SOUTH ST	STE 209	LONG BEACH	CA	90805	4592	19	06037	33.86018093	-118.1537163	Los Angeles County
103948	Fee-for-Service	1861026163	1861026163	1	1	BRIDGING CONNECTIONS FAMILY	3/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING	419 ELIZABETH ST	SUITE 4	VACAVILLE	CA	95688	4602	48	06095	38.35435832	-121.9875168	Solano County
103950	Fee-for-Service	1861443228	1861443228	1	1	BHAT, ADARSH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69494	45	Nephrology (Renal-Kidney)	0	In state provider	None	151 N SUNRISE AVE	STE 613	ROSEVILLE	CA	95661	2926	31	06061	38.74746043	-121.2655348	Placer County
103962	Fee-for-Service	1528463908	1528463908	1	1	BLYTH, MICHAEL J MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	58537	40	Pediatrics	0	In state provider	None	300 OLD RIVER RD	STE 105	BAKERSFIELD	CA	93311	9506	15	06029	35.352648	-119.1122505	Kern County
103964	Fee-for-Service	1053729954	1053729954	1	1	BROWN, HARVEY V MD INC	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	24071	41	Internal Medicine	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
103966	Fee-for-Service	1508944158	1508944158	1	1	BAISCH, EUGENE MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60848	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
103968	Fee-for-Service	1962478750	1962478750	1	1	BYLUND, DAVID J MD	3/30/1988	207ZP0102X	NA	Other	026	PHYSICIANS	52225	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
103971	Fee-for-Service	1053488981	1053488981	1	1	BOIKO, SUSAN MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	41069	07	Dermatology	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
104051	Fee-for-Service	1669080834	1669080834	1	1	BRATTEBO, AMANDA	11/8/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
104059	Fee-for-Service	1083727093	1083727093	1	1	BERNARDO HEIGHTS HEALTHCARE	3/1/2006	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11895 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99056515	-117.0752322	San Diego County
104066	Fee-for-Service	1962457812	1962457812	1	94	BEVERLY RADIOLOGY MEDICAL GR	6/8/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	1821 W OLIVE AVE	None	BURBANK	CA	91506	2435	19	06037	34.16612296	-118.3243711	Los Angeles County
104074	Fee-for-Service	1821054644	1821054644	1	1	BEBENSEE, ANN E MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87106	13	Neurology (M.D. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
104080	Fee-for-Service	1902292055	1902292055	1	1	BHATIA, BHAVNIT MD	12/30/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	162335	07	Dermatology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
104121	Fee-for-Service	1932230505	1932230505	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	2180 WEST VALLEY BLVD	OUTPT OFFICE, MTG ROOM	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
104228	Fee-for-Service	1487072559	1487072559	1	1	BADER, BASSAM MD	7/14/2021	208M00000X	NA	Other	026	PHYSICIANS	170093	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
104229	Fee-for-Service	1093777864	1093777864	1	1	BLACKBURN, JOHN D OD	6/1/2000	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7409 N CEDAR AVE	# 103	FRESNO	CA	93720	3836	10	06019	36.84340721	-119.756868	Fresno County
104234	Fee-for-Service	1326373465	1326373465	1	1	BUCKLAND, DANIELLE R LCSW	12/14/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	72498	-	NOT APPLICABLE	0	In state provider	None	845 E ARROW HIGHWAY	None	POMONA	CA	91767	2535	19	06037	34.09032048	-117.734769	Los Angeles County
104241	Fee-for-Service	1437687837	1437687837	1	1	BAE, CLAUDINE C NP	12/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
104251	Fee-for-Service	1053729954	1053729954	1	1	BROWN, HARVEY V MD INC	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	24071	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
104264	Fee-for-Service	1053488981	1053488981	1	1	BOIKO, SUSAN MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	41069	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
104305	Fee-for-Service	1710222443	1710222443	1	1	BERTHELSEN, STEVEN L DPM	5/24/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2067 W VISTA WAY	STE 265	VISTA	CA	95843	0000	37	06073	33.18505594	-117.285958	San Diego County
104342	Fee-for-Service	1689929895	1689929895	1	1	BONILLA, VINCENT LMFT	10/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8050 FLORENCE AVE	32	DOWNEY	CA	90241	9993	19	06037	33.95259338	-118.1281629	Los Angeles County
104373	Fee-for-Service	1700961463	1700961463	1	1	BAHATTI, NAVEENPAL S MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82240	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
104392	Fee-for-Service	1386039295	1386039295	1	1	BARNARD, JOHN T MD	5/18/2020	390200000X	NA	Other	026	PHYSICIANS	168616	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
104398	Fee-for-Service	1285701177	1285701177	1	1	BERKOWITZ, DAVID M MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	26069	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
104407	Fee-for-Service	1477003648	1477003648	1	1	BEVERLY HEALING HOME CARE	4/4/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	17929 VENTURA BLVD	SUITE 6	ENCINO	CA	91316	3693	19	06037	34.16386337	-118.5228305	Los Angeles County
104414	Fee-for-Service	1265440721	1265440721	1	1	BOUTIN, FRANK J	10/31/1991	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	63508	20	Orthopedic Surgery	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
104424	Fee-for-Service	1073932877	1073932877	1	1	BURKEEN, JEFFREY MD	11/1/2023	2085R0001X	NA	Other	026	PHYSICIANS	140640	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
104425	Fee-for-Service	1144289521	1144289521	1	1	BERKIN BARRY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UTAH RADIOLOGY	1034 N 500 W	None	PROVO	UT	84606	3380	00	None	40.248072	-111.6673905	Utah County
104441	Fee-for-Service	1316211634	1316211634	1	1	BRINGAS, MARTA LPCC	6/23/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
104459	Fee-for-Service	1356554323	1356554323	1	1	BROUHA, SHARON S MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91973	30	Radiology	0	In state provider	None	330 LEWIS STREET	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
104484	Fee-for-Service	1861582496	1861582496	1	1	BATTAGLIA, DEBORAH F MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102759	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
104488	Fee-for-Service	1801147731	1801147731	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	590 WEST 8TH STREET	None	SAN PEDRO	CA	90731	3120	19	06037	33.73699936	-118.2899621	Los Angeles County
104493	Fee-for-Service	1992764773	1992764773	1	1	BELTON, STEPHEN R MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39570	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2000 MOWRY AVENUE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
104507	Fee-for-Service	1982098885	1982098885	1	1	BALKHAA, BILEGSAIKHAN MD	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155469	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
104554	Fee-for-Service	1609855139	1609855139	1	1	BAYLOR HEART AND VASCULAR	3/11/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER LLP	621 N HALL STREET	None	DALLAS	TX	75226	1339	00	None	32.787963	-96.7821075	Dallas County
104565	Fee-for-Service	1689615437	1689615437	1	1	BRAUNSTEIN, JOHN B MD	4/30/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	58594	None	None	0	In state provider	None	2555 E CHAPMAN AVE	STE 500	FULLERTON	CA	92831	3620	30	06059	33.87432134	-117.8854801	Orange County
104578	Fee-for-Service	1154909661	1154909661	1	1	BRIONES, CHRISTOPHER	12/21/2023	207P00000X	NA	Other	026	PHYSICIANS	186997	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
104646	Fee-for-Service	1841510450	1841510450	1	1	BAKARE, OLUBUNMI MD	2/24/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	112606	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
104650	Fee-for-Service	1508057837	1508057837	1	1	BARRY ROBERT HALPERN, MD	8/1/1975	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
104655	Fee-for-Service	1790852150	1790852150	1	1	BARTH, RICHARD PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
104677	Fee-for-Service	1801282926	1801282926	1	1	BUGAY, JOSE M PT	9/18/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	581 LIGHTHOUSE AVE	None	PACIFIC GROVE	CA	93950	2646	27	06053	36.62106225	-121.9179244	Monterey County
104701	Fee-for-Service	1306823166	1306823166	1	1	BABATUNDE, OTULANA A MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51121	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
104711	Fee-for-Service	1497300628	1497300628	1	1	BASSO-WILLIAMS 11 BLADE OF C	7/26/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	ALIFORNIA, PC	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
104730	Fee-for-Service	1366769317	1366769317	1	1	BOUKARROU, LATIFA MD	10/17/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	156992	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104783	Fee-for-Service	1760400667	1760400667	1	1	BERG, ULRICH MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26459	36	Psychiatry	0	In state provider	None	3022 FILLMORE ST	None	SAN FRANCISCO	CA	94123	4010	38	06075	37.79734138	-122.4354687	San Francisco County
104809	Fee-for-Service	1104869551	1104869551	1	1	BENNETT-FRAZER, CARISSA	10/16/1995	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11645 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90025	6807	19	06037	34.05005135	-118.4602303	Los Angeles County
104821	Fee-for-Service	1811142177	1811142177	1	1	BONACCORSI, MARCO A MD	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105330	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
104822	Fee-for-Service	1831477322	1831477322	1	1	BANDEN, SERENITY M NP	12/22/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
104839	Fee-for-Service	1114062361	1114062361	1	1	BOONTUNG, SITTIPORN MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25148	41	Internal Medicine	0	In state provider	None	23000 CRENSHAW BLVD	STE 200	TORRANCE	CA	90505	3052	19	06037	33.816762	-118.328024	Los Angeles County
104841	Fee-for-Service	1386766095	1386766095	1	1	BORKHEIM, MARC E PHD	7/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22988	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2521	19	06037	34.06170677	-118.302787	Los Angeles County
104845	Fee-for-Service	1609855139	1609855139	1	1	BAYLOR HEART AND VASCULAR	3/11/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER LLP	621 N HALL STREET	None	DALLAS	TX	75226	1339	00	None	32.787963	-96.7821075	Dallas County
104849	Fee-for-Service	1124604954	1124604954	1	1	BUI, KAREN MD	10/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192514	08	Family Practice	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
104863	Fee-for-Service	1528488277	1528488277	1	1	BLAKEWELL, ROBERT W	8/17/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
104872	Fee-for-Service	1336548932	1336548932	1	1	BOANDANG OPTOMETRY INC	8/25/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8942 GARDEN GROVE BLVD	STE 104	GARDEN GROVE	CA	92844	3327	30	06059	33.77381236	-117.976192	Orange County
104880	Fee-for-Service	1295365955	1295365955	1	1	BUCKMAN, MICHELLE NP	9/13/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
104892	Fee-for-Service	1336308378	1336308378	1	1	BLUMENTHAL, JILL S MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117338	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
104901	Fee-for-Service	1558417212	1558417212	1	1	BROESEL, RONDI L LCSW	6/5/2018	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4747 N FIRST ST	STE 119	FRESNO	CA	93726	0563	10	06019	36.803385	-119.7724465	Fresno County
104919	Fee-for-Service	1568700904	1568700904	1	1	BLACK, ROBERT C PHD	3/20/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
104939	Fee-for-Service	1508057837	1508057837	1	1	BARRY ROBERT HALPERN, MD	8/1/1975	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
104946	Fee-for-Service	1013158971	1013158971	1	1	BAJARIA, RADHIKA N LMFT	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
104962	Fee-for-Service	1730248543	1730248543	1	1	BLAND, GEORGIA B PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
104980	Fee-for-Service	1326175597	1326175597	1	1	BAILEY, KENNETH A MD	2/7/2018	208200000X	NA	General Surgery	026	PHYSICIANS	146475	24	Plastic Surgery	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
104981	Fee-for-Service	1316160906	1316160906	1	1	BLANK, GARY A PHD	5/1/1984	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	#208B	2455 BENNETT VALLEY RD	None	SANTA ROSA	CA	95404	5663	49	06097	38.434284	-122.6918565	Sonoma County
104990	Fee-for-Service	1306823166	1306823166	1	1	BABATUNDE, OTULANA A MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51121	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
104992	Fee-for-Service	1518132521	1518132521	1	1	BRETT H BARTZ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER ST	None	COLORADO SPGS	CO	80909	5533	00	None	38.8388119	-104.7995065	El Paso County
104993	Fee-for-Service	1285233197	1285233197	1	1	BEST MED HOME HEALTH INC	9/1/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1242 E COLORADO BLVD	STE C	PASADENA	CA	91106	1896	19	06037	34.14593454	-118.124748	Los Angeles County
105004	Fee-for-Service	1285061119	1285061119	1	1	BARBARA P BRAR MD INC	12/8/2023	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
105027	Fee-for-Service	1821260019	1821260019	1	1	BOYA, SUSHMA MD	9/16/2011	390200000X	NA	Other	026	PHYSICIANS	116672	41	Internal Medicine	0	In state provider	None	8851 CENTER DRIVE	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
105038	Fee-for-Service	1134259088	1134259088	1	1	BEHAVIORAL HEALTH SERVICES	11/3/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	1775 CHESTNUT AVE	None	LONG BEACH	CA	90813	1674	19	06037	33.78936169	-118.1964259	Los Angeles County
105076	Fee-for-Service	1487117933	1487117933	1	1	BROWN, NIKKIA LMFT	7/31/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22425 SUNBRIGHT AVE	None	RED BLUFF	CA	96080	9237	52	06103	40.11839058	-122.2038466	Tehama County
105097	Fee-for-Service	1760617112	1760617112	1	1	BASRAI, ZAHIR I MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117542	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
105134	Fee-for-Service	1871652594	1871652594	1	1	BANGALAN, SHARON J	6/28/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	43112 N 15TH STREET W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
105142	Fee-for-Service	1912394511	1912394511	1	1	BADIEI, AMIR A MD	5/2/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	161311	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
105166	Fee-for-Service	1770505976	1770505976	1	1	BROWN, GREGORY L DC	2/19/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST STE	None	FOUNTAIN VALLEY	CA	92708	7302	30	06059	33.68919119	-117.9542204	Orange County
105178	Fee-for-Service	1811286743	1811286743	1	1	BABBRA, RAMANDEEP K MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123271	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
105194	Fee-for-Service	1073539102	1073539102	1	1	BRICKLIN, ALAN S MD	12/12/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	29222	22	Pathology (M.D. only)	0	In state provider	None	21114 VANOWEN ST	None	CANOGA PARK	CA	91303	2821	19	06037	34.19373808	-118.5935645	Los Angeles County
105206	Fee-for-Service	1760600969	1760600969	1	1	BRIGHT EXPECTATIONS INC	12/13/1994	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5523 JONES AVE	None	RIVERSIDE	CA	92505	1357	33	06065	33.93476694	-117.4817574	Riverside County
105212	Fee-for-Service	1144239492	1144239492	1	1	BLAKE, DAVID A MD INC	10/2/2020	207L00000X	NA	Other	026	PHYSICIANS	77088	05	Anesthesiology	0	In state provider	None	5 HOLLAND	STE 101	IRVINE	CA	92618	2568	30	06059	33.64596897	-117.7198362	Orange County
105218	Fee-for-Service	1508967142	1508967142	1	1	BRISCOE, YOLANDA B PSYD	7/5/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	28383	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DRIVE	SUITE 200	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
105229	Fee-for-Service	1437471190	1437471190	1	1	BRUSATORI, LEYLA T PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1040 MAIN ST	STE 206	NAPA	CA	94559	2605	28	06055	38.29969678	-122.2858531	Napa County
105280	Fee-for-Service	1568484756	1568484756	1	1	BELL, JAMES A MD	9/1/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	63505	20	Orthopedic Surgery	0	In state provider	None	1330 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4880	33	06065	33.84144	-116.5455715	Riverside County
105290	Fee-for-Service	1851317549	1851317549	1	1	BROWN, DOUGLAS H MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53327	None	None	0	In state provider	None	11620 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90025	6801	19	06037	34.05024415	-118.4598908	Los Angeles County
105293	Fee-for-Service	1003984287	1003984287	1	1	BRIGHT, KARIN H	3/1/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
105296	Fee-for-Service	1801114988	1801114988	1	1	BELLUCCI, BRIAN M MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125109	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	FIVE MEDICAL PLAZA	SUITE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
105316	Fee-for-Service	1891209425	1891209425	1	1	BLATZ, REBECCA CCC-SLP	10/17/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
105317	Fee-for-Service	1386761104	1386761104	1	1	BAUMAN, SARAH E	4/27/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
105340	Fee-for-Service	1003102641	1003102641	1	1	BOYARSKY, MARINA MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127902	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
105356	Fee-for-Service	1154506962	1154506962	1	1	BICKFORD, LINCOLN CHARLES M	7/2/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	152747	36	Psychiatry	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	19	06037	33.8102385	-118.3441185	Los Angeles County
105380	Fee-for-Service	1962457812	1962457812	1	31	BEVERLY RADIOLOGY MEDICAL GR	8/1/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6226 E SPRING ST	#270	LONG BEACH	CA	90815	1442	19	06037	33.81040053	-118.1102715	Los Angeles County
105403	Fee-for-Service	1649632696	1649632696	1	1	BACLIG, NIKITA V MD	12/2/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	168697	41	Internal Medicine	0	In state provider	None	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
105433	Fee-for-Service	1366559320	1366559320	1	2	BHOYRUL, SUNIL MD	7/2/2021	208600000X	NA	General Surgery	026	PHYSICIANS	61911	None	None	0	In state provider	None	9850 GENESEE AVE	SUITE 570	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
105461	Fee-for-Service	1881318194	1881318194	1	2	BAY AREA TAXI CAB INC	3/24/2023	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1400 COLEMAN AVE	SUITE F25	SANTA CLARA	CA	95050	4309	43	06085	37.35715822	-121.9362064	Santa Clara County
105462	Fee-for-Service	1417983321	1417983321	1	1	BOARDMAN, ROBERT D CRNA	7/17/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
105493	Fee-for-Service	1508374653	1508374653	1	1	BYMUN, JENNIFER LCSW	6/16/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
105501	Fee-for-Service	1497894885	1497894885	2	1	BLUE NOTE PARTNERS LLC	10/16/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3687 OLD SANTA RITA RD	#202	PLEASANTON	CA	94588	3479	01	06001	37.69788091	-121.8787941	Alameda County
105534	Fee-for-Service	1730572041	1730572041	1	1	BHARDWAJ, TANYA MD	10/30/2023	207R00000X	NA	Other	026	PHYSICIANS	189042	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
105543	Fee-for-Service	1235544578	1235544578	1	1	BURGE, JOHN R DO	8/26/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	14460	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
105550	Fee-for-Service	1306232277	1306232277	1	1	BRADY-GRUCA, HEATHER C MD	3/27/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152813	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
105594	Fee-for-Service	1437685872	1437685872	1	1	BRIMHALL PHARMACY INC	5/22/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8305 BRIMHALL RD	STE 1603	BAKERSFIELD	CA	93312	2172	15	06029	35.36876049	-119.0948805	Kern County
105595	Fee-for-Service	1780679720	1780679720	1	1	BARIBEAULT, RIC CRNA	10/7/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
105616	Fee-for-Service	1164816070	1164816070	1	1	BAEK, JI SUN MD	8/9/2021	207L00000X	NA	Other	026	PHYSICIANS	147376	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
105634	Fee-for-Service	1558802801	1558802801	1	1	BERTOT, WESTON J MD	6/9/2022	207L00000X	NA	Other	026	PHYSICIANS	162963	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
105662	Fee-for-Service	1467536987	1467536987	2	2	BISHARA, ISHAK N MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	45381	-	NOT APPLICABLE	0	In state provider	None	3131 SANTA ANITA AVE	STE 112B	EL MONTE	CA	91733	1369	19	06037	34.064991	-118.0427595	Los Angeles County
105664	Fee-for-Service	1871817585	1871817585	1	1	BRANHAM, ANGIE N PHD	10/3/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1265 65TH ST	None	EMERYVILLE	CA	94608	1110	01	06001	37.84721593	-122.2891676	Alameda County
105669	Fee-for-Service	1962457812	1962457812	1	124	BEVERLY RADIOLOGY MEDICAL GR	5/31/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	6121 N THESTA ST	STE 207	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
105676	Fee-for-Service	1457856130	1457856130	1	1	BERNSTEIN, JESSICA M MD	6/29/2023	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	185606	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
105678	Fee-for-Service	1033571427	1033571427	1	1	BIGELOW, ELAINE O MD	6/8/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	185579	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
105686	Fee-for-Service	1063619401	1063619401	1	1	BEEDE, PAULA L LMFT	10/9/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
105693	Fee-for-Service	1649632696	1649632696	1	1	BACLIG, NIKITA V MD	12/2/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	168697	68	Hematology	0	In state provider	None	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
105702	Fee-for-Service	1093246688	1093246688	1	1	BAIDWAN, BANINDER K DO	7/23/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	18131	40	Pediatrics	0	In state provider	None	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
105709	Fee-for-Service	1992965545	1992965545	1	1	BRINKMAN, ALICE M MD	6/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	102204	40	Pediatrics	0	In state provider	None	1430 E MAIN ST	SUITE 201	SANTA MARIA	CA	93454	4832	42	06083	34.9528467	-120.4127301	Santa Barbara County
105710	Fee-for-Service	1336302991	1336302991	1	1	BENSON, DOUGLAS W MD	1/26/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	28623	20	Orthopedic Surgery	0	In state provider	None	W 5TH AVE AND ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.741948	-121.848921	Butte County
105714	Fee-for-Service	1497238257	1497238257	1	1	BROCE, TIFFANY NP	10/13/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
105727	Fee-for-Service	1790767515	1790767515	1	1	BROWN-PURYEAR, LATONYA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SOUTH DAYTON ACUTE CARE	33 W RAHN RD	None	DAYTON	OH	45429	0000	00	None	39.66892895	-84.16437359	Montgomery County
105759	Fee-for-Service	1699365684	1699365684	1	1	BEGINNING LIFE HOSPICE INC	12/7/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17620 SHERMAN WAY	STE 213	VAN NUYS	CA	91406	3527	19	06037	34.20105176	-118.5171046	Los Angeles County
105862	Fee-for-Service	1902169477	1902169477	1	1	BARNES, CARIN E LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4144 S DEMAREE ST	SUITE A	VISALIA	CA	93277	8624	54	06107	36.293157	-119.33073	Tulare County
105883	Fee-for-Service	1073168852	1073168852	1	1	BARRY, CATHLEEN P	1/21/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
105887	Fee-for-Service	1083722680	1083722680	1	1	BOYNTON, URSULA N	9/1/2000	207R00000X	NA	Other	026	PHYSICIANS	67537	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	RM 1002	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
105888	Fee-for-Service	1285716316	1285716316	1	1	BATHAEE, FARSHAD DPM	4/23/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	24331 EL TORO ROAD	SUITE 370	LAGUNA WOODS	CA	92637	2752	30	06059	33.60928782	-117.7295058	Orange County
105934	Fee-for-Service	1386814499	1386814499	1	1	BARTOLETTI, MARYN L NP	3/14/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
105980	Fee-for-Service	1306898366	1306898366	1	1	BOLLIN JR, RICHARD C MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72838	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
105985	Fee-for-Service	1831264514	1831264514	1	1	BURGER, CAROL K PT	8/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
106025	Fee-for-Service	1679820245	1679820245	1	1	BAKER, MICHAEL L	7/3/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	420 E THIRD ST	STE 603	LOS ANGELES	CA	90013	1645	19	06037	34.04702011	-118.241912	Los Angeles County
106036	Fee-for-Service	1902949118	1902949118	1	1	BICKFORD, ELLIOT L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3324 STATE ST	STE J	SANTA BARBARA	CA	93105	2667	42	06083	34.44042752	-119.735577	Santa Barbara County
106047	Fee-for-Service	1699365684	1699365684	1	1	BEGINNING LIFE HOSPICE INC	12/7/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17620 SHERMAN WAY	STE 213	VAN NUYS	CA	91406	3527	19	06037	34.20105176	-118.5171046	Los Angeles County
106050	Fee-for-Service	1255782736	1255782736	1	1	BALLEZA, SHEILA JEAN	7/26/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12439 KOKOMO PLACE	None	VICTORVILLE	CA	92392	6796	36	06071	34.47699819	-117.3920095	San Bernardino County
106061	Fee-for-Service	1003497710	1003497710	1	1	BOYARKO, ALEXANDER MD	4/16/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	191293	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
106072	Fee-for-Service	1972664530	1972664530	1	1	BAPTIST HOSPITAL INC	12/6/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1110 GULF BREEZE PKWY	None	GULF BREEZE	FL	32561	4897	00	None	30.35877574	-87.15643279	Santa Rosa County
106078	Fee-for-Service	1487885067	1487885067	1	1	BINDLISH, SHAGUN MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132461	41	Internal Medicine	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94515	4339	01	06001	37.63229023	-122.0896425	Alameda County
106094	Fee-for-Service	1841561784	1841561784	1	1	BADIEE, GHOLAMREZA MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117668	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365 120 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
106115	Fee-for-Service	1578691978	1578691978	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	3421 EAST OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3030	19	06037	34.0188079	-118.204349	Los Angeles County
106117	Fee-for-Service	1891899548	1891899548	1	1	BEST OF TIMES ADULT DAY	6/9/2009	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE	4350 11TH AVE	None	LOS ANGELES	CA	90008	5205	19	06037	34.00489213	-118.3293729	Los Angeles County
106129	Fee-for-Service	1437754165	1437754165	1	1	BLESSINGS HOME HEALTH	8/24/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5657 WILSHIRE BLVD	UNIT 445	LOS ANGELES	CA	90036	3095	19	06037	34.06240635	-118.3518838	Los Angeles County
106160	Fee-for-Service	1598710857	1598710857	1	1	BROUSSEAU, DAVID A MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	82088	42	Nuclear Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
106185	Fee-for-Service	1669520011	1669520011	1	1	BABANTO, REMEDIOS A NP	6/20/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
106188	Fee-for-Service	1811174840	1811174840	1	1	BURRELL,CARMEN D DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1075 VAN VOORHIS RD	SUI	MORGANTOWN	WV	26505	3587	00	None	39.65402701	-79.96352726	Monongalia County
106197	Fee-for-Service	1760582159	1760582159	1	1	BUSHNELL, LAMAR J MD	7/31/1994	208G00000X	NA	General Surgery	026	PHYSICIANS	81373	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	145 N BRENT ST	STE 102	VENTURA	CA	93003	2838	56	06111	34.27394582	-119.2571887	Ventura County
106216	Fee-for-Service	1588650345	1588650345	1	1	BAUMGARTEN, BRUCE MD INC	1/2/1979	207L00000X	NA	Other	026	PHYSICIANS	22934	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
106239	Fee-for-Service	1669601274	1669601274	1	1	BAYRER, JAMES R MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108316	10	Gastroenterology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
106252	Fee-for-Service	1871515254	1871515254	1	1	BEAN, XYLINA D MD	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	26157	-	NOT APPLICABLE	0	In state provider	None	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	19	06037	33.92826552	-118.3092091	Los Angeles County
106254	Fee-for-Service	1801011143	1801011143	1	1	BARGETTO, GINA D	10/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
106258	Fee-for-Service	1114039914	1114039914	1	1	BIO MEDICAL APPS OF CA	3/25/1992	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	9432 VENICE BLVD	None	CULVER CITY	CA	90232	2624	19	06037	34.02499589	-118.3957107	Los Angeles County
106274	Fee-for-Service	1457667529	1457667529	1	1	BHAR, SALEH MD	10/1/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
106339	Fee-for-Service	1255782736	1255782736	1	1	BALLEZA, SHEILA JEAN	7/26/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12439 KOKOMO PLACE	None	VICTORVILLE	CA	92392	6796	36	06071	34.47699819	-117.3920095	San Bernardino County
106359	Fee-for-Service	1972664530	1972664530	1	1	BAPTIST HOSPITAL INC	12/1/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1110 GULF BREEZE PKWY	None	GULF BREEZE	FL	32561	4897	00	None	30.35877574	-87.15643279	Santa Rosa County
106384	Fee-for-Service	1376585232	1376585232	1	1	BYRNE, TIMOTHY J	2/8/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	01	General Practice	2	Out of state provider	BILTMORE CARDIOLOGY	4444 N 32ND ST	STE 175	PHOENIX	AZ	85018	3999	00	None	33.502041	-112.013424	Maricopa County
106385	Fee-for-Service	1023579000	1023579000	1	1	BATASIN, MA LOVELY DO	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	19739	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
106388	Fee-for-Service	1215911565	1215911565	1	1	BAUS, CHARLES J OD	6/17/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	56970 YUCCA TRL	STE 101	YUCCA VALLEY	CA	92284	3753	36	06071	34.12059645	-116.420985	San Bernardino County
106424	Fee-for-Service	1457301616	1457301616	1	1	BUBOLZ, BETH A MD	8/18/2021	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
106441	Fee-for-Service	1871904656	1871904656	1	1	BARSTOW PRIMARY CARE CLINIC	2/9/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	805 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3033	36	06071	34.89343047	-117.0171832	San Bernardino County
106449	Fee-for-Service	1598710857	1598710857	1	1	BROUSSEAU, DAVID A MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	82088	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
106487	Fee-for-Service	1952850919	1952850919	1	1	BAKER, JILLIAN K NP	6/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
106528	Fee-for-Service	1669601274	1669601274	1	1	BAYRER, JAMES R MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108316	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
106534	Fee-for-Service	1295919009	1295919009	1	1	BRAVO, ROGELIO C MD	2/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99242	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
106536	Fee-for-Service	1669503090	1669503090	1	1	BURGE, WILLIAM R MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	59955	None	None	0	In state provider	None	4334 CENTRAL AVE	None	RIVERSIDE	CA	92506	2918	33	06065	33.95346346	-117.3993495	Riverside County
106537	Fee-for-Service	1699724666	1699724666	1	1	BERRY, JULIE A MD	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94101	None	None	0	In state provider	None	2023 W VISTA WAY	STE J	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
106565	Fee-for-Service	1194710897	1194710897	1	1	BAILEY, GLEN H. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 E 1-240 HWY	None	OKLAHOMA CITY	OK	73135	0000	00	None	35.39046035	-97.41753054	Oklahoma County
106583	Fee-for-Service	1487494001	1487494001	1	1	BORN RESILIENT LLC	6/24/2024	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	54	06107	0	0	None
106586	Fee-for-Service	1831391358	1831391358	1	1	BERNER, MATHEW D MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
106592	Fee-for-Service	1780214403	1780214403	1	2	BATES, GARY A	3/27/2020	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	3810 ROSIN CT	100	SACRAMENTO	CA	95834	1656	34	06067	38.637702	-121.474773	Sacramento County
106598	Fee-for-Service	1851649396	1851649396	1	1	BHATIA, ISHTLEEN K MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144205	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
106668	Fee-for-Service	1114913530	1114913530	1	1	BEYMER, JEANNE V MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	78959	40	Pediatrics	0	In state provider	None	123 S SAN MATEO DR	None	SAN MATEO	CA	94401	3804	41	06081	37.56576298	-122.3254099	San Mateo County
106683	Fee-for-Service	1528470028	1528470028	1	1	BENZL, ROBERT MD	7/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	141624	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
106692	Fee-for-Service	1730287319	1730287319	1	1	BHC HEALTH SERVICES OF NV	6/28/2012	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	1240 E 9TH ST	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
106693	Fee-for-Service	1396741997	1396741997	1	1	BRAZINSKY, BRUCE A	5/1/1995	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	A PODIATRY CORPORATION	6699 ALVARADO RD	STE 2201	SAN DIEGO	CA	92120	5253	37	06073	32.77665383	-117.0540279	San Diego County
106694	Fee-for-Service	1184027724	1184027724	1	1	BENARD, ROBERT A NP	7/10/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
106712	Fee-for-Service	1790096659	1790096659	1	1	BEHAL, RATNA MD	8/30/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	163929	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
106716	Fee-for-Service	1225076219	1225076219	1	1	BASS, DAVID K MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88437	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
106728	Fee-for-Service	1871904656	1871904656	1	1	BARSTOW PRIMARY CARE CLINIC	3/6/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	805 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3033	36	06071	34.89343047	-117.0171832	San Bernardino County
106739	Fee-for-Service	1235217316	1235217316	1	1	BERTEN, RALPH O MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76156	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
106767	Fee-for-Service	1568490142	1568490142	1	1	BARTEL, JEREMY	4/21/2005	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11550 INDIAN HILLS RD	STE 210	MISSION HILLS	CA	91345	1202	19	06037	34.28024575	-118.4588775	Los Angeles County
106775	Fee-for-Service	1902977366	1902977366	1	1	BHATT, SAMIR N MD INC	4/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70837	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1510 E MAIN ST	SUITE 101	SANTA MARIA	CA	93454	4826	42	06083	34.95282793	-120.4100798	Santa Barbara County
106776	Fee-for-Service	1972931608	1972931608	1	1	BODIES IN BALANCE LLC	2/27/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9301 WILSHIRE BLVD	STE 502	BEVERLY HILLS	CA	90210	6147	19	06037	34.06707307	-118.3946743	Los Angeles County
106778	Fee-for-Service	1679932172	1679932172	1	1	BEIER, LANCELOT A MD	8/1/2019	207P00000X	NA	Other	026	PHYSICIANS	154132	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
106799	Fee-for-Service	1629000369	1629000369	1	1	BIERMA, RONALD S MD	2/16/1990	207L00000X	NA	Other	026	PHYSICIANS	43625	05	Anesthesiology	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
106822	Fee-for-Service	1063577062	1063577062	1	1	BARRON, KATHY L LCSW	12/8/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1789 W YOSEMITE AVENUE	None	MANTECA	CA	95337	5130	39	06077	37.79964	-121.246425	San Joaquin County
106830	Fee-for-Service	1972540755	1972540755	1	1	BANKS, LAURA T MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	78682	13	Neurology (M.D. only)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
106834	Fee-for-Service	1033796826	1033796826	1	1	BUCKNER, ANGELA LCSW	11/5/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	468 MANZANITA AVE	7	CHICO	CA	95926	1358	04	06007	39.75707298	-121.8433455	Butte County
106845	Fee-for-Service	1306061254	1306061254	1	1	BALDWIN PARK UNIFIED SD	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	3699 N HOLLY AVE	None	BALDWIN PARK	CA	91706	5327	19	06037	34.080111	-117.961677	Los Angeles County
106848	Fee-for-Service	1467088310	1467088310	1	1	BARDAN, CHRISTIAN MD	2/29/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187653	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
106880	Fee-for-Service	1073958823	1073958823	1	1	BLUMENTHAL, DAVID MD	12/16/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	162027	68	Hematology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
106895	Fee-for-Service	1578509469	1578509469	1	1	BOLTZ, MADALANE GAIL MD	12/31/1992	207L00000X	NA	Other	026	PHYSICIANS	77550	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
106946	Fee-for-Service	1477710127	1477710127	1	1	BLEVINS, JONATHAN W MD	10/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117764	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
106947	Fee-for-Service	1487888707	1487888707	1	1	BENDAVID, OMID J MD	6/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94055	30	Radiology	0	In state provider	None	10833 LA CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
107000	Fee-for-Service	1679079065	1679079065	1	1	BERMUDEZ, ANA M MD	9/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167282	None	None	0	In state provider	None	20642 JOHN DR	None	CASTRO VALLEY	CA	94546	5103	01	06001	37.69270814	-122.090934	Alameda County
107017	Fee-for-Service	1861676462	1861676462	1	1	BEER, JEANETTE L NP	5/16/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
107030	Fee-for-Service	1861758062	1861758062	1	1	BELLIS, JENNIFER M MD	4/30/2020	2080P0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
107043	Fee-for-Service	1225138688	1225138688	1	1	BIANCHI, CHRISTIAN MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64083	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
107062	Fee-for-Service	1902977366	1902977366	1	1	BHATT, SAMIR N MD INC	4/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70837	41	Internal Medicine	0	In state provider	None	1510 E MAIN ST	SUITE 101	SANTA MARIA	CA	93454	4826	42	06083	34.95282793	-120.4100798	Santa Barbara County
107063	Fee-for-Service	1528148566	1528148566	2	1	BRANDIS, LARRY S MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	29636	41	Internal Medicine	0	In state provider	None	6253 HOLLYWOOD BLVD	STE 1208	LOS ANGELES	CA	90028	5325	19	06037	34.10163448	-118.3263672	Los Angeles County
107090	Fee-for-Service	1467650713	1467650713	3	1	BELLA VIDA PHARMACY INC	1/26/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1037 W CARSON ST	None	TORRANCE	CA	90502	2005	19	06037	33.83160351	-118.2938715	Los Angeles County
107114	Fee-for-Service	1588655229	1588655229	1	1	BOYER, WANDA M NP	12/6/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
107118	Fee-for-Service	1992891980	1992891980	1	1	BAY CITIES AMBULANCE	10/2/2017	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	None	3505 OCEAN BLVD SE	None	COOS BAY	OR	97420	3537	00	None	43.38504647	-124.2526985	Coos County
107124	Fee-for-Service	1962457812	1962457812	1	111	BEVERLY RADIOLOGY MEDICAL GR	8/10/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER	2428 SANTA MONICA BLVD	LOWER LEVER	SANTA MONICA	CA	90404	2045	19	06037	34.0317559	-118.4762013	Los Angeles County
107128	Fee-for-Service	1871703793	1871703793	1	1	BATTISTONE, LOUIS LMFT	3/3/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	45786	-	NOT APPLICABLE	0	In state provider	None	11777 SEBASTIAN WAY	SUITE 102	RANCHO CUCAMONGA	CA	91730	0707	36	06071	34.10414799	-117.548378	San Bernardino County
107131	Fee-for-Service	1083744395	1083744395	1	1	BERKELEY YOUTH LIVING	5/28/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2110 7TH ST	None	BERKELEY	CA	94710	2318	01	06001	37.86651166	-122.2961216	Alameda County
107132	Fee-for-Service	1962457812	1962457812	1	57	BEVERLY RADIOLOGY MEDICAL GR	9/3/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6855 NOBLE AVE	None	VAN NUYS	CA	91405	3729	19	06037	34.19496251	-118.4618831	Los Angeles County
107167	Fee-for-Service	1629694997	1629694997	1	1	BASSO PHARMACY INC	9/27/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	552 SESPE AVENUE	None	FILLMORE	CA	93015	1957	56	06111	34.40038979	-118.9156652	Ventura County
107168	Fee-for-Service	1063419364	1063419364	1	1	BHULLAR, PARDEEP S MD	3/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61537	41	Internal Medicine	0	In state provider	None	758 E BULLARD AVE	STE 100	FRESNO	CA	93710	5472	10	06019	36.82313646	-119.7733995	Fresno County
107171	Fee-for-Service	1326672973	1326672973	1	1	BLESSED ELDER CARE INC	4/28/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5041 SIERRA ST	None	RIVERSIDE	CA	92504	2260	33	06065	33.94974638	-117.4129651	Riverside County
107178	Fee-for-Service	1124476981	1124476981	1	1	BAIK, GASEON LAC	11/7/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4010 BARRANCA PKWY	SUITE 205	IRVINE	CA	92604	1721	30	06059	33.68346716	-117.8075649	Orange County
107188	Fee-for-Service	1710970983	1710970983	1	1	BERUTI, DAN DO	10/12/2021	207R00000X	NA	Other	026	PHYSICIANS	11030	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
107264	Fee-for-Service	1962757443	1962757443	1	1	BLAIR MARRIAGE AND FAMILY	1/12/2018	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	THERAPY INC	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
107329	Fee-for-Service	1194950477	1194950477	1	1	BARRETT, ADRIANNA Y MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103417	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
107345	Fee-for-Service	1952301640	1952301640	1	1	BREAKEY PROSTHETICS INC	6/27/2006	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	820 MALONE RD	None	SAN JOSE	CA	95125	2639	43	06085	37.29665533	-121.882674	Santa Clara County
107353	Fee-for-Service	1174786594	1174786594	1	1	BENCHEQROUN, HASSAN K	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112435	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	SUITE # 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
107360	Fee-for-Service	1427143072	1427143072	1	1	BUI, CHUNG THE MD	9/20/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43172	01	General Practice	0	In state provider	None	10301 BOLSA AVE	STE 102	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
107385	Fee-for-Service	1528488707	1528488707	1	1	BONDALE, NIYATI S MD	6/3/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154494	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
107392	Fee-for-Service	1144415365	1144415365	1	1	BEACH, LYNN C NP	12/7/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
107404	Fee-for-Service	1851374441	1851374441	1	1	BOLD, RICHARD J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71365	02	General Surgery	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
107405	Fee-for-Service	1912105636	1912105636	1	1	BANZALI JR, FRANKLIN M	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89606	05	Anesthesiology	0	In state provider	MD	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
107453	Fee-for-Service	1669714523	1669714523	1	1	BERGAMO, CARA E MD	2/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147153	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
107454	Fee-for-Service	1467425439	1467425439	1	1	BROWN, RYAN A MD	5/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84824	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	106 LA CASA VIA	STE 140	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
107455	Fee-for-Service	1982781159	1982781159	1	8	BAART COMMUNITY HEALTHCARE	1/1/2005	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1313 CUTTING BLVD	None	RICHMOND	CA	94804	2554	07	06013	37.92523852	-122.3565435	Contra Costa County
107477	Fee-for-Service	1215434287	1215434287	1	1	BRAUNSCHWEIG, MICHELLE E MD	7/27/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163625	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107479	Fee-for-Service	1821033309	1821033309	1	1	BLOXHAM, ANNA Y MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72126	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
107528	Fee-for-Service	1962457812	1962457812	1	130	BEVERLY RADIOLOGY MEDICAL GR	9/30/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2740 S. ELM AVENUE	None	FRESNO	CA	55945	7520	10	06019	36.70101129	-119.7908643	Fresno County
107551	Fee-for-Service	1962757443	1962757443	1	1	BLAIR MARRIAGE AND FAMILY	1/12/2018	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	THERAPY INC	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
107567	Fee-for-Service	1083722144	1083722144	1	1	BREAUX, BARRY E MD	8/31/1979	207W00000X	NA	Ophthalmology	026	PHYSICIANS	34283	18	Ophthalmology	0	In state provider	None	1320 TARA HILLS DR	STE C	PINOLE	CA	94564	2532	07	06013	37.99581195	-122.3048745	Contra Costa County
107574	Fee-for-Service	1114150448	1114150448	1	1	BAKERSFIELD HEALTHCARE	10/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	AND WELLNESS CENTER, LLC	2211 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	3309	15	06029	35.38846079	-118.967356	Kern County
107583	Fee-for-Service	1982686374	1982686374	1	1	BOURGEOIS, JAMES A MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78627	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
107642	Fee-for-Service	1922294891	1922294891	1	1	BROWN-LECHNER, MINDY R CNM	10/5/2022	367A00000X	NA	Certified Nurse Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
107646	Fee-for-Service	1841325099	1841325099	1	1	BERDJIS, PEIMAN MD INC	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67173	08	Family Practice	0	In state provider	None	6222 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90048	5193	19	06037	34.06325771	-118.3641574	Los Angeles County
107656	Fee-for-Service	1316010275	1316010275	1	1	BASSIRI, ALI G MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79699	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2101 FOREST AVE	STE 112	SAN JOSE	CA	95128	1472	43	06085	37.3270795	-121.93731	Santa Clara County
107693	Fee-for-Service	1851374441	1851374441	1	1	BOLD, RICHARD J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71365	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
107714	Fee-for-Service	1619386042	1619386042	1	2	BAKERSFIELD PEDIATRICS	11/2/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL GROUP	1215 34TH ST	None	BAKERSFIELD	CA	93301	2107	15	06029	35.39050249	-119.015775	Kern County
107740	Fee-for-Service	1073295432	1073295432	1	1	BLISSFUL CANYON HOME CRE LLC	8/15/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	284 ALDERWOOD WAY	None	RIVERSIDE	CA	92506	6263	33	06065	33.92467095	-117.3259442	Riverside County
107747	Fee-for-Service	1568658995	1568658995	1	1	BRADLEY, JONATHAN T MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101148	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107748	Fee-for-Service	1255714929	1255714929	1	1	BHATT, ANOOP MD	5/7/2024	207RR0500X	NA	Other	026	PHYSICIANS	162856	83	Rheumatology	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
107780	Fee-for-Service	1790489896	1790489896	1	1	BROOKS, BRIZA C OD	9/3/2023	152WL0500X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND ST	STE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
107782	Fee-for-Service	1780039164	1780039164	1	1	BLAISDELL, MATTHEW DO	9/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16013	None	None	0	In state provider	None	19929 GREENLEY RD	None	SONORA	CA	95370	5996	55	06109	37.9837971	-120.366851	Tuolumne County
107786	Fee-for-Service	1922368901	1922368901	1	1	BIPIN AMIT DESAI	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
107789	Fee-for-Service	1932585874	1932585874	1	1	BAY AREA MEDICAL GROUP INC	2/1/2016	193200000X	NA	Other	026	PHYSICIANS	82213	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	105 N BASCOM AVE	SUITE 204	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
107804	Fee-for-Service	1962457812	1962457812	1	133	BEVERLY RADIOLOGY MEDICAL GR	8/12/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	31565 RANCHO PUEBLO RD	SUITE 101	TEMECULA	CA	92592	4838	33	06065	33.47937218	-117.1101551	Riverside County
107839	Fee-for-Service	1962757443	1962757443	1	1	BLAIR MARRIAGE AND FAMILY	2/28/2019	106H00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	THERAPY INC	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
107899	Fee-for-Service	1144858069	1144858069	1	1	BRAR, RAMEET DO	9/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21292	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
107915	Fee-for-Service	1588810816	1588810816	1	1	BOTROS, DANNY MD	7/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93969	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
107933	Fee-for-Service	1306828868	1306828868	1	1	BALUYOT, EUNICE M MD	2/22/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54525	08	Family Practice	0	In state provider	None	1725 LAS VEGAS ST	None	MODESTO	CA	95358	5500	50	06099	37.60468885	-121.0027554	Stanislaus County
107938	Fee-for-Service	1548632540	1548632540	1	1	BRONSKY PENA, HANNAH CNM	12/19/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
107941	Fee-for-Service	1043375405	1043375405	1	1	BUSHNELL,THEODORE E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE MS	359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
107942	Fee-for-Service	1316010275	1316010275	1	1	BASSIRI, ALI G MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79699	01	General Practice	0	In state provider	None	2101 FOREST AVE	STE 112	SAN JOSE	CA	95128	1472	43	06085	37.3270795	-121.93731	Santa Clara County
107982	Fee-for-Service	1043276264	1043276264	1	1	BERTUCCI, GLORIA M MD	3/1/1995	207ZP0102X	NA	Other	026	PHYSICIANS	41029	22	Pathology (M.D. only)	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
107993	Fee-for-Service	1063718252	1063718252	1	1	BLANKENSHIP, AYN A	6/5/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
108010	Fee-for-Service	1053961839	1053961839	1	1	BOYD, KRISTIN LMFT	3/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11800 CENTRAL AVE	STE 225	CHINO	CA	91710	7200	36	06071	34.0388092	-117.689654	San Bernardino County
108025	Fee-for-Service	1922069335	1922069335	1	2	BALLARD, LESLIE J MD	5/6/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52573	-	NOT APPLICABLE	0	In state provider	None	1550 HUMBOLDT ROAD	STE 3	CHICO	CA	95928	9115	04	06007	39.73641173	-121.8122593	Butte County
108080	Fee-for-Service	1255776803	1255776803	1	1	BALAR, KEVIN V MD	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132123	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
108082	Fee-for-Service	1962457812	1962457812	1	127	BEVERLY RADIOLOGY MEDICAL GR	9/11/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4500 OLIVEWOOD AVE	SUITE 100 & 200	RIVERSIDE	CA	92501	4116	33	06065	33.97245711	-117.3759874	Riverside County
108085	Fee-for-Service	1174504013	1174504013	1	1	BOSE, ALOK K MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80991	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	5030 BUSINESS CENTER DR	#230	FAIRFIELD	CA	94535	6874	48	06095	38.21736891	-122.142579	Solano County
108089	Fee-for-Service	1932585874	1932585874	1	1	BAY AREA MEDICAL GROUP INC	2/1/2016	193200000X	NA	Other	026	PHYSICIANS	82213	41	Internal Medicine	0	In state provider	None	105 N BASCOM AVE	SUITE 204	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
108091	Fee-for-Service	1871754218	1871754218	1	1	BEST MEDICAL	7/22/2008	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORATION INC	6269 N 9TH ST	None	FRESNO	CA	93710	5708	10	06019	36.82790226	-119.7581497	Fresno County
108127	Fee-for-Service	1720453889	1720453889	1	1	BROWN, MARCELLA S PT	7/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
108138	Fee-for-Service	1194084863	1194084863	1	1	BOSKOVSKI, MARKO MD	7/30/2021	208G00000X	NA	General Surgery	026	PHYSICIANS	173117	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
108159	Fee-for-Service	1003068487	1003068487	1	1	BALALI, SHABNAM MD	9/27/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171339	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
108175	Fee-for-Service	1366460081	1366460081	1	1	BERNETT, JORGE R MD	3/1/1999	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	70835	77	Infectious Disease	0	In state provider	None	365 LENNON LN	SUITE 200	WALNUT CREEK	CA	94598	5912	07	06013	37.92784983	-122.0301444	Contra Costa County
108176	Fee-for-Service	1811202757	1811202757	1	1	BHOITE, GIRIJA MD	2/13/2025	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
108202	Fee-for-Service	1679814560	1679814560	1	1	BISHOP, ANNY E LMFT	5/11/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96343	-	NOT APPLICABLE	0	In state provider	None	300 SUNNY HILLS DR	STE 3, 4	SAN ANSELMO	CA	94960	1909	21	06041	37.98269146	-122.5611947	Marin County
108237	Fee-for-Service	1194819920	1194819920	1	1	BAKERSFIELD PRIMARY PHYS	8/14/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	VERNON C SORENSON MD INC	3838 SAN DIMAS ST	STE B100	BAKERSFIELD	CA	93301	2285	15	06029	35.3946385	-119.008203	Kern County
108267	Fee-for-Service	1174573125	1174573125	1	1	BENWAY, BRIAN M MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135843	34	Urology and Urological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
108317	Fee-for-Service	1275504391	1275504391	1	1	BRADLEY, DAVID A OD	10/23/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1160 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528537	-121.6208248	Sutter County
108342	Fee-for-Service	1821398892	1821398892	1	1	BINIWALE, RAJUL	1/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12648 POWAY ROAD	None	POWAY	CA	92064	4416	37	06073	32.95481776	-117.0563777	San Diego County
108355	Fee-for-Service	1669444980	1669444980	1	1	BAMBERGER, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2310 HOLMES ST	None	KANSAS CITY	MO	64108	2602	00	None	39.08432765	-94.57585309	Jackson County
108372	Fee-for-Service	1174504013	1174504013	1	1	BOSE, ALOK K MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80991	40	Pediatrics	0	In state provider	None	5030 BUSINESS CENTER DR	#230	FAIRFIELD	CA	94535	6874	48	06095	38.21736891	-122.142579	Solano County
108424	Fee-for-Service	1386754604	1386754604	1	1	BHARGAVA, SHALINI MD	7/19/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38744	40	Pediatrics	0	In state provider	None	15082 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91704669	-118.0092197	Los Angeles County
108430	Fee-for-Service	1487266730	1487266730	1	1	BRAVO HOSPICE AND PALLIATIVE	6/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	18531 ROSCOE BLVD	STE 204	NORTHRIDGE	CA	91324	5467	19	06037	34.22075552	-118.5373395	Los Angeles County
108441	Fee-for-Service	1891726741	1891726741	1	1	BALDEON, GERMAN E MD	1/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40518	01	General Practice	0	In state provider	None	700 W 6TH ST	STE I	GILROY	CA	95020	6014	43	06085	37.00407753	-121.5779365	Santa Clara County
108449	Fee-for-Service	1073861217	1073861217	1	1	BURGESS, BRIAN T PSYD	9/21/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
108467	Fee-for-Service	1629025390	1629025390	1	1	BUDD, SCOTT C MD	6/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52574	40	Pediatrics	0	In state provider	None	425 UNIVERSITY AVE	STE 200	SACRAMENTO	CA	95825	6509	34	06067	38.570067	-121.4177265	Sacramento County
108470	Fee-for-Service	1679626337	1679626337	1	1	BARKER, MAUREEN C LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
108560	Fee-for-Service	1932685062	1932685062	1	1	BRADLEY, THOMAS C R MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
108595	Fee-for-Service	1427351535	1427351535	1	2	BRIAN O'CARROLL, D.P.M., INC	4/11/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1525 E MAIN ST	STE B	SANTA MARIA	CA	93454	4803	42	06083	34.95287831	-120.4100054	Santa Barbara County
108617	Fee-for-Service	1326041195	1326041195	1	1	BLACKWELL, CRAIG L MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52516	18	Ophthalmology	0	In state provider	None	1667 DOMINICAN WAY	STE 130	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
108634	Fee-for-Service	1235557471	1235557471	1	1	BUCHMAN, SARAH E MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135039	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
108663	Fee-for-Service	1316177462	1316177462	1	1	BUI, PHONG H MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101682	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4799	12	06023	40.78355148	-124.1420294	Humboldt County
108682	Fee-for-Service	1093084188	1093084188	1	1	BISHOP, MICHAEL C	11/13/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
108719	Fee-for-Service	1487266730	1487266730	1	1	BRAVO HOSPICE AND PALLIATIVE	6/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	18531 ROSCOE BLVD	STE 204	NORTHRIDGE	CA	91324	5467	19	06037	34.22075552	-118.5373395	Los Angeles County
108727	Fee-for-Service	1013997295	1013997295	1	1	BAUMGARTNER, MARYANNE E CRNA	9/2/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	286 EUCLID AVENUE	STE 109	SAN DIEGO	CA	92114	3611	37	06073	32.70706919	-117.0850896	San Diego County
108765	Fee-for-Service	1477603413	1477603413	1	1	BORGMAN, ANNE E MD	6/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62092	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
108771	Fee-for-Service	1104001965	1104001965	1	1	BRAY, ERIKA J OD	11/3/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 COFFEE RD	None	MODESTO	CA	95355	1161	50	06099	37.69158077	-120.9761536	Stanislaus County
108772	Fee-for-Service	1528123254	1528123254	1	1	BRADFORD, DANIEL J MD	4/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60671	08	Family Practice	0	In state provider	None	5957 W RAMSEY	None	BANNING	CA	92220	3058	33	06065	33.92937645	-116.942463	Riverside County
108775	Fee-for-Service	1215209846	1215209846	1	1	BADRAN, NAWAL MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119387	41	Internal Medicine	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
108797	Fee-for-Service	1225698624	1225698624	1	1	BADESHA, NAVPREET	11/21/2023	390200000X	NA	Other	026	PHYSICIANS	178063	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
108803	Fee-for-Service	1134492895	1134492895	1	1	BAKHTARY, MARIAM	4/11/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	119180	None	None	0	In state provider	SE MEDICAL GROUP	7230 MEDICAL CENTER DR	SUITE 203	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
108809	Fee-for-Service	1447325279	1447325279	2	1	BEST CARE HOME I INC	12/27/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6555 CALIFORNIA AVE	None	LONG BEACH	CA	90805	3515	19	06037	33.87378717	-118.1811344	Los Angeles County
108814	Fee-for-Service	1174986079	1174986079	1	1	BHIMANI, AZRA MD	4/19/2019	207R00000X	NA	Other	026	PHYSICIANS	154024	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
108820	Fee-for-Service	1306824958	1306824958	1	1	BRENDA STEWART	7/14/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	97 SHERMAN DR	None	ST JOHNSBURY	VT	05819	9280	00	None	44.44642181	-72.011799	Caledonia County
108828	Fee-for-Service	1235524380	1235524380	1	1	BERENDZEN, KRISTEN M MD	10/3/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144945	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
108836	Fee-for-Service	1922623875	1922623875	1	1	BEENE, VICTORIA D AU	10/5/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
108839	Fee-for-Service	1487846531	1487846531	1	1	BURNS, WINIFRED MD	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
108851	Fee-for-Service	1841829868	1841829868	1	1	BAUMAN, JONATHAN MD	8/10/2023	207P00000X	NA	Other	026	PHYSICIANS	187415	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
108895	Fee-for-Service	1609151984	1609151984	1	1	BOTTA, DIANNE M PT	8/19/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
108899	Fee-for-Service	1750702486	1750702486	1	1	BERMAN, ELANA S LCSW	11/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
108904	Fee-for-Service	1588989222	1588989222	1	1	BABCOCK, JASON A MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139495	02	General Surgery	0	In state provider	None	2158 JEAN AVE	None	SOUTH LAKE TAHOE	CA	96150	3412	09	06017	38.91508934	-119.9978421	El Dorado County
108921	Fee-for-Service	1396191664	1396191664	1	1	BIEWEN, CARTER	8/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150439	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
108940	Fee-for-Service	1437579851	1437579851	1	1	BAJWA, SAMI MD	10/22/2020	2084N0600X	NA	Neurology	026	PHYSICIANS	152814	13	Neurology (M.D. only)	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
108944	Fee-for-Service	1043491251	1043491251	1	1	BRADDOCK, JENNIFER J CNM	11/27/2017	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
108946	Fee-for-Service	1437594934	1437594934	1	1	BARNETTE, RYAN M MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148838	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
108967	Fee-for-Service	1003983826	1003983826	1	1	BOWMAN, MICHAEL L MD	12/6/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	49324	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
108991	Fee-for-Service	1336226067	1336226067	1	1	BALUYUT, MICHAEL MD	8/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52471	08	Family Practice	0	In state provider	None	1810 FULLERTON AVE	STE 105	CORONA	CA	92881	3109	33	06065	33.85971	-117.5503495	Riverside County
108998	Fee-for-Service	1780737080	1780737080	1	1	BURNS, MEGAN M MD	3/2/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	72797	-	NOT APPLICABLE	0	In state provider	None	300 SUNNY HILLS DRIVE	BLDG 5	SAN ANSELMO	CA	94960	1909	21	06041	37.98269146	-122.5611947	Marin County
109011	Fee-for-Service	1174996839	1174996839	1	1	BLANCHET, NICCOLE M	4/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
109014	Fee-for-Service	1508411497	1508411497	1	1	BORISH, SARAH E PHD	9/5/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	45 CASTRO ST	125	SAN FRANCISCO	CA	94114	1032	38	06075	37.76829732	-122.4357056	San Francisco County
109052	Fee-for-Service	1477603413	1477603413	1	1	BORGMAN, ANNE E MD	6/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62092	68	Hematology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
109058	Fee-for-Service	1356682306	1356682306	1	1	BURPEE, ELENA M NP	8/23/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
109059	Fee-for-Service	1285736843	1285736843	1	1	BORM, BARRY J MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73012	01	General Practice	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
109069	Fee-for-Service	1164591608	1164591608	1	1	BARRY, ROBERT S MD	5/22/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62473	40	Pediatrics	0	In state provider	None	1420 S MILLER ST	STE A	SANTA MARIA	CA	93454	6960	42	06083	34.936479	-120.4315845	Santa Barbara County
109095	Fee-for-Service	1881069169	1881069169	1	1	BARTON, ERICA M	4/29/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
109116	Fee-for-Service	1962457812	1962457812	1	154	BEVERLY RADIOLOGY MEDICAL GR	11/4/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	29798 HAUN RD	SUITE 103	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
109125	Fee-for-Service	1558101329	1558101329	1	1	BURT, CAITLIN D NP	6/5/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
109140	Fee-for-Service	1962574616	1962574616	1	1	BAGGE, LYNN A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67930	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
109157	Fee-for-Service	1851530356	1851530356	1	1	BEDI, KRISTOPHER DO	6/14/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16994	None	None	0	In state provider	None	7202 MILLBROOK	105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
109160	Fee-for-Service	1477627248	1477627248	1	1	BASS, BRENDA G MD	2/28/1980	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35872	40	Pediatrics	0	In state provider	None	9201 W SUNSET BLVD	STE 408	LOS ANGELES	CA	90069	3705	19	06037	34.09054375	-118.392295	Los Angeles County
109163	Fee-for-Service	1104900901	1104900901	1	1	BROWN, CHRISTOPHER R MD	11/6/2000	207RC0200X	NA	Other	026	PHYSICIANS	50990	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2351 CLAY ST	# 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
109199	Fee-for-Service	1225491400	1225491400	1	1	BONG, JUYONG MD	12/26/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170483	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	2491 ALLUVIAL AVE	400	CLOVIS	CA	93611	9587	10	06019	36.84477477	-119.6688867	Fresno County
109216	Fee-for-Service	1588924641	1588924641	1	1	BARES, ALANNA D MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128746	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
109219	Fee-for-Service	1558858092	1558858092	1	1	BEACH, RICHARD MD	12/20/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
109235	Fee-for-Service	1659539658	1659539658	1	1	BIRD, ANNE F MD	4/10/2017	2084P0804X	NA	Psychiatry	026	PHYSICIANS	140988	26	Psychiatry (child)	0	In state provider	None	220 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7538293	-117.1654892	San Diego County
109240	Fee-for-Service	1669919791	1669919791	1	1	BADRI INC	3/8/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5913 NILES STREET	SUITE 2	BAKERSFIELD	CA	93306	7407	15	06029	35.37594032	-118.938309	Kern County
109241	Fee-for-Service	1477766855	1477766855	1	1	BOWMAN, RYAN J MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101433	34	Urology and Urological Surgery	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
109247	Fee-for-Service	1760441695	1760441695	1	1	BROWN, CURTIS W MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
109249	Fee-for-Service	1134532039	1134532039	1	1	BESHARAT, AMIR MD DO	8/5/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	18356	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000A	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
109281	Fee-for-Service	1396751194	1396751194	1	1	BASTANMEHR, HIVA MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	94234	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
109285	Fee-for-Service	1124472311	1124472311	1	1	BORJON, AGUSTIN MD	10/7/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
109306	Fee-for-Service	1578827242	1578827242	1	1	BARVALIA, UMANG M MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155825	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
109331	Fee-for-Service	1407059702	1407059702	1	1	BRUNO, TODD MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119652	45	Nephrology (Renal-Kidney)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
109332	Fee-for-Service	1992812358	1992812358	1	1	BLESSING-MOORE, JOANN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26617	40	Pediatrics	0	In state provider	None	780 WELCH RD	STE 204	PALO ALTO	CA	94304	1518	43	06085	37.43725729	-122.1765276	Santa Clara County
109348	Fee-for-Service	1285736843	1285736843	1	1	BORM, BARRY J MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73012	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
109367	Fee-for-Service	1467017764	1467017764	1	1	BOUD, ROBERT S DO	8/1/2023	207L00000X	NA	Other	026	PHYSICIANS	20819	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	8580	30	06059	33.56008604	-117.6657795	Orange County
109390	Fee-for-Service	1528023348	1528023348	1	1	BERRY, ANNA B MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92151	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
109408	Fee-for-Service	1902960388	1902960388	1	1	BALETTE, LILY C MD	2/28/2007	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	76470	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1141 WEST REDONDO BEACH	BLVD STE 211	GARDENA	CA	90247	3584	19	06037	33.89247036	-118.2941482	Los Angeles County
109420	Fee-for-Service	1598758062	1598758062	1	1	BAGDASARIAN, BORIS DO	8/1/1993	207RX0202X	NA	Oncology	026	PHYSICIANS	6598	68	Hematology	0	In state provider	None	1505 WILSON TER	STE 370	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
109421	Fee-for-Service	1962457812	1962457812	1	99	BEVERLY RADIOLOGY MEDICAL GR	6/8/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	2680 SATURN AVE	STE 100	HUNTINGTON PARK	CA	90255	4571	19	06037	33.9768845	-118.222884	Los Angeles County
109425	Fee-for-Service	1538215439	1538215439	1	1	BURATTI, DAWN R DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10515 BALBOA BLVD	STE 375	GRANADA HILLS	CA	91344	6369	19	06037	34.261497	-118.502318	Los Angeles County
109455	Fee-for-Service	1932332319	1932332319	1	1	BRODSKY, JENNIE E MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147878	30	Radiology	0	In state provider	None	5363 BALBOA BLVD	STE 100	ENCINO	CA	91316	2802	19	06037	34.169058	-118.5011265	Los Angeles County
109459	Fee-for-Service	1962459982	1962459982	1	1	BOTHWELL, MARCELLA R MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87904	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
109461	Fee-for-Service	1932314937	1932314937	1	1	BELIZ, EFRAIN A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16055 VENTURA BLVD	STE 545	ENCINO	CA	91436	2609	19	06037	34.15632563	-118.4832351	Los Angeles County
109473	Fee-for-Service	1447733134	1447733134	1	1	BAKER, JONATHAN H LMFT	10/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
109485	Fee-for-Service	1497758213	1497758213	1	1	BOSE, SHIKHA MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65748	22	Pathology (M.D. only)	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
109486	Fee-for-Service	1225491400	1225491400	1	1	BONG, JUYONG MD	12/26/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170483	36	Psychiatry	0	In state provider	None	2491 ALLUVIAL AVE	400	CLOVIS	CA	93611	9587	10	06019	36.84477477	-119.6688867	Fresno County
109502	Fee-for-Service	1447909734	1447909734	1	1	BEAM, ELIZABETH MD	10/9/2024	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
109509	Fee-for-Service	1235331828	1235331828	1	1	BRISTOL HOSPICE SAC LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2140 PROFESSIONAL DR	STE 210	ROSEVILLE	CA	95661	3781	31	06061	38.74231476	-121.2482109	Placer County
109546	Fee-for-Service	1477788255	1477788255	1	1	BHANOT, PREETE MD INC	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86518	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18181 BUTTERFIELD BLVD	SUITE 125	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
109558	Fee-for-Service	1689693657	1689693657	1	1	BIDAR, MIZIAR MD	5/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86968	None	None	0	In state provider	None	1360 E HERNDON AVE	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
109578	Fee-for-Service	1629315114	1629315114	1	1	BILTZ, JOHN H CNP	7/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
109582	Fee-for-Service	1346208642	1346208642	1	1	BRAWLEY ENDOSCOPY &	6/19/1995	261QE0800X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGERY MED CENTER	1550 N IMPERIAL AVE	STE 3	EL CENTRO	CA	92243	6304	13	06025	32.80696546	-115.5702795	Imperial County
109593	Fee-for-Service	1578827242	1578827242	1	1	BARVALIA, UMANG M MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155825	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
109594	Fee-for-Service	1366603789	1366603789	1	1	BELLINGER, ADAM S MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123858	34	Urology and Urological Surgery	0	In state provider	None	1789 W YOSEMITE AVENUE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
109596	Fee-for-Service	1538349188	1538349188	1	1	BOLDER, FRANCOISE V	12/26/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
109597	Fee-for-Service	1831271022	1831271022	1	1	BURTON, BRUCE T MD	6/30/1982	207L00000X	NA	Other	026	PHYSICIANS	42650	05	Anesthesiology	0	In state provider	ANAHEIM MEMORIAL	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
109620	Fee-for-Service	1942594486	1942594486	1	1	BEST, CHRISTOPHER D	9/15/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
109645	Fee-for-Service	1942653159	1942653159	1	1	BAHNAM, RAMONA MD	9/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157101	08	Family Practice	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
109674	Fee-for-Service	1316654577	1316654577	1	1	BAIK, SHARON PHD	11/8/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
109677	Fee-for-Service	1528023348	1528023348	1	1	BERRY, ANNA B MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92151	47	Miscellaneous	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
109680	Fee-for-Service	1598912842	1598912842	1	1	BUSSE, JACQUELYN MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111786	40	Pediatrics	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
109692	Fee-for-Service	1902960388	1902960388	1	1	BALETTE, LILY C MD	2/28/2007	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	76470	40	Pediatrics	0	In state provider	None	1141 WEST REDONDO BEACH	BLVD STE 211	GARDENA	CA	90247	3584	19	06037	33.89247036	-118.2941482	Los Angeles County
109707	Fee-for-Service	1598758062	1598758062	1	1	BAGDASARIAN, BORIS DO	8/1/1993	207RX0202X	NA	Oncology	026	PHYSICIANS	6598	78	Neoplastic Diseases/Oncology	0	In state provider	None	1505 WILSON TER	STE 370	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
109729	Fee-for-Service	1821028838	1821028838	1	1	BUSSCHOTS, GINETTE V MD	9/24/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
109733	Fee-for-Service	1043548639	1043548639	1	1	BASEL, NAIM M DO	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10456	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	19845 LAKE CHABOT RD	STE 302	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
109739	Fee-for-Service	1700017316	1700017316	1	1	BARBARISI, HOLLY J LMFT	4/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11100 SAN PABLO AVE	STE 202	EL CERRITO	CA	94530	2100	07	06013	37.91847515	-122.3134603	Contra Costa County
109782	Fee-for-Service	1770549412	1770549412	1	1	BERNARDINO, CARLO R MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54238	18	Ophthalmology	0	In state provider	None	622 ABBOTT STREET	None	SALINAS	CA	93901	4315	27	06053	36.66170619	-121.6412319	Monterey County
109790	Fee-for-Service	1730375866	1730375866	1	1	BREED, CHARLES R MD PC	5/26/2015	193400000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2055 E SOUTHERN AVE	STE F	TEMPE	AZ	85282	7507	00	None	33.392547	-111.8978955	Maricopa County
109793	Fee-for-Service	1316371479	1316371479	1	1	BABEL, NATS J PSYD	8/21/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
109796	Fee-for-Service	1235331828	1235331828	1	1	BRISTOL HOSPICE SAC LLC	2/3/2009	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2140 PROFESSIONAL DR	STE 210	ROSEVILLE	CA	95661	3781	31	06061	38.74231476	-121.2482109	Placer County
109850	Fee-for-Service	1871087536	1871087536	1	1	BICKETT-HICKOK, RUTH A	5/23/2022	207L00000X	NA	Other	026	PHYSICIANS	176440	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
109881	Fee-for-Service	1942490925	1942490925	1	1	BURT, GREGORY W MD	6/17/2019	207R00000X	NA	Other	026	PHYSICIANS	55166	41	Internal Medicine	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
109906	Fee-for-Service	1861518011	1861518011	1	1	BOGDANICH, COLLEEN D NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27107 TOURNEY RD	None	SANTA CLARITA	CA	91355	1860	19	06037	34.41607441	-118.5761057	Los Angeles County
109913	Fee-for-Service	1245278027	1245278027	1	1	BOOTH, THOMAS E MD	5/30/1993	207R00000X	NA	Other	026	PHYSICIANS	69034	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
109917	Fee-for-Service	1467710392	1467710392	1	1	BARSEGHYAN, KARINE MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118230	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
109934	Fee-for-Service	1366529026	1366529026	1	1	BHANDARY, PRAMODE MD	11/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87429	30	Radiology	0	In state provider	None	6225 N FRESNO ST	STE 106	FRESNO	CA	93710	5268	10	06019	36.82701573	-119.781425	Fresno County
109960	Fee-for-Service	1295859858	1295859858	1	1	BARASH, YONA MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	31471	02	General Surgery	0	In state provider	None	2 MEDICAL PLAZA DR	STE 110	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
109964	Fee-for-Service	1528023348	1528023348	1	1	BERRY, ANNA B MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92151	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
109973	Fee-for-Service	1013937127	1013937127	1	1	BERMINGHAM, YAMILEE O MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62538	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
109979	Fee-for-Service	1902965734	1902965734	1	1	BECERRIL, KENNETH M	2/28/2019	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	5908 MAGNOLIA AVE	None	RIVERSIDE	CA	92506	1884	33	06065	33.96167634	-117.3912477	Riverside County
109980	Fee-for-Service	1235225376	1235225376	2	1	BELLAH, JACK L MD	11/16/2009	174400000X	NA	Other	026	PHYSICIANS	47828	20	Orthopedic Surgery	0	In state provider	None	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
110185	Fee-for-Service	1053040816	1053040816	1	1	BERKLEY, GINA L NP	11/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
110203	Fee-for-Service	1295272318	1295272318	1	1	BURCH, AMY NP	3/20/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95023149	-	NOT APPLICABLE	0	In state provider	None	3148 MIDWAY DRIVE	SUITE 113	SAN DIEGO	CA	92110	5439	37	06073	32.75039352	-117.208269	San Diego County
110219	Fee-for-Service	1508810730	1508810730	1	1	BAZZANI, MATTHEW J MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83038	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2809 OLIVE HWY	STE 220	OROVILLE	CA	95966	6133	04	06007	39.50386798	-121.5410203	Butte County
110236	Fee-for-Service	1679196034	1679196034	1	1	BLOSSOM CARE INC	12/22/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1500 W SHAW AVE	STE 302	FRESNO	CA	93711	3501	10	06019	36.80845284	-119.8204939	Fresno County
110249	Fee-for-Service	1790710002	1790710002	1	1	BRADY, WILLIAM J MD	12/31/1987	207R00000X	NA	Other	026	PHYSICIANS	62693	41	Internal Medicine	0	In state provider	None	3237 PROFESSIONAL DR	None	AUBURN	CA	95602	2414	31	06061	38.94288181	-121.100867	Placer County
110251	Fee-for-Service	1295859858	1295859858	1	1	BARASH, YONA MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	31471	78	Neoplastic Diseases/Oncology	0	In state provider	None	2 MEDICAL PLAZA DR	STE 110	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
110266	Fee-for-Service	1497790448	1497790448	1	1	BLANCHARD, DEBORAH A. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
110283	Fee-for-Service	1417112699	1417112699	1	1	BAWA, TEJVIR S MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124508	42	Nuclear Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
110285	Fee-for-Service	1457421208	1457421208	1	1	BABIK, JENNIFER M MD	11/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90799	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	STE 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
110288	Fee-for-Service	1699118216	1699118216	1	1	BOCK, RICHARD L	7/29/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47602	-	NOT APPLICABLE	0	In state provider	None	2101 E 1ST ST	None	SANTA ANA	CA	92705	4007	30	06059	33.74575646	-117.836901	Orange County
110294	Fee-for-Service	1962457200	1962457200	1	1	BURG, JOAN M MD	1/26/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	43159	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
110298	Fee-for-Service	1043344435	1043344435	1	1	BIOTHERANOSTICS INC	10/24/2018	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	9640 TOWNE CENTRE DR	SUITE 200	SAN DIEGO	CA	92121	9603	37	06073	32.88370468	-117.2097479	San Diego County
110311	Fee-for-Service	1598759615	1598759615	2	1	BONISKE, CHARLES H MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	46993	83	Rheumatology	0	In state provider	None	5319 W HILLSDALE AVE	None	VISALIA	CA	93291	5118	54	06107	36.329139	-119.3500755	Tulare County
110312	Fee-for-Service	1346363801	1346363801	1	1	BIR, R S MD INC	7/1/2001	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1384 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5313	36	06071	34.12503702	-117.2788577	San Bernardino County
110355	Fee-for-Service	1801004650	1801004650	1	1	BALL, KATHERINE L MD	12/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106522	07	Dermatology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
110410	Fee-for-Service	1144372392	1144372392	1	1	BASILE, TERRY J LMFT	10/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2260 ST GEORGE LN	STE 5	CHICO	CA	95926	1311	04	06007	39.75585755	-121.8462837	Butte County
110417	Fee-for-Service	1891214763	1891214763	1	1	BRANDSMEIER, CHARLES R NP	8/15/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
110479	Fee-for-Service	1538715123	1538715123	1	1	BISHOP, ALLYN M DPM	8/17/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
110503	Fee-for-Service	1356582894	1356582894	1	1	BERNSTEIN, MELISSA S	7/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 WASHINGTON STREET	SUITE 210	SANTA CRUZ	CA	95060	4976	44	06087	36.9664495	-122.0277383	Santa Cruz County
110507	Fee-for-Service	1952920894	1952920894	1	1	BEARD, JESSICA CNP	12/15/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16300 ROSCOE BLVD	STE 1-A	VAN NUYS	CA	91406	1258	19	06037	34.22128033	-118.4884471	Los Angeles County
110511	Fee-for-Service	1700146081	1700146081	1	1	BENEZE, ALAN N MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126644	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
110535	Fee-for-Service	1295859858	1295859858	1	1	BARASH, YONA MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	31471	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2 MEDICAL PLAZA DR	STE 110	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
110557	Fee-for-Service	1366025520	1366025520	1	1	BROOKSIDE CARE CENTER LLC	5/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1221 ROSEMARIE LANE	None	STOCKTON	CA	95207	6703	39	06077	37.98691902	-121.3196763	San Joaquin County
110583	Fee-for-Service	1407820095	1407820095	1	1	BRODIE, HILARY A MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	53000	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
110600	Fee-for-Service	1346363801	1346363801	1	1	BIR, R S MD INC	7/1/2001	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1384 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5313	36	06071	34.12503702	-117.2788577	San Bernardino County
110604	Fee-for-Service	1760561310	1760561310	1	1	BIDDULPH, MICHAEL C. MD	10/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
110624	Fee-for-Service	1518438605	1518438605	1	1	BAINS, SANAMJIT K RCP	12/16/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
110626	Fee-for-Service	1891781415	1891781415	1	1	BANKS, SONJA L PHD	7/3/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
110630	Fee-for-Service	1598288078	1598288078	1	1	BDHV MEDICAL GROUP OF CALIFO	2/25/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CLARA VALLEY	220 MERIDIAN AVE	None	SAN JOSE	CA	95126	2903	43	06085	37.325295	-121.9137735	Santa Clara County
110654	Fee-for-Service	1245340504	1245340504	1	1	BARON, JODY L MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80540	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
110661	Fee-for-Service	1356596092	1356596092	1	1	BASICH, CANDACE M MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101678	41	Internal Medicine	0	In state provider	None	450 E SPRING ST	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
110676	Fee-for-Service	1548233968	1548233968	1	1	BRYANT, DAVID DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3500 W WHEATLAND RD	None	DALLAS	TX	75237	3460	00	None	32.64745255	-96.8764365	Dallas County
110690	Fee-for-Service	1437341773	1437341773	1	1	BURTON-MOTA, JONNIE L MD	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103781	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
110697	Fee-for-Service	1962457812	1962457812	1	118	BEVERLY RADIOLOGY MEDICAL GR	4/24/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3300 W COAST HWY	STE B	NEWPORT BEACH	CA	92663	4025	30	06059	33.62136043	-117.9274297	Orange County
110772	Fee-for-Service	1962881052	1962881052	1	1	BAKSHI, KANWARPAL S MD	10/20/2021	207L00000X	NA	Other	026	PHYSICIANS	169658	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
110806	Fee-for-Service	1003994856	1003994856	1	1	BUSSA, SWAROOPA R MD	5/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81910	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
110807	Fee-for-Service	1932263878	1932263878	1	1	BAUTISTA, ALLEN S	1/1/2002	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13426 EDGEBROOK RD	None	LA MIRADA	CA	90638	3459	19	06037	33.90957452	-117.985527	Los Angeles County
110839	Fee-for-Service	1619025228	1619025228	1	1	BURROWS, CHRISTOPHER R MD	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145159	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
110881	Fee-for-Service	1265510762	1265510762	1	1	BIRNBAUM, RICHARD A MD	7/5/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	82831	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
110886	Fee-for-Service	1356728174	1356728174	1	1	BARAKAT, JOHN F MD	4/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145366	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
110899	Fee-for-Service	1710906995	1710906995	1	2	BAZ ALLERGY ASTHMA & SINUS C	9/1/2023	207KA0200X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	ENTER, IN.	7471 N FRESNO STREET	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
110917	Fee-for-Service	1598288078	1598288078	1	1	BDHV MEDICAL GROUP OF CALIFO	2/25/2019	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	CLARA VALLEY	220 MERIDIAN AVE	None	SAN JOSE	CA	95126	2903	43	06085	37.325295	-121.9137735	Santa Clara County
110921	Fee-for-Service	1275035172	1275035172	1	1	BUSSELL, MICHELE LMFT	7/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
110933	Fee-for-Service	1669544409	1669544409	1	1	BOKSZCZANIN-KNOSALA,	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51352	03	Allergy	0	In state provider	ALEKSANDRA D MD	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
110943	Fee-for-Service	1255360863	1255360863	1	1	BADGER, JAMES T MD	6/21/2000	208600000X	NA	General Surgery	026	PHYSICIANS	58251	02	General Surgery	0	In state provider	None	1101 WELCH RD	STE C9	PALO ALTO	CA	94304	1926	43	06085	37.43506092	-122.1791054	Santa Clara County
110944	Fee-for-Service	1356596092	1356596092	1	1	BASICH, CANDACE M MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101678	08	Family Practice	0	In state provider	None	450 E SPRING ST	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
110950	Fee-for-Service	1558376160	1558376160	2	1	BURNS PRESCRIPTION PHARMACY	4/2/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	866 W LANCASTER BLVD	None	LANCASTER	CA	93534	2342	19	06037	34.69722498	-118.1464724	Los Angeles County
110966	Fee-for-Service	1285131938	1285131938	1	1	BRUNNER, SETH S MD	5/15/2023	208M00000X	NA	Other	026	PHYSICIANS	185584	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
110967	Fee-for-Service	1700094380	1700094380	1	1	BRYCE FERGUSI	10/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
110982	Fee-for-Service	1962457812	1962457812	1	122	BEVERLY RADIOLOGY MEDICAL GR	8/6/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	31775 DE PORTOLA ROAD	SUITE 100	TEMECULA	CA	92592	2742	33	06065	33.48376304	-117.1041938	Riverside County
110998	Fee-for-Service	1184860496	1184860496	1	1	BANIMAHD, FARIED MD	5/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100516	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
111002	Fee-for-Service	1457013146	1457013146	1	1	BAYAN, LIZA NP	1/6/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
111003	Fee-for-Service	1639554678	1639554678	1	1	BARTULIS, SARAH CNM	8/11/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
111008	Fee-for-Service	1053579987	1053579987	1	1	BAUMBACHER, TODD A MD	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109869	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
111059	Fee-for-Service	1174544092	1174544092	1	3	BI-VALLEY MEDICAL CLINIC, IN	1/22/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	310 HARRIS AVE	SUITES A, E, F, G	SACRAMENTO	CA	95838	3247	34	06067	38.638134	-121.458573	Sacramento County
111120	Fee-for-Service	1861521478	1861521478	1	5	BRANDEIS, EMMANUEL MD	3/12/2020	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	38684	None	None	0	In state provider	None	292 S LA CIENEGA BLVD	100	BEVERLY HILLS	CA	90211	3337	19	06037	34.06283371	-118.3761195	Los Angeles County
111127	Fee-for-Service	1235382151	1235382151	1	1	BURNS, NANCY R LMFT	6/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	105 MORRIS ST	STE 196	SEBASTOPOL	CA	95472	3853	49	06097	38.40341539	-122.8191698	Sonoma County
111129	Fee-for-Service	1215375621	1215375621	1	1	BRANDSTETTER, KATHLEYN A MD	11/24/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	162557	04	Otology, Laryngology, Rhinology	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
111154	Fee-for-Service	1013218908	1013218908	1	1	BUSCHMANN, DONALD K MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53776	08	Family Practice	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
111168	Fee-for-Service	1063619013	1063619013	1	1	BODON, LISA M MD	7/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97869	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 N PALM CANYON DR	STE 107	PALM SPRINGS	CA	92262	4418	33	06065	33.838182	-116.546744	Riverside County
111169	Fee-for-Service	1255419149	1255419149	1	1	BOWEN, DAVID R MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84280	30	Radiology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
111172	Fee-for-Service	1952345811	1952345811	1	1	BUTLER, DAVID M MD	4/3/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	44732	02	General Surgery	0	In state provider	None	1301 20TH ST	STE 300	SANTA MONICA	CA	90404	2087	19	06037	34.02976782	-118.4812493	Los Angeles County
111205	Fee-for-Service	1912300906	1912300906	1	1	BOWMAN, JESSICA LCSW	12/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2220 SAINT GEORGE LN	STE 5	CHICO	CA	95926	1307	04	06007	39.7555	-121.8460989	Butte County
111208	Fee-for-Service	1952490807	1952490807	1	1	BRIGGER, MATTHEW T MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55473	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
111209	Fee-for-Service	1194750422	1194750422	1	1	BILDER, ROBERT M PHD	9/29/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
111230	Fee-for-Service	1023426517	1023426517	1	1	BENMOSHE, DANNY MD INC	4/30/2015	2084N0400X	NA	Neurology	026	PHYSICIANS	100249	None	None	0	In state provider	None	9301 WILSHIRE BLVD	STE 512	BEVERLY HILLS	CA	90210	5424	19	06037	34.06707307	-118.3946743	Los Angeles County
111284	Fee-for-Service	1962457812	1962457812	1	161	BEVERLY RADIOLOGY MEDICAL GR	3/11/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ENTER	8301 FLORENCE AVE	SUITE 101	DOWNEY	CA	90240	3936	19	06037	33.95129816	-118.125377	Los Angeles County
111290	Fee-for-Service	1023379997	1023379997	1	1	BERQUIST, ERIC F DO	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13137	08	Family Practice	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
111293	Fee-for-Service	1740289651	1740289651	1	1	BODEGA BAY FIRE PROTCTN	1/1/1986	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DIST P O BOX 6	1405 N HIGHWAY 1	None	BODEGA BAY	CA	94923	9716	49	06097	38.33501352	-123.0487165	Sonoma County
111306	Fee-for-Service	1801245451	1801245451	1	1	BUYSSE, JANELLE M DO	7/15/2022	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	19750	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
111313	Fee-for-Service	1952620692	1952620692	1	1	BLACKWELL-SCHRAG, DEBRA G LM	9/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	119 FIGUEROA ST STE 5	None	VENTURA	CA	93001	2756	56	06111	34.27916165	-119.2977526	Ventura County
111350	Fee-for-Service	1275538977	1275538977	1	1	BELL, DARL MD	7/17/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
111355	Fee-for-Service	1740262674	1740262674	1	1	BAHRAM, MIRZA MD	1/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53240	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
111375	Fee-for-Service	1952444903	1952444903	1	1	BURNETT, EDITH L LMFT	2/13/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
111402	Fee-for-Service	1013536069	1013536069	1	1	BAKHIT, CAROLINE DO	10/18/2023	207R00000X	NA	Other	026	PHYSICIANS	20894	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
111404	Fee-for-Service	1861855546	1861855546	1	1	BACK, JOSHUA MD	1/5/2018	390200000X	NA	Other	026	PHYSICIANS	152154	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
111410	Fee-for-Service	1811067234	1811067234	1	1	BROWN, MARK A MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81017	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
111440	Fee-for-Service	1477840999	1477840999	1	1	BOWERS, JASMINE A MD INC	11/28/2011	207L00000X	NA	Other	026	PHYSICIANS	42964	05	Anesthesiology	0	In state provider	None	235 N HOOVER ST	None	LOS ANGELES	CA	90004	3627	19	06037	34.07580952	-118.283404	Los Angeles County
111447	Fee-for-Service	1952321960	1952321960	1	1	BRADSHAW, RICHARD R MD	1/19/1988	207L00000X	NA	Other	026	PHYSICIANS	31970	05	Anesthesiology	0	In state provider	EISENHOWER MEM HOSP	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
111454	Fee-for-Service	1720156516	1720156516	1	1	BRANDON MORSHEDI MD	10/4/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
111460	Fee-for-Service	1952345811	1952345811	1	1	BUTLER, DAVID M MD	4/3/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	44732	04	Otology, Laryngology, Rhinology	0	In state provider	None	1301 20TH ST	STE 300	SANTA MONICA	CA	90404	2087	19	06037	34.02976782	-118.4812493	Los Angeles County
111503	Fee-for-Service	1316057078	1316057078	1	1	BEL AIR PHARMACY #522	11/18/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2155 GOLDEN CENTRE LN	None	GOLD RIVER	CA	95670	4477	34	06067	38.625246	-121.2640065	Sacramento County
111520	Fee-for-Service	1598829665	1598829665	1	1	BURGARINO, JOSEPH J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	945 N 12TH ST	None	MILWAUKEE	WI	53233	1305	00	None	43.042428	-87.92718546	Milwaukee County
111534	Fee-for-Service	1831120708	1831120708	1	1	BINGHAM COUNTY AMBULANCE	3/24/2007	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	225 N. ASH STREET	None	BLACKFOOT	ID	83221	0000	00	None	43.19158941	-112.3452799	Bingham County
111545	Fee-for-Service	1114094117	1114094117	1	1	BRYANT, LUTHER J MD	5/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70523	34	Urology and Urological Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
111578	Fee-for-Service	1225083876	1225083876	1	1	BARADAR-BOKAIE, BABAK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85378	41	Internal Medicine	0	In state provider	INC	511 E MANCHESTER BLVD	None	INGLEWOOD	CA	90301	1907	19	06037	33.96161457	-118.3478552	Los Angeles County
111603	Fee-for-Service	1235360934	1235360934	1	1	BUDJAK, RICARDO D MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124923	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
111607	Fee-for-Service	1396714663	1396714663	1	1	BETHESDA HOSPITAL INC	9/13/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10500 MONTGOMERY RD	None	CINCINNATI	OH	45242	4402	00	None	39.252267	-84.3413535	Hamilton County
111615	Fee-for-Service	1962457812	1962457812	1	167	BEVERLY RADIOLOGY MEDICAL GR	4/25/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	VALLEY	2950 SYCAMORE DR	SUITE 102	SIMI VALLEY	CA	93065	1232	56	06111	34.28932056	-118.7438673	Ventura County
111659	Fee-for-Service	1326095977	1326095977	1	1	BAEK, WILLIAM S MD	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91283	13	Neurology (M.D. only)	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
111677	Fee-for-Service	1821169889	1821169889	1	1	BAUTISTA, JENNIFER S MD	3/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80780	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
111697	Fee-for-Service	1629115357	1629115357	1	1	BRITTELL, ELISABETH H PSYD	2/17/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
111699	Fee-for-Service	1124843529	1124843529	1	1	BRANTLEY, JACOB	1/3/2025	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11750 SORRENTO VALLEY	STE 130	SAN DIEGO	CA	92121	1019	37	06073	32.91461387	-117.2343576	San Diego County
111709	Fee-for-Service	1760422992	1760422992	1	1	BROIDE, DAVID H MD	12/31/1983	207K00000X	NA	Other	026	PHYSICIANS	38964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
111711	Fee-for-Service	1043741911	1043741911	1	1	BASILIUS, JACOB R MD	7/7/2022	208800000X	NA	Other	026	PHYSICIANS	179214	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
111735	Fee-for-Service	1851329049	1851329049	1	1	BLACKBURN, JENNIFER M OD	9/15/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6860 AVENIDA ENCINAS	None	CARLSBAD	CA	92009	3201	37	06073	33.10754269	-117.3146974	San Diego County
111738	Fee-for-Service	1962457812	1962457812	1	113	BEVERLY RADIOLOGY MEDICAL GR	4/23/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ACH	17762 BEACH BLVD	110	HUNTINGTON BEACH	CA	92647	6860	30	06059	33.70404013	-117.9890603	Orange County
111744	Fee-for-Service	1649387457	1649387457	1	1	BEATTY, GEORGE W MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	62080	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	STE 2326	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
111749	Fee-for-Service	1831637198	1831637198	1	1	BUSTILLO, CAMILLE OT	1/15/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	92 ARGONAUT	SUITE 170	ALISO VIEJO	CA	92656	0000	30	06059	33.59217762	-117.7242901	Orange County
111750	Fee-for-Service	1801207006	1801207006	1	1	BARRY, JEFFREY R MD MPH	7/16/2020	207RC0200X	NA	Other	026	PHYSICIANS	149215	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
111775	Fee-for-Service	1942732003	1942732003	1	1	BHATTACHARYYA, SUJANA DO	6/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18657	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
111776	Fee-for-Service	1023288792	1023288792	1	1	BENNETT, WILLIAM L MD	12/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111782	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
111828	Fee-for-Service	1942378518	1942378518	1	1	BARRETTO, KIM L	9/9/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
111852	Fee-for-Service	1023267549	1023267549	1	1	BASU, DANA E PSYD	1/22/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
111854	Fee-for-Service	1619275658	1619275658	1	1	BRANHAM, SARAH M CRNA	4/24/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
111874	Fee-for-Service	1962457812	1962457812	1	136	BEVERLY RADIOLOGY MEDICAL GR	8/30/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CENTER	801 S MAIN ST	SUITE 205	CORONA	CA	92882	3410	33	06065	33.87299458	-117.566728	Riverside County
111885	Fee-for-Service	1013990613	1013990613	1	1	BARAKEH, JOSEPH F DO	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	8002	18	Ophthalmology	0	In state provider	None	1855 SAN MIGUEL DR	STE 28	WALNUT CREEK	CA	94596	5298	07	06013	37.89490348	-122.0529351	Contra Costa County
111896	Fee-for-Service	1396714663	1396714663	1	1	BETHESDA HOSPITAL INC	3/16/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10500 MONTGOMERY RD	None	CINCINNATI	OH	45242	4402	00	None	39.252267	-84.3413535	Hamilton County
111899	Fee-for-Service	1427136217	1427136217	1	1	BAINS, RAVINDER-RAJ S MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79821	20	Orthopedic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
111903	Fee-for-Service	1316376452	1316376452	1	1	BRENNAN, JESSICA A PSYD	4/25/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
111915	Fee-for-Service	1265539498	1265539498	1	1	BAPTIST HEALTHCARE SYSTEM	10/12/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4000 KRESGE WAY	None	LOUISVILLE	KY	40207	4605	00	None	38.23923389	-85.63896565	Jefferson County
111931	Fee-for-Service	1689633257	1689633257	1	1	BOCKSTAHLER, KRISTA G MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	73982	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
111934	Fee-for-Service	1396936738	1396936738	1	1	BAJWA, SARVPREET K DO	6/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10177	None	None	0	In state provider	None	1600 NORTH ROSE AVENUE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
111963	Fee-for-Service	1033489349	1033489349	1	1	BARTLETT, DEBRA L NP	10/27/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111975	Fee-for-Service	1194015313	1194015313	1	1	BANYARD, DEREK A MD	11/9/2020	208600000X	NA	General Surgery	026	PHYSICIANS	124088	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
111978	Fee-for-Service	1649032327	1649032327	1	1	BEAUTIFUL REFLECTIONS MARRIA	4/1/2024	225XM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	GE AND FAMILY THERAPY	18484 US HIGHWAY 18 STE	210	APPLE VALLEY	CA	92307	2319	36	06071	34.53970843	-117.2611301	San Bernardino County
111990	Fee-for-Service	1679725220	1679725220	1	1	BUCKLEY, JACK C MD	7/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98986	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1778	19	06037	34.06373445	-118.443537	Los Angeles County
112014	Fee-for-Service	1215959077	1215959077	1	1	BERMAN, MADHU MD	10/15/2012	207K00000X	NA	Other	026	PHYSICIANS	47762	None	None	0	In state provider	None	29000 S WESTERN AVE	#200	RANCHO PALOS VERD	CA	90275	0890	19	06037	33.75568625	-118.3096715	Los Angeles County
112030	Fee-for-Service	1962457812	1962457812	1	56	BEVERLY RADIOLOGY MEDICAL GR	9/8/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	175 E 9TH ST	None	CORONA	CA	92879	2283	33	06065	33.87219282	-117.5661069	Riverside County
112032	Fee-for-Service	1043293079	1043293079	1	1	BUKKAPATNAM, RADHIKA	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77931	None	None	0	In state provider	NANDUR, MD	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
112070	Fee-for-Service	1407885544	1407885544	1	1	BENKERT, JUDITH A CNM	12/6/2005	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
112093	Fee-for-Service	1932780012	1932780012	1	1	BAINS, YASMIN G DO	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	22455	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
112106	Fee-for-Service	1083051577	1083051577	1	1	BANAPOUR, POOYA MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131966	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
112175	Fee-for-Service	1336170984	1336170984	1	1	BARRY, NANCY N MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	79187	83	Rheumatology	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
112195	Fee-for-Service	1427136217	1427136217	1	1	BAINS, RAVINDER-RAJ S MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79821	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
112202	Fee-for-Service	1265539498	1265539498	1	1	BAPTIST HEALTHCARE SYSTEM	10/12/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4000 KRESGE WAY	None	LOUISVILLE	KY	40207	4605	00	None	38.23923389	-85.63896565	Jefferson County
112205	Fee-for-Service	1538464235	1538464235	1	1	BISHOP, SHARMA L MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121858	None	None	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
112226	Fee-for-Service	1396308524	1396308524	1	1	BEN-ZVY, LEIGH MD	7/1/2022	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	179585	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
112250	Fee-for-Service	1386944767	1386944767	1	1	BASHAM, CLAUDIA LCSW	7/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
112265	Fee-for-Service	1023057122	1023057122	1	1	BUSH, GREGORY W MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68138	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
112290	Fee-for-Service	1194070821	1194070821	1	1	BRYANT A TOTH MD FACS	3/12/2020	208200000X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	2100 WEBSTER ST	SUITE 424	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
112321	Fee-for-Service	1558616326	1558616326	1	1	BALL, BLAIR M DR OD	3/26/2012	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1659 EAST SIXTH STREET	SUITE A	BEAUMONT	CA	92223	5765	33	06065	33.92928054	-116.94987	Riverside County
112323	Fee-for-Service	1457671315	1457671315	1	1	BUTTS, CARMEN G MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121221	01	General Practice	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
112336	Fee-for-Service	1821341892	1821341892	1	1	BAGHERI, SHIRIN MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122568	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
112358	Fee-for-Service	1386879807	1386879807	1	1	BRUM PAVAN, DANIELLE D MD	1/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	106277	40	Pediatrics	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
112383	Fee-for-Service	1003830985	1003830985	1	1	BOWERS, MICHAEL J MD	6/30/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33642	30	Radiology	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
112394	Fee-for-Service	1275831562	1275831562	1	1	BLINDER, JOSHUA J MD	8/16/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174470	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
112413	Fee-for-Service	1962457812	1962457812	1	64	BEVERLY RADIOLOGY MEDICAL GR	9/6/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1695 S SAN JACINTO AVE	SUITE B	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
112440	Fee-for-Service	1255419032	1255419032	1	1	BODNICK, JENNIFER S MD	6/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74849	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
112446	Fee-for-Service	1083721864	1083721864	1	1	BOWERMAN, GREGORY P MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49911	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
112477	Fee-for-Service	1427136217	1427136217	1	1	BAINS, RAVINDER-RAJ S MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79821	08	Family Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
112499	Fee-for-Service	1053305714	1053305714	2	1	BEDI, ASHWANI K MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143371	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3536 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
112501	Fee-for-Service	1801290481	1801290481	1	1	BARR, JAMES CNP	5/1/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	775 E FOOTHILL BLVD	None	POMONA	CA	91767	1223	19	06037	34.1072493	-117.7374988	Los Angeles County
112507	Fee-for-Service	1033440987	1033440987	1	1	BLUE WAVE ANESTHESIA GROUP	3/11/2010	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC A MEDICAL CORP	3350 W BALL RD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
112518	Fee-for-Service	1982719480	1982719480	1	1	BOGGS, JOHN	5/31/1989	207R00000X	NA	Other	026	PHYSICIANS	62692	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
112529	Fee-for-Service	1184772170	1184772170	1	1	BLUM, STEVEN E DO	7/31/1995	207LP3000X	NA	Other	026	PHYSICIANS	4472	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
112562	Fee-for-Service	1063948214	1063948214	1	1	BROWN, MELISSA MD	7/30/2024	207L00000X	NA	Other	026	PHYSICIANS	182289	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
112563	Fee-for-Service	1184343998	1184343998	1	1	BELLWOOD MEDICAL CENTER PHAR	5/18/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MACY	10230 E ARTESIA BLVD	STE 101	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
112587	Fee-for-Service	1922330745	1922330745	1	1	BALL, DANIELLE	5/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
112607	Fee-for-Service	1023046828	1023046828	1	1	BRAY, DARREN D MD	2/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80611	40	Pediatrics	0	In state provider	None	17822 BEACH BLVD	STE 278	HUNTINGTON BEACH	CA	92647	7180	30	06059	33.70331388	-117.9890471	Orange County
112610	Fee-for-Service	1972707966	1972707966	1	1	BENTANCOURT, AMY J LMFT	11/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
112661	Fee-for-Service	1508996141	1508996141	1	1	BONILLA, MARIA L MD	11/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105637	07	Dermatology	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
112662	Fee-for-Service	1073615837	1073615837	1	1	BENSON, DAVID A MD	10/22/2019	207P00000X	NA	Other	026	PHYSICIANS	97132	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
112663	Fee-for-Service	1225448871	1225448871	1	1	BOYER, RACHEL D LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
112682	Fee-for-Service	1003961558	1003961558	1	1	BOUYSSOUNOUSE, BRIDGET M	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
112730	Fee-for-Service	1326146705	1326146705	1	1	BALYTSKY, NATALIA MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83273	05	Anesthesiology	0	In state provider	None	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
112734	Fee-for-Service	1639118334	1639118334	1	1	BUTTERFIELD, KEITH B DC	2/26/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1717 MILL STREET	None	SELMA	CA	93662	3712	10	06019	36.56724916	-119.6095915	Fresno County
112739	Fee-for-Service	1033759428	1033759428	1	1	BARRINGER, LANE CNP	4/9/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
112755	Fee-for-Service	1720428584	1720428584	1	2	BURTON, KIMBERLY A LMFT	5/5/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	116284	-	NOT APPLICABLE	0	In state provider	None	510 EAST MAGNOLIA ST	100	STOCKTON	CA	95202	1812	39	06077	37.96446348	-121.2872245	San Joaquin County
112763	Fee-for-Service	1518544907	1518544907	1	1	BUI, JUSTIN L MD	8/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190206	08	Family Practice	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
112770	Fee-for-Service	1235228636	1235228636	1	1	BLACK, STEVEN E DPM APC	2/5/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	44444 16TH ST W	STE 103	LANCASTER	CA	93534	2840	19	06037	34.6906044	-118.1584844	Los Angeles County
112778	Fee-for-Service	1144648338	1144648338	1	1	BISSIG, DAVID P MD	6/2/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	140344	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
112789	Fee-for-Service	1548200082	1548200082	1	1	BORCHERT, MARK S MD	4/28/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41974	18	Ophthalmology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
112794	Fee-for-Service	1639810997	1639810997	1	1	BHATIA, PARVEEN K NP	8/13/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15425 LOS GATOS BLVD	120	LOS GATOS	CA	95032	2553	43	06085	37.24444696	-121.9589876	Santa Clara County
112862	Fee-for-Service	1528170784	1528170784	1	1	BILLINGS, ANNETTE MD	8/26/2020	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	70024	None	None	0	In state provider	None	959 E WALNUT ST	SUITE 220	PASADENA	CA	91106	5363	19	06037	34.14962102	-118.1305187	Los Angeles County
112882	Fee-for-Service	1285714360	1285714360	1	1	BOSE, SWARAJ MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65554	18	Ophthalmology	0	In state provider	None	2617 E CHAPMAN AVE	STE 301	ORANGE	CA	92869	3234	30	06059	33.7878445	-117.8254845	Orange County
112883	Fee-for-Service	1568863231	1568863231	1	1	BERNEY, BRIDGIT M LCSW	1/8/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
112892	Fee-for-Service	1619718095	1619718095	1	1	BROWN, KRYSTAL LCSW	7/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
112907	Fee-for-Service	1285925222	1285925222	1	1	BUI, MARY L MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129124	07	Dermatology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
112981	Fee-for-Service	1013223379	1013223379	1	1	BARLOW, JULIE NP	7/11/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	181 ANDRIEUX ST	STE 107	SONOMA	CA	95476	6932	49	06097	38.28809911	-122.4613026	Sonoma County
112987	Fee-for-Service	1013981505	1013981505	1	1	BAITY, MATTHEW R PHD	6/17/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
113039	Fee-for-Service	1083924583	1083924583	1	1	BRADFIELD, ERIC NP	7/26/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2901 SILLECT AVE.	201	BAKERSFIELD	CA	93308	6373	15	06029	35.38611256	-119.0393796	Kern County
113043	Fee-for-Service	1053501213	1053501213	1	1	BAUTISTA, ARWINNAH MD PC	9/8/2014	207R00000X	NA	Other	026	PHYSICIANS	51221	41	Internal Medicine	0	In state provider	None	1430 PLAZA BLVD	SUITE E18 & E19A	NATIONAL CITY	CA	91950	3665	37	06073	32.67675068	-117.0913076	San Diego County
113046	Fee-for-Service	1962457812	1962457812	1	165	BEVERLY RADIOLOGY MEDICAL GR	1/17/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1901 OUTLET CENTER DR	SUITE 120	OXNARD	CA	93036	0663	56	06111	34.21965581	-119.1491337	Ventura County
113105	Fee-for-Service	1073586863	1073586863	1	1	BACANI, AMY D LMFT	6/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
113147	Fee-for-Service	1518068857	1518068857	1	1	BAY MEDIC TRANSPORTATION INC	2/12/2018	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	959 DETROIT AVE	None	CONCORD	CA	94518	2501	07	06013	37.95082699	-122.0272663	Contra Costa County
113179	Fee-for-Service	1720357445	1720357445	1	1	BLAUNER, MONICA LCSW	5/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	822 S ROBERTSON BLVD	STE 308	LOS ANGELES	CA	90035	1613	19	06037	34.06196169	-118.3835585	Los Angeles County
113204	Fee-for-Service	1093808933	1093808933	1	2	BURSTEIN MD A PROFESSIONAL	12/26/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53604	40	Pediatrics	0	In state provider	CORPORATION	5901 W OLYMPIC BLVD	#503B	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
113236	Fee-for-Service	1699717322	1699717322	1	1	BRIAN DIENER	1/15/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2401 SOUTHWEST BLVD	None	TULSA	OK	74107	0000	00	None	36.127557	-96.006952	Tulsa County
113244	Fee-for-Service	1356684757	1356684757	1	1	BELMONTE, CHARI D MD	1/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133291	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
113248	Fee-for-Service	1235268988	1235268988	1	1	BROOKS, PATRICIA A LCSW	10/30/2014	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	620 BROADWAY	None	SONOMA	CA	95476	7002	49	06097	38.28948668	-122.4582131	Sonoma County
113255	Fee-for-Service	1487817854	1487817854	1	1	BASSILA, JEAN CLAUDE MD	5/24/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	145965	45	Nephrology (Renal-Kidney)	0	In state provider	None	435 DOYLE PARK DRIVE	None	SANTA ROSA	CA	95405	4515	49	06097	38.442978	-122.6989935	Sonoma County
113287	Fee-for-Service	1285675454	1285675454	1	1	BURKE, JAMES M MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77089	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
113290	Fee-for-Service	1962457812	1962457812	1	53	BEVERLY RADIOLOGY MEDICAL GR	9/3/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	5363 BALBOA BLVD	# 100	ENCINO	CA	91316	2802	19	06037	34.169058	-118.5011265	Los Angeles County
113304	Fee-for-Service	1225143977	1225143977	1	1	BANSAL, VINOD K MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45776	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
113366	Fee-for-Service	1679992242	1679992242	1	1	BIRNBAUM, JEFFREY R MD	6/16/2020	207PP0204X	NA	Other	026	PHYSICIANS	167988	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
113384	Fee-for-Service	1710954946	1710954946	1	1	BILL, MARTA B PA	7/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	20647	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91342	4619	19	06037	34.221609	-118.5360405	Los Angeles County
113481	Fee-for-Service	1205559713	1205559713	1	1	BAY IMAGING CONSULTANTS MEDI	5/30/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CAL GROUP INC	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
113487	Fee-for-Service	1841698479	1841698479	1	1	BAGRAMYAN, ANGELO ANDRE	12/18/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	26923 SAND CANYON RD	None	SANTA CLARITA	CA	91387	3930	19	06037	34.3973137	-118.4153061	Los Angeles County
113503	Fee-for-Service	1427034446	1427034446	1	1	BEGOVIC, VEDKA MD	10/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79535	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
113540	Fee-for-Service	1487817854	1487817854	1	1	BASSILA, JEAN CLAUDE MD	5/24/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	145965	41	Internal Medicine	0	In state provider	None	435 DOYLE PARK DRIVE	None	SANTA ROSA	CA	95405	4515	49	06097	38.442978	-122.6989935	Sonoma County
113566	Fee-for-Service	1821263260	1821263260	1	1	BAIYEE, DANIEL E MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106073	22	Pathology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
113579	Fee-for-Service	1962457812	1962457812	1	159	BEVERLY RADIOLOGY MEDICAL GR	1/14/2025	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	HEIM	408 BEACH BLVD	SUITE 106	ANAHEIM	CA	92804	1853	30	06059	33.82709101	-117.9932293	Orange County
113580	Fee-for-Service	1043489016	1043489016	1	1	BAYWOOD COURT	12/5/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	21966 DOLORES ST	None	CASTRO VALLEY	CA	94546	6959	01	06001	37.68533434	-122.0790081	Alameda County
113585	Fee-for-Service	1104167428	1104167428	1	1	BENCHMARK PULMONARY	3/5/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	ASSOCIATES INC	18330 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.2207147	-118.5329907	Los Angeles County
113587	Fee-for-Service	1821212366	1821212366	1	1	BARRY, PIERS A MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98300	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
113588	Fee-for-Service	1518063510	1518063510	1	1	BAGHDASSARIAN, RUBEN MD	5/31/1985	208800000X	NA	Other	026	PHYSICIANS	38697	34	Urology and Urological Surgery	0	In state provider	None	701 E 28TH ST	STE 310	LONG BEACH	CA	90806	2775	19	06037	33.80803441	-118.1847137	Los Angeles County
113590	Fee-for-Service	1225143977	1225143977	1	1	BANSAL, VINOD K MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45776	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
113610	Fee-for-Service	1285830315	1285830315	1	1	BABAI, DORSA DO	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7523	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
113652	Fee-for-Service	1770535304	1770535304	1	1	BROSKA, PAMELA MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	61351	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
113730	Fee-for-Service	1629080445	1629080445	1	1	BANDY, WILLIAM C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53887	89	Surgery-Traumatic	0	In state provider	None	W 5TH AVE & ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.741948	-121.848921	Butte County
113741	Fee-for-Service	1619055415	1619055415	1	1	BINI, STEFANO A MD	12/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73404	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
113760	Fee-for-Service	1053796722	1053796722	1	1	BOOTMAN, KAELYN M LMFT	7/3/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 EAST AVE	4A	CHICO	CA	95926	1629	04	06007	39.76116577	-121.8188568	Butte County
113764	Fee-for-Service	1437191566	1437191566	1	1	BUSH, WALTER R MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77957	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
113775	Fee-for-Service	1841698479	1841698479	1	1	BAGRAMYAN, ANGELO ANDRE	12/18/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	26923 SAND CANYON RD	None	SANTA CLARITA	CA	91387	3930	19	06037	34.3973137	-118.4153061	Los Angeles County
113781	Fee-for-Service	1427067768	1427067768	1	1	BAYACA, FRANCIS B MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86117	08	Family Practice	0	In state provider	None	30 BRENNAN ST	None	WATSONVILLE	CA	95076	4303	44	06087	36.91346025	-121.7577455	Santa Cruz County
113816	Fee-for-Service	1316040876	1316040876	1	1	BESH, BASIL R MD, INC	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	83582	20	Orthopedic Surgery	0	In state provider	None	3555 BEACON AVE	None	FREMONT	CA	94538	1407	01	06001	37.54931973	-121.9815069	Alameda County
113835	Fee-for-Service	1205137452	1205137452	1	2	BAHMAN LALEZARI,M.D.INC	10/20/2023	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4972 PICO BLVD	201	LOS ANGELES	CA	90019	4200	19	06037	34.04775908	-118.3454539	Los Angeles County
113845	Fee-for-Service	1427293505	1427293505	1	1	BENOIS-GREEN, SHERLYN A	7/20/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
113856	Fee-for-Service	1699746446	1699746446	1	1	BRADLEY, STEPHEN P MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	41489	02	General Surgery	0	In state provider	None	5375 LAKESHORE BLVD	None	LAKEPORT	CA	95453	6123	17	06033	39.10616812	-122.9035389	Lake County
113871	Fee-for-Service	1104167428	1104167428	1	1	BENCHMARK PULMONARY	3/5/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES INC	18330 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.2207147	-118.5329907	Los Angeles County
113872	Fee-for-Service	1962457812	1962457812	1	102	BEVERLY RADIOLOGY MEDICAL GR	2/26/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 111-112	LOS ANGELES	CA	90045	3807	19	06037	33.96022076	-118.3961982	Los Angeles County
113879	Fee-for-Service	1184860496	1184860496	1	2	BANIMAHD, FARIED MD	8/6/2019	207P00000X	NA	Other	086	MEDICAL DIRECTORS	100516	-	NOT APPLICABLE	0	In state provider	None	1533 EAST 4TH STREET	None	SANTA ANA	CA	92701	9300	30	06059	33.74814149	-117.848421	Orange County
113880	Fee-for-Service	1225143977	1225143977	1	1	BANSAL, VINOD K MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45776	01	General Practice	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
113893	Fee-for-Service	1750492856	1750492856	1	1	BLACKWELL, CHARLES D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
113927	Fee-for-Service	1154675015	1154675015	1	1	BOSLEY, JUSTIN C MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129628	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
113940	Fee-for-Service	1770535304	1770535304	1	1	BROSKA, PAMELA MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	61351	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
113958	Fee-for-Service	1447783485	1447783485	1	1	BARSKY, MARIA MD	5/26/2020	208M00000X	NA	Other	026	PHYSICIANS	159536	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
113968	Fee-for-Service	1871087841	1871087841	1	1	BROSNAN RODHOUSE, HEATHER J	8/11/2022	207L00000X	NA	Other	026	PHYSICIANS	178497	None	None	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
113971	Fee-for-Service	1396023685	1396023685	1	1	BAILEY, ROMANA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72224	None	None	0	In state provider	None	3030 CHILDREN WAY	SUITE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
114002	Fee-for-Service	1033297866	1033297866	1	1	BESMAN, ANATOLE J MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89421	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
114008	Fee-for-Service	1750469300	1750469300	1	1	BRAA, HENRY A MD	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55606	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
114037	Fee-for-Service	1497738439	1497738439	1	1	BLAKE, GARY D MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44807	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8010 FROST ST	STE 402	SAN DIEGO	CA	92123	4234	37	06073	32.80026879	-117.1520059	San Diego County
114039	Fee-for-Service	1295708576	1295708576	1	1	BARGER, ANDREW V MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98560	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
114041	Fee-for-Service	1871514703	1871514703	1	1	BOUIT, TROY K MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77408	30	Radiology	0	In state provider	None	1700 S COURT ST	STE A	VISALIA	CA	93277	4931	54	06107	36.315108	-119.2916925	Tulare County
114046	Fee-for-Service	1497897433	1497897433	1	1	BLOCK, THADDEUS S MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76438	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114049	Fee-for-Service	1407196413	1407196413	1	1	BHUTTO RAMIREZ, KHADIJAH H	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
114055	Fee-for-Service	1790856748	1790856748	1	1	BOOY, THOMAS P MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50084	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
114101	Fee-for-Service	1790795342	1790795342	1	1	BARROWS, THOMAS H MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53171	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3800 JANES RD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
114142	Fee-for-Service	1003462441	1003462441	1	1	BOGOPULSKY, LEAH LCSW	4/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
114143	Fee-for-Service	1619036514	1619036514	1	4	BORREGO COMM HLTH FNDTN	12/20/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	69175 RAMON ROAD	STE A	CATHEDRAL CITY	CA	92234	3344	33	06065	33.813621	-116.456193	Riverside County
114144	Fee-for-Service	1972867570	1972867570	1	1	BEVAN, EMILY R MD FACOG	10/10/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
114146	Fee-for-Service	1740296698	1740296698	1	1	BODNAR, MICHAEL G MD	7/27/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	64258	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
114148	Fee-for-Service	1376620666	1376620666	1	1	BENNETT, DANIEL R MD	5/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61192	36	Psychiatry	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
114158	Fee-for-Service	1962457812	1962457812	1	75	BEVERLY RADIOLOGY MEDICAL GR	10/6/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2708 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	19	06037	33.80432955	-118.1594295	Los Angeles County
114162	Fee-for-Service	1053385195	1053385195	1	1	BRUBAKER, LINDA T MD	4/5/2017	2088F0040X	NA	Other	026	PHYSICIANS	87848	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
114168	Fee-for-Service	1962457812	1962457812	1	156	BEVERLY RADIOLOGY MEDICAL GR	1/9/2025	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2900 LOMA VISTA RD	SUITE 101	VENTURA	CA	93003	2907	56	06111	34.27545839	-119.2569382	Ventura County
114172	Fee-for-Service	1598834517	1598834517	1	1	BHATIA, KAWALJEET K	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42050	40	Pediatrics	0	In state provider	None	7888 WREN AVE	STE C 137	GILROY	CA	95020	4965	43	06085	37.010619	-121.5870205	Santa Clara County
114239	Fee-for-Service	1912393273	1912393273	1	1	BAINS, JASMEET K MD	8/30/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	151771	-	NOT APPLICABLE	0	In state provider	None	2000 BAKER STREET	None	BAKERSFIELD	CA	93305	3061	15	06029	35.38964269	-118.9883711	Kern County
114243	Fee-for-Service	1639679822	1639679822	1	1	BOLT, RYAN M NP	3/21/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95008584	-	NOT APPLICABLE	0	In state provider	None	3539 COLLEGE AVE	100,110,115,120,125,130,	SAN DIEGO	CA	92115	7032	37	06073	32.745315	-117.0565311	San Diego County
114257	Fee-for-Service	1063560050	1063560050	1	1	BORDI, SANDRA K CRNA	8/22/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5427	19	06037	34.21980849	-118.4301135	Los Angeles County
114263	Fee-for-Service	1356441869	1356441869	1	1	BATRA, RITU S MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75794	07	Dermatology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
114290	Fee-for-Service	1518972223	1518972223	1	1	BRYNES, RUSSELL K MD	12/31/1994	207ZP0102X	NA	Other	026	PHYSICIANS	26576	22	Pathology (M.D. only)	0	In state provider	DEPT. OF PATHOLOGY	2011 ZONAL AVE	None	LOS ANGELES	CA	90089	0181	19	06037	34.05979479	-118.2053794	Los Angeles County
114409	Fee-for-Service	1811949464	1811949464	1	1	BAUCHER, DAVID W PT	11/13/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
114421	Fee-for-Service	1760979207	1760979207	1	1	BLAKE, WILLIAM R PT	9/10/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
114456	Fee-for-Service	1962457812	1962457812	1	37	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	25455 MEDICAL CENTER DR	#100	MURRIETA	CA	92562	5963	33	06065	33.55689911	-117.1863428	Riverside County
114465	Fee-for-Service	1134468390	1134468390	1	1	BLATOV, RUSTAM A CRNA	2/11/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
114473	Fee-for-Service	1306511589	1306511589	1	1	BERGUM GROUP HOMES INC	4/4/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	HOME	1097 CORONA LANE	None	COSTA MESA	CA	92626	5522	30	06059	33.6754644	-117.9035311	Orange County
114479	Fee-for-Service	1609320423	1609320423	1	1	BUCHANAN, NAOMI S	8/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4609 HIGHWAY 49 S	None	MARIPOSA	CA	95338	9701	22	06043	37.46040251	-119.9443914	Mariposa County
114484	Fee-for-Service	1164458725	1164458725	1	1	BOMMARITO, ANTHONY G MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	73256	05	Anesthesiology	0	In state provider	None	301 N NEWPORT BLVD	None	NEWPORT BEACH	CA	92663	4120	30	06059	33.6242782	-117.9284249	Orange County
114506	Fee-for-Service	1962457812	1962457812	1	140	BEVERLY RADIOLOGY MEDICAL GR	6/19/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	11360 MOUNTAIN VIEW AVE	SUITE C	LOMA LINDA	CA	92354	3861	36	06071	34.04666844	-117.2436991	San Bernardino County
114536	Fee-for-Service	1669558615	1669558615	1	1	BENHAIM, PROSPER MD	8/31/1988	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	65324	01	General Practice	0	In state provider	None	257 CASTRO ST	None	SAN FRANCISCO	CA	94114	1527	38	06075	37.76474225	-122.4353607	San Francisco County
114544	Fee-for-Service	1588820187	1588820187	1	1	BOAS, ZACHARY P MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125953	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
114549	Fee-for-Service	1942263322	1942263322	1	1	BOGHOSSIAN, GERARD H DPM	11/5/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	43839 N 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
114561	Fee-for-Service	1053385146	1053385146	1	1	BIBLE, MONTE DO	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	5565	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
114564	Fee-for-Service	1194953901	1194953901	1	1	BAKHTAR, OMID DO	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13330	41	Internal Medicine	0	In state provider	None	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
114578	Fee-for-Service	1093414591	1093414591	1	1	BRUNNER, LESLIE OT	9/8/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
114579	Fee-for-Service	1356632632	1356632632	1	1	BUDZIK, JONATHAN M MD	12/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124091	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
114595	Fee-for-Service	1659859510	1659859510	1	1	BAGHUMYAN, LIANA CNP	8/5/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2975 NORTH SYCAMORE DR.	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
114600	Fee-for-Service	1770013096	1770013096	1	1	BANG, EUNJU LAC	10/4/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3315 ALMADEN EXPWY	STE 27	SAN JOSE	CA	95118	1557	43	06085	37.27376786	-121.8786796	Santa Clara County
114606	Fee-for-Service	1053537852	1053537852	1	2	BOLY, LAWRENCE RAYMOND MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	48825	41	Internal Medicine	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
114618	Fee-for-Service	1902828619	1902828619	1	1	BERENSON, JEFFREY A MD	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	39574	41	Internal Medicine	0	In state provider	None	45081 LITTLE LAKE ST	None	MENDOCINO	CA	95460	0000	23	06045	39.30723036	-123.8001505	Mendocino County
114622	Fee-for-Service	1225422611	1225422611	1	1	BREEZE OF LIFE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	412 W BROADWAY	STE 202	GLENDALE	CA	91204	1297	19	06037	34.14682413	-118.261622	Los Angeles County
114632	Fee-for-Service	1205137452	1205137452	1	1	BAHMAN LALEZARI,M.D.INC	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51462	None	None	0	In state provider	None	4944 W PICO BLVD	None	LOS ANGELES	CA	90019	4228	19	06037	34.04790155	-118.3443429	Los Angeles County
114638	Fee-for-Service	1013303130	1013303130	1	1	BRICE, JOSHUA MD	10/8/2021	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	147364	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
114667	Fee-for-Service	1245302082	1245302082	1	1	BACKENSTOW, ERIN N MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	79185	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
114671	Fee-for-Service	1619152253	1619152253	1	1	BOYD, YASMINA B DO	2/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7941	08	Family Practice	0	In state provider	None	1294 W 6TH ST	None	SAN PEDRO	CA	90731	2987	19	06037	33.73885348	-118.3056165	Los Angeles County
114681	Fee-for-Service	1295024933	1295024933	1	1	BATARSE, RODOLFO R MD	2/6/2013	207R00000X	NA	Other	026	PHYSICIANS	74778	45	Nephrology (Renal-Kidney)	0	In state provider	MEDICAL CORPORATION	71-511 HIGHWAY 111	STE H	RANCHO MIRAGE	CA	92270	4465	33	06065	33.7750795	-116.4496953	Riverside County
114696	Fee-for-Service	1578543187	1578543187	1	1	BALDWIN, HILLEL Z. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
114713	Fee-for-Service	1306255179	1306255179	1	1	BISHOP, AMBER J LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
114724	Fee-for-Service	1316944697	1316944697	1	1	BODNE, DAVID MD	8/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
114739	Fee-for-Service	1174833909	1174833909	1	1	BASKETT, JAMIE S LCSW	10/2/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
114763	Fee-for-Service	1962457812	1962457812	1	4	BEVERLY RADIOLOGY MEDICAL GR	5/21/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8750 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	2713	19	06037	34.06685846	-118.3829408	Los Angeles County
114764	Fee-for-Service	1093049496	1093049496	1	1	BISHOP, SOMER L PHD	3/4/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
114767	Fee-for-Service	1164041539	1164041539	1	1	BAILLIE, ANNA MD	8/20/2024	207P00000X	NA	Other	026	PHYSICIANS	187253	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
114820	Fee-for-Service	1619267366	1619267366	1	1	BRADLEY, SICILY A MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129501	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
114835	Fee-for-Service	1225340755	1225340755	1	1	BRUNO, DIANA MD	11/21/2016	207VC0200X	NA	Obstetrics & Gynecology	026	PHYSICIANS	119651	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09813032	-118.2901794	Los Angeles County
114867	Fee-for-Service	1356632632	1356632632	1	1	BUDZIK, JONATHAN M MD	12/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124091	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
114880	Fee-for-Service	1962457812	1962457812	1	96	BEVERLY RADIOLOGY MEDICAL GR	6/8/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	17779 VENTURA BLVD	None	ENCINO	CA	91316	3717	19	06037	34.16283238	-118.5199399	Los Angeles County
114890	Fee-for-Service	1902268469	1902268469	1	1	BOYDSTUN, NATASHA V DO	8/21/2023	207P00000X	NA	Other	026	PHYSICIANS	19124	None	None	0	In state provider	None	10670 WEXFORD ST	None	SAN DIEGO	CA	92131	3940	37	06073	32.93893186	-117.0982186	San Diego County
114898	Fee-for-Service	1881772465	1881772465	1	1	BAINS, CHARANJIT S MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83909	41	Internal Medicine	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
114908	Fee-for-Service	1174141550	1174141550	1	1	BALES, ALINE M NP	12/21/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
114910	Fee-for-Service	1225422611	1225422611	1	1	BREEZE OF LIFE INC	5/9/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	412 W BROADWAY	STE 202	GLENDALE	CA	91204	1297	19	06037	34.14682413	-118.261622	Los Angeles County
114922	Fee-for-Service	1558450601	1558450601	1	1	BIODATA MED LABORATORIES	3/17/1998	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	INC	5494 ARROW HWY	None	MONTCLAIR	CA	91763	1604	36	06071	34.09237045	-117.68544	San Bernardino County
114966	Fee-for-Service	1104554294	1104554294	1	1	BROBERG, JANEL LMFT	3/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
114969	Fee-for-Service	1538260583	1538260583	1	1	BERGER, WILLIAM E MD	9/20/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	35918	03	Allergy	0	In state provider	None	101 CITY DRIVE S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
114978	Fee-for-Service	1346280492	1346280492	1	1	BROWN, MARY ALICE	8/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51256	01	General Practice	0	In state provider	None	999 S FAIRMONT AVE	STE 130	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
115016	Fee-for-Service	1700925484	1700925484	1	1	BEHRMAN, VICTORIA A MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78063	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
115025	Fee-for-Service	1063423226	1063423226	1	1	BHATNAGAR, RAJIV S MD	3/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79106	07	Dermatology	0	In state provider	None	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
115035	Fee-for-Service	1912393273	1912393273	1	2	BAINS, JASMEET K MD	10/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151771	08	Family Practice	0	In state provider	None	3838 SAN DIMAS STREET	STE A200	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
115043	Fee-for-Service	1104931575	1104931575	1	1	BURGESS, DARYL DO	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	6246	01	General Practice	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
115045	Fee-for-Service	1801974993	1801974993	1	1	BORQUEZ, MARIA X MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32202	40	Pediatrics	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
115084	Fee-for-Service	1245330331	1245330331	1	1	BOND, BARBARA LYNNE MD	11/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
115090	Fee-for-Service	1255968558	1255968558	1	1	BERNSTEIN, HANNAH M MD	5/18/2023	390200000X	NA	Other	026	PHYSICIANS	180583	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
115098	Fee-for-Service	1750007654	1750007654	1	1	BENSON, MORGAN E NP	3/24/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7130 N SHARON AVE	STE 100	FRESNO	CA	93720	3386	10	06019	36.83983419	-119.7592871	Fresno County
115106	Fee-for-Service	1801233101	1801233101	1	1	BOW, HANSEN C MD	8/26/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	172096	None	None	0	In state provider	None	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
115134	Fee-for-Service	1881424174	1881424174	1	1	BALTZER, ABIGAIL I	10/11/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26501 RANCHO PKWY SOUTH	103	LAKE FOREST	CA	92630	8359	30	06059	33.67429702	-117.6716867	Orange County
115141	Fee-for-Service	1720525595	1720525595	1	1	BRITO, BIANCA LCSW	9/26/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
115157	Fee-for-Service	1356632632	1356632632	1	1	BUDZIK, JONATHAN M MD	12/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124091	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
115166	Fee-for-Service	1083633713	1083633713	2	1	BRIAN JONES MD	11/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	None	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
115173	Fee-for-Service	1679237879	1679237879	1	1	BASCOM, DWIGHT W NP	1/27/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
115195	Fee-for-Service	1730287905	1730287905	1	1	BRAR, MANPREET S MD	11/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101602	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
115219	Fee-for-Service	1982781159	1982781159	1	6	BAART COMMUNITY HEALTHCARE	5/29/2002	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1111 MARKET ST	FL 1	SAN FRANCISCO	CA	94103	1513	38	06075	37.78018987	-122.4128297	San Francisco County
115239	Fee-for-Service	1437305737	1437305737	1	1	BAY IMAGING CONSULTANTS	8/4/2011	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	3100 SUMMIT STREET	None	OAKLAND	CA	94609	4312	01	06001	37.82018974	-122.2643221	Alameda County
115240	Fee-for-Service	1679527857	1679527857	1	1	BUNTEN, DAVID C MD	6/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8066	None	None	0	In state provider	None	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	30	06059	33.67620851	-117.7948348	Orange County
115289	Fee-for-Service	1942662168	1942662168	1	1	BEAZER, ALEX MD	8/3/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	169030	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
115303	Fee-for-Service	1700925484	1700925484	1	1	BEHRMAN, VICTORIA A MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78063	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
115321	Fee-for-Service	1114452687	1114452687	1	1	BHAKTA, KRUPESH A DO	10/17/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
115330	Fee-for-Service	1639317266	1639317266	1	1	BOWENS, KAROL L MD INC	9/1/1999	193400000X	NA	Other	026	PHYSICIANS	54708	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3621 MARTIN L KING JR BL	STE 2	LYNWOOD	CA	90262	5420	19	06037	33.93082719	-118.2024698	Los Angeles County
115345	Fee-for-Service	1962457812	1962457812	1	146	BEVERLY RADIOLOGY MEDICAL GR	4/3/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2080 CENTURY PARK	SUITE 1204	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
115346	Fee-for-Service	1336297142	1336297142	1	1	BUI, MAI THANH MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	36929	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
115352	Fee-for-Service	1285712083	1285712083	1	1	BARRAZA, JAIME MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	37389	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
115353	Fee-for-Service	1104306570	1104306570	1	1	BEDOYAN, ISABEL MD	12/22/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174346	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
115378	Fee-for-Service	1982037271	1982037271	1	1	BERNARDINO, CONALU L MD	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140284	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
115400	Fee-for-Service	1366634826	1366634826	1	1	BELTRAN, LILLIBETH C MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97527	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
115401	Fee-for-Service	1598145302	1598145302	1	1	BRODMANN, KYLE A MD	3/15/2018	207P00000X	NA	Other	026	PHYSICIANS	148674	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
115425	Fee-for-Service	1477510428	1477510428	1	1	BEIZAI, KRISTIN S MD	7/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62658	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
115431	Fee-for-Service	1285744615	1285744615	1	1	BERTRAND, KARI A MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76553	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7880 WREN AVE	STE F163	GILROY	CA	95020	7802	43	06085	37.00983795	-121.5870382	Santa Clara County
115439	Fee-for-Service	1548412315	1548412315	1	1	BALGUMA, JENNIFER A MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101956	08	Family Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
115454	Fee-for-Service	1104073402	1104073402	1	1	BECKER, KENDRA A MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104990	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
115464	Fee-for-Service	1881074748	1881074748	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	1853 LANDER AVE	None	TURLOCK	CA	95380	6240	50	06099	37.47576547	-120.8490932	Stanislaus County
115469	Fee-for-Service	1023053899	1023053899	1	1	BRUNO, GILLIAN MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73851	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
115497	Fee-for-Service	1326127010	1326127010	1	1	BROWN, ARLENE L MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69240	36	Psychiatry	0	In state provider	None	1100 S AKERS ST	None	VISALIA	CA	93277	8311	54	06107	36.320823	-119.3480235	Tulare County
115509	Fee-for-Service	1659734895	1659734895	1	1	BARNARD, ERIC R MD	11/3/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	179175	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
115514	Fee-for-Service	1932147568	1932147568	1	1	BERKELEY PRIMARY CARE	11/1/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL CORPORATION	3000 COLBY ST	STE 304	BERKELEY	CA	94705	2058	01	06001	37.85473248	-122.2575793	Alameda County
115518	Fee-for-Service	1609274505	1609274505	1	1	BAY AREA SURGICAL SPECIALIST	5/28/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SERVICES, LLC	460 N WIGET LN	A	WALNUT CREEK	CA	94598	2408	07	06013	37.92885718	-122.0298397	Contra Costa County
115537	Fee-for-Service	1982889622	1982889622	1	1	BLUMBERG, JEREMY M MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100479	14	Neurological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
115539	Fee-for-Service	1871925222	1871925222	1	1	BOYD, ROSCHELLE R NP	11/15/2019	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
115546	Fee-for-Service	1346342763	1346342763	1	1	BIO-MEDICAL APPS OF CA	7/1/2004	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	FRESENIUS MEDICAL CARE	200 WAKE AVE	None	EL CENTRO	CA	92243	9632	13	06025	32.77119784	-115.5459748	Imperial County
115596	Fee-for-Service	1255361770	1255361770	1	1	BARABE, DAVID N MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80208	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
115607	Fee-for-Service	1487821757	1487821757	1	1	BAMSHAD, BABAK R MD INC	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	81239	34	Urology and Urological Surgery	0	In state provider	None	8635 W 3RD ST	STE 765W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
115609	Fee-for-Service	1215115670	1215115670	1	1	BOSHRA, JULIE MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98562	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
115615	Fee-for-Service	1528357555	1528357555	1	1	BROWN, LORI L PHD	10/17/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3135 BOEING AVENUE	SUITE A2	MCKINLEYVILLE	CA	95519	9373	12	06023	40.96714219	-124.1136378	Humboldt County
115618	Fee-for-Service	1639317266	1639317266	1	1	BOWENS, KAROL L MD INC	9/1/1999	193400000X	NA	Other	026	PHYSICIANS	54708	08	Family Practice	0	In state provider	None	3621 MARTIN L KING JR BL	STE 2	LYNWOOD	CA	90262	5420	19	06037	33.93082719	-118.2024698	Los Angeles County
115622	Fee-for-Service	1215968524	1215968524	1	1	BARRETT, MAUREEN A OT	3/5/2019	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
115624	Fee-for-Service	1639184161	1639184161	1	1	BATEMAN, LISA M MD	8/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73384	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
115631	Fee-for-Service	1689760431	1689760431	1	1	BEAUCHAMP, KRISTINE LMFT	8/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3711 LONG BEACH BLVD	601	LONG BEACH	CA	90807	3315	19	06037	33.824583	-118.1893785	Los Angeles County
115672	Fee-for-Service	1023143427	1023143427	1	1	BAUTISTA, RAYMUNDO S MD APC	5/31/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	52874	45	Nephrology (Renal-Kidney)	0	In state provider	None	118 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3364	19	06037	34.1359527	-117.8664233	Los Angeles County
115673	Fee-for-Service	1447530910	1447530910	1	1	BAKHTIANI, PRIYANKA MD	8/24/2020	2080P0205X	NA	Endocrinology	026	PHYSICIANS	169154	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
115687	Fee-for-Service	1861660482	1861660482	1	1	BOKEN, EMILY E MD	7/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103273	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
115704	Fee-for-Service	1477872919	1477872919	1	3	BEVERLY RADIOLOGY MEDICAL	9/5/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP	800 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	4006	36	06071	34.13592446	-117.269325	San Bernardino County
115738	Fee-for-Service	1912119322	1912119322	1	1	BEMENT, DEBRA K DO	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10376	08	Family Practice	0	In state provider	None	310 SANTA FE DR	None	ENCINITAS	CA	92024	5110	37	06073	33.038406	-117.285354	San Diego County
115759	Fee-for-Service	1053475087	1053475087	1	1	BELL, CHRISTINE R MD	12/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82604	05	Anesthesiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
115803	Fee-for-Service	1932147568	1932147568	1	1	BERKELEY PRIMARY CARE	11/1/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	3000 COLBY ST	STE 304	BERKELEY	CA	94705	2058	01	06001	37.85473248	-122.2575793	Alameda County
115821	Fee-for-Service	1033636766	1033636766	1	1	BABAKHAN, LILIA OD	9/18/2024	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25834 THE OLD RD	None	STEVENSON RANCH	CA	91381	1710	19	06037	34.39045108	-118.5733191	Los Angeles County
115850	Fee-for-Service	1427021690	1427021690	1	1	BRYCE MUNSON	3/4/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1035 116TH AVE NE	None	BELLEVUE	WA	98004	4604	00	None	47.620296	-122.1856955	King County
115869	Fee-for-Service	1487815692	1487815692	1	1	BOAS, FRANZ E MD	5/11/2021	2085R0204X	NA	Other	026	PHYSICIANS	108883	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
115875	Fee-for-Service	1649200619	1649200619	1	1	BARRETT, BARBIE J MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	31518	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
115889	Fee-for-Service	1780440248	1780440248	1	2	BENESSERE MARRIAGE AND FAMIL	9/23/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	Y THERAPY, INC	1158 CIRBY WAY	SUITE B	ROSEVILLE	CA	95661	4478	31	06061	38.72946937	-121.2742038	Placer County
115920	Fee-for-Service	1174543060	1174543060	1	1	BANKS,DIANA D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CITY	UT	84124	0000	00	None	40.68703142	-111.857243	Salt Lake County
115923	Fee-for-Service	1841251659	1841251659	1	1	BUI, TUONG N MD	12/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179191	None	None	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
115960	Fee-for-Service	1023143427	1023143427	1	1	BAUTISTA, RAYMUNDO S MD APC	5/31/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	52874	41	Internal Medicine	0	In state provider	None	118 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3364	19	06037	34.1359527	-117.8664233	Los Angeles County
115963	Fee-for-Service	1699115659	1699115659	1	1	BOHNENBLUST, EVAN R MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133808	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
116006	Fee-for-Service	1730440025	1730440025	1	1	BLAIR, THOMAS E MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126929	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
116027	Fee-for-Service	1205549789	1205549789	1	1	BANAN DARGHAH, AZITA NP	12/17/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6789 N BLACKSTONE AVE	None	FRESNO	CA	93710	3530	10	06019	36.83695148	-119.7904013	Fresno County
116044	Fee-for-Service	1588493795	1588493795	1	1	BARAJAS, NANCY OD	9/24/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6134 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	2923	19	06037	33.98457344	-118.2251414	Los Angeles County
116046	Fee-for-Service	1538579081	1538579081	1	1	BURTCH, ROBERT D LCSW	5/7/2018	251S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5078 BULLION ST	STE 1	MARIPOSA	CA	95338	0000	22	06043	37.48819922	-119.967001	Mariposa County
116058	Fee-for-Service	1770756884	1770756884	1	1	BRANDEL, JOSEPH M MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97614	02	General Surgery	0	In state provider	None	365 LENNON LN	STE 250	WALNUT CREEK	CA	94598	5915	07	06013	37.92784983	-122.0301444	Contra Costa County
116080	Fee-for-Service	1033639661	1033639661	1	1	BENNETT, LAUREL E NP	11/17/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95006782	-	NOT APPLICABLE	0	In state provider	None	1137 HARTNELL AVENUE, 11	SUITES D & E	REDDING	CA	96002	2113	45	06089	40.56375851	-122.3504415	Shasta County
116098	Fee-for-Service	1578780185	1578780185	1	1	BLUE SKY HOME HLTH CARE INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	16501 SHERMAN WAY	SUITE 210	VAN NUYS	CA	91406	2737	19	06037	34.20125005	-118.4927785	Los Angeles County
116135	Fee-for-Service	1144228750	1144228750	1	1	BROWN,ALAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1632 116TH AVE NE	STE C	BELLEVUE	WA	98004	0000	00	None	47.62537356	-122.1856545	King County
116167	Fee-for-Service	1407184047	1407184047	1	1	BHANGOO, SARUPINDER S MD INC	12/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40294	41	Internal Medicine	0	In state provider	None	9508 STOCKDALE HWY	STE 140 A	BAKERSFIELD	CA	93311	3623	15	06029	35.35453237	-119.1086014	Kern County
116214	Fee-for-Service	1457992604	1457992604	1	1	BIOSERENITY USA INC.	9/10/2020	261QS1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	801 CROMWELL PARK DR	SUITE 108	GLEN BURNIE	MD	21061	2539	00	None	39.17642166	-76.64137802	Anne Arundel County
116224	Fee-for-Service	1972755452	1972755452	1	1	BABU, VARSHA MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114038	67	Endocrinology	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
116245	Fee-for-Service	1972716470	1972716470	1	1	BRAKKE, NATHAN R MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108775	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
116284	Fee-for-Service	1972864387	1972864387	1	1	BERGER, ARDIN S DO	7/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16103	05	Anesthesiology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
116306	Fee-for-Service	1942738679	1942738679	1	1	BUCKLEY, NICHOLAS S DO	4/30/2021	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1900 NORFOLK ST	350	SAN MATEO	CA	94403	1171	41	06081	37.55346907	-122.2910192	San Mateo County
116307	Fee-for-Service	1356751572	1356751572	1	1	BERNHISEL, ASHLIE A MD	9/11/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	156353	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
116314	Fee-for-Service	1851590061	1851590061	1	1	BUSSEY, LARA S DO	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13736	30	Radiology	0	In state provider	None	1720 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74490068	-121.8505328	Butte County
116339	Fee-for-Service	1780846709	1780846709	1	1	BREWER, MATTHEW P DO	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11689	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	SUITE 108	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
116340	Fee-for-Service	1184905069	1184905069	1	1	BERQUIST, KARI L PHD	10/20/2011	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
116361	Fee-for-Service	1689780777	1689780777	1	1	BURK, CHARLES R DO	3/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15335	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	450 EAST ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
116379	Fee-for-Service	1639289705	1639289705	1	1	BERARD, WILLIAM M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65401	05	Anesthesiology	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
116386	Fee-for-Service	1942472105	1942472105	1	1	BATISTA, SHARON M MD	5/28/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	136666	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
116392	Fee-for-Service	1962562850	1962562850	1	1	BADIN, FRANK MD	3/24/1992	207R00000X	NA	Other	026	PHYSICIANS	41546	41	Internal Medicine	0	In state provider	None	999 N TUSTIN AVE	STE 103	SANTA ANA	CA	92705	6501	30	06059	33.754167	-117.834191	Orange County
116411	Fee-for-Service	1588319099	1588319099	1	1	BARAGIOLA, TINA L DOULA	5/10/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
116441	Fee-for-Service	1700958535	1700958535	1	1	BAROT, DAKSHA N MD	1/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	50690	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
116449	Fee-for-Service	1679557367	1679557367	1	1	BERGSTROM, RICHARD T MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80467	04	Otology, Laryngology, Rhinology	0	In state provider	None	3305 PLACER ST	STE A	REDDING	CA	96001	2364	45	06089	40.57539992	-122.4150037	Shasta County
116451	Fee-for-Service	1255543260	1255543260	1	1	BOTH-GRAGG, JANEE B LMFT	11/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
116464	Fee-for-Service	1952081697	1952081697	1	1	BETTER MINDSET THERAPY APC L	7/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6038 SOUTH ST	None	LAKEWOOD	CA	90713	1312	19	06037	33.85808157	-118.1140116	Los Angeles County
116473	Fee-for-Service	1174692206	1174692206	1	1	BATES, JAMES E MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73930	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
116500	Fee-for-Service	1962457812	1962457812	1	34	BEVERLY RADIOLOGY MEDICAL GR	7/31/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	44725 10TH ST WEST	STE 150	LANCASTER	CA	93534	3000	19	06037	34.695693	-118.1480965	Los Angeles County
116510	Fee-for-Service	1972755452	1972755452	1	1	BABU, VARSHA MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114038	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
116522	Fee-for-Service	1891142147	1891142147	1	1	BLOOMING HOME HEALTH CARE	2/1/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	10545 BURBANK BLVD	UNIT 107	NORTH HOLLYWOOD	CA	91601	2247	19	06037	34.1721655	-118.3608315	Los Angeles County
116534	Fee-for-Service	1972716470	1972716470	1	1	BRAKKE, NATHAN R MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108775	40	Pediatrics	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
116561	Fee-for-Service	1508508268	1508508268	1	1	BRANDES, SYDNEY N PT	6/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1855 E COCHRAN STREET	109	SIMI VALLEY	CA	93065	2263	56	06111	34.27906738	-118.7628635	Ventura County
116572	Fee-for-Service	1235412172	1235412172	1	1	BAUMAN, FATHIAH M LMFT	10/10/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	310 PINE AVE STE B	None	GOLETA	CA	93117	3737	42	06083	34.43451781	-119.8266063	Santa Barbara County
116587	Fee-for-Service	1134274350	1134274350	1	1	BADII, CYRUS A MD	3/9/2018	174400000X	NA	Other	026	PHYSICIANS	87894	10	Gastroenterology (M.D. only)	0	In state provider	None	2510 DOUGLAS BLVD	#300	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
116595	Fee-for-Service	1154520583	1154520583	1	1	BHATT, AMI S MD	7/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147817	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116630	Fee-for-Service	1013936475	1013936475	1	1	BACCI, ROBERT PT	6/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5533 W HILLSDALE AVE	SUITE 'A'	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
116659	Fee-for-Service	1083678791	1083678791	1	1	BARTON HEALTHCARE SYSTEM	5/29/1998	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2092 LAKE TAHOE BLVD	STE 500	SOUTH LAKE TAHOE	CA	96150	6429	09	06017	38.91521892	-120.0014062	El Dorado County
116668	Fee-for-Service	1407151384	1407151384	1	1	BROWN, GINA M	6/10/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18700 BEACH BLVD	STE 120	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
116671	Fee-for-Service	1821614140	1821614140	1	1	BUI, JOHN K OD FAAO	11/12/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1013 E CAPITOL EXPY	None	SAN JOSE	CA	95121	2415	43	06085	37.29895883	-121.8236374	Santa Clara County
116678	Fee-for-Service	1821451097	1821451097	1	1	BARRETT, JEFFREY MD	5/22/2019	207P00000X	NA	Other	026	PHYSICIANS	150687	66	Emergency Medicine (Urgent Care)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
116773	Fee-for-Service	1568754869	1568754869	1	1	BURCHETTE, CHARLES P CRNA	7/2/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
116775	Fee-for-Service	1760426647	1760426647	1	1	BELLAMAH, DAVID H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MISSOULA SURGIVAL	500 WEST BROADWAY,	5TH FLR	MISSOULA	MT	59802	0000	00	None	46.874889	-114.000444	Missoula County
116784	Fee-for-Service	1962457812	1962457812	1	142	BEVERLY RADIOLOGY MEDICAL GR	9/28/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6440 SOUTH ST	None	LAKEWOOD	CA	90713	1713	19	06037	33.85826253	-118.107441	Los Angeles County
116791	Fee-for-Service	1962457812	1962457812	1	149	BEVERLY RADIOLOGY MEDICAL GR	10/4/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	OUP	44725 10TH ST	SUITE 140	LANCASTER	CA	93534	3051	19	06037	34.695693	-118.1480965	Los Angeles County
116808	Fee-for-Service	1780889360	1780889360	1	1	BANEZ, MARIA NORMA V MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102576	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
116809	Fee-for-Service	1386646826	1386646826	1	1	BROWN, HEIDI L MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54109	66	Emergency Medicine (Urgent Care)	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
116819	Fee-for-Service	1184814014	1184814014	1	2	BAKOTIC PATHOLOGY ASSOCIATES	8/23/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	6240 SHILOH RD	None	ALPHARETTA	GA	30005	8347	00	None	34.111233	-84.205233	Forsyth County
116823	Fee-for-Service	1720040793	1720040793	1	1	BAKER, WILLIAM F MD	12/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	32298	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9330 STOCKDALE HWY	STE 300	BAKERSFIELD	CA	93311	3615	15	06029	35.35452946	-119.106351	Kern County
116829	Fee-for-Service	1619970845	1619970845	1	1	BIOSCRIP PHARMACY SERVICES	9/25/2006	3336M0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	INC	2795 CHARTER ST	None	COLUMBUS	OH	43228	4607	00	None	40.00987596	-83.13477267	Franklin County
116835	Fee-for-Service	1457389082	1457389082	1	2	BUNNELL, WILLIAM P MD	2/1/2018	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1312 DRAKE RIDGE CREST	None	REDLANDS	CA	92373	6519	36	06071	34.0301866	-117.1916544	San Bernardino County
116843	Fee-for-Service	1003589144	1003589144	1	1	BURNSIDE, KASEY NP	11/26/2024	2080P0207X	NA	Hematology	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
116845	Fee-for-Service	1346456183	1346456183	1	1	BAJNRAUH, ROBERT MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132226	24	Plastic Surgery	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
116860	Fee-for-Service	1164872636	1164872636	1	1	BLUE JASMINE VILLA	5/1/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	18 SEQUOIA TREE LANE	None	IRVINE	CA	92612	2244	30	06059	33.66427556	-117.8129677	Orange County
116869	Fee-for-Service	1346295888	1346295888	1	1	BARANDICA, ROBERT	6/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60069	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
116883	Fee-for-Service	1154520583	1154520583	1	1	BHATT, AMI S MD	7/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147817	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116895	Fee-for-Service	1962457812	1962457812	1	39	BEVERLY RADIOLOGY MEDICAL GR	8/23/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	28780 SINGLE OAK DR	STE 155	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
116898	Fee-for-Service	1114944782	1114944782	1	1	BUSH, DAVID A MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78860	30	Radiology	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
116901	Fee-for-Service	1740596626	1740596626	1	1	BROWN, CHRIS E LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
116915	Fee-for-Service	1407128580	1407128580	1	1	BARBA, DANIEL MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119351	20	Orthopedic Surgery	0	In state provider	None	355 E GRAND AVE	STE 2	ESCONDIDO	CA	92025	3313	37	06073	33.12354429	-117.0775982	San Diego County
116917	Fee-for-Service	1417929175	1417929175	1	1	BHATNAGAR, PANKAJ K MD	4/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	6850 N DURANGO DR	STE 204	LAS VEGAS	NV	89149	4596	00	None	36.285876	-115.285266	Clark County
116946	Fee-for-Service	1083678791	1083678791	1	1	BARTON HEALTHCARE SYSTEM	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2092 LAKE TAHOE BLVD	STE 500	SOUTH LAKE TAHOE	CA	96150	6429	09	06017	38.91521892	-120.0014062	El Dorado County
116951	Fee-for-Service	1811497084	1811497084	1	1	BURSTON, JOHN L MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
116967	Fee-for-Service	1710911623	1710911623	1	1	BOULTON, HAROLD M MD	4/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111525	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5996	20	06039	36.94519024	-120.0420086	Madera County
116977	Fee-for-Service	1629137336	1629137336	1	1	BOOY, PERDITA CRNA	9/1/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
116992	Fee-for-Service	1093811077	1093811077	1	1	BAE, DAVID K DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	301 W HUNTINGTON DR	STE 300	ARCADIA	CA	91007	1527	19	06037	34.13481053	-118.0425638	Los Angeles County
117038	Fee-for-Service	1336584028	1336584028	2	1	BRUCE, KARI G MD	7/20/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	143346	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
117070	Fee-for-Service	1962457812	1962457812	1	170	BEVERLY RADIOLOGY MEDICAL GR	4/18/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	EVERLY HILLS	8750 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	2703	19	06037	34.06685846	-118.3829408	Los Angeles County
117081	Fee-for-Service	1962457812	1962457812	1	115	BEVERLY RADIOLOGY MEDICAL GR	4/24/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	23961 CALLE DE LA MAGDAL	STE 243	LAGUNA HILLS	CA	92653	3600	30	06059	33.60999658	-117.7126577	Orange County
117109	Fee-for-Service	1720040793	1720040793	1	1	BAKER, WILLIAM F MD	12/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	32298	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9330 STOCKDALE HWY	STE 300	BAKERSFIELD	CA	93311	3615	15	06029	35.35452946	-119.106351	Kern County
117119	Fee-for-Service	1255826269	1255826269	1	1	BAKER, HOLDEN	12/9/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4206 WOODRUFF AVENUE	None	LAKEWOOD	CA	90713	3143	19	06037	33.834438	-118.116514	Los Angeles County
117142	Fee-for-Service	1053475087	1053475087	1	2	BELL, CHRISTINE R MD	9/22/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	82604	-	NOT APPLICABLE	0	In state provider	None	2100 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	5721	34	06067	38.572722	-121.479849	Sacramento County
117150	Fee-for-Service	1790974277	1790974277	1	1	BENJAMIN, NATALIE B LCSW	5/2/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 ANDERSON RD	None	DAVIS	CA	95616	1210	57	06113	38.56196834	-121.7586125	Yolo County
117152	Fee-for-Service	1689056012	1689056012	1	1	BERRY-MILLETT, RACHEL L MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150794	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
117160	Fee-for-Service	1679771596	1679771596	1	1	BODE, ERIC MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER ST	None	COLORADO SPGS	CO	80909	5533	00	None	38.8388119	-104.7995065	El Paso County
117163	Fee-for-Service	1710140850	1710140850	1	1	BOSE, ROHIT MD	11/6/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	156803	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117186	Fee-for-Service	1114944782	1114944782	1	1	BUSH, DAVID A MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78860	78	Neoplastic Diseases/Oncology	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
117196	Fee-for-Service	1528696671	1528696671	1	1	BORDEN, ALEXIS C DO	8/30/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22744	09	Gynecology (D.O. only)	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
117198	Fee-for-Service	1114134533	1114134533	1	1	BRADLEY, GREER V OT	9/19/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
117201	Fee-for-Service	1790224442	1790224442	1	1	BOYLE, MARISSA K MD	10/26/2018	208600000X	NA	General Surgery	026	PHYSICIANS	146239	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
117202	Fee-for-Service	1306938766	1306938766	1	1	BOXER, LINDA M MD	10/31/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	48865	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
117234	Fee-for-Service	1346723053	1346723053	1	1	BALINT, JEREMY PT	1/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
117245	Fee-for-Service	1043521347	1043521347	1	1	BANDLE, LESLIE LMFT	6/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
117246	Fee-for-Service	1881676534	1881676534	1	1	BERKEY, DIANE CRNA	1/3/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
117252	Fee-for-Service	1033347943	1033347943	1	1	BROOKS, CATHERINE A DO	6/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
117263	Fee-for-Service	1982824181	1982824181	1	1	BEKKER-NEMIROVSKY, ALISA	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94054	41	Internal Medicine	0	In state provider	MD	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
117274	Fee-for-Service	1114920535	1114920535	1	1	BRUCE, HENRY E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	17513	20	Orthopedic Surgery	0	In state provider	None	24411 HEALTH CENTER DR	STE 320	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
117283	Fee-for-Service	1497117964	1497117964	1	1	BROWN, MAUREEN H	1/6/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	24447 ROSEGATE PLACE	None	DIAMOND BAR	CA	91765	1465	19	06037	34.02883752	-117.786582	Los Angeles County
117284	Fee-for-Service	1619062007	1619062007	1	1	BARLEY, WILLIAM P JR MD	5/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	72071	01	General Practice	0	In state provider	None	1000 FOWLER WAY	STE 8	PLACERVILLE	CA	95667	5738	09	06017	38.72679661	-120.7923668	El Dorado County
117291	Fee-for-Service	1770538928	1770538928	1	1	BUMANN, ROBERT R MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
117350	Fee-for-Service	1336281583	1336281583	1	1	BAIJAL, POOJA MD	1/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100792	08	Family Practice	0	In state provider	None	2610 AUGUSTINE DRIVE	None	SANTA CLARA	CA	95054	2900	43	06085	37.38233149	-121.9735799	Santa Clara County
117363	Fee-for-Service	1962457812	1962457812	1	2	BEVERLY RADIOLOGY MEDICAL GR	5/21/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
117373	Fee-for-Service	1386295541	1386295541	1	1	BRANTON, CHIMERE E	3/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1144 COFFEE RD	None	MODESTO	CA	95355	4205	50	06099	37.659627	-120.9756125	Stanislaus County
117386	Fee-for-Service	1235156738	1235156738	2	1	BLUMENSTOCK, EDWARD M MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	22905	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
117393	Fee-for-Service	1992983746	1992983746	1	1	BRYANT, BOBBY J MD	6/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89970	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
117423	Fee-for-Service	1871090324	1871090324	1	1	BHATT, APURVA P MD	10/31/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	174272	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
117447	Fee-for-Service	1861618597	1861618597	1	1	BAWAADAM, HASNAIN S MD	6/1/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168125	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117470	Fee-for-Service	1568133692	1568133692	1	1	BUNKER, JASON OD	11/12/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 E STOWELL RD	None	SANTA MARIA	CA	93454	7001	42	06083	34.93834649	-120.422502	Santa Barbara County
117485	Fee-for-Service	1528696671	1528696671	1	1	BORDEN, ALEXIS C DO	8/30/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22744	15	Obstetrics (D.O. only)	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
117515	Fee-for-Service	1184885758	1184885758	1	1	BROOKS, CRAIG L MD	10/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
117529	Fee-for-Service	1972621290	1972621290	1	1	BREMNER, HEIDI L	6/28/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15446 S WESTERN AVENUE	None	GARDENA	CA	90249	4319	19	06037	33.89042107	-118.3091303	Los Angeles County
117545	Fee-for-Service	1346746930	1346746930	1	1	BANKS-DEAN, LAKAI M MD	6/26/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	167046	-	NOT APPLICABLE	0	In state provider	None	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0928	36	06071	34.1268333	-117.2687417	San Bernardino County
117563	Fee-for-Service	1801953161	1801953161	1	1	BUTLER, REBECCA	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
117565	Fee-for-Service	1346730454	1346730454	1	1	BONANNO, SHAILA A MD	9/25/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	186626	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
117567	Fee-for-Service	1235673062	1235673062	1	1	BAO, LOC CRNA	2/21/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
117568	Fee-for-Service	1497117964	1497117964	1	1	BROWN, MAUREEN H	1/6/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	24447 ROSEGATE PLACE	None	DIAMOND BAR	CA	91765	1465	19	06037	34.02883752	-117.786582	Los Angeles County
117610	Fee-for-Service	1063701670	1063701670	1	1	BESBRIS, JESSICA M S MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124868	13	Neurology (M.D. only)	0	In state provider	None	200 ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.06481928	-118.3836235	Los Angeles County
117640	Fee-for-Service	1700229721	1700229721	1	1	BUDIMAN, ALEX DO	4/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14857	None	None	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
117654	Fee-for-Service	1154491363	1154491363	1	1	BRAY, ROBERT L LCSW	1/1/2000	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5959 MISSION GORGE RD	STE 106	SAN DIEGO	CA	92120	4019	37	06073	32.78281135	-117.0987896	San Diego County
117655	Fee-for-Service	1598712978	1598712978	1	2	BAZEL, MICHAEL MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78177	01	General Practice	0	In state provider	None	4001 FLORENCE AVE	None	BELL	CA	90201	3403	19	06037	33.97124511	-118.1965827	Los Angeles County
117656	Fee-for-Service	1962457812	1962457812	1	135	BEVERLY RADIOLOGY MEDICAL GR	8/12/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	40700 CALIFORNIA OAKS RD	SUITE 103	MURRIETA	CA	92562	5795	33	06065	33.57067363	-117.2045035	Riverside County
117657	Fee-for-Service	1245200336	1245200336	1	1	BOYLE, SHERRY M MD	4/30/1996	207P00000X	NA	Other	026	PHYSICIANS	83235	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
117674	Fee-for-Service	1235156738	1235156738	2	1	BLUMENSTOCK, EDWARD M MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	22905	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
117690	Fee-for-Service	1780692632	1780692632	1	1	BERKELEY EMERG MED GRP	6/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
117705	Fee-for-Service	1154581965	1154581965	1	1	BIEWENGA, ERIC D MD	11/16/2018	208800000X	NA	Other	026	PHYSICIANS	109989	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
117708	Fee-for-Service	1215468459	1215468459	1	1	BOLLER, MARIE J MD	8/30/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158900	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
117754	Fee-for-Service	1780852673	1780852673	1	1	BRAR, RIPUDAMAN S MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	109019	-	NOT APPLICABLE	0	In state provider	None	1515 MARKET AVENUE	None	SAN PABLO	CA	94806	4357	07	06013	37.95843049	-122.3544946	Contra Costa County
117761	Fee-for-Service	1982660080	1982660080	1	1	BENNETT, STACIE C MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74688	01	General Practice	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
117765	Fee-for-Service	1992066955	1992066955	1	1	BERBERIAN, CHRISTOPHER E MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122964	41	Internal Medicine	0	In state provider	None	13562 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.2197697	-118.4282426	Los Angeles County
117782	Fee-for-Service	1598715922	1598715922	1	1	BERGER, DAVID L MD	4/28/1999	207L00000X	NA	Other	026	PHYSICIANS	43541	05	Anesthesiology	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
117820	Fee-for-Service	1396998654	1396998654	1	1	BOST, MEGHAN M E MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7155	00	None	42.32787853	-122.863311	Jackson County
117830	Fee-for-Service	1871520742	1871520742	1	1	BRANDAU, KIM M MD	8/23/1995	208600000X	NA	General Surgery	026	PHYSICIANS	81471	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
117855	Fee-for-Service	1174914147	1174914147	1	1	BAGLEY, JAKE W PT	4/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
117860	Fee-for-Service	1801424692	1801424692	1	1	BROWN, REGINA MD	6/7/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	192382	07	Dermatology	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
117866	Fee-for-Service	1831564350	1831564350	1	1	BAGDASARIAN, ANDREW J PT	5/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7311 GREENHAVEN	200	SACRAMENTO	CA	95831	3572	34	06067	38.492622	-121.5219195	Sacramento County
117873	Fee-for-Service	1992402408	1992402408	1	1	BIENESTAR HUMAN SERVICES INC	8/29/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	180 E MISSION BLVD	None	POMONA	CA	91766	1843	19	06037	34.05510524	-117.7491982	Los Angeles County
117882	Fee-for-Service	1538153713	1538153713	1	1	BRAR, PARDEEP S MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54142	10	Gastroenterology (M.D. only)	0	In state provider	None	1541 FLORIDA AVE	SUITE 200	MODESTO	CA	95350	4423	50	06099	37.666863	-120.9962775	Stanislaus County
117922	Fee-for-Service	1154489433	1154489433	1	1	BIERER, GREGORY B MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77403	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
117944	Fee-for-Service	1598712978	1598712978	1	2	BAZEL, MICHAEL MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78177	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 FLORENCE AVE	None	BELL	CA	90201	3403	19	06037	33.97124511	-118.1965827	Los Angeles County
117981	Fee-for-Service	1962457812	1962457812	1	49	BEVERLY RADIOLOGY MEDICAL GR	7/31/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP	5536 RESEDA BLVD	None	TARZANA	CA	91356	2608	19	06037	34.170507	-118.5359745	Los Angeles County
117999	Fee-for-Service	1578942991	1578942991	1	1	BARTON, MARK MD	7/28/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176937	None	None	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
118000	Fee-for-Service	1285819391	1285819391	1	1	BALASUBRAMANIAN,	12/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	GOVINDAN R MD INC	9300 STOCKDALE HWY	None	BAKERSFIELD	CA	93311	3613	15	06029	35.3545315	-119.1053925	Kern County
118008	Fee-for-Service	1568955250	1568955250	1	1	BARAZON, GIGI	6/29/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10053 EDDYSTONE STREET	None	RIVERSIDE	CA	92503	2821	33	06065	33.92715009	-117.4666836	Riverside County
118010	Fee-for-Service	1629237276	1629237276	1	1	BELLO, JUSTINE A MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116375	01	General Practice	0	In state provider	None	27231 LA PAZ RD	SUITE A	LAGUNA NIGUEL	CA	92677	3627	30	06059	33.56889655	-117.7077443	Orange County
118064	Fee-for-Service	1497847826	1497847826	1	1	BROOKS, MEREDITH R MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101556	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118184	Fee-for-Service	1679690200	1679690200	1	1	BHAT, ANUPAMA S	9/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97133	41	Internal Medicine	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
118244	Fee-for-Service	1144812678	1144812678	1	1	BDSJ HOLDINGS LLC	3/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6400 BRENTWOOD BLVD	None	BRENTWOOD	CA	94513	2190	07	06013	37.96257067	-121.6960925	Contra Costa County
118252	Fee-for-Service	1639541014	1639541014	1	1	BAYEN, NOLAN K MD	6/15/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138558	08	Family Practice	0	In state provider	None	1485 RIVER PARK DR	SUITE 200	SACRAMENTO	CA	95815	4501	34	06067	38.599614	-121.438728	Sacramento County
118258	Fee-for-Service	1508301334	1508301334	1	1	BRINSON, DASHANNA LCSW	4/26/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 W 190TH ST STE	455H	GARDENA	CA	90248	4320	19	06037	33.85835623	-118.2987754	Los Angeles County
118265	Fee-for-Service	1205861465	1205861465	1	1	BLANCHARD, MICHAEL D MD	1/14/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73255	08	Family Practice	0	In state provider	None	969 PLUMAS ST	None	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
118291	Fee-for-Service	1376893156	1376893156	1	1	BELLOTTI, CHRISTINE LP	12/29/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
118296	Fee-for-Service	1568955250	1568955250	1	1	BARAZON, GIGI	6/29/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10053 EDDYSTONE STREET	None	RIVERSIDE	CA	92503	2821	33	06065	33.92715009	-117.4666836	Riverside County
118302	Fee-for-Service	1689910390	1689910390	1	1	BUSSEL, MARINA MD	2/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73015	36	Psychiatry	0	In state provider	None	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	19	06037	33.81888054	-118.182069	Los Angeles County
118307	Fee-for-Service	1093376469	1093376469	1	1	BETZ, ALEXANDER W MD	3/11/2024	207L00000X	NA	Other	026	PHYSICIANS	182449	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3522	48	06095	38.26109552	-122.0470245	Solano County
118342	Fee-for-Service	1992761357	1992761357	1	1	BLINN, JOHN F III MD	8/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	25105	41	Internal Medicine	0	In state provider	None	3132 W MARCH LN	None	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
118347	Fee-for-Service	1922377712	1922377712	1	1	BAINS, SIKANDER MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139339	01	General Practice	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
118358	Fee-for-Service	1699786772	1699786772	1	1	BURTON, JOHN T MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	69524	20	Orthopedic Surgery	0	In state provider	None	5030 BUSINESS CENTER DR	STE 140	FAIRFIELD	CA	94591	6876	48	06095	38.21736891	-122.142579	Solano County
118371	Fee-for-Service	1538930797	1538930797	1	1	BROOKS, AMBER E BIRTH DOULA	10/31/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
118406	Fee-for-Service	1528565181	1528565181	1	1	BRYMAN, JASON A MD	10/3/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	165486	20	Orthopedic Surgery	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
118437	Fee-for-Service	1073631743	1073631743	1	1	BRADLEY, VICTORIA M LMFT	9/25/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21219	-	NOT APPLICABLE	0	In state provider	None	108 W HARRISON AVE	None	VENTURA	CA	93001	1822	56	06111	34.28636101	-119.3010541	Ventura County
118452	Fee-for-Service	1568549517	1568549517	1	1	BUHBE, STACY W PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2991 KALMIA ST	None	SAN DIEGO	CA	92104	5414	37	06073	32.73077048	-117.129753	San Diego County
118471	Fee-for-Service	1912000126	1912000126	1	1	BAJWA, KULBIR K MD	7/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51042	41	Internal Medicine	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
118478	Fee-for-Service	1811999642	1811999642	1	1	BLAINE, JACK C CRNA	11/28/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
118503	Fee-for-Service	1134168040	1134168040	1	1	BRILL, JUDITH E MD	3/13/1989	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	42301	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
118521	Fee-for-Service	1780885046	1780885046	1	1	BINDER, WILLIAM S MD	7/6/2009	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	90238	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
118548	Fee-for-Service	1396293684	1396293684	1	1	BHUTIA, TASHI P PT	9/7/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
118552	Fee-for-Service	1780023226	1780023226	1	1	BUELL, JENNIFER S OD	7/6/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1537 PACIFIC AVE	SUITE 100	SANTA CRUZ	CA	95060	3943	44	06087	36.97596432	-122.0267851	Santa Cruz County
118562	Fee-for-Service	1962457812	1962457812	1	112	BEVERLY RADIOLOGY MEDICAL GR	8/9/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP	2336 SANTA MONICA BLVD	STE 206	SANTA MONICA	CA	90404	2095	19	06037	34.03136627	-118.4766854	Los Angeles County
118566	Fee-for-Service	1790050144	1790050144	1	1	BAGHBAN, ADAM S MD	10/4/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	154273	77	Infectious Disease	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
118579	Fee-for-Service	1598183790	1598183790	1	1	BUI, PEGGY Y MD	6/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141064	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
118587	Fee-for-Service	1396021648	1396021648	1	1	BRYAN, ROY G MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124590	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
118591	Fee-for-Service	1770872574	1770872574	1	1	BAUER, STEPHANIE J DO	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12605	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2755 HERNDON AVENUE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
118602	Fee-for-Service	1154826006	1154826006	1	1	BAJAJ, TUSHAR MD	1/27/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
118620	Fee-for-Service	1356399521	1356399521	1	1	BERNSTEIN, KENNETH E MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88216	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	ROOM 8725	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
118624	Fee-for-Service	1528666013	1528666013	1	1	BALDORADO, AILYN R NP	6/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
118666	Fee-for-Service	1740733187	1740733187	1	1	BERNARD, SHENELL MD	1/4/2024	208M00000X	NA	Other	026	PHYSICIANS	187208	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
118668	Fee-for-Service	1639523772	1639523772	1	1	BIRDI, AMANDIP DO	7/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17672	08	Family Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
118688	Fee-for-Service	1811396153	1811396153	1	1	BREKKE-VELAZQUEZ, SARAH LCS	5/25/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
118723	Fee-for-Service	1962431015	1962431015	1	1	BRINAMEN, CHARLES F PSYD	6/24/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	870 MARKET ST	SUITE 753	SAN FRANCISCO	CA	94102	2901	38	06075	37.7848184	-122.4070488	San Francisco County
118746	Fee-for-Service	1164440699	1164440699	1	1	BALOH, ROBERT H MD	2/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55017	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90051	0717	19	06037	34.07671715	-118.3799413	Los Angeles County
118753	Fee-for-Service	1619473667	1619473667	1	1	BURKENROAD, AARON D MD	4/26/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	165303	68	Hematology	0	In state provider	None	700 W 7TH ST	S-270-D	LOS ANGELES	CA	90017	3977	19	06037	34.04833759	-118.2582588	Los Angeles County
118760	Fee-for-Service	1528106721	1528106721	1	2	BAART BEHAVIORAL HEALTH SERV	3/4/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	11682 ATLANTIC AVE	None	LYNWOOD	CA	90262	3832	19	06037	33.91730723	-118.1889829	Los Angeles County
118771	Fee-for-Service	1588870950	1588870950	1	1	BRAUNER,MARK DO	6/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
118782	Fee-for-Service	1730202565	1730202565	1	1	BOATSMAN, ERIN E MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94007	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
118801	Fee-for-Service	1073992608	1073992608	1	1	BRUMM, JOHN D MD	6/7/2019	207L00000X	NA	Other	026	PHYSICIANS	162426	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
118809	Fee-for-Service	1245857150	1245857150	1	1	BYSTRYNSKI, JONATHAN PHD	1/23/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
118819	Fee-for-Service	1306415542	1306415542	1	1	BELTRAN, JENNIFER C CNP	12/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
118845	Fee-for-Service	1083109904	1083109904	1	1	BOUTROS, LOURICE OD	2/10/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3235 E COLORADO BLVD	SUITE 101	PASADENA	CA	91107	3837	19	06037	34.14624852	-118.0838475	Los Angeles County
118849	Fee-for-Service	1962457812	1962457812	1	119	BEVERLY RADIOLOGY MEDICAL GR	4/24/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3828 SCHAUFELE AVD	STE 250	LONG BEACH	CA	90808	0016	19	06037	33.8283	-118.1479725	Los Angeles County
118853	Fee-for-Service	1790050144	1790050144	1	1	BAGHBAN, ADAM S MD	10/4/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	154273	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
118858	Fee-for-Service	1104842541	1104842541	1	1	BASHAM, SHARON L MD	6/1/1998	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	60091	None	None	0	In state provider	None	433 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1310	42	06083	34.44682583	-119.7794619	Santa Barbara County
118859	Fee-for-Service	1821316506	1821316506	1	1	BETTENCOURT-MITCHELL, SANDRA	2/14/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
118864	Fee-for-Service	1093892747	1093892747	1	1	BRENNEMAN, GAYNE M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	41223	05	Anesthesiology	0	In state provider	None	1300 NORTH VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
118868	Fee-for-Service	1245478254	1245478254	1	1	BENEDICT, SEAN M MFT	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36505	-	NOT APPLICABLE	0	In state provider	None	1820 J STREET	None	SACRAMENTO	CA	95811	3010	34	06067	38.57688	-121.4816625	Sacramento County
118881	Fee-for-Service	1740357698	1740357698	1	1	BALFOUR & SHAPIRO ODS	1/1/1991	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 S BROADWAY	None	LOS ANGELES	CA	90013	2301	19	06037	34.04692027	-118.2517853	Los Angeles County
118885	Fee-for-Service	1033233457	1033233457	1	1	BUNTIC, JAZMIN C LMFT	1/13/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	40045	-	NOT APPLICABLE	0	In state provider	None	2090 EVANS LN	None	SAN JOSE	CA	95125	2072	43	06085	37.29521613	-121.8762569	Santa Clara County
118897	Fee-for-Service	1013396068	1013396068	1	1	BHANSALI, SHYAM DO	10/23/2019	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	17528	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
118928	Fee-for-Service	1962457812	1962457812	1	86	BEVERLY RADIOLOGY MEDICAL GR	12/1/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	23961 CALLE DE LA MAGDA	STE 130	LAGUNA HILLS	CA	92653	3616	30	06059	33.60999658	-117.7126577	Orange County
118950	Fee-for-Service	1548245921	1548245921	1	1	BERMAN, DAVID H MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	20952	01	General Practice	0	In state provider	None	25 EVERGREEN AVE	None	MILL VALLEY	CA	94941	3356	21	06041	37.89602472	-122.5369359	Marin County
118952	Fee-for-Service	1154892081	1154892081	1	1	BETA HOME HEALTH CARE INC	1/10/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	705 E VIRGINIA WAY	UNIT D	BARSTOW	CA	92311	3955	36	06071	34.88815781	-117.018543	San Bernardino County
118981	Fee-for-Service	1013584457	1013584457	1	1	BENDEBEL, CHELSEA G PT	1/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
118992	Fee-for-Service	1548520455	1548520455	1	1	BLANCO, JENNIFER E MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134934	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
119000	Fee-for-Service	1215265947	1215265947	1	1	BAJWA, AMANDEEP K MD	8/2/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146167	08	Family Practice	0	In state provider	None	550 W RANCH VIEW DR	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
119017	Fee-for-Service	1225053168	1225053168	1	1	BEDI, SARABJIT S MD	8/6/2012	207L00000X	NA	Other	026	PHYSICIANS	94320	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
119081	Fee-for-Service	1811923360	1811923360	1	1	BENEDON, RICHARD S MD	6/30/1983	207P00000X	NA	Other	026	PHYSICIANS	44923	66	Emergency Medicine (Urgent Care)	0	In state provider	None	24451 VIA ESTRADA	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.6055378	-117.7083215	Orange County
119092	Fee-for-Service	1629020615	1629020615	1	1	BLUM, GARY M MD	10/16/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	58816	30	Radiology	0	In state provider	None	345 S A ST	None	OXNARD	CA	93030	5804	56	06111	34.19938431	-119.1786013	Ventura County
119100	Fee-for-Service	1558354852	1558354852	1	1	BARNES, DAVID R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KOOTENAI MEDICAL CENTER	2003 LINCOLN WAY	None	COEUR D ALENE	ID	83814	2611	00	None	47.69465937	-116.7917936	Kootenai County
119102	Fee-for-Service	1255595443	1255595443	1	1	BLUMBERG, SETH MD	2/5/2020	208M00000X	NA	Other	026	PHYSICIANS	112063	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119135	Fee-for-Service	1871585489	1871585489	1	1	BLACK, LEHMAN E III MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64472	None	None	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
119155	Fee-for-Service	1639177934	1639177934	1	1	BRETAN, PETER N MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	46251	66	Emergency Medicine (Urgent Care)	0	In state provider	None	165 ROWLAND WAY	STE 303	NOVATO	CA	94945	5059	21	06041	38.09824386	-122.559872	Marin County
119163	Fee-for-Service	1831626381	1831626381	1	1	BOOKER, SHELBY R DO	7/3/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18789	None	None	0	In state provider	None	1100 TRANCAS ST	STE 209	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
119192	Fee-for-Service	1982781159	1982781159	1	3	BAART COMMUNITY HEALTHCARE	11/15/2001	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1926 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2402	19	06037	34.06588198	-118.2686209	Los Angeles County
119212	Fee-for-Service	1962457812	1962457812	1	32	BEVERLY RADIOLOGY MEDICAL GR	8/20/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	27141 HIDAWAY	STE 103	CANYON COUNTRY	CA	91351	4138	19	06037	34.41483	-118.469039	Los Angeles County
119246	Fee-for-Service	1548285752	1548285752	1	1	BELL, RICHARD K MD	3/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85659	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
119284	Fee-for-Service	1518279884	1518279884	1	1	BUI, DUY Q MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134858	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
119302	Fee-for-Service	1518384635	1518384635	1	1	BOITTIN, NATHALIE MD	9/3/2019	390200000X	NA	Other	026	PHYSICIANS	139627	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
119306	Fee-for-Service	1245200682	1245200682	1	1	BEAGLE, GREGORY L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
119329	Fee-for-Service	1710155452	1710155452	1	1	BOYNTON, BRIAN P MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88884	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
119385	Fee-for-Service	1972554996	1972554996	1	1	BATES, DOUGLAS J MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	64644	30	Radiology	0	In state provider	None	25405 HANCOCK AVE	STE 107	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
119392	Fee-for-Service	1871579011	1871579011	1	1	BRENNEMAN, JANICE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING ASSOCI	10700 E GEDDES AVE, 200	None	ENGLEWOOD	CO	80112	0000	00	None	39.58449488	-104.8639802	Arapahoe County
119394	Fee-for-Service	1194458513	1194458513	1	1	BARAKAT, BARAA OT	9/30/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
119396	Fee-for-Service	1609300649	1609300649	1	1	BRODSKY, MERRICK A MD	5/17/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	178273	07	Dermatology	0	In state provider	None	1300 AVENIDA VISTA HERMO	150	SAN CLEMENTE	CA	92673	6315	30	06059	33.45766933	-117.5920941	Orange County
119442	Fee-for-Service	1639177934	1639177934	1	1	BRETAN, PETER N MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	46251	34	Urology and Urological Surgery	0	In state provider	None	165 ROWLAND WAY	STE 303	NOVATO	CA	94945	5059	21	06041	38.09824386	-122.559872	Marin County
119452	Fee-for-Service	1891727954	1891727954	1	1	BLAIR, JONATHAN B MD	2/28/1988	207P00000X	NA	Other	026	PHYSICIANS	27493	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
119473	Fee-for-Service	1912182312	1912182312	1	1	BRICHLER, BENJAMIN A MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99058	None	None	0	In state provider	None	11795 EDUCATION ST	#201	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
119505	Fee-for-Service	1912603465	1912603465	1	1	BETHESDA SENIOR CARE LLC	11/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8874 NIMBUS WAY	None	ORANGEVALE	CA	95662	4522	34	06067	38.671434	-121.226454	Sacramento County
119557	Fee-for-Service	1386854347	1386854347	1	1	BRISTOL, RUTH E MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98464	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
119565	Fee-for-Service	1487684536	1487684536	1	1	BOUNDS, JEFFREY A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32313	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE 2400	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
119577	Fee-for-Service	1659469229	1659469229	1	1	BENT, DEBORAH L NP	4/23/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4849 VAN NUYS BLVD	SUITE 100	SHERMAN OAKS	CA	91423	4823	19	06037	34.159113	-118.4487465	Los Angeles County
119582	Fee-for-Service	1952504854	1952504854	1	1	BASCH, JANICE E PHD	7/13/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	721 S A STREET	SUITE B	OXNARD	CA	93030	7179	56	06111	34.19452954	-119.1786519	Ventura County
119595	Fee-for-Service	1295846954	1295846954	1	1	BILLINGHAM, PATTY A LMFT	6/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	670 PLACERVILLE DRIVE	2	PLACERVILLE	CA	95667	4200	09	06017	38.73161765	-120.8213885	El Dorado County
119606	Fee-for-Service	1932256153	1932256153	1	1	BARONE, SAMUEL B MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100192	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
119612	Fee-for-Service	1952316812	1952316812	1	1	BAZILE, GERARD MD APMC	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87229	41	Internal Medicine	0	In state provider	None	8525 GIBBS DR	STE 210	SAN DIEGO	CA	92101	1765	37	06073	32.814594	-117.141219	San Diego County
119614	Fee-for-Service	1780435628	1780435628	1	1	BJE ESTERMAN, PC	6/11/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1720 W BALL RD	STE 4C	ANAHEIM	CA	92804	5500	30	06059	33.8178465	-117.9425115	Orange County
119632	Fee-for-Service	1760427439	1760427439	1	2	BRIO HOME HEALTH SERVICE	2/7/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14712 PIPELINE AVENUE	SUITE B	CHINO HILLS	CA	91709	1298	36	06071	33.985728	-117.715258	San Bernardino County
119651	Fee-for-Service	1497166672	1497166672	1	1	BENEVOLENCE INDUSTRIES INC	7/31/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	805 W LA VETA AVE	SUITE 110	ORANGE	CA	92868	3933	30	06059	33.78064152	-117.8606475	Orange County
119659	Fee-for-Service	1003838020	1003838020	1	1	BELL, MAURICE A MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75981	41	Internal Medicine	0	In state provider	None	3816 WOODRUFF AVE	STE 412	LONG BEACH	CA	90808	2146	19	06037	33.828102	-118.1165525	Los Angeles County
119663	Fee-for-Service	1407339781	1407339781	1	1	BBC SENIOR SERVICES &	10/3/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CONSULTING, LLC	4107 LEVENDI LANE	None	SACRAMENTO	CA	95821	2242	34	06067	38.638458	-121.357863	Sacramento County
119671	Fee-for-Service	1487093373	1487093373	1	1	BLUEN, BENJAMIN E MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155129	41	Internal Medicine	0	In state provider	None	8635 W 3RD STREET	SUITE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
119686	Fee-for-Service	1396736633	1396736633	1	1	BUNCKE, GREGORY M MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	49617	24	Plastic Surgery	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
119723	Fee-for-Service	1801039821	1801039821	1	1	BROAD, JENNIFER L MD	1/23/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	113123	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	SUITE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
119748	Fee-for-Service	1710937156	1710937156	1	1	BANTA, BRADY J MD	5/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151246	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
119799	Fee-for-Service	1962457812	1962457812	1	100	BEVERLY RADIOLOGY MEDICAL GR	12/28/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	3900 SHERMAN DR	STE 110	RIVERSIDE	CA	92503	4006	33	06065	33.92756479	-117.4375031	Riverside County
119800	Fee-for-Service	1962457812	1962457812	1	76	BEVERLY RADIOLOGY MEDICAL GR	10/14/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	25775 W MCBEAN PKWY	STE 216	VALENCIA	CA	91355	3703	19	06037	34.40042013	-118.5511416	Los Angeles County
119810	Fee-for-Service	1962457812	1962457812	1	163	BEVERLY RADIOLOGY MEDICAL GR	1/10/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2151 E GONZALES RD	SUITE 101	OXNARD	CA	93036	3712	56	06111	34.21894845	-119.1499425	Ventura County
119812	Fee-for-Service	1841634128	1841634128	1	1	BAHM, SARAH M MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137194	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
119815	Fee-for-Service	1639258247	1639258247	1	2	BENNETT, BARBARA A MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	27785	40	Pediatrics	0	In state provider	None	1625 VAN NESS	None	SAN FRANCISCO	CA	95865	4947	38	06075	37.79086154	-122.4225663	San Francisco County
119825	Fee-for-Service	1972613198	1972613198	2	1	BALACUIT, PETER C MD	3/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33654	01	General Practice	0	In state provider	None	416 S MYRTLE AVE	None	MONROVIA	CA	91016	2812	19	06037	34.14746348	-118.0009385	Los Angeles County
119870	Fee-for-Service	1306191473	1306191473	1	1	BRAR, KARANBIR S MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124869	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
119901	Fee-for-Service	1952316812	1952316812	1	1	BAZILE, GERARD MD APMC	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87229	67	Endocrinology	0	In state provider	None	8525 GIBBS DR	STE 210	SAN DIEGO	CA	92101	1765	37	06073	32.814594	-117.141219	San Diego County
119903	Fee-for-Service	1780435628	1780435628	1	1	BJE ESTERMAN, PC	6/11/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1720 W BALL RD	STE 4C	ANAHEIM	CA	92804	5500	30	06059	33.8178465	-117.9425115	Orange County
119911	Fee-for-Service	1730186032	1730186032	1	1	BHARAT K PATEL M.D.	12/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1680 DIAGONAL RD	None	WORTHINGTON	MN	56187	1008	00	None	43.63245526	-95.61545829	Nobles County
119914	Fee-for-Service	1780214403	1780214403	1	4	BATES, GARY A	6/14/2020	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	9980 LIVE OAK BLVD.	None	LIVE OAK	CA	95953	2334	51	06101	39.2758002	-121.6612272	Sutter County
119931	Fee-for-Service	1497166672	1497166672	1	1	BENEVOLENCE INDUSTRIES INC	7/31/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	805 W LA VETA AVE	SUITE 110	ORANGE	CA	92868	3933	30	06059	33.78064152	-117.8606475	Orange County
119945	Fee-for-Service	1962457812	1962457812	1	123	BEVERLY RADIOLOGY MEDICAL GR	9/17/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	231 W FIR AVE	None	CLOVIS	CA	93611	0220	10	06019	36.83897746	-119.715138	Fresno County
119959	Fee-for-Service	1487093373	1487093373	1	1	BLUEN, BENJAMIN E MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155129	77	Infectious Disease	0	In state provider	None	8635 W 3RD STREET	SUITE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
119972	Fee-for-Service	1396736633	1396736633	1	1	BUNCKE, GREGORY M MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	49617	46	Hand Surgery	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
120002	Fee-for-Service	1477709293	1477709293	1	1	BARASH, ILONA A MD	4/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104921	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
120007	Fee-for-Service	1477592681	1477592681	2	1	BROWN, SCOTT L MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85788	34	Urology and Urological Surgery	0	In state provider	None	8851 CENTER DR	STE 501	LA MESA	CA	91942	3058	37	06073	32.78189749	-117.0075062	San Diego County
120022	Fee-for-Service	1508398124	1508398124	1	1	BRENNER, MARIELLE A MD	9/6/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
120028	Fee-for-Service	1457917668	1457917668	1	1	BEST HOME HEALTH IN	5/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	12501 CHANDLER BLVD	STE 204	VALLEY VILLAGE	CA	91607	1961	19	06037	34.16870346	-118.4056065	Los Angeles County
120035	Fee-for-Service	1821257825	1821257825	1	1	BURR, DOUGLAS C LAC	7/24/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
120057	Fee-for-Service	1750435996	1750435996	1	1	BAMFORD, LAURA P MD	7/8/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169020	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
120067	Fee-for-Service	1710910286	1710910286	1	1	BLANCHE, CARLOS MD	4/8/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	39859	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
120079	Fee-for-Service	1497107825	1497107825	1	1	BHANDOHAL, JANPREET S MD	8/21/2019	207R00000X	NA	Other	026	PHYSICIANS	161187	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
120081	Fee-for-Service	1366693210	1366693210	1	1	BASSEL OBAID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1515 DELAWARE ST	None	LONGVIEW	WA	98632	2360	00	None	46.13070304	-122.9400459	Cowlitz County
120093	Fee-for-Service	1073596573	1073596573	1	1	BELL, TIMOTHY V MD	5/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	85325	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
120098	Fee-for-Service	1962457812	1962457812	1	132	BEVERLY RADIOLOGY MEDICAL GR	7/29/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING NORTHRIDGE	18301 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4104	19	06037	34.22080173	-118.5319911	Los Angeles County
120115	Fee-for-Service	1073796009	1073796009	1	1	BABU, ELIZABETH MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117761	77	Infectious Disease	0	In state provider	None	1910 OUTLET CENTER DR	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
120124	Fee-for-Service	1407181274	1407181274	1	1	BUCKNOR, MATTHEW D MD	10/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111072	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	SANTA CLARA	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara
120178	Fee-for-Service	1760877302	1760877302	1	1	BELL, SHANNON R DO	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
120185	Fee-for-Service	1689663270	1689663270	1	1	BROWN, ROBERT M DO	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7760	66	Emergency Medicine (Urgent Care)	0	In state provider	None	41870 GARSTIN RD	None	BIG BEAR LAKE	CA	92151	6490	36	06071	34.24602097	-116.8885243	San Bernardino County
120191	Fee-for-Service	1780435628	1780435628	1	1	BJE ESTERMAN, PC	6/11/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1720 W BALL RD	STE 4C	ANAHEIM	CA	92804	5500	30	06059	33.8178465	-117.9425115	Orange County
120194	Fee-for-Service	1508398629	1508398629	1	1	BAREISS, ANNA K MD	11/15/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	183685	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
120199	Fee-for-Service	1295271641	1295271641	1	1	BENTON, KATHRYN L LPCC	11/30/2020	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
120212	Fee-for-Service	1962457812	1962457812	1	110	BEVERLY RADIOLOGY MEDICAL GR	7/3/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	801 S MAIN STREET	SUITE 101	CORONA	CA	92882	3410	33	06065	33.87299458	-117.566728	Riverside County
120225	Fee-for-Service	1902856818	1902856818	1	1	BURNS, RICHARD MD INC	1/9/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	45246	18	Ophthalmology	0	In state provider	None	3405 KENYON ST	STE 101	SAN DIEGO	CA	92110	5004	37	06073	32.74866031	-117.2135544	San Diego County
120226	Fee-for-Service	1558414953	1558414953	1	1	BLACKSTONE MEDICAL CORP	3/21/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4500 BROCKTON AVE	STE 305	RIVERSIDE	CA	92501	4027	33	06065	33.97785263	-117.3836152	Riverside County
120228	Fee-for-Service	1598156689	1598156689	1	1	BIANCHI, WILLIAM D DO	1/22/2020	207P00000X	NA	Other	026	PHYSICIANS	17373	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 PROSPECT PL	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
120255	Fee-for-Service	1720428584	1720428584	1	1	BURTON, KIMBERLY A LMFT	1/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1545 ST. MARKS PLAZA	SUITE 5	STOCKTON	CA	95207	6411	39	06077	37.98892524	-121.3254177	San Joaquin County
120294	Fee-for-Service	1477592681	1477592681	2	1	BROWN, SCOTT L MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85788	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8851 CENTER DR	STE 501	LA MESA	CA	91942	3058	37	06073	32.78189749	-117.0075062	San Diego County
120295	Fee-for-Service	1659451573	1659451573	1	1	BUNTIN, CHANTE S MD	10/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76678	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
120304	Fee-for-Service	1912414673	1912414673	1	1	BAYSHORE OPHTHALMIC CARE	1/26/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	162 CLINTON ST	None	REDWOOD CITY	CA	94062	1552	41	06081	37.48582242	-122.2390745	San Mateo County
120334	Fee-for-Service	1942028543	1942028543	1	1	BUENROSTRO, JUSTINA TOLABOR	10/9/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
120353	Fee-for-Service	1457613150	1457613150	1	1	BURK, DAVID R MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145807	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120373	Fee-for-Service	1477926038	1477926038	1	1	BEST LIFE HOME CARE LLC	4/5/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7205 BARANGA DRIVE	None	CITRUS HEIGHTS	CA	95621	3610	34	06067	38.696868	-121.3031295	Sacramento County
120392	Fee-for-Service	1255309555	1255309555	1	1	BRUNBERG, JAMES A MD INC	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	35147	13	Neurology (M.D. only)	0	In state provider	None	3122 N MILLBROOK AVE	STE E	FRESNO	CA	93703	1458	10	06019	36.778896	-119.7634925	Fresno County
120403	Fee-for-Service	1790220879	1790220879	1	1	BENJAMIN, DOMINIQUE CNP	3/11/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4235 PACIFIC COAST HWY	None	TORRANCE	CA	90505	5525	19	06037	33.80817211	-118.3588219	Los Angeles County
120453	Fee-for-Service	1376907113	1376907113	1	1	BASAM, MOTAHAR	3/21/2018	390200000X	NA	Other	026	PHYSICIANS	151154	None	None	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
120459	Fee-for-Service	1225494230	1225494230	1	1	BREITHAUPT, ANDREW G MD	11/3/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	167017	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
120474	Fee-for-Service	1972500700	1972500700	1	1	BAIRD, NANCY R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1701 N SENATE BLVD	None	INDIANAPOLIS	IN	46202	1239	00	None	39.78959047	-86.16551711	Marion County
120477	Fee-for-Service	1780416826	1780416826	1	1	BRANCH, MEREDITH	10/24/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5807 UNIVERSITY AVE	SUITE 6	SAN DIEGO	CA	92115	6295	37	06073	32.74918877	-117.0721384	San Diego County
120497	Fee-for-Service	1962457812	1962457812	1	105	BEVERLY RADIOLOGY MEDICAL GR	8/11/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	222 W EULALIA ST	None	GLENDALE	CA	91204	2849	19	06037	34.12653215	-118.257121	Los Angeles County
120500	Fee-for-Service	1073571113	1073571113	1	1	BARRETT, IVAN R MD	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	24458	30	Radiology	0	In state provider	None	10445 BALBOA BLVD	None	GRANADA HILLS	CA	91344	7323	19	06037	34.259094	-118.5023365	Los Angeles County
120533	Fee-for-Service	1376002683	1376002683	1	1	BOUTROS, NADER MD	9/6/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	180657	13	Neurology (M.D. only)	0	In state provider	None	2190 LYNN RD	SUITE 380	THOUSAND OAKS	CA	91360	1856	56	06111	34.20728091	-118.8855456	Ventura County
120574	Fee-for-Service	1447960745	1447960745	1	1	BARRON, BRANDO O PT	12/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
120597	Fee-for-Service	1215199922	1215199922	1	1	BRIGHT HAVEN HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9631 BUSINESS CENTER DR	SUITE C	RANCHO CUCAMONGA	CA	91730	4545	36	06071	34.09804952	-117.594963	San Bernardino County
120612	Fee-for-Service	1760468565	1760468565	1	1	BLOCK, MICHAEL A MD	6/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	26618	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
120669	Fee-for-Service	1851732622	1851732622	1	1	BASEL, SAYED M MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120406	None	None	0	In state provider	None	460 GREENFIELD AVE	STE 1	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
120688	Fee-for-Service	1942482633	1942482633	1	1	BHANSALI, SEEMA M MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103583	41	Internal Medicine	0	In state provider	None	900 HYDE STREET	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
120698	Fee-for-Service	1174077325	1174077325	1	1	BRIDGE AGENCY, INC	9/12/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	400 S FARRELL DRIVE	SUITE B100	PALM SPRINGS	CA	92262	5961	33	06065	33.81787498	-116.5180068	Riverside County
120708	Fee-for-Service	1174942148	1174942148	1	1	BRUSCA, SAMUEL B MD	6/6/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	168461	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
120721	Fee-for-Service	1760622245	1760622245	1	1	BOYD, EVA K MD	12/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110955	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
120726	Fee-for-Service	1467716530	1467716530	1	1	BAHIA, SURINDER S MD	2/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150215	08	Family Practice	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
120729	Fee-for-Service	1629439245	1629439245	1	1	BARBERO, LUCKY LCSW	7/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	145 EAST LIVE OAK	UNIT # F	ARCADIA	CA	91001	5246	19	06037	34.10813818	-118.0259008	Los Angeles County
120759	Fee-for-Service	1083779367	1083779367	1	1	BUTTONWILLOW UNION SD	12/24/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	42600 HWY 58	None	BUTTONWILLOW	CA	93206	9700	15	06029	35.39934964	-119.4741885	Kern County
120775	Fee-for-Service	1366856403	1366856403	1	1	BRILEY, DENVER R DO	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16159	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
120798	Fee-for-Service	1770994147	1770994147	1	1	BLACKBURN, JAMES LMFT	3/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
120810	Fee-for-Service	1003828948	1003828948	1	1	BECK AND CASEY MDS	6/4/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	BISHOP PEDIATRICS & ALLE	152 PIONEER LN	STE H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
120841	Fee-for-Service	1609154749	1609154749	1	1	BURKI, FARZAUQ MD	2/8/2024	207R00000X	NA	Other	026	PHYSICIANS	139772	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
120866	Fee-for-Service	1235229915	1235229915	1	1	BOACKLE, SUSAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
120872	Fee-for-Service	1982714762	1982714762	1	1	BELL, VERA M PHD	4/30/1995	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3780 KILROY AIRPORT WAY	STE 370	LONG BEACH	CA	90806	2491	19	06037	33.80733529	-118.1450095	Los Angeles County
120886	Fee-for-Service	1215199922	1215199922	1	1	BRIGHT HAVEN HOSPICE CARE	10/12/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9631 BUSINESS CENTER DR	SUITE C	RANCHO CUCAMONGA	CA	91730	4545	36	06071	34.09804952	-117.594963	San Bernardino County
120895	Fee-for-Service	1184791998	1184791998	1	2	BAY AREA COMMUNITY HEALTH	5/4/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
120929	Fee-for-Service	1609271279	1609271279	1	1	BLEU PHYSICAL THERAPY AND PE	5/9/2016	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RFORMANCE PC	1819 W VALLEY BLVD.	UNIT B	ALHAMBRA	CA	91803	2344	19	06037	34.07738758	-118.1436791	Los Angeles County
120931	Fee-for-Service	1548292303	1548292303	1	1	BALAKRISHNAN, A MD INC	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30274	40	Pediatrics	0	In state provider	None	155 N JACKSON AVE	STE 101	SAN JOSE	CA	95116	1925	43	06085	37.3616851	-121.8467236	Santa Clara County
120953	Fee-for-Service	1902127681	1902127681	1	1	BUTLER, TYRA M LMFT	2/8/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	765 N. MAIN STREET	SUITE 120	CORONA	CA	92880	1313	33	06065	33.892072	-117.5636837	Riverside County
120958	Fee-for-Service	1700203346	1700203346	1	1	BEDELL, FORNATI W MD	5/8/2019	208800000X	NA	Other	026	PHYSICIANS	161638	34	Urology and Urological Surgery	0	In state provider	None	23823 VALENCIA BLVD	STE 250	SANTA CLARITA	CA	91355	9512	19	06037	34.41347743	-118.5523087	Los Angeles County
120960	Fee-for-Service	1578130993	1578130993	1	1	BIOLOGICS INC	7/15/2022	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	13501 PARK VISTA BLVD	150	FORT WORTH	TX	76177	3204	00	None	32.974902	-97.26301599	Tarrant County
120983	Fee-for-Service	1942374251	1942374251	1	1	BORNSTEIN, HAROLD S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34048	36	Psychiatry	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
120984	Fee-for-Service	1174077325	1174077325	1	1	BRIDGE AGENCY, INC	9/12/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	400 S FARRELL DRIVE	SUITE B100	PALM SPRINGS	CA	92262	5961	33	06065	33.81787498	-116.5180068	Riverside County
120988	Fee-for-Service	1053314716	1053314716	1	1	BALFOUR, GEORGE W MD	1/1/1982	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	27276	01	General Practice	0	In state provider	None	3344 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90016	3115	19	06037	34.02686233	-118.37204	Los Angeles County
121012	Fee-for-Service	1073850392	1073850392	2	1	BUKOV, KONSTANTIN MD INC	9/16/2014	193400000X	NA	Other	026	PHYSICIANS	116876	01	General Practice	0	In state provider	None	2299 POST STREET	SUITE 303	SAN FRANCISCO	CA	94115	3441	38	06075	37.78434298	-122.4392033	San Francisco County
121030	Fee-for-Service	1598838690	1598838690	1	1	BEIGI, MARYAM R MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50248	None	None	0	In state provider	None	16661 VENTURA BLVD	STE 604	ENCINO	CA	91436	1980	19	06037	34.15820737	-118.496492	Los Angeles County
121048	Fee-for-Service	1982288544	1982288544	1	1	BACCHETTA, ROSA MD	6/30/2021	207RA0201X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
121054	Fee-for-Service	1255692935	1255692935	1	1	BEDFORD, CHRISTOPHER A MD	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149455	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
121099	Fee-for-Service	1003828948	1003828948	1	1	BECK AND CASEY MDS	1/29/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	BISHOP PEDIATRICS & ALLE	152 PIONEER LN	STE H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
121115	Fee-for-Service	1992700603	1992700603	1	1	BARBA, DOLORES MD	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	46041	01	General Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
121126	Fee-for-Service	1790723658	1790723658	1	1	BARBEE, CARL A MD	5/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1905 MAIN STREET	None	KLAMATH FALLS	OR	97601	2638	00	None	42.22838442	-121.7691707	Klamath County
121139	Fee-for-Service	1033792411	1033792411	1	1	BLASINGAME, NICHOLAS DPM	8/1/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 3100	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
121175	Fee-for-Service	1104849959	1104849959	1	1	BHOLAT, MICHELLE A MD MPH	1/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77772	01	General Practice	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
121184	Fee-for-Service	1184791998	1184791998	1	2	BAY AREA COMMUNITY HEALTH	5/4/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
121217	Fee-for-Service	1184821092	1184821092	1	1	BRANDT, DOUGLAS W MD	12/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
121236	Fee-for-Service	1871547380	1871547380	1	1	BARKSDALE,VERNON C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	570 W BROWN RD	None	MESA	AZ	85201	0000	00	None	33.434577	-111.8444355	Maricopa County
121272	Fee-for-Service	1821515487	1821515487	1	1	BARRIOS, RENE A LMFT	10/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	770 E SHAW AVE	STE 230	FRESNO	CA	93710	7708	10	06019	36.80886739	-119.7731624	Fresno County
121281	Fee-for-Service	1053314716	1053314716	1	1	BALFOUR, GEORGE W MD	1/1/1982	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	27276	20	Orthopedic Surgery	0	In state provider	None	3344 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90016	3115	19	06037	34.02686233	-118.37204	Los Angeles County
121311	Fee-for-Service	1538272257	1538272257	1	1	BROWN, RONALD L MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74668	03	Allergy	0	In state provider	None	1970 LAKE BLVD	STE 2	DAVIS	CA	95616	5663	57	06113	38.56083314	-121.7861904	Yolo County
121334	Fee-for-Service	1982023842	1982023842	1	1	BETESH, SEAN M	10/3/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6620 COYLE AVE	STE 202	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
121339	Fee-for-Service	1013437607	1013437607	1	1	BURGREN, NAREH V MD	9/14/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	156573	None	None	0	In state provider	None	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
121356	Fee-for-Service	1366572356	1366572356	1	1	BERRY, TRISAN T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6325 E TANQUE VERDE RD	None	TUCSON	AZ	85715	3808	00	None	32.244246	-110.856771	Pima County
121383	Fee-for-Service	1346372661	1346372661	1	1	BRETT V CURTIS MD A PROFESSI	2/19/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	101 CASA BUENA DR	None	CORTE MADERA	CA	94925	1762	21	06041	37.92483214	-122.51669	Marin County
121387	Fee-for-Service	1003828948	1003828948	1	1	BECK AND CASEY MDS	1/29/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	BISHOP PEDIATRICS & ALLE	152 PIONEER LN	STE H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
121405	Fee-for-Service	1992700603	1992700603	1	1	BARBA, DOLORES MD	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	46041	41	Internal Medicine	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
121447	Fee-for-Service	1427158351	1427158351	1	1	BANUELOS, JOSE L JR MD	4/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	47968	01	General Practice	0	In state provider	None	1448 FLORIDA AVE	None	MODESTO	CA	95350	4424	50	06099	37.66523613	-120.9962072	Stanislaus County
121455	Fee-for-Service	1922030253	1922030253	1	1	BONDI, MARK W PHD	7/31/1992	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
121457	Fee-for-Service	1538513056	1538513056	1	1	BOYAJIAN, SILVA MD	9/4/2019	207P00000X	NA	Other	026	PHYSICIANS	150387	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
121460	Fee-for-Service	1962457812	1962457812	1	84	BEVERLY RADIOLOGY MEDICAL GR	12/15/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
121475	Fee-for-Service	1821022179	1821022179	1	1	BIO MEDICAL APPLICATIONS	12/20/2006	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	5220 TELFORD ST	None	LOS ANGELES	CA	90022	1722	19	06037	34.03466612	-118.1526126	Los Angeles County
121478	Fee-for-Service	1063909851	1063909851	1	1	BAY IMAGING CONSULTANTS MEDI	5/21/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CAL GROUP INC	10 WOODLAND ROAD	None	ST. HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
121484	Fee-for-Service	1073563938	1073563938	1	1	BAJWA, HARPRIT K DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	20	Orthopedic Surgery	0	In state provider	None	3106 PONTE MORINO DR	SUITE B	CAMERON PARK	CA	95682	8277	09	06017	38.66372604	-120.9664345	El Dorado County
121504	Fee-for-Service	1861537961	1861537961	1	1	BUENA VISTA EYE MEDICAL	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66511	18	Ophthalmology	0	In state provider	CENTER INC	6930 ATLANTIC AVE	STE 3	BELL	CA	90201	3647	19	06037	33.97258109	-118.1877179	Los Angeles County
121511	Fee-for-Service	1912443003	1912443003	1	1	BIANES, LILIBETH NP	10/29/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
121518	Fee-for-Service	1699263400	1699263400	1	1	BRIONES, WILMA NATHALIE	11/9/2022	207P00000X	NA	Other	026	PHYSICIANS	178880	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
121546	Fee-for-Service	1497803399	1497803399	1	1	BRONSON, JOHN BRIAN MD	12/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80250	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
121555	Fee-for-Service	1629062559	1629062559	1	1	BROWNING, RANDALL G MD	8/31/1993	207P00000X	NA	Other	026	PHYSICIANS	55672	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
121564	Fee-for-Service	1346270691	1346270691	1	1	BEKHTEL, ALEKSANDR E DO	9/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8611	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
121616	Fee-for-Service	1033405246	1033405246	1	1	BEDELL, JAMES L DO	9/20/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16235	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
121654	Fee-for-Service	1801816343	1801816343	1	1	BATLIN, ANDRA E MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87310	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	None	SANTA CRUZ	CA	95065	1719	44	06087	36.98879599	-121.9826354	Santa Cruz County
121674	Fee-for-Service	1871596346	1871596346	1	1	BRIAN K. BARSTAD M.D.	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	203 S WESTERN AVE	None	TONASKET	WA	98855	8803	00	None	48.70704298	-119.4392841	Okanogan County
121720	Fee-for-Service	1548312762	1548312762	1	1	BARNES, DIANE M	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37327	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
121751	Fee-for-Service	1962457812	1962457812	1	72	BEVERLY RADIOLOGY MEDICAL GR	4/7/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	3545 WILSHIRE BLVD	STE 102	LOS ANGELES	CA	90010	2305	19	06037	34.0617575	-118.301985	Los Angeles County
121771	Fee-for-Service	1134652217	1134652217	1	1	BLACK, MICHAEL MD	4/13/2021	208M00000X	NA	Other	026	PHYSICIANS	157088	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
121808	Fee-for-Service	1366648594	1366648594	1	1	BEACH OBSTETRICS & GYNECOLOG	4/16/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	Y MEDICAL GROUP A MEDICA	19582 BEACH BLVD STE 202	None	HUNTINGTON BEACH	CA	92648	2996	30	06059	33.67831649	-117.9885198	Orange County
121819	Fee-for-Service	1942622428	1942622428	1	1	BEEBE, SARAH R CRNA	11/21/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
121841	Fee-for-Service	1164871844	1164871844	1	1	BATTON, EMILY MD	8/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160832	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
121849	Fee-for-Service	1972079663	1972079663	1	1	BAUER, ROBERT R NP	10/1/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
121858	Fee-for-Service	1093999625	1093999625	1	1	BECKER, JOSEPH U MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107912	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1333 NEWELL AVE	None	WALNUT CREEK	CA	94596	0000	07	06013	37.89355053	-122.0557416	Contra Costa County
121912	Fee-for-Service	1083174072	1083174072	1	1	BARAI, RAKHEE MD	7/8/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	178261	67	Endocrinology	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
121921	Fee-for-Service	1982781159	1982781159	1	4	BAART COMMUNITY HEALTHCARE	11/14/2006	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11315 S ATLANTIC BLVD	None	LYNWOOD	CA	90262	3007	19	06037	33.92275026	-118.1869042	Los Angeles County
121941	Fee-for-Service	1831171271	1831171271	1	1	BELLO, DAMIAN R MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	63510	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
121959	Fee-for-Service	1891854535	1891854535	1	1	BURT, KRISTEN D MD	2/8/2008	207P00000X	NA	Other	026	PHYSICIANS	95321	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
122003	Fee-for-Service	1437606944	1437606944	1	1	BERNERT, REBECCA A PHD	8/11/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
122024	Fee-for-Service	1336428317	1336428317	1	1	BACON, AKILA F LMFT	9/26/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
122030	Fee-for-Service	1467632414	1467632414	2	1	BIEGEL, SUSAN C MD INC	8/13/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1113 ALTA AVE	STE 220	UPLAND	CA	91786	2803	36	06071	34.10824455	-117.6322743	San Bernardino County
122041	Fee-for-Service	1962457812	1962457812	1	150	BEVERLY RADIOLOGY MEDICAL GR	10/29/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
122061	Fee-for-Service	1932205119	1932205119	1	1	BERNSTEIN, ROBERT J.	4/30/1989	207RP1001X	NA	Pulmonology	026	PHYSICIANS	65091	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
122071	Fee-for-Service	1023348778	1023348778	1	1	BEVING, JESSICA LMFT	10/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 E. SANTA CLARA ST.	None	VENTURA	CA	93001	5972	56	06111	34.27957166	-119.289727	Ventura County
122080	Fee-for-Service	1164506143	1164506143	1	1	BALLINGER, HOWARD A MD	6/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	23330	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
122088	Fee-for-Service	1255669826	1255669826	1	1	BHIMSEN, AVINASH A MD	7/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120745	41	Internal Medicine	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
122099	Fee-for-Service	1962457812	1962457812	1	42	BEVERLY RADIOLOGY MEDICAL GR	9/1/2002	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP	8283 GROVE AVE	STE 101	RANCHO CUCAMONGA	CA	91730	3138	36	06071	34.10380433	-117.6285116	San Bernardino County
122106	Fee-for-Service	1043931769	1043931769	1	1	BOYD, CHRISTOPHER PHD	10/11/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27201 TOURNEY RD STE 210	None	VALENCIA	CA	91355	1804	19	06037	34.41741018	-118.5770409	Los Angeles County
122199	Fee-for-Service	1144273533	1144273533	1	1	BAL, DALJIT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14155 N 83RD AVE	None	PEORIA	AZ	85381	5639	00	None	33.612813	-112.2362415	Maricopa County
122206	Fee-for-Service	1457616997	1457616997	1	1	BROWN, MARISSA L MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142166	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
122235	Fee-for-Service	1891452090	1891452090	1	1	BELISARIO, DIANA L CNP	7/22/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3910 VISTA WAY	106	OCEANSIDE	CA	92056	4513	37	06073	33.18382239	-117.2937426	San Diego County
122247	Fee-for-Service	1770945370	1770945370	1	1	BRYANT, ZACK E MD	9/19/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158462	08	Family Practice	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
122285	Fee-for-Service	1881051019	1881051019	1	1	BOCKMAN, ZACHARY J LAC	10/23/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
122294	Fee-for-Service	1558570911	1558570911	1	1	BONI, JENNIFER M MD	7/13/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173221	None	None	0	In state provider	None	3501 PALMER DR	STE 204	CAMERON PARK	CA	95682	8276	09	06017	38.66181999	-120.9663334	El Dorado County
122299	Fee-for-Service	1598993966	1598993966	1	1	BENJAMIN, KAREN J LCSW	8/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	2643 APPIAN WAY	E	PINOLE	CA	94564	2253	07	06013	37.98860818	-122.2989385	Contra Costa County
122314	Fee-for-Service	1487032082	1487032082	1	1	BENZL, JERRY F MD	8/18/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	154471	None	None	0	In state provider	None	9377 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5340	36	06071	34.083504	-117.575611	San Bernardino County
122315	Fee-for-Service	1285083998	1285083998	1	1	BALL, MYKALANNE LMFT	8/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 INDIANA AVE	130	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
122317	Fee-for-Service	1467632414	1467632414	2	1	BIEGEL, SUSAN C MD INC	8/13/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1113 ALTA AVE	STE 220	UPLAND	CA	91786	2803	36	06071	34.10824455	-117.6322743	San Bernardino County
122323	Fee-for-Service	1679192561	1679192561	1	1	BOLTON, LEIGH S NP	10/30/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
122347	Fee-for-Service	1356714109	1356714109	1	1	BRIJIL, MARITZA LCSW	9/17/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
122361	Fee-for-Service	1114005790	1114005790	1	1	BHAGAT, VIPUL S MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96399	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
122366	Fee-for-Service	1790135507	1790135507	1	1	BI, XIAO MD	12/24/2020	390200000X	NA	Other	026	PHYSICIANS	157796	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
122384	Fee-for-Service	1932535812	1932535812	1	1	BRINSON, CIRSTEN J LCSW	5/5/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	162 N SANTA FE ST	None	HEMET	CA	92543	4451	33	06065	33.74923371	-116.9629676	Riverside County
122409	Fee-for-Service	1548348329	1548348329	1	1	BARONOFSKY, SAMUEL I MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63136	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
122426	Fee-for-Service	1639261530	1639261530	1	1	BUKOWSKI, DINAH M MD	6/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55517	41	Internal Medicine	0	In state provider	None	250 BON AIR ROAD	ROOM 3209	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
122428	Fee-for-Service	1144649609	1144649609	1	1	BLENDSHIP INC	2/4/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	222 N MOUNTAIN AVE	SUITE 209	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
122444	Fee-for-Service	1336125533	1336125533	1	1	BEAR LAKE COUNTY MEMORIAL	11/12/2014	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	164 SOUTH 5TH ST	None	MONTPELIER	ID	83254	1557	00	None	42.316385	-111.3008561	Bear Lake County
122459	Fee-for-Service	1346725967	1346725967	1	1	BRADFORD, JADE J	12/31/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2999 WESTMINSTER AVE	STE 104	SEAL BEACH	CA	90740	5389	30	06059	33.75965552	-118.078875	Orange County
122476	Fee-for-Service	1518147610	1518147610	1	1	BHANDARI, TANUJA A MD	5/13/2008	2085R0001X	NA	Other	026	PHYSICIANS	101871	78	Neoplastic Diseases/Oncology	0	In state provider	None	401 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3803	36	06071	34.1358627	-117.2757778	San Bernardino County
122481	Fee-for-Service	1063464279	1063464279	1	1	BAKER, DAVID M MD	11/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94733	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2170 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
122542	Fee-for-Service	1629257811	1629257811	1	1	BEVENS, MELODY A LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7293 DUMOSA AVE	STE 8	YUCCA VALLEY	CA	92284	3700	36	06071	34.12094334	-116.4177385	San Bernardino County
122543	Fee-for-Service	1457333908	1457333908	1	1	BURGER PHYSICAL THERAPY AND	3/8/2022	261QR0401X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION AGENCY IN	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
122556	Fee-for-Service	1407968209	1407968209	1	1	BIO MEDICAL APPS OF CA	3/2/2010	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	44950 VALLEY CENTRAL WAY	UNITS 108-109	LANCASTER	CA	93536	7209	19	06037	34.6987638	-118.1740754	Los Angeles County
122567	Fee-for-Service	1366785214	1366785214	1	1	BEG, MUNA A MD	10/5/2020	207RC0200X	NA	Other	026	PHYSICIANS	139125	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
122571	Fee-for-Service	1811031388	1811031388	1	1	BAHIJA, SAOUF MD	9/20/2007	174400000X	NA	Other	026	PHYSICIANS	100669	08	Family Practice	0	In state provider	None	1400 EAST CHURCH STREET	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
122587	Fee-for-Service	1033362363	1033362363	1	1	BAKERSFIELD PATHOLOGY	8/29/2009	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	3000 SILLECT AVE	None	BAKERSFIELD	CA	93308	6336	15	06029	35.3863406	-119.0389104	Kern County
122601	Fee-for-Service	1346258274	1346258274	2	1	B-SAN DIEGO LLC	5/1/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1350 EUCLID AVE	None	SAN DIEGO	CA	92105	5424	37	06073	32.718861	-117.084966	San Diego County
122608	Fee-for-Service	1649298282	1649298282	1	1	BROWN, DIANE E MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100480	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
122613	Fee-for-Service	1184791998	1184791998	1	1	BAY AREA COMMUNITY HEALTH	9/20/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
122618	Fee-for-Service	1811555865	1811555865	1	1	BHAGAT, NIDHI P MD	12/12/2022	208M00000X	NA	Other	026	PHYSICIANS	180809	None	None	0	In state provider	None	9500 STOCKDALE HWY	STE 203	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
122628	Fee-for-Service	1326404948	1326404948	1	2	BHAISAJA PC	3/18/2024	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	ES PC	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
122637	Fee-for-Service	1306459482	1306459482	1	1	BAIJU, BLESSY OD	9/15/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
122639	Fee-for-Service	1306033741	1306033741	1	1	BRENNAN, KATHLEEN M MD	4/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94984	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
122664	Fee-for-Service	1083869242	1083869242	1	1	BURGESS, MICHAEL R MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106128	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
122667	Fee-for-Service	1639221948	1639221948	1	1	BURNHAM, WALTER JR MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62133	20	Orthopedic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
122668	Fee-for-Service	1043395718	1043395718	1	1	BOTELLO, FUENSANTA MD	7/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44082	36	Psychiatry	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
122676	Fee-for-Service	1205193547	1205193547	1	1	BIRNIE, KRISTA L MD	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126547	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
122696	Fee-for-Service	1134153968	1134153968	1	1	BRIGHT, DEBRA E MD	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74942	40	Pediatrics	0	In state provider	None	17075 DEVONSHIRE ST	STE 300	NORTHRIDGE	CA	91325	5409	19	06037	34.25755945	-118.50471	Los Angeles County
122718	Fee-for-Service	1144649609	1144649609	1	1	BLENDSHIP INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	222 N MOUNTAIN AVE	SUITE 209	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
122722	Fee-for-Service	1487082319	1487082319	1	1	BUN, THEAR OD	12/4/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1366 S RIVERSIDE AVE	None	RIALTO	CA	92376	7608	36	06071	34.076583	-117.373455	San Bernardino County
122728	Fee-for-Service	1235326729	1235326729	1	1	BOWMAN, GERALD D CPO	3/30/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	15243 VANOWEN ST	STE 208	VAN NUYS	CA	91405	2133	19	06037	34.19394848	-118.4654115	Los Angeles County
122744	Fee-for-Service	1225660764	1225660764	1	1	BURCH, RACHEL L PT	9/6/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
122747	Fee-for-Service	1619591179	1619591179	1	1	BLACK WELLNESS & PROSPERITY	9/19/2024	261Q00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	CENTER	2201 CALAVERAS ST	None	FRESNO	CA	93721	1103	10	06019	36.7415758	-119.7943429	Fresno County
122750	Fee-for-Service	1851687297	1851687297	1	1	BLACKBURN, BRIAN R DO	12/4/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	17167	20	Orthopedic Surgery	0	In state provider	None	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
122773	Fee-for-Service	1093882938	1093882938	1	1	BENDER, ROBERT L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26107	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
122818	Fee-for-Service	1841285277	1841285277	1	2	BHATTI, LAVEEZA MD	10/21/2020	207R00000X	NA	Other	026	PHYSICIANS	54090	41	Internal Medicine	0	In state provider	None	5901 GREEN VALLEY CIRCLE	SUITE 405	CULVER CITY	CA	90230	6971	19	06037	33.98409358	-118.3923715	Los Angeles County
122831	Fee-for-Service	1457333908	1457333908	1	1	BURGER PHYSICAL THERAPY AND	8/4/2020	261QR0401X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	REHABILITATION AGENCY IN	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
122858	Fee-for-Service	1285690446	1285690446	1	1	BAYANI, JACOB E CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
122865	Fee-for-Service	1962457812	1962457812	1	83	BEVERLY RADIOLOGY MEDICAL GR	12/15/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	1002 N FAIRVIEW	None	SANTA ANA	CA	92703	1811	30	06059	33.75346151	-117.9023004	Orange County
122868	Fee-for-Service	1255483483	1255483483	1	1	BOISE, RICHARD C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36281	40	Pediatrics	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
122889	Fee-for-Service	1962457812	1962457812	1	63	BEVERLY RADIOLOGY MEDICAL GR	8/24/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8263 GROVE AVE	STE 102	RANCHO CUCAMONGA	CA	91730	3107	36	06071	34.10436536	-117.6285141	San Bernardino County
122900	Fee-for-Service	1629430483	1629430483	1	1	BOBER, RYAN MD	6/28/2023	207R00000X	NA	Other	026	PHYSICIANS	185074	None	None	0	In state provider	None	11620 WILSHIRE BLVD	SUITE 100 1ST FLOOR	LOS ANGELES	CA	90025	1706	19	06037	34.05024415	-118.4598908	Los Angeles County
122902	Fee-for-Service	1184791998	1184791998	1	1	BAY AREA COMMUNITY HEALTH	10/2/2006	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
122904	Fee-for-Service	1780603514	1780603514	1	1	BHAT, BALA KRISHNA	11/20/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	43451	01	General Practice	0	In state provider	None	345 HALCYON RD	None	ARROYO GRANDE	CA	93420	0000	40	06079	35.113419	-120.5915945	San Luis Obispo County
122916	Fee-for-Service	1326404948	1326404948	1	2	BHAISAJA PC	3/18/2024	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	ES PC	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
122923	Fee-for-Service	1689073454	1689073454	1	1	BOYKINS, SHAMANICKA BIRTH D	5/21/2024	101YM0800X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
122931	Fee-for-Service	1144592916	1144592916	1	1	BEST HOME HEALTH PROVIDERS	9/23/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	26236 INDUSTRIAL BLVD	None	HAYWARD	CA	94545	2922	01	06001	37.63439588	-122.1119739	Alameda County
122949	Fee-for-Service	1083869242	1083869242	1	1	BURGESS, MICHAEL R MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106128	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
122971	Fee-for-Service	1962457812	1962457812	1	101	BEVERLY RADIOLOGY MEDICAL GR	1/21/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	1441 AVOCADO AVENUE	SUITE 301	NEWPORT BEACH	CA	92660	7704	30	06059	33.61338536	-117.8693961	Orange County
122972	Fee-for-Service	1033188529	1033188529	1	1	BENSON, ROBERT C MD	6/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39172	30	Radiology	0	In state provider	None	2615 ST SIMONS	None	TUSTIN	CA	92782	1229	30	06059	33.74279171	-117.7795936	Orange County
122978	Fee-for-Service	1629101340	1629101340	2	1	BAUTISTA MEDICAL GROUP	2/18/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SOUTHERN CALIFORNIA INC	427 CENTRAL AVE	None	FILLMORE	CA	93015	1329	56	06111	34.40149146	-118.9139494	Ventura County
122999	Fee-for-Service	1538849187	1538849187	1	1	BRIGHTER DAY FAMILY THERAPY	4/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11175 AZUSA CT	STE 110	RANCHO CUCAMONGA	CA	91730	4933	36	06071	34.09081588	-117.5605461	San Bernardino County
123005	Fee-for-Service	1134222458	1134222458	1	1	BLAKELY, KENT W MD	8/8/2019	207RR0500X	NA	Other	026	PHYSICIANS	162755	83	Rheumatology	0	In state provider	None	1701 4TH ST	STE 210	SANTA ROSA	CA	95404	7530	49	06097	38.448801	-122.699439	Sonoma County
123032	Fee-for-Service	1619591179	1619591179	1	1	BLACK WELLNESS & PROSPERITY	6/30/2023	261Q00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	10	06019	0	0	None
123046	Fee-for-Service	1326055658	1326055658	1	1	BALAKRISHNAN, SANGEETHA MD	10/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112505	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1004 FOWLER WAY	STE 4	PLACERVILLE	CA	95667	5746	09	06017	38.72683597	-120.7921028	El Dorado County
123047	Fee-for-Service	1821005778	1821005778	1	1	BARNETT, DAVE M MD	10/31/1986	207RP1001X	NA	Pulmonology	026	PHYSICIANS	43738	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
123048	Fee-for-Service	1982781159	1982781159	1	5	BAART COMMUNITY HEALTHCARE	11/15/2001	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	LA PUENTE CLINIC	15229 AMAR RD	None	LA PUENTE	CA	91744	2066	19	06037	34.03783114	-117.9526334	Los Angeles County
123074	Fee-for-Service	1114085636	1114085636	1	1	BLUMENKRANZ, MARK S MD	10/31/1990	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32202	18	Ophthalmology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
123080	Fee-for-Service	1831222728	1831222728	1	1	BACHRACH, KENNETH M PHD	1/8/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	8726	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD ST	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
123084	Fee-for-Service	1063696581	1063696581	1	1	BORDE, MADHUSUDAN MD INC	1/31/1990	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35179	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1460 N CAMINO ALTO	STE 111	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
123106	Fee-for-Service	1528100658	1528100658	1	1	BHATT, VEDA S MD	12/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62337	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
123112	Fee-for-Service	1164675534	1164675534	1	1	BLUEBRIDGE PRO SVCS INC	9/6/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	420 W BASELINE RD	STE D	CLAREMONT	CA	91711	1621	19	06037	34.12157451	-117.7211025	Los Angeles County
123114	Fee-for-Service	1962457812	1962457812	1	129	BEVERLY RADIOLOGY MEDICAL GR	8/15/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	AGING	622 W. DUARTE RD	SUITE 104	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
123118	Fee-for-Service	1457333908	1457333908	1	1	BURGER PHYSICAL THERAPY AND	4/12/2022	261QR0401X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION AGENCY IN	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
123119	Fee-for-Service	1194036095	1194036095	1	1	BASS, JEREMY S MD	10/1/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155878	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
123130	Fee-for-Service	1841796505	1841796505	1	1	BORRA, PHANI MD	6/6/2023	208M00000X	NA	Other	026	PHYSICIANS	178931	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
123136	Fee-for-Service	1679771208	1679771208	1	1	BOROFF, MICHAEL S PSYD	9/15/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
123139	Fee-for-Service	1205140704	1205140704	1	1	BURKE, EDMUND MD	5/7/2018	207LC0200X	NA	Other	026	PHYSICIANS	142776	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
123164	Fee-for-Service	1669457370	1669457370	1	1	BALSBAUGH, THOMAS A MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71607	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
123184	Fee-for-Service	1477511806	1477511806	1	1	BHARADWAJ, AMITABH K MD	6/3/2013	207W00000X	NA	Ophthalmology	026	PHYSICIANS	101201	18	Ophthalmology	0	In state provider	None	1320 TARA HILLS DR	STE H	PINOLE	CA	94564	2532	07	06013	37.99581195	-122.3048745	Contra Costa County
123189	Fee-for-Service	1184791998	1184791998	1	1	BAY AREA COMMUNITY HEALTH	10/2/2006	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
123193	Fee-for-Service	1710259171	1710259171	1	1	BRIGGS, NATASHA J LMFT	11/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	190 SIERRA CT	SUITE B111	PALMDALE	CA	93550	7605	19	06037	34.64013337	-118.1280539	Los Angeles County
123203	Fee-for-Service	1326404948	1326404948	1	2	BHAISAJA PC	3/18/2024	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ES PC	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
123239	Fee-for-Service	1083869242	1083869242	1	1	BURGESS, MICHAEL R MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106128	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
123269	Fee-for-Service	1285878074	1285878074	1	1	BECKLER, ANDREW D MD	7/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128283	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 250	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
123274	Fee-for-Service	1851445183	1851445183	1	1	BALDWIN, ESTER M LCSW PHD	12/8/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79964	-121.246425	San Joaquin County
123284	Fee-for-Service	1023037108	1023037108	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	1560 LACEY BLVD	103	HANFORD	CA	93230	3581	16	06031	36.32836582	-119.4852255	Kings County
123323	Fee-for-Service	1538130588	1538130588	1	1	BATLLE, JUAN C MD	2/10/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176176	None	None	0	In state provider	None	1101 VAN NESS AVE	3RD FLOOR	SAN FRANCISCO	CA	94109	6919	38	06075	37.78610439	-122.421569	San Francisco County
123324	Fee-for-Service	1134753445	1134753445	1	1	BATACLAN, RONALD P NP	6/2/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
123332	Fee-for-Service	1194014258	1194014258	1	1	BROOKS, JAYSSON T MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139710	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
123333	Fee-for-Service	1821005778	1821005778	1	1	BARNETT, DAVE M MD	10/31/1986	207RP1001X	NA	Pulmonology	026	PHYSICIANS	43738	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
123342	Fee-for-Service	1770946279	1770946279	1	1	BAPTY, SAMANTHA J MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162083	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
123354	Fee-for-Service	1487947966	1487947966	1	1	BHARUCHA, NEIL J MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	609 E ORANGEBURG AVE	201	MODESTO	CA	95350	5512	50	06099	37.66364947	-120.9857985	Stanislaus County
123370	Fee-for-Service	1063696581	1063696581	1	1	BORDE, MADHUSUDAN MD INC	1/31/1990	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35179	41	Internal Medicine	0	In state provider	None	1460 N CAMINO ALTO	STE 111	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
123373	Fee-for-Service	1972923852	1972923852	1	1	BRAND, JONATHAN M LAC	9/19/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
123387	Fee-for-Service	1710422886	1710422886	1	1	BILEMDJIAN, TALEEN NP	1/5/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
123388	Fee-for-Service	1962457812	1962457812	1	137	BEVERLY RADIOLOGY MEDICAL GR	8/12/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	R	8710 MONROE CT	SUITE 100	RANCHO CUCAMONGA	CA	91730	4883	36	06071	34.09544496	-117.5747968	San Bernardino County
123403	Fee-for-Service	1962457812	1962457812	1	3	BEVERLY RADIOLOGY MEDICAL GR	5/21/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	455 N ROXBURY DR	None	BEVERLY HILLS	CA	90210	5001	19	06037	34.06807822	-118.4069809	Los Angeles County
123415	Fee-for-Service	1619036514	1619036514	1	2	BORREGO COMM HLTH FNDTN	9/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	55497 VAN BUREN ST	None	THERMAL	CA	92274	9412	33	06065	33.645622	-116.1988867	Riverside County
123456	Fee-for-Service	1609437136	1609437136	1	1	BURSON, KELSEY J DO	7/16/2023	207P00000X	NA	Other	026	PHYSICIANS	20853	None	None	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
123472	Fee-for-Service	1750581278	1750581278	1	1	BADER, SEMON R MD	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98350	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
123477	Fee-for-Service	1184791998	1184791998	1	1	BAY AREA COMMUNITY HEALTH	4/27/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
123481	Fee-for-Service	1508968025	1508968025	2	1	BELLINGER, BRIAN	7/11/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	822 G ST	11	ARCATA	CA	95521	6224	12	06023	40.86821305	-124.0859305	Humboldt County
123502	Fee-for-Service	1407956527	1407956527	1	1	BATES, MARGARET MD	2/12/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50676	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
123545	Fee-for-Service	1821315045	1821315045	1	1	BRIGGS, MICHELLE L OT	2/23/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
123549	Fee-for-Service	1043253909	1043253909	1	1	BOWEN, SCOTT L MD	7/24/1991	207P00000X	NA	Other	026	PHYSICIANS	49749	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
123595	Fee-for-Service	1326627589	1326627589	1	1	BHOGAL, RAMNIK MD	10/22/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
123605	Fee-for-Service	1134280605	1134280605	1	1	BODKIN, DAVID J MD	11/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62107	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
123607	Fee-for-Service	1649456955	1649456955	1	1	BI-BETT	6/12/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1342 E 27TH STREET	None	OAKLAND	CA	94606	3266	01	06001	37.79774266	-122.2348494	Alameda County
123611	Fee-for-Service	1669543971	1669543971	1	1	BORG, RANDALL K MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62262	05	Anesthesiology	0	In state provider	None	615 W EAST AVE	None	CHICO	CA	95926	7201	04	06007	39.75064171	-121.8715471	Butte County
123623	Fee-for-Service	1053853614	1053853614	1	1	BLUMENFELD, LIZA	5/10/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
123637	Fee-for-Service	1649699208	1649699208	1	1	BULTMAN, ERIC M MD	7/16/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	137947	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
123666	Fee-for-Service	1235425547	1235425547	1	1	BURCH BARNIKEL, TAYLOR L MD	4/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140832	01	General Practice	0	In state provider	None	1820 41ST AVE	SUITE C	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
123669	Fee-for-Service	1629074901	1629074901	1	1	BOLNICK, ALAN D MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	9280 W SUNSET ROAD	# 236	LAS VEGAS	NV	89148	4861	00	None	36.07027746	-115.29495	Clark County
123673	Fee-for-Service	1154798403	1154798403	1	1	BYERS, HANNAH E	2/19/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8100 BUCKS HARBOR WAY	None	SACRAMENTO	CA	95828	5440	34	06067	38.465847	-121.3891245	Sacramento County
123676	Fee-for-Service	1932744349	1932744349	1	1	BRIGHTER DAY HEALTHCARE	6/4/2020	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1911 N KENWOOD ST	None	BURBANK	CA	91505	1420	19	06037	34.18340906	-118.3525191	Los Angeles County
123680	Fee-for-Service	1538792627	1538792627	1	1	BROWN, CHRISTINE A PT	1/26/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
123688	Fee-for-Service	1962457812	1962457812	1	106	BEVERLY RADIOLOGY MEDICAL GR	12/5/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	11620 WILSHIRE BLVD	SUITE 100	LOS ANGELES	CA	90025	6801	19	06037	34.05024415	-118.4598908	Los Angeles County
123700	Fee-for-Service	1619036514	1619036514	1	2	BORREGO COMM HLTH FNDTN	9/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	55497 VAN BUREN ST	None	THERMAL	CA	92274	9412	33	06065	33.645622	-116.1988867	Riverside County
123723	Fee-for-Service	1386129203	1386129203	1	1	BEST SKILLED HOME HEALTH INC	11/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10523 BURBANK BLVD	STE 222	NORTH HOLLYWOOD	CA	91601	2236	19	06037	34.17216449	-118.36017	Los Angeles County
123796	Fee-for-Service	1104375393	1104375393	1	1	BLAKE, KATIE LCSW	3/14/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
123813	Fee-for-Service	1770995789	1770995789	1	1	BALL, LINDSEY L MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145307	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
123830	Fee-for-Service	1508122300	1508122300	1	1	BURK, REBECCA E MD	2/24/2021	207RC0200X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
123839	Fee-for-Service	1336508506	1336508506	1	2	BEBAL, BRENDA L NP	6/25/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
123841	Fee-for-Service	1467689893	1467689893	1	1	BUTLER, JASON A PHD	8/29/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	430 40TH STREET	1	OAKLAND	CA	94609	1000	01	06001	37.8286829	-122.2613927	Alameda County
123846	Fee-for-Service	1578657169	1578657169	1	1	BARAN, JASON J PT	3/12/2018	174400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26700 TOWNE CENTER DRIVE	SUITE 110	FOOTHILL RANCH	CA	92610	2844	30	06059	33.67455886	-117.6639195	Orange County
123890	Fee-for-Service	1134280605	1134280605	1	1	BODKIN, DAVID J MD	11/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62107	68	Hematology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
123951	Fee-for-Service	1578098844	1578098844	1	1	BOGGS, HANS K MD	11/4/2019	208600000X	NA	General Surgery	026	PHYSICIANS	157867	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123959	Fee-for-Service	1134156912	1134156912	1	1	BOUCHER, RALPH A MD	7/1/2002	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44666	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	20130 LAKE CHABOT RD	STE 302	CASTRO VALLEY	CA	94546	5340	01	06001	37.69738066	-122.087041	Alameda County
123961	Fee-for-Service	1154798403	1154798403	1	1	BYERS, HANNAH E	2/19/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8100 BUCKS HARBOR WAY	None	SACRAMENTO	CA	95828	5440	34	06067	38.465847	-121.3891245	Sacramento County
123965	Fee-for-Service	1811906597	1811906597	1	1	BECK, RICHARD J	3/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2074 LAKE TAHOE BLVD	STE 2	SOUTH LAKE TAHOE	CA	96150	6408	09	06017	38.91488542	-120.0019087	El Dorado County
123988	Fee-for-Service	1619036514	1619036514	1	2	BORREGO COMM HLTH FNDTN	9/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	55497 VAN BUREN ST	None	THERMAL	CA	92274	9412	33	06065	33.645622	-116.1988867	Riverside County
124031	Fee-for-Service	1851477731	1851477731	1	1	BURNETT, MARTHA OD	12/31/1992	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
124036	Fee-for-Service	1780691287	1780691287	1	1	BROWNING, PATRICK D MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	70237	None	None	0	In state provider	None	652 PETALUMA AVE	STE I	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
124081	Fee-for-Service	1962549600	1962549600	1	2	BAART BEHAVIORAL HEALTH SERV	3/4/1988	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3707 AND 3711 SUNSET LN	A & B	ANTIOCH	CA	94509	6101	07	06013	37.98434728	-121.8042006	Contra Costa County
124104	Fee-for-Service	1306994173	1306994173	1	1	BAER, JEANNE MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 10TH AVE	None	NEW YORK	NY	10019	0000	00	None	40.770081	-73.9874025	New York County
124123	Fee-for-Service	1780842609	1780842609	1	1	BANDARCHI-CHAMKHALEH,	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83490	22	Pathology (M.D. only)	0	In state provider	BIZHAN MD	10833 LE CONTE AVE	STE B186 CHS	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
124136	Fee-for-Service	1043398878	1043398878	1	1	BARBER, TROY MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65398	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
124157	Fee-for-Service	1497743462	1497743462	1	1	BAJWA, MOHSIN K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	710 FM 1960 RD W	None	HOUSTON	TX	77090	3402	00	None	30.020697	-95.4426555	Harris County
124198	Fee-for-Service	1801938485	1801938485	1	1	BEARE, JOHN P MD	9/28/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	26007	01	General Practice	0	In state provider	None	1720 EL CAMINO REAL	STE 101	BURLINGAME	CA	94010	3211	41	06081	37.59341466	-122.381361	San Mateo County
124235	Fee-for-Service	1861842981	1861842981	1	1	BENICIA TRANSPORTATION INC	8/18/2016	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1350 HAYES ST	SUITE C-4	BENICIA	CA	94510	2945	48	06095	38.04764833	-122.139033	Solano County
124251	Fee-for-Service	1962457812	1962457812	1	155	BEVERLY RADIOLOGY MEDICAL GR	1/3/2025	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	38209 47TH ST E	SUITE D	PALMDALE	CA	93552	3113	19	06037	34.576173	-118.045189	Los Angeles County
124270	Fee-for-Service	1588239354	1588239354	1	1	BAGATELLE-BLACK, TRACY LMFT	8/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
124275	Fee-for-Service	1437557634	1437557634	1	1	BAYOH, SERAY H NP	12/17/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
124287	Fee-for-Service	1942217286	1942217286	1	1	BRAZELL, DONALD MD	2/20/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183768	08	Family Practice	0	In state provider	None	3415 S SEPULVEDA BLVD	STE 1122	LOS ANGELES	CA	90034	6060	19	06037	34.02086527	-118.4235306	Los Angeles County
124289	Fee-for-Service	1740349364	1740349364	1	1	BASS, HAROLD N MD	1/1/1982	207SG0201X	NA	Other	026	PHYSICIANS	12691	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
124408	Fee-for-Service	1619431327	1619431327	1	1	BAINS, ANUDEEP K RCP	2/19/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
124428	Fee-for-Service	1669550265	1669550265	1	1	BOCOBO, FAITH R MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61746	03	Allergy	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
124471	Fee-for-Service	1255399143	1255399143	1	1	BREVIG, RYAN D MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72272	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
124490	Fee-for-Service	1093808933	1093808933	1	1	BURSTEIN MD A PROFESSIONAL	11/14/2019	193200000X	NA	Other	026	PHYSICIANS	53604	None	None	0	In state provider	CORPORATION	6325 TOPANGA CYN BLVD	224	WOODLAND HILLS	CA	91367	2006	19	06037	34.184934	-118.6059175	Los Angeles County
124492	Fee-for-Service	1801888177	1801888177	1	1	BARRY J WENDT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 JAMES SIMPSON JR WA	None	COVINGTON	KY	41011	0801	00	None	39.0715176	-84.51775131	Kenton County
124498	Fee-for-Service	1083290639	1083290639	1	1	BENNION, RYAN DO	6/17/2024	207P00000X	NA	Other	026	PHYSICIANS	20321	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
124536	Fee-for-Service	1710319546	1710319546	1	1	BAI, YANG MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136377	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
124591	Fee-for-Service	1043470446	1043470446	1	1	BILYEU, CHRISTINA Y MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136732	36	Psychiatry	0	In state provider	None	2008 MORSE AVENUE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
124607	Fee-for-Service	1174902829	1174902829	1	1	BODENE, LINDSAY A NP	7/9/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7237 E SOUTHGATE DR	STE A	SACRAMENTO	CA	95823	2631	34	06067	38.494629	-121.435686	Sacramento County
124623	Fee-for-Service	1962457812	1962457812	1	47	BEVERLY RADIOLOGY MEDICAL GR	3/25/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	415 ROLLING OAKS DR	STE 125	THOUSAND OAKS	CA	91361	1038	56	06111	34.17439717	-118.8691161	Ventura County
124641	Fee-for-Service	1841367794	1841367794	1	1	BENDELSTEIN, JULIAN MD	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42049	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
124654	Fee-for-Service	1902089352	1902089352	1	1	BAES, DANTE M MD	12/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100977	40	Pediatrics	0	In state provider	None	1100 DELBON AVE	None	TURLOCK	CA	95382	2021	50	06099	37.5106124	-120.8356611	Stanislaus County
124655	Fee-for-Service	1326333618	1326333618	1	1	BRYANT, JOSEEN A MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136892	01	General Practice	0	In state provider	None	4314 W SLAUSON AVE	None	LOS ANGELES	CA	90043	2808	19	06037	33.98885257	-118.3509655	Los Angeles County
124657	Fee-for-Service	1659677516	1659677516	1	1	BAKER, BRUCE C MD INC	3/1/2011	207L00000X	NA	Other	026	PHYSICIANS	72025	05	Anesthesiology	0	In state provider	None	624 E ELDER ST	None	FALLBROOK	CA	92028	3004	37	06073	33.38020455	-117.2446307	San Diego County
124689	Fee-for-Service	1376584540	1376584540	1	1	BONAKDAR, ROBERT A MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70723	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
124723	Fee-for-Service	1346317161	1346317161	1	1	BROOKEY, JOHN M MD	9/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	59165	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
124744	Fee-for-Service	1104993542	1104993542	1	1	BROWN, HARRY M PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
124763	Fee-for-Service	1437180361	1437180361	1	1	BEAN, WARREN SCOTT PH.D	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	504 S E ST	None	SANTA ROSA	CA	95404	5138	49	06097	38.433807	-122.7044475	Sonoma County
124770	Fee-for-Service	1710018445	1710018445	1	1	BENDIMEZ, LISA PSYD	2/18/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
124772	Fee-for-Service	1760059513	1760059513	1	1	BELL'S COTTAGE LLC	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	26272 KATHY LANE	None	HEMET	CA	92544	6409	33	06065	33.73967767	-116.9331355	Riverside County
124783	Fee-for-Service	1992045439	1992045439	1	1	BUCKLEY, MARY K LCSW	8/25/2015	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1341 W BULLARD AVE	STE 5	FRESNO	CA	93711	2463	10	06019	36.82280264	-119.8152034	Fresno County
124837	Fee-for-Service	1205903069	1205903069	1	1	BOTT, SHERRY Y NP	7/30/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	75036 GERALD FORD DR	None	PALM DESERT	CA	92211	2080	33	06065	33.78158473	-116.353994	Riverside County
124838	Fee-for-Service	1356365654	1356365654	1	1	BANKS, CLAUDETTE M MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	65827	18	Ophthalmology	0	In state provider	None	323 N PRAIRIE AVE	STE 201	INGLEWOOD	CA	90301	4500	19	06037	33.966333	-118.3439975	Los Angeles County
124863	Fee-for-Service	1790546125	1790546125	1	1	BRIDGE ACADEMY COLLECTIVE	11/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SELING	2904 N BREA BLVD	200	FULLERTON	CA	92835	2015	30	06059	33.90439776	-117.9065866	Orange County
124873	Fee-for-Service	1265085138	1265085138	1	1	BAKER, ELIZABETH NP	2/16/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	36	06071	34.06914052	-117.2695442	San Bernardino County
124883	Fee-for-Service	1609022797	1609022797	1	1	BAY IMAGING CONSULTANTS	5/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
124893	Fee-for-Service	1962457812	1962457812	1	143	BEVERLY RADIOLOGY MEDICAL GR	9/28/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ENTER	211 N PRAIRIE AVE	SUITE E	INGLEWOOD	CA	90301	1412	19	06037	33.965136	-118.3439955	Los Angeles County
124920	Fee-for-Service	1104833045	1104833045	1	1	BRADEN PARTNERS L P	3/15/2013	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	41758 12TH ST W	STE E	PALMDALE	CA	93551	1421	19	06037	34.641837	-118.1513145	Los Angeles County
124961	Fee-for-Service	1689671968	1689671968	1	1	BROMER, STEVEN P MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62542	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	# 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
125006	Fee-for-Service	1821737271	1821737271	1	1	BUSTA ENTERPRISES, LLC	7/15/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1360 HOUGHTON AVE	None	CORNING	CA	96021	2956	52	06103	39.92281929	-122.1882431	Tehama County
125047	Fee-for-Service	1336709641	1336709641	1	1	BIRNBAUM, AVRILLE PSYD	8/16/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	409 13TH	STE 1900	OAKLAND	CA	94612	2605	01	06001	37.80326679	-122.2707988	Alameda County
125053	Fee-for-Service	1790248318	1790248318	1	1	BAEZ, DAVID LCSW	5/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
125059	Fee-for-Service	1588074371	1588074371	1	1	BOKHOOR, PAYAM B MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140749	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
125084	Fee-for-Service	1548360225	1548360225	1	1	BREITMAN, BARBARA L LMFT	9/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	80554 AVENIDA SAN FERNAN	None	INDIO	CA	92203	7525	33	06065	33.74826372	-116.2594533	Riverside County
125110	Fee-for-Service	1104851500	1104851500	1	1	BLACK, ALEXANDER C MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	58928	68	Hematology	0	In state provider	None	10 CONGRESS ST	STE 502	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
125118	Fee-for-Service	1477814911	1477814911	1	1	BOERNER, TARA J LMFT	10/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2676	19	06037	34.17245599	-118.5633517	Los Angeles County
125121	Fee-for-Service	1710248075	1710248075	1	1	BERT, LINDA M LMFT	10/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16152 BEACH BLVD.	170	HUNTINGTON BEACH	CA	92647	3818	30	06059	33.72889962	-117.9891397	Orange County
125123	Fee-for-Service	1053843672	1053843672	1	1	BELL, CAITLIN F MD	6/27/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	157107	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125134	Fee-for-Service	1689633927	1689633927	1	1	BALIS SCOTT DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.812245	-96.841584	Dallas County
125159	Fee-for-Service	1316000854	1316000854	1	1	BURBANK HOME CARE, INC	3/24/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4730 WOODMAN AVE	SUITE 304	SHERMAN OAKS	CA	91423	2400	19	06037	34.156701	-118.4312045	Los Angeles County
125161	Fee-for-Service	1467736918	1467736918	1	1	BAXMAN, STEPHANIE LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
125165	Fee-for-Service	1043512155	1043512155	1	1	BRAR, CHARNJEET K MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114523	40	Pediatrics	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
125195	Fee-for-Service	1447660154	1447660154	1	1	BAKER, STEVEN A MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139005	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125203	Fee-for-Service	1467617142	1467617142	1	1	BOHORQUEZ, DIANNE E PHD	3/4/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3611 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2608	19	06037	33.93073129	-118.2045443	Los Angeles County
125216	Fee-for-Service	1144616806	1144616806	1	1	BESSOFF, KOVI MD	6/8/2023	207RC0200X	NA	Other	026	PHYSICIANS	143878	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
125235	Fee-for-Service	1063839462	1063839462	1	1	BLECHINGER, DEREK R C MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137927	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
125241	Fee-for-Service	1518974542	1518974542	2	1	B-EAST, LLC	5/1/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8625 LAMAR ST	None	SPRING VALLEY	CA	91977	2518	37	06073	32.7386665	-117.013662	San Diego County
125251	Fee-for-Service	1780633537	1780633537	1	1	BESS, LUDMILA B MD APC	11/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40563	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5901 W OLYMPIC BLVD	STE 503	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
125256	Fee-for-Service	1255828323	1255828323	1	1	BRENNAN, MICHELLE E MD	4/29/2022	390200000X	NA	Other	026	PHYSICIANS	174854	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	19	06037	34.158213	-118.328112	Los Angeles County
125257	Fee-for-Service	1720316144	1720316144	1	1	BICHAI, WILLIAM N MD INC	10/1/2009	193400000X	NA	Other	026	PHYSICIANS	92564	None	None	0	In state provider	ENTER	3900 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	5725	15	06029	35.395731	-119.0081545	Kern County
125278	Fee-for-Service	1528345915	1528345915	1	1	BALDWIN PARK MEDICAL CENTER	6/25/2014	193200000X	NA	Other	026	PHYSICIANS	7473	01	General Practice	0	In state provider	INC	14362 E RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08622063	-117.9606346	Los Angeles County
125306	Fee-for-Service	1932661469	1932661469	1	1	BISHOP, KRISTEN M MD	8/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180499	36	Psychiatry	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
125308	Fee-for-Service	1528287174	1528287174	1	1	BLAKELY, COLLIN M MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106689	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
125346	Fee-for-Service	1033325170	1033325170	1	1	BROWN, BETHANY E LCSW	5/23/2016	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	TIBURON BLDG	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
125387	Fee-for-Service	1235287210	1235287210	1	1	BESSEY, ADRIENNE MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69692	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
125397	Fee-for-Service	1104851500	1104851500	1	1	BLACK, ALEXANDER C MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	58928	78	Neoplastic Diseases/Oncology	0	In state provider	None	10 CONGRESS ST	STE 502	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
125401	Fee-for-Service	1942843578	1942843578	1	1	BAKER, MARY K PT	4/30/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
125426	Fee-for-Service	1124050190	1124050190	1	1	BIOMOTION PHYSICAL THERAPY P	3/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	865 PATRIOT DRIVE	202	MOORPARK	CA	93021	3405	56	06111	34.27758343	-118.8663357	Ventura County
125434	Fee-for-Service	1023729183	1023729183	1	1	BLACKWELL, MARIA T BIRTH DOU	1/4/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
125436	Fee-for-Service	1912389354	1912389354	1	1	BARANWAL, ERICA OD	11/26/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5832 BEACH BLVD	STE 109	BUENA PARK	CA	90621	2022	30	06059	33.875469	-117.9981525	Orange County
125450	Fee-for-Service	1194795518	1194795518	1	1	BALL, LEE W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
125457	Fee-for-Service	1619036514	1619036514	1	1	BORREGO COMM HLTH FNDTN	3/28/2008	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO CTHDRL CTY	69175 RAMON ROAD	STE A	CATHEDRAL CITY	CA	92234	3344	33	06065	33.813621	-116.456193	Riverside County
125471	Fee-for-Service	1912314766	1912314766	1	1	BENYOUNG, LINDA MSW LCSW	4/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
125492	Fee-for-Service	1689033649	1689033649	1	1	BOS, NATHAN DO	10/16/2023	207P00000X	NA	Other	026	PHYSICIANS	21847	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
125498	Fee-for-Service	1043966401	1043966401	1	1	BUITRON, GUADALUPE LCSW	10/4/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
125551	Fee-for-Service	1619036514	1619036514	1	6	BORREGO COMM HLTH FNDTN	2/11/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	83791 DATE AVE	None	INDIO	CA	92201	4737	33	06065	33.71133254	-116.2051035	Riverside County
125572	Fee-for-Service	1023124013	1023124013	1	1	BUTT, FAUZIA K MD	8/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52883	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
125597	Fee-for-Service	1528287174	1528287174	1	1	BLAKELY, COLLIN M MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106689	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
125600	Fee-for-Service	1184702847	1184702847	1	1	BROWN, MICHAEL W MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68271	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
125604	Fee-for-Service	1992236673	1992236673	1	1	BANERJEE, DIPTI MD	12/6/2021	390200000X	NA	Other	026	PHYSICIANS	161801	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
125613	Fee-for-Service	1427212455	1427212455	1	1	BRINKMAN, ADAM S MD	11/1/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	600 HIGHLAND AVE	None	MADISON	WI	53792	0001	00	None	43.07868393	-89.4316606	Dane County
125648	Fee-for-Service	1194869685	1194869685	1	1	BOHEN,SEAN P MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68379	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
125687	Fee-for-Service	1235111717	1235111717	1	1	BROWN, HARVEY V	5/1/1987	207R00000X	NA	Other	026	PHYSICIANS	24071	01	General Practice	0	In state provider	None	435 N ROXBURY DR	STE 311	BEVERLY HILLS	CA	90210	5005	19	06037	34.06777102	-118.4067032	Los Angeles County
125696	Fee-for-Service	1265748040	1265748040	1	1	BROWN, BRENT A DO	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14508	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
125725	Fee-for-Service	1215279724	1215279724	1	1	BELYEU, BRITTANEY M MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144003	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
125743	Fee-for-Service	1619036514	1619036514	1	1	BORREGO COMM HLTH FNDTN	5/22/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO CTHDRL CTY	69175 RAMON ROAD	STE A	CATHEDRAL CITY	CA	92234	3344	33	06065	33.813621	-116.456193	Riverside County
125769	Fee-for-Service	1245737170	1245737170	1	1	BABY, BINTU CNP	3/20/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	576 E EL CAMINO REAL	None	SUNNYVALE	CA	94087	1940	43	06085	37.36249974	-122.0260401	Santa Clara County
125803	Fee-for-Service	1841623196	1841623196	1	1	BOYER, ASHLEY	7/8/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
125840	Fee-for-Service	1619036514	1619036514	1	6	BORREGO COMM HLTH FNDTN	2/11/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	83791 DATE AVE	None	INDIO	CA	92201	4737	33	06065	33.71133254	-116.2051035	Riverside County
125852	Fee-for-Service	1770535585	1770535585	2	1	BEREZNIAK, MARA MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	7940	01	General Practice	0	In state provider	None	11400 PLEASANT VALLEY RD	None	PENN VALLEY	CA	95946	9001	29	06057	39.22490424	-121.2041338	Nevada County
125862	Fee-for-Service	1558848531	1558848531	1	1	BANNETT, YAIR MD	7/22/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156985	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
125923	Fee-for-Service	1902965841	1902965841	1	1	BETTS, ANDRES	9/30/1986	207LP2900X	NA	Other	026	PHYSICIANS	55823	05	Anesthesiology	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
125931	Fee-for-Service	1346695004	1346695004	1	1	BAIDWAN, SUKHMANDEEP MD	2/13/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166420	36	Psychiatry	0	In state provider	None	1400 EXPO PKWY	None	SACRAMENTO	CA	95815	4230	34	06067	38.597067	-121.457286	Sacramento County
125938	Fee-for-Service	1194869685	1194869685	1	1	BOHEN,SEAN P MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68379	78	Neoplastic Diseases/Oncology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
125946	Fee-for-Service	1457427197	1457427197	1	3	BHARDWAJ, ASHWANI MD	2/1/1997	207R00000X	NA	Other	026	PHYSICIANS	54408	41	Internal Medicine	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
125975	Fee-for-Service	1982648846	1982648846	1	1	BOLOWICH,FRANZ K DO	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
125989	Fee-for-Service	1225665920	1225665920	1	1	BUSH, JENNIFER MD	7/8/2023	207R00000X	NA	Other	026	PHYSICIANS	185750	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
125991	Fee-for-Service	1730125048	1730125048	1	1	BAGLEY, STEVEN C MD	2/10/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	77084	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126033	Fee-for-Service	1619036514	1619036514	1	1	BORREGO COMM HLTH FNDTN	2/6/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO CTHDRL CTY	69175 RAMON ROAD	STE A	CATHEDRAL CITY	CA	92234	3344	33	06065	33.813621	-116.456193	Riverside County
126045	Fee-for-Service	1417515883	1417515883	1	1	BOWERS, KEEGAN	7/12/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
126054	Fee-for-Service	1568176444	1568176444	1	1	BAUTISTA, ANALISSA K PT	3/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
126079	Fee-for-Service	1720163249	1720163249	1	1	BOB, JOHN K	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	534 PINE ST	STE A	STOCKTON	CA	95204	5536	39	06077	37.97439027	-121.2897236	San Joaquin County
126162	Fee-for-Service	1376946277	1376946277	1	1	BAYSIDE HEALTHCARE INC	12/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	553 F STREET	None	CHULA VISTA	CA	91910	3515	37	06073	32.63834671	-117.0904666	San Diego County
126174	Fee-for-Service	1679098495	1679098495	1	1	BADER, NICOLE C PT	3/30/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16008 KAMANA RD.,	SUITE 200	APPLE VALLEY	CA	92307	0000	36	06071	34.54191149	-117.2725046	San Bernardino County
126180	Fee-for-Service	1295164887	1295164887	1	1	BROWN, AKUA MD	5/25/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	152180	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
126270	Fee-for-Service	1700897477	1700897477	1	1	BRYANT, SEAN O MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75487	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
126318	Fee-for-Service	1396905964	1396905964	1	1	BROWN, MICHAEL G LMFT	10/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15495 LOS GATOS BLVD	STE 5	LOS GATOS	CA	95032	2544	43	06085	37.24309798	-121.9596433	Santa Clara County
126320	Fee-for-Service	1619036514	1619036514	1	1	BORREGO COMM HLTH FNDTN	2/6/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTRO MEDICO CTHDRL CTY	69175 RAMON ROAD	STE A	CATHEDRAL CITY	CA	92234	3344	33	06065	33.813621	-116.456193	Riverside County
126335	Fee-for-Service	1962457812	1962457812	1	120	BEVERLY RADIOLOGY MEDICAL GR	4/24/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	25500 RANCHO NIGUEL RD	STE 140	LAGUNA NIGUEL	CA	92677	7373	30	06059	33.55578198	-117.6849338	Orange County
126344	Fee-for-Service	1366523805	1366523805	1	1	BURG, ANDREW C MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43765	22	Pathology (M.D. only)	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
126350	Fee-for-Service	1649599085	1649599085	1	1	BEVERLY RADIOLOGY MEDICAL	7/1/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	27168 NEWPORT RD	STE B	MENIFEE	CA	92584	7383	33	06065	33.68505351	-117.185472	Riverside County
126351	Fee-for-Service	1336258037	1336258037	1	2	BANSUAN, RAINER G MD	11/30/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	51021	-	NOT APPLICABLE	0	In state provider	None	2180 W VALLEY BLVD	None	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
126364	Fee-for-Service	1538282678	1538282678	1	1	BRIAN P NOLAN DO	8/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
126392	Fee-for-Service	1750431888	1750431888	1	1	BALLON-CASEMENT, JULIANNE	7/5/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
126401	Fee-for-Service	1457521510	1457521510	1	1	BOUZAGLOU, ARMAND MD APC	9/17/2008	2085R0001X	NA	Other	026	PHYSICIANS	26098	30	Radiology	0	In state provider	None	201 S ALVARADO	STE A	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
126406	Fee-for-Service	1235269861	1235269861	1	1	BROYLES, DONNY R OD	4/3/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31573 RANCHO PUEBLO RD	STE 101	TEMECULA	CA	92592	4835	33	06065	33.4795997	-117.1092187	Riverside County
126447	Fee-for-Service	1750361424	1750361424	1	1	BOOTH, LOWELL J OD	4/4/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1102 IRVINE BLVD	None	TUSTIN	CA	92780	3529	30	06059	33.74822099	-117.8105618	Orange County
126456	Fee-for-Service	1962593681	1962593681	1	1	BERKOWITZ, RICHARD J MD	9/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57423	30	Radiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
126460	Fee-for-Service	1134587439	1134587439	1	1	BREON, ANDREA L	5/11/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
126467	Fee-for-Service	1356824189	1356824189	1	1	BOSQUE, ERICA LCSW	10/31/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4415 SONOMA HWY	SUITE A, E/F	SANTA ROSA	CA	95409	4165	49	06097	38.45819154	-122.6759063	Sonoma County
126471	Fee-for-Service	1407993975	1407993975	1	1	BAHRI, SHIDFAR S MD	10/6/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51230	01	General Practice	0	In state provider	None	2011 WESTCLIFF DR	STE 1	NEWPORT BEACH	CA	92660	5508	30	06059	33.62741724	-117.9073738	Orange County
126506	Fee-for-Service	1548238108	1548238108	1	1	BYBEE, DAVID B.	11/30/1988	174400000X	NA	Other	026	PHYSICIANS	69334	14	Neurological Surgery	0	In state provider	None	205 W GRANGER AVE	None	MODESTO	CA	95350	4402	50	06099	37.6673525	-120.9954534	Stanislaus County
126545	Fee-for-Service	1437567740	1437567740	1	1	BURKE, DANIEL P	8/2/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BOULEVARD	STE 220	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
126548	Fee-for-Service	1386614717	1386614717	1	1	BUETOW, STEPHEN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
126596	Fee-for-Service	1295913481	1295913481	1	1	BAIK, ANNIE K MD	6/11/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	97269	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
126613	Fee-for-Service	1477149631	1477149631	1	1	BLESS HOME HEALTH	2/3/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17042 DEVONSHIRE ST	STE 205	NORTHRIDGE	CA	91325	1674	19	06037	34.25750455	-118.503648	Los Angeles County
126650	Fee-for-Service	1194297895	1194297895	1	1	BENEVOLENCE INDUSTRIES INC	7/17/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	2065 W 6TH STREET	STE 110	LOS ANGELES	CA	90057	3158	19	06037	34.05940126	-118.274492	Los Angeles County
126673	Fee-for-Service	1184681009	1184681009	1	1	BUTOWSKI, NICHOLAS A MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74692	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
126682	Fee-for-Service	1861176976	1861176976	1	1	BANKAS, LILY E PT	8/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39650 LIBERTY ST	SUITE 140	FREMONT	CA	94538	2225	01	06001	37.54662058	-121.9736002	Alameda County
126692	Fee-for-Service	1457521510	1457521510	1	1	BOUZAGLOU, ARMAND MD APC	9/17/2008	2085R0001X	NA	Other	026	PHYSICIANS	26098	78	Neoplastic Diseases/Oncology	0	In state provider	None	201 S ALVARADO	STE A	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
126709	Fee-for-Service	1285692368	1285692368	1	1	BOHMAN, BRYAN K MD	4/27/1993	207L00000X	NA	Other	026	PHYSICIANS	47659	05	Anesthesiology	0	In state provider	None	3333 BUCHANAN ST	None	SAN FRANCISCO	CA	94123	2841	38	06075	37.80084825	-122.4329057	San Francisco County
126724	Fee-for-Service	1154413524	1154413524	1	1	BAO, GANG MD INC	12/29/2006	207RP1001X	NA	Pulmonology	026	PHYSICIANS	83170	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6699 ALVARADO RD.	2306	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
126728	Fee-for-Service	1083014864	1083014864	1	1	BONITA SPRINGS HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	8545 MONTEREY ROAD	UNIT B	GILROY	CA	95020	4273	43	06085	37.0205875	-121.5754749	Santa Clara County
126729	Fee-for-Service	1275605024	1275605024	1	1	BHAT, NALINI MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47791	22	Pathology (M.D. only)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
126740	Fee-for-Service	1265490387	1265490387	1	1	BOHMAN, WILLIAM R MD	10/31/1995	207L00000X	NA	Other	026	PHYSICIANS	65557	05	Anesthesiology	0	In state provider	None	701 WELCH RD	STE 216	PALO ALTO	CA	94304	1705	43	06085	37.43702969	-122.1737907	Santa Clara County
126757	Fee-for-Service	1407993975	1407993975	1	1	BAHRI, SHIDFAR S MD	10/6/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51230	18	Ophthalmology	0	In state provider	None	2011 WESTCLIFF DR	STE 1	NEWPORT BEACH	CA	92660	5508	30	06059	33.62741724	-117.9073738	Orange County
126792	Fee-for-Service	1548238108	1548238108	1	1	BYBEE, DAVID B.	11/30/1988	174400000X	NA	Other	026	PHYSICIANS	69334	89	Surgery-Traumatic	0	In state provider	None	205 W GRANGER AVE	None	MODESTO	CA	95350	4402	50	06099	37.6673525	-120.9954534	Stanislaus County
126794	Fee-for-Service	1982771895	1982771895	1	1	BAUTISTA, ROBERT M MD	10/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77155	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
126805	Fee-for-Service	1750437034	1750437034	1	1	BRAVO, MARIA V LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
126817	Fee-for-Service	1033129358	1033129358	1	1	BOOKS, HEATHER L MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81548	40	Pediatrics	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
126821	Fee-for-Service	1265448419	1265448419	1	1	BUI, LYNN D MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55757	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
126827	Fee-for-Service	1689779209	1689779209	1	1	BONIS, WILLIAM EARLE MD	2/8/2015	207RH0003X	NA	Oncology	026	PHYSICIANS	53478	None	None	0	In state provider	None	265 COHASSET RD	STE 150	CHICO	CA	95926	2273	04	06007	39.75090044	-121.8522609	Butte County
126837	Fee-for-Service	1366749624	1366749624	1	1	BIRESCIK, AMANDA A	11/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
126852	Fee-for-Service	1659407955	1659407955	1	1	BANGASAN, ROSSANO L MD	11/30/2015	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	82239	-	NOT APPLICABLE	0	In state provider	None	1401 L ST	None	BAKERSFIELD	CA	93301	4522	15	06029	35.37071435	-119.0164657	Kern County
126854	Fee-for-Service	1720385214	1720385214	1	1	BAY AREA FOOT AND ANKLE SPEC	2/14/2017	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	48 FENTON ST	None	LIVERMORE	CA	94550	4144	01	06001	37.678005	-121.7834135	Alameda County
126857	Fee-for-Service	1417950445	1417950445	1	1	BROADVIEW INCORPORATED	5/4/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4570 GRIFFIN AVE	None	LOS ANGELES	CA	90031	1422	19	06037	34.09654388	-118.2020249	Los Angeles County
126898	Fee-for-Service	1831730514	1831730514	1	1	BRAR, AMNEET NP	5/17/2024	207N00000X	NA	Dermatology	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
126915	Fee-for-Service	1699090480	1699090480	1	1	BRODERICK, DANIEL K MD	2/7/2021	207L00000X	NA	Other	026	PHYSICIANS	167613	None	None	0	In state provider	None	23625 WR HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
126937	Fee-for-Service	1134382237	1134382237	1	1	BATRA, JASPREET S MD	8/17/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177317	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
126942	Fee-for-Service	1154417657	1154417657	1	1	BERKOWITZ, R LAURENCE MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	36957	24	Plastic Surgery	0	In state provider	None	3803 S BASCOM AVE	STE 102	CAMPBELL	CA	95008	7317	43	06085	37.25907527	-121.9475431	Santa Clara County
126966	Fee-for-Service	1922150978	1922150978	1	1	BULLARD, MIRIAM K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79511	40	Pediatrics	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
126971	Fee-for-Service	1205494846	1205494846	1	1	BATH, MANDEEP K MD	11/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188377	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
126975	Fee-for-Service	1326500984	1326500984	1	1	BHUKHEN, AKTA	8/22/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183926	None	None	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
126976	Fee-for-Service	1457521510	1457521510	1	1	BOUZAGLOU, ARMAND MD APC	9/17/2008	2085R0001X	NA	Other	026	PHYSICIANS	26098	01	General Practice	0	In state provider	None	201 S ALVARADO	STE A	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
126984	Fee-for-Service	1871984864	1871984864	1	1	BARIN, ISABEL LMFT	3/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
126988	Fee-for-Service	1881751295	1881751295	1	1	BROWN, HEATHER LMFT	5/4/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
127012	Fee-for-Service	1154413524	1154413524	1	1	BAO, GANG MD INC	12/29/2006	207RP1001X	NA	Pulmonology	026	PHYSICIANS	83170	41	Internal Medicine	0	In state provider	None	6699 ALVARADO RD.	2306	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
127014	Fee-for-Service	1083014864	1083014864	1	1	BONITA SPRINGS HOSPICE CARE	10/10/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	8545 MONTEREY ROAD	UNIT B	GILROY	CA	95020	4273	43	06085	37.0205875	-121.5754749	Santa Clara County
127017	Fee-for-Service	1538249495	1538249495	1	1	BUNUAN, MICHAEL F DO	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9642	41	Internal Medicine	0	In state provider	None	1000 NUT TREE ROAD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
127067	Fee-for-Service	1962560896	1962560896	1	1	BERGANZA, JOSE D MD INC	1/1/1997	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SAN JOSE MULTISPECIALTY	14514 RAMONA BLVD	STE 3	BALDWIN PARK	CA	91706	3361	19	06037	34.08673112	-117.9583626	Los Angeles County
127118	Fee-for-Service	1891903142	1891903142	1	1	BAMBRAH-DHAMIJA, MEHTAB	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93640	08	Family Practice	0	In state provider	MD	18326 PIONEER BLVD	None	ARTESIA	CA	90701	5533	19	06037	33.864912	-118.082172	Los Angeles County
127156	Fee-for-Service	1427251099	1427251099	1	1	BEWERSDORF, MARYBETH MD	10/31/1988	207LP2900X	NA	Other	026	PHYSICIANS	64584	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
127162	Fee-for-Service	1962457812	1962457812	1	108	BEVERLY RADIOLOGY MEDICAL GR	8/7/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	18133 VENTURA BLVD	#200	TARZANA	CA	91356	3616	19	06037	34.1657808	-118.5283188	Los Angeles County
127202	Fee-for-Service	1184860496	1184860496	1	3	BANIMAHD, FARIED MD	3/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	100516	-	NOT APPLICABLE	0	In state provider	None	5232 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5710	19	06037	34.09810648	-118.304811	Los Angeles County
127232	Fee-for-Service	1588869853	1588869853	1	1	BI-BETT	2/14/2017	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11540 MARSH CREEK RD	None	CLAYTON	CA	94517	9759	07	06013	37.90029732	-121.8651978	Contra Costa County
127243	Fee-for-Service	1346387412	1346387412	1	1	BROWN, BARRY A MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38470	08	Family Practice	0	In state provider	None	1375 MAIN ST	None	SAINT HELENA	CA	94574	1904	28	06055	38.5050916	-122.4700525	Napa County
127251	Fee-for-Service	1568510428	1568510428	1	1	BRIDGEFORD, DENISE C MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62858	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
127254	Fee-for-Service	1922150978	1922150978	1	1	BULLARD, MIRIAM K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79511	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
127262	Fee-for-Service	1558447631	1558447631	1	1	BEHERA, SARINA K MD	2/8/2015	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	80712	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2100 WEBSTER STREET	SUITE 511	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
127310	Fee-for-Service	1740011550	1740011550	1	1	BOWERS, SARA PT	10/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2051 STATHAM BLVD	None	OXNARD	CA	93033	3901	56	06111	34.17967669	-119.1655477	Ventura County
127313	Fee-for-Service	1619900347	1619900347	1	1	BHARGAVA, MONICA MD	6/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87934	41	Internal Medicine	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
127318	Fee-for-Service	1568402022	1568402022	1	1	BAQIR ALI MALIK, MD	5/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3901 BEAUBIEN ST	None	DETROIT	MI	48201	2119	00	None	42.35164453	-83.05377946	Wayne County
127331	Fee-for-Service	1396308615	1396308615	1	1	BASCOMBE, KRISTEN M MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	178857	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
127341	Fee-for-Service	1528139565	1528139565	1	1	BROWN, RICHARD K MD	8/31/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46254	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
127357	Fee-for-Service	1962560896	1962560896	1	1	BERGANZA, JOSE D MD INC	1/1/1997	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	SAN JOSE MULTISPECIALTY	14514 RAMONA BLVD	STE 3	BALDWIN PARK	CA	91706	3361	19	06037	34.08673112	-117.9583626	Los Angeles County
127358	Fee-for-Service	1083641542	1083641542	1	1	BHATIA, AMARDEEP S MD	9/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88820	30	Radiology	0	In state provider	None	6305 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
127361	Fee-for-Service	1174773113	1174773113	1	1	BHATIA, SHAILENDER K MD	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127665	None	None	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2636	19	06037	33.93112671	-118.2035532	Los Angeles County
127362	Fee-for-Service	1265708341	1265708341	1	1	BAILEY, JASON J MD	5/10/2017	390200000X	NA	Other	026	PHYSICIANS	146182	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
127379	Fee-for-Service	1770619173	1770619173	1	1	BGC PHARMACY INC	11/1/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BOB'S PHARMACY	629 E YOSEMITE AVE	None	MANTECA	CA	95336	5801	39	06077	37.79746351	-121.2085845	San Joaquin County
127425	Fee-for-Service	1811273972	1811273972	1	1	BOYD, EMILY C NP	5/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
127432	Fee-for-Service	1508914318	1508914318	1	1	BARRIGA, MARCELINO C MD	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85837	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
127452	Fee-for-Service	1760429856	1760429856	1	1	BRENNAN, MICHAEL E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DESERT VISTA HOSPITAL	570 W BROWN RD	None	MINNEAPOLIS	MN	55486	0001	00	None	45.06512674	-93.26669115	Anoka County
127470	Fee-for-Service	1073035994	1073035994	1	1	BELL, LETECIA A	8/14/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5920 WALNUT WAY	None	PALMDALE	CA	93551	2812	19	06037	34.63572766	-118.234604	Los Angeles County
127472	Fee-for-Service	1780679258	1780679258	1	1	BUI, JEFFERY MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99664	20	Orthopedic Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
127491	Fee-for-Service	1962457812	1962457812	1	131	BEVERLY RADIOLOGY MEDICAL GR	3/20/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	JOHN'S	1700 N. ROSE AVENUE	SUITE 110	OXNARD	CA	93030	7630	56	06111	34.21746	-119.155545	Ventura County
127513	Fee-for-Service	1821087511	1821087511	1	1	BISHAY, EMAD D MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77193	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
127522	Fee-for-Service	1922324979	1922324979	1	1	BELCHE, STACEY L CCC-SLP	8/16/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
127535	Fee-for-Service	1033579404	1033579404	1	1	BUTTNER, MELISSA M PHD	8/1/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
127546	Fee-for-Service	1922150978	1922150978	1	1	BULLARD, MIRIAM K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79511	02	General Surgery	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
127553	Fee-for-Service	1245421676	1245421676	1	1	BRIEN M. RABENHORST	1/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
127595	Fee-for-Service	1962457812	1962457812	1	70	BEVERLY RADIOLOGY MEDICAL GR	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8805 HAVEN AVE	STE 220	RANCHO CUCAMONGA	CA	91730	5149	36	06071	34.09424614	-117.5756838	San Bernardino County
127632	Fee-for-Service	1811307010	1811307010	1	1	BASEER, NERMEEN N DO	12/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14558	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
127642	Fee-for-Service	1013627405	1013627405	1	1	BLOSSOM CREEKS ASSISTED	7/7/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LIVING 2 INC	2770 N BURGAN AVE	None	FRESNO	CA	93727	8972	10	06019	36.775791	-119.677154	Fresno County
127652	Fee-for-Service	1306160593	1306160593	1	1	BERNSTEIN, FREDERIC J DO	10/12/2022	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	20335	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
127653	Fee-for-Service	1053859041	1053859041	1	1	BAZARGANI, SOROUSH MD	5/22/2023	208800000X	NA	Other	026	PHYSICIANS	171098	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
127664	Fee-for-Service	1417222779	1417222779	1	1	BUDDHE, SUJATHA MD	8/15/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	188579	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
127670	Fee-for-Service	1497789648	1497789648	1	1	BARRY & TAFFY, INC	10/29/1993	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	5955 DE SOTO AVE	STE 160	WOODLAND HILLS	CA	91367	5116	19	06037	34.17886752	-118.5904007	Los Angeles County
127695	Fee-for-Service	1558566372	1558566372	1	1	BERUMEN, JENNIFER A MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106782	02	General Surgery	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
127696	Fee-for-Service	1699252858	1699252858	1	1	BRIGHTSTAR HOME HEALTH INC	7/10/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12509 OXNARD ST	SUITE 213	NORTH HOLLYWOOD	CA	91606	4441	19	06037	34.17943548	-118.405683	Los Angeles County
127707	Fee-for-Service	1184269490	1184269490	1	1	BLACHER, SARAH MD	5/17/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
127713	Fee-for-Service	1881686558	1881686558	1	1	BRYAN,JOSEPH S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ASSOCIATED RETINA CONSUL	7600 N 15TH STREET	STE # 155	PHOENIX	AZ	85020	0000	00	None	33.548301	-112.050603	Maricopa County
127727	Fee-for-Service	1114122769	1114122769	1	1	BAE, SEONG G MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123341	02	General Surgery	0	In state provider	None	15211 VAN OWEN STREET	SUITE 208	VAN NUYS	CA	91405	3623	19	06037	34.19395411	-118.4642527	Los Angeles County
127750	Fee-for-Service	1871857953	1871857953	1	1	BATIEHA, KARAM A MD	9/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
127757	Fee-for-Service	1073035994	1073035994	1	1	BELL, LETECIA A	8/14/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5920 WALNUT WAY	None	PALMDALE	CA	93551	2812	19	06037	34.63572766	-118.234604	Los Angeles County
127779	Fee-for-Service	1962457812	1962457812	1	95	BEVERLY RADIOLOGY MEDICAL GR	6/8/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3055 WILSHIRE BLVD	SUITE 150	LOS ANGELES	CA	90010	1118	19	06037	34.06185807	-118.2880358	Los Angeles County
127794	Fee-for-Service	1770602815	1770602815	1	1	BALACHANDRAN, RUPA	7/23/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1234 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3911	38	06075	37.781144	-122.4390035	San Francisco County
127800	Fee-for-Service	1821087511	1821087511	1	1	BISHAY, EMAD D MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77193	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
127815	Fee-for-Service	1275047631	1275047631	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	3000 FLORAL AVE	None	SELMA	CA	93662	9414	10	06019	36.57635971	-119.6317081	Fresno County
127824	Fee-for-Service	1134251358	1134251358	1	1	BRANVOLD, RONALD D	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1723 1ST ST	None	SUSANVILLE	CA	96130	4531	18	06035	40.41606127	-120.6474027	Lassen County
127828	Fee-for-Service	1467623488	1467623488	1	1	BURKE, DENAN Y LMFT	5/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 MARSH STREET	SUITE 108	SAN LUIS OBISPO	CA	93401	0508	40	06079	35.28418203	-120.6540933	San Luis Obispo County
127864	Fee-for-Service	1417213794	1417213794	1	1	BRAGINSKY, LENA MD	5/1/2020	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162553	15	Obstetrics (D.O. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
127873	Fee-for-Service	1942230420	1942230420	1	1	BECKER, BRAD A MD	8/31/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	76566	07	Dermatology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
127921	Fee-for-Service	1700958550	1700958550	1	1	BELANI, SHARINA S MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90237	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
127925	Fee-for-Service	1083615512	1083615512	1	1	BAEHR, GEORGE MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58677	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7860 MISSION CENTER CT	# 20	SAN DIEGO	CA	92108	1329	37	06073	32.77370228	-117.1549878	San Diego County
127941	Fee-for-Service	1336910199	1336910199	1	1	BHUPINDER S ROMANA MD INC	7/10/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	1205 EAST NORTH STREET	None	MANTECA	CA	95336	5960	39	06077	37.80110374	-121.1974853	San Joaquin County
127966	Fee-for-Service	1417186305	1417186305	1	1	BEDKE, BRENT J MD	2/4/2019	207ZP0105X	NA	Other	026	PHYSICIANS	-	22	Pathology (M.D. only)	1	Border provider	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
127992	Fee-for-Service	1962457812	1962457812	1	169	BEVERLY RADIOLOGY MEDICAL GR	4/18/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8670 WILSHIRE BLVD	SUITE 101	BEVERLY HILLS	CA	90211	2924	19	06037	34.06629779	-118.3807407	Los Angeles County
128013	Fee-for-Service	1457816233	1457816233	1	1	BELOVED HOME HEALTH CARE INC	3/14/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	103 W ALAMEDA AVE	SUITE 12	BURBANK	CA	91502	2253	19	06037	34.17123949	-118.3032671	Los Angeles County
128014	Fee-for-Service	1407048739	1407048739	1	1	BROOK, ILANIT E MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102507	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
128046	Fee-for-Service	1205198900	1205198900	1	1	BRUNETTE, HEIDI C PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94188	3109	38	06075	37.78096053	-122.4637512	San Francisco County
128064	Fee-for-Service	1962457812	1962457812	1	166	BEVERLY RADIOLOGY MEDICAL GR	1/17/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	5411 ETIWANDA AVE	SUITE 101	TARZANA	CA	91356	6158	19	06037	34.169112	-118.530837	Los Angeles County
128069	Fee-for-Service	1013597558	1013597558	1	1	BRUNDAGE, SARA DO	10/21/2024	390200000X	NA	Other	026	PHYSICIANS	20505	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
128072	Fee-for-Service	1962457812	1962457812	1	33	BEVERLY RADIOLOGY MEDICAL GR	8/2/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6848 MAGNOLIA AVE	None	RIVERSIDE	CA	92506	2858	33	06065	33.94954856	-117.3989256	Riverside County
128074	Fee-for-Service	1265250070	1265250070	1	1	BAER-MODENA, ISABEL	1/15/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
128082	Fee-for-Service	1720656572	1720656572	1	1	BROWN-HILL MEDICAL GROUP, IN	10/5/2022	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5311 WEST CENTINELA AVE	None	LOS ANGELES	CA	90045	8803	19	06037	33.97728749	-118.3728026	Los Angeles County
128089	Fee-for-Service	1194896159	1194896159	1	1	BILLSON, JASON D MD	12/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76296	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
128180	Fee-for-Service	1184045809	1184045809	1	1	BAVISHI, PUNIT K MD	9/21/2023	207R00000X	NA	Other	026	PHYSICIANS	138807	None	None	0	In state provider	None	13355 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5802	19	06037	33.91091877	-118.3527745	Los Angeles County
128184	Fee-for-Service	1487685095	1487685095	1	1	BOONE, MATTHEW C MD	12/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	57757	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
128202	Fee-for-Service	1619146008	1619146008	1	1	BAILEY, RANDALL MD	9/25/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	102412	36	Psychiatry	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
128203	Fee-for-Service	1235384785	1235384785	1	1	BLOCK, MICHAEL R MD INC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	24174	45	Nephrology (Renal-Kidney)	0	In state provider	None	970 MONUMENT ST	STE 210	PACIFIC PALISADES	CA	90272	3891	19	06037	34.0463954	-118.5240711	Los Angeles County
128281	Fee-for-Service	1962457812	1962457812	1	14	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3808 RIVERSIDE DR	None	BURBANK	CA	91505	4050	19	06037	34.15252315	-118.3412174	Los Angeles County
128323	Fee-for-Service	1013968601	1013968601	1	1	BEHESHTI, NADER MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78971	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
128326	Fee-for-Service	1689711293	1689711293	1	1	BOGHANI, SALIMAH A MD	11/24/2008	207R00000X	NA	Other	026	PHYSICIANS	97612	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
128336	Fee-for-Service	1902907900	1902907900	1	1	BENDER, SANDRA A MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56115	40	Pediatrics	0	In state provider	None	47-647 CALEO BAY	SUITE 101	LA QUINTA	CA	92253	8857	33	06065	33.70362335	-116.2938105	Riverside County
128348	Fee-for-Service	1497842397	1497842397	1	1	BAJAJ, SAMEER MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135341	41	Internal Medicine	0	In state provider	None	1680 E 120TH ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
128362	Fee-for-Service	1962457812	1962457812	1	20	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	230 S MAIN ST	#101	ORANGE	CA	92868	3851	30	06059	33.785154	-117.867318	Orange County
128372	Fee-for-Service	1528171196	1528171196	1	1	BODAPATI, RAJESWARI K MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94529	08	Family Practice	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
128373	Fee-for-Service	1194574699	1194574699	1	1	BALLESTEROS, JORGE PHD	11/22/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
128396	Fee-for-Service	1669495149	1669495149	1	1	BUXTON, WILLIAM G MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67676	13	Neurology (M.D. only)	0	In state provider	None	1245 16TH ST	None	SANTA MONICA	CA	90404	1235	19	06037	34.02726451	-118.4857138	Los Angeles County
128398	Fee-for-Service	1790021517	1790021517	1	1	BLACKFLY INVESTMENTS LLC	10/15/2018	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	14401 SE 1ST STREET	None	VANCOUVER	WA	98684	3503	00	None	45.619812	-122.5243305	Clark County
128403	Fee-for-Service	1144690777	1144690777	1	1	BUGG, CHARLES W MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
128418	Fee-for-Service	1124513833	1124513833	1	1	BU, SISI MD	10/18/2023	207L00000X	NA	Other	026	PHYSICIANS	164378	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
128419	Fee-for-Service	1982979340	1982979340	1	1	BUKAR, NADIA NP	3/19/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12728 FUTURA ST	None	SAN DIEGO	CA	92130	2152	37	06073	32.94846795	-117.2226567	San Diego County
128424	Fee-for-Service	1174718399	1174718399	1	1	BASSETT, JEFFREY C MD	9/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104448	34	Urology and Urological Surgery	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
128438	Fee-for-Service	1104904846	1104904846	1	1	BHATT, BHARAT V DO	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6652	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
128447	Fee-for-Service	1104435817	1104435817	1	1	BRADFORD HEALTHCARE	9/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1916 ORANGE TREE LANE	STE 450A	REDLANDS	CA	92374	4520	36	06071	34.06785848	-117.2189386	San Bernardino County
128449	Fee-for-Service	1962457812	1962457812	1	74	BEVERLY RADIOLOGY MEDICAL GR	10/6/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	12818 HEACOCK ST	STE C-2	MORENO VALLEY	CA	92553	3165	33	06065	33.934923	-117.243762	Riverside County
128473	Fee-for-Service	1851427520	1851427520	1	1	BEATTY, ALEXIS MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106523	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	3220	38	06075	37.76344756	-122.4581992	San Francisco County
128496	Fee-for-Service	1194330795	1194330795	2	1	BEWELLRX, INC.	2/18/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21102 DEVONSHIRE ST	None	CHATSWORTH	CA	91311	2316	19	06037	34.2572105	-118.5932205	Los Angeles County
128497	Fee-for-Service	1841216041	1841216041	1	1	BEIRNE, JOSHUA P MD	7/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91482	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
128508	Fee-for-Service	1245611250	1245611250	1	1	BHANDAL, HARJOT S MD	6/2/2021	207L00000X	NA	Other	026	PHYSICIANS	147426	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
128532	Fee-for-Service	1316332166	1316332166	1	1	BHAKTA, SAMIR S MD	11/8/2020	207L00000X	NA	Other	026	PHYSICIANS	162556	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
128567	Fee-for-Service	1932426012	1932426012	1	1	BARTH, LAURA	10/27/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
128571	Fee-for-Service	1013991124	1013991124	1	1	BUXA, GARY A MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74853	04	Otology, Laryngology, Rhinology	0	In state provider	None	3305 PLACER ST	STE A	REDDING	CA	96001	2364	45	06089	40.57539992	-122.4150037	Shasta County
128627	Fee-for-Service	1902907900	1902907900	1	1	BENDER, SANDRA A MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56115	41	Internal Medicine	0	In state provider	None	47-647 CALEO BAY	SUITE 101	LA QUINTA	CA	92253	8857	33	06065	33.70362335	-116.2938105	Riverside County
128629	Fee-for-Service	1902143696	1902143696	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	563 I ST	None	REEDLEY	CA	93654	2431	10	06019	36.60099334	-119.4595171	Fresno County
128640	Fee-for-Service	1114916707	1114916707	1	1	BEWS, JAMES E PHD	3/15/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10817 SANTA MONICA BLVD	100	LOS ANGELES	CA	90025	4655	19	06037	34.05031409	-118.4356182	Los Angeles County
128649	Fee-for-Service	1447816061	1447816061	1	1	BANKS, DENEDRIA R LCSW	2/6/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
128661	Fee-for-Service	1962457812	1962457812	1	45	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP	36320 INLAND VALLEY DR	STE 303	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
128697	Fee-for-Service	1235217357	1235217357	1	1	BALASUBRAMANIAN, MAHESWA	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96252	41	Internal Medicine	0	In state provider	J MD	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
128737	Fee-for-Service	1104435817	1104435817	1	1	BRADFORD HEALTHCARE	9/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1916 ORANGE TREE LANE	STE 450A	REDLANDS	CA	92374	4520	36	06071	34.06785848	-117.2189386	San Bernardino County
128749	Fee-for-Service	1578929139	1578929139	1	1	BARRY, OLIVIA H MD	12/13/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	183280	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
128772	Fee-for-Service	1225456361	1225456361	1	1	BOURKE, CHRISTOPHER S DPM	7/6/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
128813	Fee-for-Service	1942653159	1942653159	1	2	BAHNAM, RAMONA MD	8/20/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157101	08	Family Practice	0	In state provider	None	200 SOUTH WELLS ROAD	100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
128815	Fee-for-Service	1376502013	1376502013	1	1	BRADLEY, RUSSELL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 N MAIN ST	None	TOOELE	UT	84074	9819	00	None	40.56668579	-112.2959013	Tooele County
128819	Fee-for-Service	1689659153	1689659153	1	1	BARTLETT, CHRIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER	None	COLORADO SPRINGS	CO	80909	0000	00	None	38.8388119	-104.7995065	El Paso County
128868	Fee-for-Service	1558657882	1558657882	1	1	BOONE, MICHAEL W MD	10/28/2020	207P00000X	NA	Other	026	PHYSICIANS	165678	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
128877	Fee-for-Service	1053926071	1053926071	1	1	BRAND HOSPICE CARE	7/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7630 VINELAND AVE	SUITE 209A	SUN VALLEY	CA	91352	4535	19	06037	34.209189	-118.3703025	Los Angeles County
128885	Fee-for-Service	1407990773	1407990773	1	1	BOTA, ROBERT G	1/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103585	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
128907	Fee-for-Service	1497340046	1497340046	1	1	BIO-MEDICAL APPLICATIONS	3/8/2022	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	5 MASSIE COURT	None	SACRAMENTO	CA	95823	4301	34	06067	38.476017	-121.4205165	Sacramento County
128909	Fee-for-Service	1962457812	1962457812	1	87	BEVERLY RADIOLOGY MEDICAL GR	12/1/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	16300 SAND CANYON AVENUE	STE 203	IRVINE	CA	92618	3704	30	06059	33.66115075	-117.7742405	Orange County
128930	Fee-for-Service	1194327981	1194327981	1	1	BOAN, EVELYN B NP	8/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	726 N MEDICAL CENTER DR	STE. 125	CLOVIS	CA	93611	6881	10	06019	36.84186593	-119.6624867	Fresno County
128948	Fee-for-Service	1275136541	1275136541	1	1	BUSANO, RACHEL D	12/11/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13403 S OLEANDER AVE	None	COMPTON	CA	90222	2926	19	06037	33.91002946	-118.2316399	Los Angeles County
128950	Fee-for-Service	1962457812	1962457812	1	17	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4334 CENTRAL AVE	None	RIVERSIDE	CA	92506	2918	33	06065	33.95346346	-117.3993495	Riverside County
128960	Fee-for-Service	1871528992	1871528992	1	1	BRINDLEY, RAY MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83986	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
128986	Fee-for-Service	1851787436	1851787436	1	1	BIAGI, BRIAN N MD	6/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	235 WEST 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
129009	Fee-for-Service	1689874265	1689874265	1	1	BUCCINO, YVETTE LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
129035	Fee-for-Service	1598877508	1598877508	2	1	BEHL, ASHOK MD	5/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	38400	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	567 W PUTNAM AVENUE	STE 1	PORTERVILLE	CA	93257	3260	54	06107	36.06956761	-119.0296417	Tulare County
129082	Fee-for-Service	1235805458	1235805458	1	1	BURBANK INFECTIOUS DISEASES	11/18/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	PC	501 BUENA VISTA	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
129128	Fee-for-Service	1750607453	1750607453	1	1	BABER, JOHN T MD	11/20/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	119504	02	General Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
129133	Fee-for-Service	1669472387	1669472387	1	1	BAYLOR ALL SAINTS MEDICAL CE	7/24/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTS MEDICAL CENTER - FOR	1400 8TH AVE	None	FORT WORTH	TX	76104	4110	00	None	32.72995601	-97.34376587	Tarrant County
129143	Fee-for-Service	1750500674	1750500674	1	1	BOONE, JON L MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84076	26	Psychiatry (child)	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
129150	Fee-for-Service	1083243281	1083243281	1	1	BOUZARIF, GHITA MD	7/3/2023	207R00000X	NA	Other	026	PHYSICIANS	179404	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
129163	Fee-for-Service	1053926071	1053926071	1	1	BRAND HOSPICE CARE	7/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7630 VINELAND AVE	SUITE 209A	SUN VALLEY	CA	91352	4535	19	06037	34.209189	-118.3703025	Los Angeles County
129167	Fee-for-Service	1255528972	1255528972	1	1	BLOMQUIST, CARIANNE DO	4/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	12300	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
129179	Fee-for-Service	1013091081	1013091081	1	1	BOYLAN, BARBARA A	2/16/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62299	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
129186	Fee-for-Service	1083980585	1083980585	1	1	BARNES, JAMES W MD	9/28/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	159330	None	None	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
129192	Fee-for-Service	1508200890	1508200890	1	1	BARTRET, VICTORIA M MD MPH	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131948	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
129194	Fee-for-Service	1811366586	1811366586	1	1	BILBERRY HOLDINGS LLC	11/3/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	20259 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5307	01	06001	37.69698787	-122.0869631	Alameda County
129199	Fee-for-Service	1962457812	1962457812	1	103	BEVERLY RADIOLOGY MEDICAL GR	4/18/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	700 N CENTRAL AVE	STE 100	GLENDALE	CA	91203	3283	19	06037	34.15708991	-118.2579615	Los Angeles County
129226	Fee-for-Service	1851898571	1851898571	1	1	BISANZ, BRYAN A MD	4/11/2022	207P00000X	NA	Other	026	PHYSICIANS	164688	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
129230	Fee-for-Service	1942279401	1942279401	1	1	BANERJEE, SUPRATIM MD	3/12/2003	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	54064	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5945 TRUXTUN EXTENSION	None	BAKERSFIELD	CA	93309	0610	15	06029	35.36322921	-119.0706029	Kern County
129233	Fee-for-Service	1487819058	1487819058	1	1	BARBARA, ANNA G MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95202	84	Surgery-Head and Neck	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
129236	Fee-for-Service	1275136541	1275136541	1	1	BUSANO, RACHEL D	12/11/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13403 S OLEANDER AVE	None	COMPTON	CA	90222	2926	19	06037	33.91002946	-118.2316399	Los Angeles County
129244	Fee-for-Service	1205087947	1205087947	1	1	BURGESS, MARQUIA M LMFT	5/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
129292	Fee-for-Service	1649213216	1649213216	1	1	BUCK, CAMERON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
129293	Fee-for-Service	1669738274	1669738274	1	1	BOLTON, MICHAEL A MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	90270	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
129303	Fee-for-Service	1457382533	1457382533	1	1	BUDRIS, ALFRED V MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10876	05	Anesthesiology	0	In state provider	None	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	30	06059	33.746805	-117.834147	Orange County
129348	Fee-for-Service	1164864104	1164864104	1	1	BRIDGE, BRYCE LMFT	12/2/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	38	06075	37.7813638	-122.4082438	San Francisco County
129368	Fee-for-Service	1487981569	1487981569	1	1	BREWER, ANH N DO	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11688	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
129370	Fee-for-Service	1326404948	1326404948	1	1	BHAISAJA PC	4/8/2016	207L00000X	NA	Other	026	PHYSICIANS	103576	05	Anesthesiology	0	In state provider	None	10 WOODLAND RD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
129372	Fee-for-Service	1265442032	1265442032	1	1	BRUNNS, WILLIAM C MD	7/22/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	32217	36	Psychiatry	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
129397	Fee-for-Service	1801936844	1801936844	1	1	BATRA, JAGMOHAN S	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75793	None	None	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
129409	Fee-for-Service	1366889834	1366889834	1	1	BRIM, RACHEL M MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137388	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
129422	Fee-for-Service	1669472387	1669472387	1	1	BAYLOR ALL SAINTS MEDICAL CE	7/24/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTS MEDICAL CENTER - FOR	1400 8TH AVE	None	FORT WORTH	TX	76104	4110	00	None	32.72995601	-97.34376587	Tarrant County
129426	Fee-for-Service	1962457812	1962457812	1	121	BEVERLY RADIOLOGY MEDICAL GR	4/24/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	675 CAMINO DE LOS MARES	STE 101	SAN CLEMENTE	CA	92673	2836	30	06059	33.45710369	-117.6474248	Orange County
129431	Fee-for-Service	1750500674	1750500674	1	1	BOONE, JON L MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84076	36	Psychiatry	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
129445	Fee-for-Service	1679746572	1679746572	1	1	BAIRD, ROWAN C A MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131522	01	General Practice	0	In state provider	None	3946 NORWOOD AVE	None	SACRAMENTO	CA	95838	3300	34	06067	38.639952	-121.456359	Sacramento County
129449	Fee-for-Service	1700827326	1700827326	1	1	BARE, IAN E MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80711	08	Family Practice	0	In state provider	None	26991 CROWN VALLEY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
129471	Fee-for-Service	1174109847	1174109847	1	1	BHATTACHARJEE, SAPTATI	7/29/2024	390200000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
129489	Fee-for-Service	1669470142	1669470142	1	1	BRODIE, THOMAS S MD	5/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25725	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	171 W BORT ST	STE 101	LONG BEACH	CA	90805	2111	19	06037	33.87046199	-118.2050591	Los Angeles County
129514	Fee-for-Service	1164179552	1164179552	1	1	BAKHT ROSHAN MD, A PROFESSIO	4/12/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	NAL CORPORATION	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
129523	Fee-for-Service	1962457812	1962457812	1	48	BEVERLY RADIOLOGY MEDICAL GR	5/7/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1240 WESTLAKE BLVD	STE 111	WESTLAKE VILLAGE	CA	91361	1976	56	06111	34.14966879	-118.8378084	Ventura County
129574	Fee-for-Service	1932358553	1932358553	1	2	BARYLSKI, CHAD R NP	2/24/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
129601	Fee-for-Service	1609845601	1609845601	1	1	BAUER, TINO F MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2640 E BARNETT RD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
129608	Fee-for-Service	1215031307	1215031307	1	1	BEECHEL, CHRISTOPHER S LMFT	10/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2255 MYRTLE AVE	STE A	EUREKA	CA	95501	3386	12	06023	40.78688533	-124.132153	Humboldt County
129617	Fee-for-Service	1578623229	1578623229	1	1	BRIGDEN, NANCY K LAC	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ACUPUNCTURE PAIN MGNT	21320 HAWTHORNE BLVD	STE 225	TORRANCE	CA	90503	5661	19	06037	33.83462628	-118.3529587	Los Angeles County
129676	Fee-for-Service	1639351208	1639351208	1	1	BURKE, MARY D PT	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 LAKEVIEW HWY	None	PETALUMA	CA	94954	5698	49	06097	38.32168809	-122.6254468	Sonoma County
129681	Fee-for-Service	1699824086	1699824086	1	1	BRAINARD, JASON C MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
129683	Fee-for-Service	1710910658	1710910658	1	1	BOWER, LAURA S	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
129706	Fee-for-Service	1669493094	1669493094	1	1	BIEN, RICHARD S	9/11/2006	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	430 SOUTH WESTERN AVENUE	SUITE 102 A	LOS ANGELES	CA	90020	4173	19	06037	34.066206	-118.309082	Los Angeles County
129756	Fee-for-Service	1154437390	1154437390	1	1	BRENCHLEY, RYAN L MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69974	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
129758	Fee-for-Service	1861412611	1861412611	1	1	BELITSKI, ANDREI G MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66333	01	General Practice	0	In state provider	None	2701 W ALAMEDA AVE	STE 405	BURBANK	CA	91505	4409	19	06037	34.15751343	-118.3303715	Los Angeles County
129784	Fee-for-Service	1194892877	1194892877	1	1	BARRA-STEVENS, DEBRA A	8/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45828	40	Pediatrics	0	In state provider	None	1800 SULLIVAN AVE	RM 202	DALY CITY	CA	94015	2222	41	06081	37.68077723	-122.4728941	San Mateo County
129808	Fee-for-Service	1639486608	1639486608	1	1	BELL-DAYOAN, JENNIFER C	5/12/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
129838	Fee-for-Service	1245369651	1245369651	1	1	BONFANTI, DAVID	5/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
129840	Fee-for-Service	1407112212	1407112212	1	1	BERRY, TAMARA M MD	3/8/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	150443	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
129849	Fee-for-Service	1538190160	1538190160	1	1	BALASA, VINOD V MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	63509	78	Neoplastic Diseases/Oncology	0	In state provider	None	9300 VALLEY CHILDRENS	PLACE	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
129900	Fee-for-Service	1427677137	1427677137	1	1	BERGAL, MICHELLE DO	8/29/2023	207P00000X	NA	Other	026	PHYSICIANS	20525	None	None	0	In state provider	None	2050 VIBORG RD	None	SOLVANG	CA	93463	2220	42	06083	34.60246267	-120.1261332	Santa Barbara County
129952	Fee-for-Service	1275594160	1275594160	1	1	BANCHI, MICHAEL T MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22668	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2865 ATLANTIC AVE	STE 25	LONG BEACH	CA	90806	1740	19	06037	33.809418	-118.185058	Los Angeles County
129961	Fee-for-Service	1457844078	1457844078	1	1	BRIER, ELIZABETH A MD	10/4/2021	207R00000X	NA	Other	026	PHYSICIANS	166586	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
129999	Fee-for-Service	1619075116	1619075116	1	1	BAUGH, WILLIAM P MD INC	2/1/2002	193400000X	NA	Other	026	PHYSICIANS	77769	07	Dermatology	0	In state provider	None	333 W BASTANCHURY RD	STE 110	FULLERTON	CA	92835	3433	30	06059	33.89358012	-117.9327635	Orange County
130019	Fee-for-Service	1740351592	1740351592	1	1	BRADLEY, JOHN S MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35234	40	Pediatrics	0	In state provider	None	3666 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1949	37	06073	32.80970214	-117.1513084	San Diego County
130032	Fee-for-Service	1518532621	1518532621	1	1	BERENGER, BRENDAN N	5/6/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	180957	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130071	Fee-for-Service	1962457812	1962457812	1	82	BEVERLY RADIOLOGY MEDICAL GR	12/15/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	1236 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2607	30	06059	33.8508897	-117.9761562	Orange County
130074	Fee-for-Service	1386412104	1386412104	1	1	BIANCA N. MARTINEZ, LICENSED	10/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	14448 E AMHERST ST	None	MOORPARK	CA	93021	1302	56	06111	34.29539532	-118.8597957	Ventura County
130091	Fee-for-Service	1033132048	1033132048	1	1	BREALL O'BRIEN WEINREB	4/16/1977	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	LEE SOTO CHUN TENG MDS	2250 HAYES ST	STE 204	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
130101	Fee-for-Service	1104116011	1104116011	1	1	BATNIJI, RAJAIE S MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118002	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130107	Fee-for-Service	1063558682	1063558682	1	1	BALMANOUKIAN, ANI S MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117624	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
130115	Fee-for-Service	1477550648	1477550648	1	1	BHAVSAR, RAJIV I MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50717	41	Internal Medicine	0	In state provider	None	1321 N HARBOR BLVD	STE 302	FULLERTON	CA	92835	4131	30	06059	33.88346929	-117.9251709	Orange County
130134	Fee-for-Service	1538190160	1538190160	1	1	BALASA, VINOD V MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	63509	68	Hematology	0	In state provider	None	9300 VALLEY CHILDRENS	PLACE	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
130141	Fee-for-Service	1356867998	1356867998	1	1	BRANCH, KATHERINE	11/2/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4624 SAGAR AVENUE	None	SACRAMENTO	CA	95821	3037	34	06067	38.636334	-121.356702	Sacramento County
130163	Fee-for-Service	1801309455	1801309455	1	1	BURKE-CRAVENS, AMBER D NP	3/4/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
130185	Fee-for-Service	1942797956	1942797956	1	1	BERENS, ANNE E MD	8/4/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164834	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
130192	Fee-for-Service	1902225063	1902225063	1	1	BELLEROSE, ROBERT J MD	7/22/2019	207L00000X	NA	Other	026	PHYSICIANS	140923	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANNAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
130258	Fee-for-Service	1033309539	1033309539	1	1	BASKERVILLE, SHEATON M LMFT	3/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
130281	Fee-for-Service	1609372515	1609372515	1	1	BHATT, BRIAN MD	2/13/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	175868	None	None	0	In state provider	None	24330 MCBEAN PKWY	None	VALENCIA	CA	91355	1929	19	06037	34.39471253	-118.560951	Los Angeles County
130282	Fee-for-Service	1619976248	1619976248	1	1	BELL VILLA CARE ASSOC.,	6/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	9028 ROSE ST	None	BELLFLOWER	CA	90706	6418	19	06037	33.86956549	-118.141704	Los Angeles County
130290	Fee-for-Service	1548672926	1548672926	1	1	BECK, NATALY S MD	8/7/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163400	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130304	Fee-for-Service	1740351592	1740351592	1	1	BRADLEY, JOHN S MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35234	77	Infectious Disease	0	In state provider	None	3666 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1949	37	06073	32.80970214	-117.1513084	San Diego County
130311	Fee-for-Service	1043893449	1043893449	1	1	BOCKMAN, BURANEE MD	9/13/2024	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
130358	Fee-for-Service	1427365576	1427365576	1	1	BURKE, SHABNAM S MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118720	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
130376	Fee-for-Service	1033132048	1033132048	1	1	BREALL O'BRIEN WEINREB	4/16/1977	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	LEE SOTO CHUN TENG MDS	2250 HAYES ST	STE 204	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
130395	Fee-for-Service	1063558682	1063558682	1	1	BALMANOUKIAN, ANI S MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117624	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
130422	Fee-for-Service	1538190160	1538190160	1	1	BALASA, VINOD V MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	63509	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS	PLACE	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
130428	Fee-for-Service	1417299231	1417299231	1	1	BRENMAN, STEPHANIE V MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132462	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
130429	Fee-for-Service	1902078884	1902078884	1	1	BARRY, MICHELLE D	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
130430	Fee-for-Service	1356867998	1356867998	1	1	BRANCH, KATHERINE	11/2/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4624 SAGAR AVENUE	None	SACRAMENTO	CA	95821	3037	34	06067	38.636334	-121.356702	Sacramento County
130447	Fee-for-Service	1699204321	1699204321	1	1	BELTRAN, MARICELA T MD	2/2/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167331	None	None	0	In state provider	None	11306 MOUNTAIN VIEW	A	LOMA LINDA	CA	92354	3832	36	06071	34.047513	-117.243647	San Bernardino County
130475	Fee-for-Service	1013156215	1013156215	1	1	BASS, ALICE LCSW	5/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13340 CALIFORNIA ST.	SUITE F	YUCAIPA	CA	92399	5016	36	06071	34.0115556	-117.0393047	San Bernardino County
130479	Fee-for-Service	1790707305	1790707305	1	1	BOURGAULT, MICHELLE L MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	66456	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1580 VALENCIA ST	STE 508	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
130540	Fee-for-Service	1235342494	1235342494	1	1	BAUMGARTEN, JANA M	10/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83172	25	Physical Medicine and Rehabilitation	0	In state provider	None	8631 W 3RD ST	STE 915E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
130584	Fee-for-Service	1003020413	1003020413	1	1	BATTY, GEORGE N MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128314	78	Neoplastic Diseases/Oncology	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
130623	Fee-for-Service	1770018889	1770018889	1	1	BAE, ALISON S MD	7/18/2023	208200000X	NA	General Surgery	026	PHYSICIANS	184492	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130642	Fee-for-Service	1629071758	1629071758	1	1	BRIGHTON COMMUNITY HOSPITAL	4/22/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ASSOCIATION	1600 PRAIRE CENTER PKWY	None	BRIGHTON	CO	80601	4006	00	None	39.96461455	-104.770985	Adams County
130643	Fee-for-Service	1427365576	1427365576	1	1	BURKE, SHABNAM S MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118720	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
130647	Fee-for-Service	1760484927	1760484927	1	1	BATTY, JOHN W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	715 MARTIN LUTHER KING A	STE 101	ALBUQUERQUE	NM	87102	3661	00	None	35.08555522	-106.6387037	Bernalillo County
130684	Fee-for-Service	1811082415	1811082415	1	1	BURRIS, JAMES J DO	10/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	6403	01	General Practice	0	In state provider	None	2540 N SANTIAGO BLVD	None	ORANGE	CA	92867	1862	30	06059	33.83083711	-117.8334144	Orange County
130713	Fee-for-Service	1275989717	1275989717	1	1	BRINK, DEREK I DO	7/29/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	18109	18	Ophthalmology	0	In state provider	None	3190 CHURN CREEK RD	None	REDDING	CA	96002	2122	45	06089	40.56104546	-122.3531114	Shasta County
130754	Fee-for-Service	1477872919	1477872919	1	1	BEVERLY RADIOLOGY MEDICAL	8/10/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP III	10459 MT VIEW AVE	STE E	LOMA LINDA	CA	92354	2033	36	06071	34.063722	-117.2436545	San Bernardino County
130776	Fee-for-Service	1538227541	1538227541	1	1	BERNARD HEILMAN M.D.	3/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 SW 10TH ST	None	MADISON	SD	57042	3200	00	None	43.99302789	-97.11819925	Lake County
130785	Fee-for-Service	1871856922	1871856922	1	1	BROWN, SHERRY-ANN MD	11/15/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	188515	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
130792	Fee-for-Service	1568768570	1568768570	1	1	BRYAN, ROSS E LMFT	10/8/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 WATER ST	STE F2	SANTA CRUZ	CA	95062	4131	44	06087	36.98046158	-122.018718	Santa Cruz County
130795	Fee-for-Service	1366068827	1366068827	1	1	BRONDSTETTER, THERESA I CNP	7/30/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130799	Fee-for-Service	1144586942	1144586942	1	1	BARDES, ALLISON G MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142949	18	Ophthalmology	0	In state provider	None	44815 FIG AVE	None	LANCASTER	CA	93534	3144	19	06037	34.69630244	-118.1431105	Los Angeles County
130802	Fee-for-Service	1598026908	1598026908	1	1	BUTANO DIALYSIS LLC	4/17/2013	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	440 N 11TH AVE	None	HANFORD	CA	93230	4404	16	06031	36.33040423	-119.6552566	Kings County
130808	Fee-for-Service	1083227797	1083227797	1	1	BEVERLY M HODGES ADVANCED PR	6/19/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	814 14TH ST	STE E	MODESTO	CA	95354	1028	50	06099	37.6418777	-120.9946568	Stanislaus County
130842	Fee-for-Service	1013961358	1013961358	1	1	BRUCE CROSS	10/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 W 21ST ST	STE A-1	CLOVIS	NM	88101	4087	00	None	34.41934648	-103.2309765	Curry County
130870	Fee-for-Service	1003020413	1003020413	1	1	BATTY, GEORGE N MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128314	68	Hematology	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
130882	Fee-for-Service	1497755326	1497755326	1	1	BRAKEMA, RIEMKE M MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
130914	Fee-for-Service	1962457812	1962457812	1	24	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8227 RESEDA BLVD	None	RESEDA	CA	91335	1247	19	06037	34.220178	-118.536107	Los Angeles County
130932	Fee-for-Service	1629071758	1629071758	1	1	BRIGHTON COMMUNITY HOSPITAL	4/22/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ASSOCIATION	1600 PRAIRE CENTER PKWY	None	BRIGHTON	CO	80601	4006	00	None	39.96461455	-104.770985	Adams County
130935	Fee-for-Service	1265547624	1265547624	1	1	BOYATT, JASON E MD	3/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	74267	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	317 WEST PUEBLO STREET	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
130964	Fee-for-Service	1811680739	1811680739	1	1	BHATT, AMANDA T PT	10/19/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26881 JEFFERSON AVE.	C	MURRIETA	CA	92562	9119	33	06065	33.52789449	-117.1735624	Riverside County
130965	Fee-for-Service	1295753036	1295753036	1	1	BROWNRIDGE, CHARLES T MD	8/21/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41073	02	General Surgery	0	In state provider	None	3855 J ST	None	SACRAMENTO	CA	95816	5520	34	06067	38.570337	-121.455279	Sacramento County
130984	Fee-for-Service	1164433868	1164433868	1	1	BEN-ZUR, URI M MD INC	6/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	75051	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5525 ETIWANDA AVE	STE 222	TARZANA	CA	91356	6121	19	06037	34.17046451	-118.5308463	Los Angeles County
130985	Fee-for-Service	1700958527	1700958527	1	1	BODAI, BALAZS I MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36803	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
130989	Fee-for-Service	1922020833	1922020833	1	1	BAKER, CRAIG MD	12/1/1998	208G00000X	NA	General Surgery	026	PHYSICIANS	62537	02	General Surgery	0	In state provider	None	14900 IMPERIAL HWY	None	LA MIRADA	CA	90638	2172	19	06037	33.91710433	-118.0132986	Los Angeles County
131009	Fee-for-Service	1336150069	1336150069	1	2	BALDWIN, POLLY F MD	12/4/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	76190	-	NOT APPLICABLE	0	In state provider	None	245 INGER DRIVE	103 B	SANTA MARIA	CA	93454	8669	42	06083	34.92661232	-120.4330162	Santa Barbara County
131045	Fee-for-Service	1538367982	1538367982	1	1	BARTOLINI, SUSAN MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	98927	40	Pediatrics	0	In state provider	None	970 EMBARCADERO DEL MAR	None	ISLA VISTA	CA	93117	4887	42	06083	34.411707	-119.857011	Santa Barbara County
131075	Fee-for-Service	1497936900	1497936900	1	1	BARLEBEN, ANDREW MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99417	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
131077	Fee-for-Service	1609295658	1609295658	1	1	BLEVINS, KATHERINE S MD	8/9/2021	208600000X	NA	General Surgery	026	PHYSICIANS	138064	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
131107	Fee-for-Service	1467536987	1467536987	2	1	BISHARA, ISHAK N MD	3/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	45381	08	Family Practice	0	In state provider	None	2006 DURFEE AVE	None	EL MONTE	CA	91733	3713	19	06037	34.04578162	-118.0297235	Los Angeles County
131149	Fee-for-Service	1962457812	1962457812	1	79	BEVERLY RADIOLOGY MEDICAL GR	12/26/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	23101 SHERMAN PLACE	STE 210	WEST HILLS	CA	91307	2015	19	06037	34.20099112	-118.6297991	Los Angeles County
131154	Fee-for-Service	1396138103	1396138103	1	1	BOUNOUA, FARIDA MD INC	9/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	89619	None	None	0	In state provider	None	2323 DE LA VINA ST	STE 207	SANTA BARBARA	CA	93105	3880	42	06083	34.43202913	-119.7212339	Santa Barbara County
131166	Fee-for-Service	1356560080	1356560080	1	1	BURUGA, GABRIEL & LAVINA	9/7/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1825 W CRIS AVE	None	ANAHEIM	CA	92804	6110	30	06059	33.80836115	-117.9469985	Orange County
131170	Fee-for-Service	1497755326	1497755326	1	1	BRAKEMA, RIEMKE M MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
131176	Fee-for-Service	1336150069	1336150069	1	1	BALDWIN, POLLY F MD	8/15/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76190	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
131177	Fee-for-Service	1114601309	1114601309	1	1	BROWNSTONE HOMES OF REFUGE	7/16/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	560 W 90TH STREET	None	LOS ANGELES	CA	90044	5724	19	06037	33.95505637	-118.2847169	Los Angeles County
131206	Fee-for-Service	1982991501	1982991501	1	1	BEENKEN, KANDICE R DO	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15340	20	Orthopedic Surgery	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
131208	Fee-for-Service	1568656353	1568656353	1	1	BARAD, MEREDITH J MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88123	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
131221	Fee-for-Service	1184700114	1184700114	1	1	BRAITMAN, SAMUEL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25958	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
131230	Fee-for-Service	1356429906	1356429906	1	1	BUGATTO, BARRY J MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	69901	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
131289	Fee-for-Service	1326254558	1326254558	1	1	BROWN, REBECCA S MD	4/24/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	90897	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
131308	Fee-for-Service	1316484892	1316484892	1	1	BROWN, LAUREN M LMFT	8/1/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	1364000	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET ROAD	STE 165	CHICO	CA	95926	2460	04	06007	39.7519137	-121.8477606	Butte County
131340	Fee-for-Service	1538203203	1538203203	1	1	BROWN, ELIZABETH A	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	27301 CATALA AVE	None	SAUGUS	CA	91350	2147	19	06037	34.43924756	-118.5239356	Los Angeles County
131351	Fee-for-Service	1578896197	1578896197	1	1	BALTZ PSYCHIATRY NURSING	5/13/2014	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	INC	3032 ROWENA AVE	None	LOS ANGELES	CA	90039	2005	19	06037	34.10897378	-118.2705479	Los Angeles County
131361	Fee-for-Service	1487910717	1487910717	1	1	BLAIR, THOMAS R W MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127318	36	Psychiatry	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
131373	Fee-for-Service	1619925443	1619925443	1	1	BARBARO, NICHOLAS M MD	1/1/1994	207T00000X	NA	General Surgery	026	PHYSICIANS	43778	14	Neurological Surgery	0	In state provider	None	533 PARNASSUS AVE	# 126U	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
131386	Fee-for-Service	1568758563	1568758563	1	1	BORHANI, KOROSH K DO	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13734	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
131389	Fee-for-Service	1023199858	1023199858	1	1	BERKOWITZ, NELSON J MD	9/20/1994	207L00000X	NA	Other	026	PHYSICIANS	55477	40	Pediatrics	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
131408	Fee-for-Service	1730127432	1730127432	1	1	BAAS, BRIAN S	10/23/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2835 CHILDRESS DR	None	ANDERSON	CA	96007	3563	45	06089	40.45498247	-122.2907255	Shasta County
131413	Fee-for-Service	1164957957	1164957957	1	1	BIRS, ANTOINETTE MD	7/24/2024	207R00000X	NA	Other	026	PHYSICIANS	169606	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
131423	Fee-for-Service	1871920652	1871920652	1	2	BADR MEDICAL CORPORATION	8/22/2023	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	1500 CHEVY CHASE DR	204	GLENDALE	CA	91206	4152	19	06037	34.15201194	-118.2322051	Los Angeles County
131429	Fee-for-Service	1689691537	1689691537	2	1	BAUTISTA, DAISY I MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	36896	01	General Practice	0	In state provider	A MEDICAL CORPORATION	1930 WILSHIRE BOULEVARD	SUITE 803	LOS ANGELES	CA	90057	3636	19	06037	34.05720458	-118.2744084	Los Angeles County
131445	Fee-for-Service	1114936424	1114936424	1	1	BOWLAND, CLAY R MD	11/30/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	45999	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
131450	Fee-for-Service	1740449610	1740449610	1	1	BLACKSHEAR, KEISHA LMFT	10/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
131451	Fee-for-Service	1841326501	1841326501	1	1	BETJEMANN, STEPHANIE A CCC-S	6/26/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LP	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
131460	Fee-for-Service	1871571125	1871571125	1	1	BLOCK,NATHAN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 N SMITH AVE	None	ST PAUL	MN	55102	2344	00	None	44.94251219	-93.1074995	Ramsey County
131476	Fee-for-Service	1679053631	1679053631	1	1	BUTLERTERRY, SYDNEY C PT	1/31/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
131498	Fee-for-Service	1104931542	1104931542	1	1	BALFOUR, GLENN M MD	12/23/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	785 GRAND AVE	218	CARLSBAD	CA	92008	2371	37	06073	33.16222938	-117.3468169	San Diego County
131510	Fee-for-Service	1184700114	1184700114	1	1	BRAITMAN, SAMUEL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25958	25	Physical Medicine and Rehabilitation	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
131517	Fee-for-Service	1487849592	1487849592	1	1	BROWN, DAVID M LMFT	6/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
131528	Fee-for-Service	1720120256	1720120256	1	1	BEZERRA-FLANDERS, WILSON LP	4/6/2022	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CC	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
131542	Fee-for-Service	1487629564	1487629564	1	1	BIR, ARVINDER S MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91355	08	Family Practice	0	In state provider	None	555 E TACHEVAH DR	STE 2W105	PALM SPRINGS	CA	92262	5743	33	06065	33.83753681	-116.5424435	Riverside County
131572	Fee-for-Service	1548348220	1548348220	1	1	BAKER, FREDERIC D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24507	40	Pediatrics	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
131660	Fee-for-Service	1235458621	1235458621	1	1	BLAND, STEPHEN L MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	5590	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 1010	LOS ANGELES	CA	90017	4001	19	06037	34.05270508	-118.2641005	Los Angeles County
131662	Fee-for-Service	1053691337	1053691337	1	1	BE, VIET A MD INC	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	48753	None	None	0	In state provider	None	11160 WARNER AVENUE	SUITE 301	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
131679	Fee-for-Service	1023199858	1023199858	1	1	BERKOWITZ, NELSON J MD	9/20/1994	207L00000X	NA	Other	026	PHYSICIANS	55477	05	Anesthesiology	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
131690	Fee-for-Service	1013042928	1013042928	1	1	BARTLETT, RANDALL M	1/1/1979	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	23033 LYONS AVE	STE 3	NEWHALL	CA	91321	2774	19	06037	34.38013033	-118.5361055	Los Angeles County
131721	Fee-for-Service	1689691537	1689691537	2	1	BAUTISTA, DAISY I MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	36896	40	Pediatrics	0	In state provider	A MEDICAL CORPORATION	1930 WILSHIRE BOULEVARD	SUITE 803	LOS ANGELES	CA	90057	3636	19	06037	34.05720458	-118.2744084	Los Angeles County
131754	Fee-for-Service	1912229808	1912229808	1	1	BURRELL, WHITNEY A MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125028	02	General Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
131768	Fee-for-Service	1235993544	1235993544	1	1	BELMARK INC	4/9/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	STE 200	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
131792	Fee-for-Service	1962457812	1962457812	1	12	BEVERLY RADIOLOGY MEDICAL GR	7/31/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3901 LAS POSAS RD	STE 104	CAMARILLO	CA	93010	1501	56	06111	34.2415821	-119.0183756	Ventura County
131800	Fee-for-Service	1356480016	1356480016	1	1	BUFFMAN, BARRY R MD	11/7/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	82000	-	NOT APPLICABLE	0	In state provider	None	660 E LOS ANGELES AVE	SUITE B2	SIMI VALLEY	CA	93065	1884	56	06111	34.27162154	-118.7846685	Ventura County
131840	Fee-for-Service	1790125300	1790125300	1	1	BARKER, FIZURA B PSYD	12/6/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
131879	Fee-for-Service	1851330047	1851330047	1	1	BURDEN, JAMES W MD	3/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81005	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
131883	Fee-for-Service	1861555880	1861555880	1	1	BOBROW, ANDREI V MD	10/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80277	40	Pediatrics	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
131884	Fee-for-Service	1235143314	1235143314	1	1	BROWN, MICHAEL H MD	1/15/1971	208800000X	NA	Other	026	PHYSICIANS	8290	34	Urology and Urological Surgery	0	In state provider	None	2023 VALE RD	STE 210	SAN PABLO	CA	94806	3898	07	06013	37.95369824	-122.3378493	Contra Costa County
131919	Fee-for-Service	1235339078	1235339078	1	1	BRENENSTALL, ELIZABETH K LCS	1/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	2377 W FOOTHILL BLVD	STE 11	UPLAND	CA	91786	3577	36	06071	34.10690963	-117.6975663	San Bernardino County
131934	Fee-for-Service	1619036514	1619036514	1	3	BORREGO COMM HLTH FNDTN	9/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	55497 VAN BUREN ST	None	THERMAL	CA	92274	9412	33	06065	33.645622	-116.1988867	Riverside County
131960	Fee-for-Service	1396386041	1396386041	1	1	BRIGNOLA, RACHELBETH PT	2/23/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2895 LOMA VISTA ROAD	SUITE H	VENTURA	CA	93003	1542	56	06111	34.27543868	-119.2574459	Ventura County
131967	Fee-for-Service	1174502629	1174502629	1	1	BERGSNEIDER, MARVIN MD	2/28/1993	207T00000X	NA	General Surgery	026	PHYSICIANS	65556	14	Neurological Surgery	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
131983	Fee-for-Service	1770861767	1770861767	1	1	BAREH, GIHAN M MD	3/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133723	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
132027	Fee-for-Service	1518954577	1518954577	1	1	BANSAL, VIPIN MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77285	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
132031	Fee-for-Service	1750516951	1750516951	1	1	BUENA VISTA EMERGENCY	7/13/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL SERVICES	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
132051	Fee-for-Service	1881250025	1881250025	1	1	BLUE SKY MANOR INC	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	280 N WILSHIRE AVE	None	ANAHEIM	CA	92801	1335	30	06059	33.83425214	-117.9343579	Orange County
132052	Fee-for-Service	1306017801	1306017801	1	2	BRIAN J. EICHENBERG, M.D., A	7/13/2023	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	PROFESSIONAL CORPORATIO	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
132076	Fee-for-Service	1760715163	1760715163	1	1	BROWN, SHENISE CRNA	10/19/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
132084	Fee-for-Service	1962457812	1962457812	1	9	BEVERLY RADIOLOGY MEDICAL GR	7/27/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	44725 10TH ST W	STE 150	LANCASTER	CA	93534	3000	19	06037	34.695693	-118.1480965	Los Angeles County
132132	Fee-for-Service	1801891932	1801891932	1	1	BURGAR, ALEXANDRA M MD	4/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87081	46	Hand Surgery	0	In state provider	None	5601 NORRIS CANYON RD	STE 130A	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
132139	Fee-for-Service	1053799874	1053799874	1	1	BELDEN, LEIGHTON E MD	8/3/2020	208600000X	NA	General Surgery	026	PHYSICIANS	168913	02	General Surgery	0	In state provider	None	1095 MARSHALL WAY	STE 202	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
132168	Fee-for-Service	1497003289	1497003289	1	1	BRENTWOOD UNION SCHOOL	10/5/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	255 GUTHRIE LANE	None	BRENTWOOD	CA	94513	4025	07	06013	37.92231	-121.6827085	Contra Costa County
132173	Fee-for-Service	1386731628	1386731628	1	1	BAYER, EDWARD A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36953	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
132187	Fee-for-Service	1376571562	1376571562	1	1	BRODERICK VILLA, GREGORY	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82944	02	General Surgery	0	In state provider	MD	365 HAWTHORNE AVENUE	SUITE 101	OAKLAND	CA	94609	3117	01	06001	37.82079728	-122.2633226	Alameda County
132221	Fee-for-Service	1619036514	1619036514	1	3	BORREGO COMM HLTH FNDTN	9/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	55497 VAN BUREN ST	None	THERMAL	CA	92274	9412	33	06065	33.645622	-116.1988867	Riverside County
132282	Fee-for-Service	1285105148	1285105148	1	1	BRANDT, JOANNA L LCSW	12/8/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
132293	Fee-for-Service	1912143421	1912143421	1	1	BIELOSE CHUKWUNWIKE KONWE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.812245	-96.841584	Dallas County
132322	Fee-for-Service	1457058315	1457058315	1	1	BELL, KRISTIE C LMFT	2/26/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
132343	Fee-for-Service	1851594089	1851594089	1	1	BATSHA, ANSOO MD	9/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93231	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
132359	Fee-for-Service	1093895179	1093895179	1	1	BOTZBACH, PAMELA T MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80856	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
132373	Fee-for-Service	1104925841	1104925841	1	1	BOTELHO, BARBARA B MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51147	45	Nephrology (Renal-Kidney)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
132390	Fee-for-Service	1639559677	1639559677	1	1	BROWN, BRADLEY MD	4/6/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	168724	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
132400	Fee-for-Service	1568646776	1568646776	1	1	BANSAL, ALOK S MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120272	18	Ophthalmology	0	In state provider	None	2512 SAMARITAN CT	# A	SAN JOSE	CA	95124	4002	43	06085	37.25087737	-121.9503926	Santa Clara County
132406	Fee-for-Service	1932113685	1932113685	1	1	BETTS, RANDOLPH J MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	25707	08	Family Practice	0	In state provider	None	274 W BADILLO ST	None	COVINA	CA	91723	1906	19	06037	34.08623971	-117.8942892	Los Angeles County
132418	Fee-for-Service	1497865364	1497865364	1	1	BISHOP, MICHAEL H DO	4/18/2008	207P00000X	NA	Other	026	PHYSICIANS	5759	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 W LEGION RD BLDG 2	#205	BRAWLEY	CA	92227	7732	13	06025	32.95996012	-115.5538196	Imperial County
132446	Fee-for-Service	1003234113	1003234113	1	1	BRENDEL, JINLIN W DO	9/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18976	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
132451	Fee-for-Service	1861162109	1861162109	1	1	BEN HEALTH HOME HEALTH CARE	12/11/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	7344 VAN NUYS BLVD	STE 11	VAN NUYS	CA	91405	1997	19	06037	34.203906	-118.4487245	Los Angeles County
132465	Fee-for-Service	1497768881	1497768881	1	1	BROWN, RYAN F MD	8/1/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	177627	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
132498	Fee-for-Service	1811330954	1811330954	1	1	BAYONA, MICHAEL T MD	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	161916	30	Radiology	0	In state provider	None	2020 COURT ST	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
132520	Fee-for-Service	1821292962	1821292962	1	1	BEZDEK, SEAN LPCC	4/18/2024	106H00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10940 FAIR OAKS BLVD STE	None	FAIR OAKS	CA	95628	5958	34	06067	38.650077	-121.263678	Sacramento County
132544	Fee-for-Service	1093430373	1093430373	1	1	BAKERSFIELD REHAB LLC	9/2/2024	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2828 H ST	STE H	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
132547	Fee-for-Service	1568566891	1568566891	1	1	BERLIN, STEVEN H MD INC	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	48861	05	Anesthesiology	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
132551	Fee-for-Service	1619319100	1619319100	1	1	BASSILI, MARINA PSYD	8/21/2023	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
132561	Fee-for-Service	1720685795	1720685795	1	1	BELL, ANDREA CNP	3/17/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3327 ROSECRANS ST	None	SAN DIEGO	CA	92110	4223	37	06073	32.74779742	-117.2076448	San Diego County
132611	Fee-for-Service	1568017036	1568017036	1	1	BARRAGAN-O'BRIEN, MAYRA V LM	11/25/2024	390200000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	12321 MAGNOLIA AVE	SUITE D	RIVERSIDE	CA	92503	4736	33	06065	33.89046742	-117.4991751	Riverside County
132644	Fee-for-Service	1619496155	1619496155	1	1	BREWER, RACHEL	2/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5266 HOLLISTER AVE	STE 205	SANTA BARBARA	CA	93111	2037	42	06083	34.43497016	-119.8071895	Santa Barbara County
132661	Fee-for-Service	1104925841	1104925841	1	1	BOTELHO, BARBARA B MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51147	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
132690	Fee-for-Service	1013918770	1013918770	1	1	BROWN, LYNN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5633 N LIDGERWOOD ST	None	SPOKANE	WA	99208	1224	00	None	47.709423	-117.406944	Spokane County
132699	Fee-for-Service	1831478155	1831478155	1	1	BOMBARDIERI, ANNA MARIA MD	8/6/2020	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
132732	Fee-for-Service	1790834638	1790834638	1	1	BAKER, WALLACE A MD	6/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	93801	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
132739	Fee-for-Service	1396206090	1396206090	1	1	BERRETT, SAWYER DO	9/27/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	23040	36	Psychiatry	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
132746	Fee-for-Service	1437644044	1437644044	1	1	BALL, STEPHEN L	4/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
132787	Fee-for-Service	1962457812	1962457812	1	158	BEVERLY RADIOLOGY MEDICAL GR	1/10/2025	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2705 LOMA VISTA RD	SUITE 100	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
132822	Fee-for-Service	1922069335	1922069335	1	1	BALLARD, LESLIE J MD	10/30/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52573	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
132823	Fee-for-Service	1356327936	1356327936	1	1	BIAS, KELLY CRNA	9/7/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
132861	Fee-for-Service	1316225923	1316225923	1	1	BOURQUE, SUZANNE M MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117673	13	Neurology (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
132869	Fee-for-Service	1639228505	1639228505	1	1	BOHL, JANELLE M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67410	40	Pediatrics	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
132886	Fee-for-Service	1063698009	1063698009	1	1	BEEBE, JAY J CRNA	6/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6863	49	06097	38.28843573	-122.4651035	Sonoma County
132932	Fee-for-Service	1962457812	1962457812	1	139	BEVERLY RADIOLOGY MEDICAL GR	8/2/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	NG	18495 CORWIN RD	None	APPLE VALLEY	CA	92307	2329	36	06071	34.5407283	-117.2608224	San Bernardino County
132953	Fee-for-Service	1285612598	1285612598	1	1	BAJORIN, ROBERT F	3/28/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 200	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
132966	Fee-for-Service	1134410103	1134410103	1	1	BAVISETTY, SUPRIYA MD	3/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122963	40	Pediatrics	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
132970	Fee-for-Service	1245379452	1245379452	1	1	BUNCH, SARAH M PSYD	6/20/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
133025	Fee-for-Service	1538825500	1538825500	1	1	BROWN, KRISTI LMFT	12/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
133081	Fee-for-Service	1346229879	1346229879	1	1	BAYLEN, BARRY G MD	8/1/1995	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	21418	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
133097	Fee-for-Service	1629475165	1629475165	1	1	BROWN, ADAM K DPM	1/8/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	8635 W 3RD ST	SUITE 1090 WEST	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
133105	Fee-for-Service	1457137705	1457137705	1	1	BIRAGBARA, DUMKA	5/16/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
133113	Fee-for-Service	1528271046	1528271046	1	1	BREIT, AARON T MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100795	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
133114	Fee-for-Service	1033246939	1033246939	1	1	BHARDWAJ, RATANA G MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52766	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
133134	Fee-for-Service	1255964417	1255964417	1	1	BRIGNOLE, ANGELA LCSW	4/1/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
133135	Fee-for-Service	1750686598	1750686598	1	1	BASSETT, PAMELA A PA	10/11/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	13242	-	NOT APPLICABLE	0	In state provider	None	43845 10TH ST WEST	UNIT 1D	LANCASTER	CA	93534	4800	19	06037	34.68012017	-118.1479449	Los Angeles County
133218	Fee-for-Service	1962457812	1962457812	1	6	BEVERLY RADIOLOGY MEDICAL GR	1/4/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP	886 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3105	33	06065	33.8608198	-117.5509248	Riverside County
133246	Fee-for-Service	1528571874	1528571874	1	1	BRELIAN MEDICAL INC	2/1/2019	193400000X	NA	Other	026	PHYSICIANS	109924	41	Internal Medicine	0	In state provider	None	711 WEST COLLEGE ST	STE 203	LOS ANGELES	CA	90012	3177	19	06037	34.06541412	-118.2414102	Los Angeles County
133250	Fee-for-Service	1710186655	1710186655	1	1	BELCZYK, RONALD J DPM	6/5/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	110 NEW STINE RD	None	BAKERSFIELD	CA	93309	2605	15	06029	35.35333762	-119.0610348	Kern County
133302	Fee-for-Service	1033737051	1033737051	1	1	BEAUTIFUL HOMES RESIDENTIAL	8/3/2021	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE INC.	22525 CERISE AVENUE	None	TORRANCE	CA	90505	2913	19	06037	33.821244	-118.3332095	Los Angeles County
133328	Fee-for-Service	1679599674	1679599674	1	1	BROWN, MEHRI MD	10/31/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	80030	36	Psychiatry	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 140	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
133333	Fee-for-Service	1023408903	1023408903	1	1	BARNARD, EVANGELINA PSYD	6/3/2024	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
133364	Fee-for-Service	1609954353	1609954353	1	1	BHAT, SANDHYA U MD	8/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70285	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
133365	Fee-for-Service	1598996944	1598996944	1	1	BALASINGHAM, SHIVASHANKER MD	9/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	500 SW RAMSEY	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
133396	Fee-for-Service	1710090816	1710090816	1	1	BALLARD, TIMOTHY C MD	10/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94006	01	General Practice	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
133401	Fee-for-Service	1104368729	1104368729	1	1	BAINBRIDGE, ERIN NP	11/25/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
133435	Fee-for-Service	1477571958	1477571958	1	1	BROWN, RICHARD A MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43071	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
133451	Fee-for-Service	1376562793	1376562793	1	1	BROWN,LANCE A MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54544	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
133457	Fee-for-Service	1538601182	1538601182	1	1	BIAGINI, TRESE M CNP	5/15/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
133497	Fee-for-Service	1073573283	1073573283	1	1	BROUKHIM, BENJAMIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37198	20	Orthopedic Surgery	0	In state provider	None	11650 RIVERSIDE DR	STE 2	NORTH HOLLYWOOD	CA	91602	1066	19	06037	34.15760548	-118.387413	Los Angeles County
133528	Fee-for-Service	1609916907	1609916907	1	1	BERGE, CHERYL S LMFT	7/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15 ILAHEE LN	100	CHICO	CA	95973	7205	04	06007	39.75224248	-121.8701858	Butte County
133531	Fee-for-Service	1528571874	1528571874	1	1	BRELIAN MEDICAL INC	2/1/2019	193400000X	NA	Other	026	PHYSICIANS	109924	10	Gastroenterology (M.D. only)	0	In state provider	None	711 WEST COLLEGE ST	STE 203	LOS ANGELES	CA	90012	3177	19	06037	34.06541412	-118.2414102	Los Angeles County
133544	Fee-for-Service	1215987086	1215987086	1	1	BLASE, WILLIAM P MD	4/30/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	50680	18	Ophthalmology	0	In state provider	None	2390 E FLORIDA AVE	STE 207	HEMET	CA	92544	4755	33	06065	33.7477405	-116.94681	Riverside County
133556	Fee-for-Service	1972651875	1972651875	1	1	BATISTE, COLUMBUS D II,	10/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70393	41	Internal Medicine	0	In state provider	MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
133585	Fee-for-Service	1669963914	1669963914	1	1	BROOKS, ALAYSIA LCSW	1/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
133594	Fee-for-Service	1457546913	1457546913	1	1	BHAVSAR, KALPESH MD PROF	4/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111070	36	Psychiatry	0	In state provider	CORP	4619 ROSEMEAD BLVD	None	ROSEMEAD	CA	91722	3710	19	06037	34.08871316	-118.073569	Los Angeles County
133605	Fee-for-Service	1770527608	1770527608	1	1	BRAND, RICHARD D MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30006	41	Internal Medicine	0	In state provider	APC	2241 WANKEL WAY	STE B	OXNARD	CA	93030	0191	56	06111	34.21679844	-119.1467863	Ventura County
133619	Fee-for-Service	1083205306	1083205306	1	1	BRAND SURGICAL INSTITUTE	11/22/2021	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	716 W BROADWAY	None	GLENDALE	CA	91204	1010	19	06037	34.14674052	-118.269936	Los Angeles County
133654	Fee-for-Service	1598996944	1598996944	1	1	BALASINGHAM, SHIVASHANKER MD	9/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	500 SW RAMSEY	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
133664	Fee-for-Service	1366536021	1366536021	1	1	BENNETT, SARAH E LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
133683	Fee-for-Service	1124104492	1124104492	1	1	BEHL, ASHOK MD INC	1/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	38400	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	567 W PUTNAM AVENUE	STE 1	PORTERVILLE	CA	93257	3260	54	06107	36.06956761	-119.0296417	Tulare County
133684	Fee-for-Service	1356389639	1356389639	1	1	BASON-MITCHELL, MARK MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72356	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
133707	Fee-for-Service	1013986330	1013986330	1	1	BOGALE, SAMI H MD	9/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84700	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
133741	Fee-for-Service	1578552154	1578552154	1	1	BLAKEMORE, STEPHEN E	6/15/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	BLAKEMORE CTR BEAR&BALAN	2111 GEER RD	STE 205	TURLOCK	CA	95382	2459	50	06099	37.512891	-120.848996	Stanislaus County
133781	Fee-for-Service	1700259165	1700259165	1	1	BAKERSFIELD BEHAVIORAL	10/18/2016	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE HOSPITAL LLC	5201 WHITE LANE	None	BAKERSFIELD	CA	93309	6200	15	06029	35.31802403	-119.0605539	Kern County
133784	Fee-for-Service	1346485315	1346485315	1	1	BALIKIAN, SEVAG MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105269	None	None	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
133798	Fee-for-Service	1831326750	1831326750	1	1	BULIC, SEBINA MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124093	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
133810	Fee-for-Service	1457518219	1457518219	1	1	BERNDTSON, ALLISON E MD	12/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105854	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
133815	Fee-for-Service	1083630883	1083630883	1	1	BARAFF, LARRY J MD	4/1/1995	207PE0004X	NA	Other	026	PHYSICIANS	35538	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
133827	Fee-for-Service	1417217530	1417217530	1	1	BEATTIE, MEAGHAN J MD	8/25/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	129612	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
133839	Fee-for-Service	1194810119	1194810119	1	1	BODNAR, SHELLI M MD	12/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60986	08	Family Practice	0	In state provider	None	46752 MISSION BLVD	STE A	FREMONT	CA	94539	7949	01	06001	37.49039813	-121.9286833	Alameda County
133853	Fee-for-Service	1801898283	1801898283	1	1	BADEN, TRISSA A MD	5/6/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	49503	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	350 30TH ST	STE 208	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
133924	Fee-for-Service	1518104173	1518104173	1	1	BRUEGGEMANN, DANIEL MD	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126123	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
133935	Fee-for-Service	1437474921	1437474921	1	1	BISHAY, LARA C MD	9/1/2018	2080P0214X	NA	Pulmonology	026	PHYSICIANS	157075	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
133951	Fee-for-Service	1497841407	1497841407	1	1	BRUMMER, CHARLES S MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	33329	40	Pediatrics	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
133964	Fee-for-Service	1689711913	1689711913	1	1	BADGER, PAMELA M MFT	1/21/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18715	-	NOT APPLICABLE	0	In state provider	None	3340 KEMPER STREET	SUITE 105	SAN DIEGO	CA	92110	4907	37	06073	32.7529355	-117.2146751	San Diego County
133992	Fee-for-Service	1164569463	1164569463	1	1	BAROMEDICAL PHYSICIAN	9/15/1994	207PE0005X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES MEDICAL GROUP	720 NORTH TUSTIN AVE	SUITE 100	SANTA ANA	CA	92705	3606	30	06059	33.75168221	-117.8342151	Orange County
134013	Fee-for-Service	1134145972	1134145972	1	1	BISSONNETTE, PETER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
134015	Fee-for-Service	1386037299	1386037299	1	1	BRADSHAW, AMANDA J CNM	1/25/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
134034	Fee-for-Service	1730639683	1730639683	1	1	BLOOM OBSTETRICS AND	4/12/2017	193400000X	NA	Other	026	PHYSICIANS	12852	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GYNECOLOGY INC	18555 VENTURA BLVD	SUITE C	TARZANA	CA	91356	4192	19	06037	34.16958413	-118.5380552	Los Angeles County
134042	Fee-for-Service	1881287191	1881287191	1	1	BARRAZA, STEPHANIE LCSW	2/2/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
134043	Fee-for-Service	1144546284	1144546284	1	1	BARKER, BRENT J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118345	05	Anesthesiology	0	In state provider	None	11234 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
134046	Fee-for-Service	1750401998	1750401998	1	1	BANDT, ANYA E MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65186	07	Dermatology	0	In state provider	None	3883 AIRWAY DR	STE 130	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
134057	Fee-for-Service	1669009080	1669009080	1	1	BERTSCH DOBRICK, JENNA M MD	8/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179860	36	Psychiatry	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
134085	Fee-for-Service	1063943728	1063943728	1	1	BAXI, KESHA N DO	7/8/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18308	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
134087	Fee-for-Service	1861467615	1861467615	1	1	BIESEN-BRADELY, RITS MD	6/20/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42203	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	8207 SIERRA COLLEGE BLVD	STE 500	ROSEVILLE	CA	95661	9407	31	06061	38.74777516	-121.2263996	Placer County
134105	Fee-for-Service	1083630883	1083630883	1	1	BARAFF, LARRY J MD	4/1/1995	207PE0004X	NA	Other	026	PHYSICIANS	35538	77	Infectious Disease	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
134121	Fee-for-Service	1578545950	1578545950	1	1	BYUN, RAYMOND MD	7/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75882	77	Infectious Disease	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
134127	Fee-for-Service	1174587448	1174587448	1	1	BAILON, RACHEL M MD	3/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109988	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
134135	Fee-for-Service	1770647299	1770647299	1	1	BARBA, PETER A MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	90384	08	Family Practice	0	In state provider	None	899 SPRING ST	None	PLACERVILLE	CA	95667	4437	09	06017	38.73200705	-120.8030538	El Dorado County
134138	Fee-for-Service	1508269762	1508269762	1	1	BAUER, CHASE D	10/22/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
134142	Fee-for-Service	1619997665	1619997665	1	1	BURKE, NADINE J MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84078	40	Pediatrics	0	In state provider	None	3801 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
134155	Fee-for-Service	1801386800	1801386800	1	1	BASSALI, MARIAM A MD	8/31/2021	390200000X	NA	Other	026	PHYSICIANS	174159	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
134161	Fee-for-Service	1528009073	1528009073	1	1	BELOM, DENNIS J MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	38987	08	Family Practice	0	In state provider	None	BIG BASIN AND LAUREL RDS	None	BOULDER CREEK	CA	95006	0000	44	06087	37.124883	-122.1246405	Santa Cruz County
134200	Fee-for-Service	1275747214	1275747214	1	1	BOHN, MARJORIE A MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10201	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
134213	Fee-for-Service	1962613257	1962613257	1	1	BAKKAR, RANIA M MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139793	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
134215	Fee-for-Service	1255664124	1255664124	1	2	BOO, THOMAS MD	9/5/2023	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	80249	-	NOT APPLICABLE	0	In state provider	None	1290 TAVERN ROAD	None	MAMMOTH LAKES	CA	93546	2619	26	06051	37.64485013	-118.9639529	Mono County
134227	Fee-for-Service	1821418492	1821418492	1	1	BADIEFARD, SAEIDEH PT	11/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1125 E 17TH ST	STE W237	SANTA ANA	CA	92701	2205	30	06059	33.76004145	-117.854838	Orange County
134249	Fee-for-Service	1083980163	1083980163	1	1	BAILEY, LIN H MD	12/8/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147006	None	None	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
134252	Fee-for-Service	1366887762	1366887762	1	1	BRENNAN, SARAH C MD	11/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134033	40	Pediatrics	0	In state provider	None	17100 EUCLID STREET	PICU	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
134265	Fee-for-Service	1437245065	1437245065	1	1	BHARATSINH J ZALA	4/19/1996	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1410 W ALONDRA BLVD	None	COMPTON	CA	90220	3533	19	06037	33.88839148	-118.2446201	Los Angeles County
134270	Fee-for-Service	1023493889	1023493889	1	1	BOURKE, MARINA NP	11/8/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
134296	Fee-for-Service	1356738579	1356738579	1	1	BAJWA, HISHAM Z MD	7/19/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
134297	Fee-for-Service	1174835565	1174835565	1	1	BATRA, RASHMI MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114474	22	Pathology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
134301	Fee-for-Service	1285473025	1285473025	1	1	BUSECK, SUSAN LCSW	10/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
134317	Fee-for-Service	1285712927	1285712927	1	1	BURTON, ARLENE R MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73155	36	Psychiatry	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
134347	Fee-for-Service	1609873850	1609873850	1	1	BABAJANIAN, MASIS	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83907	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3536 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
134370	Fee-for-Service	1265692925	1265692925	1	1	BANTA, VERONICA M MD	4/2/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104447	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
134379	Fee-for-Service	1639118052	1639118052	1	1	BHALLA, NEELAM M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51287	14	Neurological Surgery	0	In state provider	None	632 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
134409	Fee-for-Service	1578545950	1578545950	1	1	BYUN, RAYMOND MD	7/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75882	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
134435	Fee-for-Service	1528587763	1528587763	1	1	BELTRAN, ADRIANA MEDINA	11/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
134477	Fee-for-Service	1821352337	1821352337	1	1	BUCH, VIVEK P MD	6/22/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	167057	14	Neurological Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
134490	Fee-for-Service	1275589079	1275589079	1	1	BENDAVID, ELI J MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69279	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
134508	Fee-for-Service	1225488331	1225488331	1	1	BIRT, MICAELA PSYD	4/15/2020	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
134522	Fee-for-Service	1629398540	1629398540	1	1	BYSANI, KAVITHA MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119187	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PARKWAY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
134545	Fee-for-Service	1922864222	1922864222	1	1	BOGDANOVICH, JAMES R PT	3/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 MISSION INN AVE	B	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
134548	Fee-for-Service	1780074559	1780074559	1	1	BROOKLIN OAKS PHARMACY INC	2/24/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	597 12TH ST	None	PASO ROBLES	CA	93445	2202	40	06079	35.62667376	-120.6921356	San Luis Obispo County
134552	Fee-for-Service	1053887117	1053887117	1	1	BAHRA, ERIC M LCSW	4/24/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
134554	Fee-for-Service	1801030267	1801030267	1	1	BILENKAYA, IRINA NP	9/6/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
134589	Fee-for-Service	1578544136	1578544136	1	1	BRANDT, JAMES D MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54094	18	Ophthalmology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
134591	Fee-for-Service	1083702096	1083702096	1	1	BELL,TERRELL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COOK CHILDREN'S PHYS	801 SEVENTH AVE	None	FORTWORTH	TX	76104	0000	00	None	32.73710364	-97.3419336	Tarrant County
134601	Fee-for-Service	1932737582	1932737582	1	1	BARIKZI, LEEDA DO	9/26/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
134607	Fee-for-Service	1043504004	1043504004	1	1	BOHN, HEATHER H DO	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	11750	01	General Practice	0	In state provider	None	400 NORTH PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
134628	Fee-for-Service	1295916625	1295916625	1	1	BARNES, ERIK P LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1015 CEDAR STREET	None	SANTA CRUZ	CA	95060	3803	44	06087	36.97562721	-122.0279865	Santa Cruz County
134640	Fee-for-Service	1881237873	1881237873	1	1	BURGHER, ALLEGRA P OD	11/7/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2446 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
134655	Fee-for-Service	1538102082	1538102082	1	1	BACA, RALPH M MD	9/17/1990	207P00000X	NA	Other	026	PHYSICIANS	69780	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
134659	Fee-for-Service	1689930521	1689930521	1	1	BERENSTEIN, LAURA	7/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	760 POLHEMUS RD	None	SAN MATEO	CA	94402	3938	41	06081	37.52051982	-122.3386627	San Mateo County
134749	Fee-for-Service	1619036324	1619036324	1	1	BASU, ROMIE MD	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78853	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
134787	Fee-for-Service	1730178070	1730178070	1	1	BABOOLAL, HEMANTH A MD	2/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104042	05	Anesthesiology	0	In state provider	None	514 WEST PUEBLO STREET	2ND FL	SANTA BARBARA	CA	93105	4294	42	06083	34.4279775	-119.7247284	Santa Barbara County
134807	Fee-for-Service	1285688010	1285688010	1	1	BEHRASHI, AZITA MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93671	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
134827	Fee-for-Service	1982808507	1982808507	1	1	BLACK, MARCELIA A LCSW	5/1/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
134836	Fee-for-Service	1760417232	1760417232	1	1	BROOKS HOME I.V., INC.	3/31/1998	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BROOKS HEALTH CARE	5070 N 6TH ST,	STE 169	FRESNO	CA	93710	7508	10	06019	36.810441	-119.7632005	Fresno County
134841	Fee-for-Service	1356867840	1356867840	1	1	BAGNALL, CARLY J PT	10/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8790 CUYAMACA ST.	SUITE A	SANTEE	CA	92071	4295	37	06073	32.83583009	-116.9839098	San Diego County
134843	Fee-for-Service	1922259753	1922259753	1	1	BOSTON HEART DIAGNOSTICS COR	6/13/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	PORATION	200 CROSSING BLVD	None	FRAMINGHAM	MA	01702	4486	00	None	42.296256	-71.491221	Middlesex County
134882	Fee-for-Service	1740587690	1740587690	1	1	BEATTIE, JESS E LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
134888	Fee-for-Service	1225045149	1225045149	1	1	BUI, PENNA K MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81774	05	Anesthesiology	0	In state provider	None	3991 MACARTHUR BLVD	STE 105	NEWPORT BEACH	CA	92660	3009	30	06059	33.65957329	-117.8631723	Orange County
134939	Fee-for-Service	1669542189	1669542189	2	1	BESTCARE HEALTH SERVICES LLC	9/5/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	570 S MOUNT VERNON AVE	SUITE F2	SAN BERNARDINO	CA	92410	2760	36	06071	34.090776	-117.3138565	San Bernardino County
135011	Fee-for-Service	1982604765	1982604765	1	1	BERCUTT, LAWRENCE D MD	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76620	05	Anesthesiology	0	In state provider	None	3939 J ST	STE 310	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
135036	Fee-for-Service	1952971483	1952971483	1	1	BERNDT, JONATHAN	6/13/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
135052	Fee-for-Service	1710329370	1710329370	1	1	BERGESON, SARAH D LMFT	3/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1096 CALIMESA BLVD	203	CALIMESA	CA	92320	1563	33	06065	33.99811401	-117.0594965	Riverside County
135053	Fee-for-Service	1831387083	1831387083	1	1	BROWN, BRIAN M MD INC	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	52712	18	Ophthalmology	0	In state provider	None	10933 LAKEWOOD BLVD	None	DOWNEY	CA	90241	3808	19	06037	33.93756015	-118.1230982	Los Angeles County
135075	Fee-for-Service	1881679520	1881679520	1	1	BAUER, MICHELLE C PT	1/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
135092	Fee-for-Service	1821037425	1821037425	1	1	BURSTEIN, JENNIFER L	8/4/1995	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9625 MONTE VISTA AVE	STE 120	MONTCLAIR	CA	91763	2234	36	06071	34.08006762	-117.6982272	San Bernardino County
135123	Fee-for-Service	1104323757	1104323757	1	1	BIER, MICHAEL L MD	7/29/2021	207R00000X	NA	Other	026	PHYSICIANS	163939	None	None	0	In state provider	None	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
135130	Fee-for-Service	1184791998	1184791998	1	3	BAY AREA COMMUNITY HEALTH	4/30/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
135150	Fee-for-Service	1073707527	1073707527	1	1	BRUCE, KRISTINE J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13611 E COLFAX AVE	None	AURORA	CO	80045	5701	00	None	39.74039327	-104.8302052	Adams County
135176	Fee-for-Service	1407497860	1407497860	1	1	BHAMBHRA, NAEHA CRNA	5/16/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
135180	Fee-for-Service	1790863876	1790863876	1	1	BACHIK, MICHAEL MD	6/11/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	38068	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	545 E CLEVELAND ST	STE A	STOCKTON	CA	95204	5535	39	06077	37.97379447	-121.2893338	San Joaquin County
135205	Fee-for-Service	1295754737	1295754737	1	1	BROWN, MICHELE L LMFT	12/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
135222	Fee-for-Service	1700076189	1700076189	1	1	BRENDEN LEE HANSEN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 N MAIN ST	None	COUPEVILLE	WA	98239	3413	00	None	48.213756	-122.686102	Island County
135234	Fee-for-Service	1063866150	1063866150	1	1	BEROUKHIM, KOUROSH MD	8/6/2021	207ND0101X	NA	Dermatology	026	PHYSICIANS	152655	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
135253	Fee-for-Service	1619145083	1619145083	1	1	BRICKLEY, JENNIFER	8/23/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3416 AMERICAN RIVER DR	STE B	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
135259	Fee-for-Service	1790325074	1790325074	1	1	BLACKWELL, KIMBERLY J CRNA	10/16/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
135300	Fee-for-Service	1891424388	1891424388	1	1	BONTHIUS, NATALIE MD	11/7/2024	207P00000X	NA	Other	026	PHYSICIANS	190796	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
135305	Fee-for-Service	1962961169	1962961169	1	1	BARAJAS-NUNO, SAUL MD	8/1/2022	207R00000X	NA	Other	026	PHYSICIANS	180180	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
135326	Fee-for-Service	1679007827	1679007827	1	1	BASSI, SATNAAM S MD	9/9/2021	207R00000X	NA	Other	026	PHYSICIANS	174016	None	None	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
135329	Fee-for-Service	1316958721	1316958721	1	1	BARRIOS, OSCAR U MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	56229	05	Anesthesiology	0	In state provider	None	1801 HANOVER DR	STE F	DAVIS	CA	95616	1067	57	06113	38.55895232	-121.7567316	Yolo County
135407	Fee-for-Service	1770818536	1770818536	1	1	BASELLE, ZACHARY J DO	6/3/2022	207P00000X	NA	Other	026	PHYSICIANS	19564	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4900	39	06077	37.80110374	-121.1974853	San Joaquin County
135408	Fee-for-Service	1275944514	1275944514	1	1	BIORESOLUTIONS LLC	3/14/2016	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	N56W16688 RIDGEWOOD DRIV	None	MENOMONEE FALLS	WI	53051	5657	00	None	43.1206555	-88.119135	Waukesha County
135417	Fee-for-Service	1184791998	1184791998	1	3	BAY AREA COMMUNITY HEALTH	4/30/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1999 MOWRY AVENUE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
135418	Fee-for-Service	1922305218	1922305218	1	1	BOYETT, SARAH B LCSW	8/2/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
135422	Fee-for-Service	1659936854	1659936854	1	1	BUTLER, GRIFFIN CCC-SLP	12/16/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	528 13TH AVENUE	APARTMENT B	SANTA CRUZ	CA	95062	4807	44	06087	36.96471653	-121.9922228	Santa Cruz County
135431	Fee-for-Service	1285867887	1285867887	1	2	BEVERLY RADIOLOGY MEDICAL	10/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	12370 HESPERIA RD	#15	VICTORVILLE	CA	92395	4786	36	06071	34.47625382	-117.2913208	San Bernardino County
135440	Fee-for-Service	1437112919	1437112919	1	1	BOHMAN, BRUCE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1046 W 6TH AVE	None	ALBANY	OR	97321	0000	00	None	44.63214872	-123.1157723	Linn County
135468	Fee-for-Service	1225436553	1225436553	1	1	BOX, DAVID M MD	7/14/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	167065	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
135474	Fee-for-Service	1265470546	1265470546	1	1	BOECHE, RENEE ELOISE	7/31/1990	207P00000X	NA	Other	026	PHYSICIANS	5864	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 SUMMIT ST	None	OAKLAND	CA	94609	3410	01	06001	37.82018974	-122.2643221	Alameda County
135478	Fee-for-Service	1851300016	1851300016	1	1	BERTON, NEILA ROBIN PHD	3/13/1993	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4849 VAN NUYS BLVD	STE 210	SHERMAN OAKS	CA	91403	2126	19	06037	34.159113	-118.4487465	Los Angeles County
135511	Fee-for-Service	1114556289	1114556289	1	1	BAINS, JASKARAN MD	1/3/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
135535	Fee-for-Service	1326027806	1326027806	1	1	BALAKHANE, GUITA MD	8/21/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63871	01	General Practice	0	In state provider	None	8635 W 3RD ST	# 695W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
135542	Fee-for-Service	1700958139	1700958139	1	1	BURNAM, MICHAEL H MD	5/31/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25295	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16133 VENTURA BLVD	None	ENCINO	CA	91436	2403	19	06037	34.15656164	-118.4849569	Los Angeles County
135567	Fee-for-Service	1861811044	1861811044	1	1	BEACH, LEILA Y MD	6/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143003	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135569	Fee-for-Service	1447427364	1447427364	1	1	BROWN, SHERRILL R MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109871	41	Internal Medicine	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
135574	Fee-for-Service	1205847654	1205847654	1	1	BAUM, BRADLEY L MD	7/1/1996	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	51197	20	Orthopedic Surgery	0	In state provider	None	802 MAGNOLIA AVE	STE 106	CORONA	CA	92879	3125	33	06065	33.8596449	-117.5529774	Riverside County
135585	Fee-for-Service	1750717435	1750717435	1	1	BEJAR LUA, ARACELI LCSW	1/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
135588	Fee-for-Service	1487038253	1487038253	1	1	BLICKENSTAFF, JACOB W MD	8/13/2019	390200000X	NA	Other	026	PHYSICIANS	144164	05	Anesthesiology	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
135629	Fee-for-Service	1033136536	1033136536	1	1	BRANDT, DARIN E DO	12/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11523	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
135670	Fee-for-Service	1417154790	1417154790	1	1	BAYAN, KEITH R MD	1/26/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	93872	None	None	0	In state provider	None	2200 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2910	19	06037	33.893289	-118.395933	Los Angeles County
135710	Fee-for-Service	1386078343	1386078343	1	1	BUSTILLOS, MARCEE LMFT	2/12/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
135713	Fee-for-Service	1063609048	1063609048	1	1	BIRD, JOHN O	7/1/1996	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	7575 N DEL MAR AVE	STE 101	FRESNO	CA	93711	6857	10	06019	36.847782	-119.7958885	Fresno County
135718	Fee-for-Service	1134665730	1134665730	1	1	BONNEY, PHILLIP MD	6/1/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	151561	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135727	Fee-for-Service	1932196516	1932196516	1	1	BORLA, GIRIDHAR R MD	4/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86993	78	Neoplastic Diseases/Oncology	0	In state provider	None	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
135751	Fee-for-Service	1760707400	1760707400	1	1	BARRIENTOS, SANDRA I PSYD	1/24/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
135752	Fee-for-Service	1255821120	1255821120	1	1	BIREN-FETZ, JOHN C DO	5/10/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22502	30	Radiology	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
135753	Fee-for-Service	1093344921	1093344921	1	1	BAINS, MANPREET MD	10/17/2023	207R00000X	NA	Other	026	PHYSICIANS	185264	None	None	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
135830	Fee-for-Service	1679118749	1679118749	1	1	BAEK, MIN A OD	4/15/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
135869	Fee-for-Service	1306007109	1306007109	1	1	BLANCO, LILIA A MD	10/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107389	08	Family Practice	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
135870	Fee-for-Service	1437423399	1437423399	1	1	BERGER, KEREN CCC-SLP	7/11/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9700 RESEDA BLVD	STE 208	NORTHRIDGE	CA	91324	5504	19	06037	34.246647	-118.5360505	Los Angeles County
135884	Fee-for-Service	1073604674	1073604674	1	1	BIRCH, ELIZABETH A LMFT	11/19/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	242 W. MAIN STREET	105	TUSTIN	CA	92780	4320	30	06059	33.74204521	-117.8257741	Orange County
135888	Fee-for-Service	1427028430	1427028430	1	1	BUTLER JOHN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4911 SANDHILL DR	None	SUGAR LAND	TX	77479	5320	00	None	29.59948264	-95.68213887	Fort Bend County
135917	Fee-for-Service	1922047299	1922047299	1	1	BENNETT, KRISTIN M MD	11/2/2006	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	94636	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
135935	Fee-for-Service	1568952356	1568952356	1	1	BERNABA, MICHAEL MD	8/11/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	178962	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
135961	Fee-for-Service	1659452506	1659452506	1	1	BURNHAM, EMILY B OD	2/21/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1171 MURRIETA BLVD	STE 100	LIVERMORE	CA	94550	4143	01	06001	37.67592941	-121.7802007	Alameda County
135968	Fee-for-Service	1396947529	1396947529	1	1	BUCKLEY, JESSICA R MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99530	40	Pediatrics	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
135972	Fee-for-Service	1992018469	1992018469	1	1	BEACHSIDE ADULT AND FAMILY	9/11/2018	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	THERAPY	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
135983	Fee-for-Service	1861606253	1861606253	1	1	BENEDICK, SUSAN F MD	6/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	46098	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136020	Fee-for-Service	1083990089	1083990089	1	1	BODAGALA, JAYASREE MD	2/6/2024	208M00000X	NA	Other	026	PHYSICIANS	192526	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
136050	Fee-for-Service	1710187133	1710187133	1	1	BUTRUM, MATTHEW W MD	4/1/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	162974	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
136062	Fee-for-Service	1740239953	1740239953	1	1	BURKE, JOHN K MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78146	01	General Practice	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
136087	Fee-for-Service	1033642517	1033642517	1	1	BRUNSON, CHRISTOPHER P MD	7/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187463	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
136094	Fee-for-Service	1952728222	1952728222	1	1	BRAUNSTEIN, ERIC D MD	7/13/2022	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	177639	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
136095	Fee-for-Service	1679542252	1679542252	1	1	BENOIT, RICHARD M MD	1/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	63799	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
136155	Fee-for-Service	1528122645	1528122645	1	1	BAYER, EDMOND	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
136160	Fee-for-Service	1821020140	1821020140	1	1	BHULLAR, NARINDER MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69029	13	Neurology (M.D. only)	0	In state provider	None	64 ASPEN WAY	STE 101	WATSONVILLE	CA	95076	3084	44	06087	36.93085993	-121.7799849	Santa Cruz County
136161	Fee-for-Service	1326509928	1326509928	1	1	BUDRI, DALAL MD	9/1/2022	207P00000X	NA	Other	026	PHYSICIANS	176783	None	None	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
136186	Fee-for-Service	1255892923	1255892923	1	1	BARATA, SABRINA C MD	10/31/2023	207R00000X	NA	Other	026	PHYSICIANS	191522	None	None	0	In state provider	None	6633 TELEPHONE RD	200, 210	VENTURA	CA	93003	5569	56	06111	34.26667679	-119.20405	Ventura County
136208	Fee-for-Service	1932791357	1932791357	1	1	BRISTER, VANESSA S LCSW	9/14/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3630 N WHEELER AVE	None	FRESNO	CA	93722	1171	10	06019	36.78807251	-119.8900199	Fresno County
136220	Fee-for-Service	1073284295	1073284295	1	1	BOWMAN, MARY M LMFT	4/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	81 DAVID LOVE PLACE	SUITE 106	SANTA BARBARA	CA	93117	3266	42	06083	34.43614838	-119.8389944	Santa Barbara County
136230	Fee-for-Service	1720012123	1720012123	1	1	BUYALOS, RICHARD	9/30/1988	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60146	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	924 WESTWOOD BLVD	STE 335	LOS ANGELES	CA	90024	2929	19	06037	34.06309787	-118.4452763	Los Angeles County
136237	Fee-for-Service	1689059420	1689059420	1	1	BOBMAN, JACOB T MD	8/5/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	149236	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
136247	Fee-for-Service	1952427106	1952427106	1	1	BAER, JAMES R CRNA	6/10/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
136261	Fee-for-Service	1992018469	1992018469	1	1	BEACHSIDE ADULT AND FAMILY	9/11/2018	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	THERAPY	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
136263	Fee-for-Service	1295853869	1295853869	1	1	BORG, INELDA J OT	10/18/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
136267	Fee-for-Service	1548509631	1548509631	1	1	BABAKHANI, ARNEH MD	12/2/2020	207R00000X	NA	Other	026	PHYSICIANS	131761	None	None	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91931	1800	37	06073	32.62382113	-116.9960539	San Diego County
136300	Fee-for-Service	1609018464	1609018464	1	1	BRIAN YOST D.O. INC.	9/24/2020	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4510 BROCKTON AVE	STE 375	RIVERSIDE	CA	92501	4020	33	06065	33.97675372	-117.3850798	Riverside County
136316	Fee-for-Service	1417178153	1417178153	1	1	BRAR, SARINA K MD	5/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98670	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
136327	Fee-for-Service	1558478701	1558478701	1	1	BEREJNOI, KIRILL V MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102844	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
136336	Fee-for-Service	1134519622	1134519622	1	1	BENSON, VASUNDHARA K	8/21/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1007 E COOLEY DR	STE 101	COLTON	CA	92324	3901	36	06071	34.05461152	-117.310599	San Bernardino County
136341	Fee-for-Service	1851452619	1851452619	1	1	BRIZEE, RANDAL PT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
136350	Fee-for-Service	1740239953	1740239953	1	1	BURKE, JOHN K MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78146	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
136352	Fee-for-Service	1447789037	1447789037	1	1	BOCK, LESLIE LMFT	9/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
136372	Fee-for-Service	1073597738	1073597738	1	1	BROWN, JAMES R MD	3/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4618	19	06037	34.22145548	-118.4566005	Los Angeles County
136387	Fee-for-Service	1073562203	1073562203	1	1	BRUKSCH, LAWRENCE M MD	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31595	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8631 W 3RD STREET	SUITE 240E	LOS ANGELES	CA	90048	5970	19	06037	34.07361928	-118.3803143	Los Angeles County
136424	Fee-for-Service	1265717565	1265717565	1	1	BEDOLLA, STEPHANIE NP	6/29/2024	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
136495	Fee-for-Service	1437156262	1437156262	1	1	BREYTENBACH, HENDRICK MD	12/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69161	08	Family Practice	0	In state provider	None	1100 LAS TABLAS ROAD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
136522	Fee-for-Service	1720012123	1720012123	1	1	BUYALOS, RICHARD	9/30/1988	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60146	67	Endocrinology	0	In state provider	None	924 WESTWOOD BLVD	STE 335	LOS ANGELES	CA	90024	2929	19	06037	34.06309787	-118.4452763	Los Angeles County
136529	Fee-for-Service	1730568411	1730568411	1	1	BAIDWAN, GURLAL S DO	9/12/2024	208M00000X	NA	Other	026	PHYSICIANS	22687	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
136546	Fee-for-Service	1992018469	1992018469	1	1	BEACHSIDE ADULT AND FAMILY	9/11/2018	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	THERAPY	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
136555	Fee-for-Service	1073588026	1073588026	1	1	BURKHALTER, JENIFER L MD	3/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93937	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0890	34	06067	38.651409	-121.3290945	Sacramento County
136576	Fee-for-Service	1336504182	1336504182	1	1	BRAND, KAREN S	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
136593	Fee-for-Service	1619918943	1619918943	1	1	BOKHARI,SYED W MD	2/8/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	69346	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4646 BROCKTON AVE	STE 302	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
136595	Fee-for-Service	1285773986	1285773986	1	1	BECK, ADRIANNE C MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	75127	25	Physical Medicine and Rehabilitation	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
136600	Fee-for-Service	1104086164	1104086164	1	1	BELL, ROBERT L MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111992	02	General Surgery	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
136638	Fee-for-Service	1477223659	1477223659	1	1	BRINSON, TIMEISHA R LPCC	12/13/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
136640	Fee-for-Service	1740387414	1740387414	1	1	BASILIO, ZIRNA D PT	6/8/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6640 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65911992	-117.7737909	Orange County
136643	Fee-for-Service	1366154726	1366154726	1	2	BOSS MEDICAL TRANSPORT, INC	1/24/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	550 OLEANDER RD	7	PALM SPRINGS	CA	92264	1504	33	06065	33.81511751	-116.4962192	Riverside County
136703	Fee-for-Service	1891713418	1891713418	1	1	BENNETT, PATRICK M MD	3/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	78346	34	Urology and Urological Surgery	0	In state provider	None	1000 SO. ELISEO DR.	#201	GREENBRAE	CA	94904	2151	21	06041	37.94348559	-122.5335273	Marin County
136707	Fee-for-Service	1265836696	1265836696	1	1	BROWN, CRYSTAL N MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132655	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
136735	Fee-for-Service	1881874238	1881874238	1	1	BHAYANI, NEIL H MD	8/6/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	125857	02	General Surgery	0	In state provider	None	2110 EL SEGUNDO BLVD	110	EL SEGUNDO	CA	90245	4548	19	06037	33.91624545	-118.390199	Los Angeles County
136779	Fee-for-Service	1972836252	1972836252	1	1	BHATIA, SUNDEEP MD INC	12/26/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
136784	Fee-for-Service	1568003259	1568003259	1	1	BELIEVE HOME HEALTH CARE INC	2/3/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	348 EAST OLIVE AVE	STE J2	BURBANK	CA	91502	1235	19	06037	34.18267998	-118.3068106	Los Angeles County
136793	Fee-for-Service	1952730194	1952730194	1	1	BROCK, ASHA B LMFT	3/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	593 W SAINT CHARLES ST	None	SAN ANDREAS	CA	95249	0000	05	06009	38.20076867	-120.6917798	Calaveras County
136825	Fee-for-Service	1407460629	1407460629	1	1	BARAJAS, MARIA LCSW	3/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 N PALM CANYON DR	215	PALM SPRINGS	CA	92262	5658	33	06065	33.827652	-116.5468485	Riverside County
136855	Fee-for-Service	1871671438	1871671438	1	1	BEEKLEY, SARAH J MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74950	40	Pediatrics	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
136856	Fee-for-Service	1669589404	1669589404	1	1	BUYS, ELIZABETH MD	4/19/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
136863	Fee-for-Service	1427468545	1427468545	1	1	BANSAL, GAURAV K DO	7/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16258	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
136869	Fee-for-Service	1356904825	1356904825	1	1	BARRON, KATHRYN E MD	11/15/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	183716	None	None	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
136881	Fee-for-Service	1619918943	1619918943	1	1	BOKHARI,SYED W MD	2/8/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	69346	41	Internal Medicine	0	In state provider	None	4646 BROCKTON AVE	STE 302	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
136928	Fee-for-Service	1033522032	1033522032	1	2	BECKER, STACI S MD	3/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	141836	05	Anesthesiology	0	In state provider	None	975 SOUTH FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
136943	Fee-for-Service	1235855180	1235855180	1	1	BE WELL SENIOR LIVING II INC	1/12/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5104 VARNA AVE	None	SHERMAN OAKS	CA	91423	1527	19	06037	34.16320926	-118.4246727	Los Angeles County
136953	Fee-for-Service	1538222856	1538222856	1	1	BERTUCCI, WILLIAM R MD	7/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86634	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 526	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
136967	Fee-for-Service	1841539632	1841539632	1	1	BABICH, VIOLETTA LMFT	2/19/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
136969	Fee-for-Service	1689712317	1689712317	1	1	BASS, DWIGHT R MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	3600 POWER INN RD	STE G	SACRAMENTO	CA	95826	3826	34	06067	38.541726	-121.4096355	Sacramento County
136995	Fee-for-Service	1578172268	1578172268	1	1	BENJAMINS, ANNA M CNP	12/4/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3650 E. SOUTH ST	STE 106	LAKEWOOD	CA	90712	1532	19	06037	33.8601747	-118.1494013	Los Angeles County
137037	Fee-for-Service	1922635127	1922635127	1	1	BEVERLY HOSPICE CARE INC	5/19/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6931 VAN NUYS BLVD	STE 332B	VAN NUYS	CA	91405	3937	19	06037	34.19649	-118.448787	Los Angeles County
137048	Fee-for-Service	1770503286	1770503286	1	1	BORAZJANI, GHOLAMREZA MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	46397	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
137065	Fee-for-Service	1285857268	1285857268	1	1	BROC B PARSON	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	962 SAGE DR	None	CEDAR CITY	UT	84720	1885	00	None	37.66055637	-113.0809841	Iron County
137066	Fee-for-Service	1033178249	1033178249	1	1	BERNING, THEA J MD	6/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
137080	Fee-for-Service	1285167189	1285167189	1	1	BATIZY, LILLIAN H MD	6/1/2020	207P00000X	NA	Other	026	PHYSICIANS	160065	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
137085	Fee-for-Service	1811061195	1811061195	1	1	BURNS, ROBERT MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84528	07	Dermatology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
137091	Fee-for-Service	1710059563	1710059563	1	1	BHANDARI, LAKSHMI MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69973	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
137112	Fee-for-Service	1205993177	1205993177	1	1	BUTTERFLY, ANYIKA OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
137123	Fee-for-Service	1962457812	1962457812	1	91	BEVERLY RADIOLOGY MEDICAL GR	11/30/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	3900 SHERMAN DR	STE 100	RIVERSIDE	CA	92503	4006	33	06065	33.92756479	-117.4375031	Riverside County
137188	Fee-for-Service	1598798639	1598798639	1	1	BALATBAT, ANTONIO B N MD	8/1/1998	207R00000X	NA	Other	026	PHYSICIANS	52164	41	Internal Medicine	0	In state provider	None	124 E WEBSTER ST	None	COLUSA	CA	95932	2950	06	06011	39.20761123	-122.0010846	Colusa County
137246	Fee-for-Service	1891784203	1891784203	1	1	BARULICH, MATTHEW J MD	3/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	40451	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2158 JEAN AVE	None	SOUTH LAKE TAHOE	CA	96150	3412	09	06017	38.91508934	-119.9978421	El Dorado County
137251	Fee-for-Service	1932153731	1932153731	1	1	BISWAS, MAHUA MD	6/30/1990	2085R0204X	NA	Other	026	PHYSICIANS	48575	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
137269	Fee-for-Service	1598867079	1598867079	1	1	BUCKNER, TINA L PHD	8/3/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3130 5TH AVE	None	SAN DIEGO	CA	92103	5839	37	06073	32.73813729	-117.1603812	San Diego County
137270	Fee-for-Service	1265406318	1265406318	1	1	BINDAL, ASHWANI K MD	9/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41237	01	General Practice	0	In state provider	None	2147 MOWRY AVE	# B3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
137278	Fee-for-Service	1124232582	1124232582	1	1	BANSAL, VIVEK MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99986	24	Plastic Surgery	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
137286	Fee-for-Service	1972628071	1972628071	1	1	BOOTH, GORDON A MD	5/13/2019	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	28665	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10605 SCRIPPS POWAY PKWY	SUITE B AND C	SAN DIEGO	CA	92131	3925	37	06073	32.93714729	-117.0990446	San Diego County
137311	Fee-for-Service	1356308704	1356308704	1	1	BORSARI, CHRISTINA M MD	4/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72615	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 E VALENCIA MESA DR	STE 310	FULLERTON	CA	92835	3800	30	06059	33.89343304	-117.9279349	Orange County
137319	Fee-for-Service	1689907461	1689907461	1	1	BADLANI, POOJA M MD	3/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117250	45	Nephrology (Renal-Kidney)	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
137326	Fee-for-Service	1922635127	1922635127	1	1	BEVERLY HOSPICE CARE INC	5/19/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6931 VAN NUYS BLVD	STE 332B	VAN NUYS	CA	91405	3937	19	06037	34.19649	-118.448787	Los Angeles County
137331	Fee-for-Service	1174790489	1174790489	1	1	BAYONA MOLANO, MARIA MD	8/17/2023	2085R0204X	NA	Other	026	PHYSICIANS	133192	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
137336	Fee-for-Service	1285787531	1285787531	1	1	BRIGHAM CITY AMBULANCE	12/14/2017	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20 N MAIN ST	None	BRIGHAM CITY	UT	84302	2171	00	None	41.51101271	-112.0157405	Box Elder County
137377	Fee-for-Service	1811061195	1811061195	1	1	BURNS, ROBERT MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84528	02	General Surgery	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
137390	Fee-for-Service	1932685740	1932685740	1	1	BRANTLEY, TARA P DDS	8/15/2024	1223S0112X	NA	Dental Provider	026	PHYSICIANS	182566	47	Miscellaneous	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
137403	Fee-for-Service	1245773456	1245773456	1	1	BRODIE, KARA D MD	10/3/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	166173	04	Otology, Laryngology, Rhinology	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
137438	Fee-for-Service	1982657060	1982657060	1	1	BUCKLEY, DAVID W MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	57383	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
137441	Fee-for-Service	1194262303	1194262303	1	1	BARROWS, MARLINE D	10/23/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2012 N RIVERSIDE AVE	STE J	RIALTO	CA	92377	4603	36	06071	34.13892569	-117.3719933	San Bernardino County
137447	Fee-for-Service	1811368913	1811368913	1	1	BAKER, TERA R	12/14/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
137466	Fee-for-Service	1235502030	1235502030	1	1	BULLARD, STEVEN B CRNA	2/6/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
137474	Fee-for-Service	1699823021	1699823021	1	1	BATNIJI, KAMAL A MD	3/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25477	04	Otology, Laryngology, Rhinology	0	In state provider	None	500 N GARFIELD AVE	STE 302	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
137486	Fee-for-Service	1780214403	1780214403	1	5	BATES, GARY A	10/25/2021	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	2200 5TH AVENUE	None	OROVILLE	CA	95965	5816	04	06007	39.50224835	-121.5648993	Butte County
137487	Fee-for-Service	1346650629	1346650629	1	1	BRENNAN, ANGELA E DO	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14789	01	General Practice	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
137502	Fee-for-Service	1073547667	1073547667	1	1	BALLON LANDA, GONZALO R	8/18/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MD INC	4136 BACHMAN PL	None	SAN DIEGO	CA	92103	2028	37	06073	32.75258794	-117.1632586	San Diego County
137528	Fee-for-Service	1619203734	1619203734	1	1	BINEGAR, DANI L PHD	2/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
137530	Fee-for-Service	1063448686	1063448686	1	1	BASHI,AMANI A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSPS,CLIN	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
137532	Fee-for-Service	1457119836	1457119836	1	1	BUNDLES OF JOY DOULA SERVICE	3/11/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
137561	Fee-for-Service	1306988167	1306988167	1	1	BARKER, CATHERINE P OD	12/1/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	363 S A ST	None	OXNARD	CA	93030	5804	56	06111	34.1991684	-119.1786033	Ventura County
137563	Fee-for-Service	1326122029	1326122029	1	1	BROOKS-REILLY, RHODA C LCSW	6/9/2011	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	33309 LILAC ROAD	None	VALLEY CENTER	CA	92082	3213	37	06073	33.31856744	-117.0847688	San Diego County
137593	Fee-for-Service	1043264690	1043264690	1	1	BANISADRE, MUSSA MD INC.	10/26/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	38740	68	Hematology	0	In state provider	None	1524 MCHENRY AVE	STE 120	MODESTO	CA	95350	4566	50	06099	37.666233	-120.993933	Stanislaus County
137603	Fee-for-Service	1952002735	1952002735	1	1	BARBDIO GROUP OF COMPANIES	8/28/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	NC	715 CASSIA ST	None	REDWOOD CITY	CA	94063	2019	41	06081	37.4855889	-122.2234117	San Mateo County
137608	Fee-for-Service	1689907461	1689907461	1	1	BADLANI, POOJA M MD	3/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117250	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
137610	Fee-for-Service	1740287341	1740287341	1	1	BERMAN, KEVIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	PHOENIX BAPTIST HOSPITAL	6025 N 20TH AVE	None	PHOENIX	AZ	85015	0000	00	None	33.52438694	-112.1018208	Maricopa County
137613	Fee-for-Service	1336729979	1336729979	1	1	BARRIOLA RUBARTH, RODRIGO	8/5/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
137620	Fee-for-Service	1063539575	1063539575	1	1	BRUZZONE, DANIEL E PSYD	5/9/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2790 SKYPARK DRIVE	215	TORRANCE	CA	90505	5388	19	06037	33.80456075	-118.3357569	Los Angeles County
137627	Fee-for-Service	1598821589	1598821589	1	1	BAKHTAR, OMID R MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86149	22	Pathology (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
137630	Fee-for-Service	1629573563	1629573563	1	1	BURCOVSCHII, SERGHEI MD	2/2/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
137656	Fee-for-Service	1104083922	1104083922	1	1	BARHAGHI, MICHELLE G MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122911	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	717 SOUTH AVERILL AVE	None	SAN PEDRO	CA	90732	3813	19	06037	33.7370883	-118.3078499	Los Angeles County
137672	Fee-for-Service	1831332642	1831332642	1	1	BIO MED FULLERTON	3/22/1985	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	149 W LAMBERT RD	None	BREA	CA	92821	4042	30	06059	33.92488725	-117.8971529	Orange County
137679	Fee-for-Service	1326829771	1326829771	1	1	BUNTING, CONNOR AU	5/31/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
137685	Fee-for-Service	1194750919	1194750919	1	1	BEARDEN, CARRIE E PHD	4/1/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90074	0001	19	06037	34.07067	-118.4432445	Los Angeles County
137763	Fee-for-Service	1225250236	1225250236	1	1	BUGA, SORIN MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55230	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
137840	Fee-for-Service	1750744371	1750744371	1	1	BANU, MATEI MD	6/8/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
137846	Fee-for-Service	1174589527	1174589527	1	1	BLYTHE, JASON M DPM	12/6/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2480 MISSION ST	STE 327	SAN FRANCISCO	CA	94110	2463	38	06075	37.75745685	-122.418984	San Francisco County
137851	Fee-for-Service	1346462694	1346462694	1	1	BASHARMAL, AHMAD O MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55901	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
137871	Fee-for-Service	1285862375	1285862375	1	1	BARTON, EDWARD G MD	7/20/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	101958	13	Neurology (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
137875	Fee-for-Service	1083933212	1083933212	1	1	BRYANT, PAUL MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147362	36	Psychiatry	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
137879	Fee-for-Service	1306872544	1306872544	1	1	BAKERJIAN, DEBRA RNP	3/13/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	PRIEST NP SERVICES	134 PAUL DR	STE 2	SAN RAFAEL	CA	94903	2029	21	06041	38.01764866	-122.5370672	Marin County
137888	Fee-for-Service	1730256629	1730256629	1	1	BRASFIELD, FARAH M MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64944	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
137894	Fee-for-Service	1851449235	1851449235	1	1	BERMAN, MICHAEL J	3/28/1995	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	3728	08	Family Practice	0	In state provider	None	82-365 HIGHWAY 111	STE 3B	INDIO	CA	92201	0000	33	06065	33.67930264	-116.1735495	Riverside County
137927	Fee-for-Service	1831115740	1831115740	1	1	BROOKS HOME IV INC	8/1/2005	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	OPTIONCARE FRESNO	3070 M ST	STE 6	MERCED	CA	95348	3221	24	06047	37.31850748	-120.4784489	Merced County
137957	Fee-for-Service	1801406046	1801406046	1	1	BLUE SKY HOSPICE CARE INC	12/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	UNIT 105	VAN NUYS	CA	91405	4673	19	06037	34.19138471	-118.4487668	Los Angeles County
137982	Fee-for-Service	1134291453	1134291453	1	1	BANNISTER, DAVID L MD	4/11/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31541	40	Pediatrics	0	In state provider	None	729 SUNRISE AVE	STE 501	ROSEVILLE	CA	95661	4526	31	06061	38.73444822	-121.2720033	Placer County
138004	Fee-for-Service	1871531145	1871531145	1	1	BHARGAVA, PARUL A MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	52719	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138008	Fee-for-Service	1306913298	1306913298	1	1	BRAUN-YOUNG, KRISTA R MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75336	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
138043	Fee-for-Service	1851740146	1851740146	1	1	BOX, IAN	4/19/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
138049	Fee-for-Service	1669014684	1669014684	1	1	BOWEN, JODI C LPCC	12/5/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
138073	Fee-for-Service	1982746343	1982746343	1	1	BUTCHERT, DAVID J OD	7/2/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11847 SOUTH STREET	None	CERRITOS	CA	90703	6825	19	06037	33.85850849	-118.080567	Los Angeles County
138106	Fee-for-Service	1669196424	1669196424	1	1	BAKER, LISA NP	2/22/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7050 N RECREATION AVE	STE 101	FRESNO	CA	93720	8001	10	06019	36.83835219	-119.7404373	Fresno County
138108	Fee-for-Service	1467612390	1467612390	1	1	BAIN, SARAH E MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105112	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
138116	Fee-for-Service	1831704261	1831704261	1	1	BRIGHT PALLIATIVE AND	5/19/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, INC	1314 W GLENOAKS BLVD	STE 202	GLENDALE	CA	91201	3145	19	06037	34.16648918	-118.2835374	Los Angeles County
138161	Fee-for-Service	1083933212	1083933212	1	1	BRYANT, PAUL MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147362	26	Psychiatry (child)	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
138174	Fee-for-Service	1346921566	1346921566	1	1	BUTLER, ERICA	1/31/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
138185	Fee-for-Service	1003830092	1003830092	1	1	BUSHNELL, FREDERIC III	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74349	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
138204	Fee-for-Service	1346771425	1346771425	1	1	BECK, ALYSSA E	6/26/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	163080	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138224	Fee-for-Service	1407464233	1407464233	1	1	BULCAO, ALEXIS M AU	10/7/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
138244	Fee-for-Service	1801406046	1801406046	1	1	BLUE SKY HOSPICE CARE INC	12/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	UNIT 105	VAN NUYS	CA	91405	4673	19	06037	34.19138471	-118.4487668	Los Angeles County
138248	Fee-for-Service	1518043314	1518043314	1	1	BEST,JENNIFER A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	0000	00	None	47.60414369	-122.3235136	King County
138258	Fee-for-Service	1548252703	1548252703	1	1	BAL, JAGDEEP S MD	5/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	84035	41	Internal Medicine	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
138261	Fee-for-Service	1366881302	1366881302	1	1	BALELO, CHRISTINA M NP	9/16/2019	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
138300	Fee-for-Service	1144422247	1144422247	1	1	BUCKLE, F GRANT MD	12/31/1989	174400000X	NA	Other	026	PHYSICIANS	24871	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	STE 511	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
138306	Fee-for-Service	1407298458	1407298458	1	1	BHATTARAI, RICHA MD	1/17/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	170482	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
138309	Fee-for-Service	1699863860	1699863860	1	1	BELANI, KUMAR G MD	1/1/1999	207ZP0101X	NA	Other	026	PHYSICIANS	37432	05	Anesthesiology	0	In state provider	None	BOX 0648	None	SAN FRANCISCO	CA	94143	0001	38	06075	0	0	None
138326	Fee-for-Service	1033202650	1033202650	1	1	BROWN, LEZLEY R MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52481	08	Family Practice	0	In state provider	None	11400 PLEASANT VALLEY RD	None	PENN VALLEY	CA	95946	9001	29	06057	39.22490424	-121.2041338	Nevada County
138341	Fee-for-Service	1801968680	1801968680	1	1	BARNES ARCATA FAMILY	10/1/1984	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DRUG	1080 G ST	None	ARCATA	CA	95521	5816	12	06023	40.87025126	-124.0851909	Humboldt County
138362	Fee-for-Service	1588216816	1588216816	1	1	BROOKDALE HOSPICE INC	2/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	400 W VENTURA BLVD	SUITE 110	CAMARILLO	CA	93010	9138	56	06111	34.21684652	-119.078244	Ventura County
138400	Fee-for-Service	1831704261	1831704261	1	1	BRIGHT PALLIATIVE AND	5/19/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, INC	1314 W GLENOAKS BLVD	STE 202	GLENDALE	CA	91201	3145	19	06037	34.16648918	-118.2835374	Los Angeles County
138405	Fee-for-Service	1205472115	1205472115	1	1	BLAKE, CATRINA P CNP	4/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
138431	Fee-for-Service	1447261136	1447261136	1	1	BONIS, DANIEL C MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75707	05	Anesthesiology	0	In state provider	None	1300 NORTH VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
138432	Fee-for-Service	1891144549	1891144549	1	1	BHINDER, PARAMBIR S MD	9/1/2019	207R00000X	NA	Other	026	PHYSICIANS	161403	41	Internal Medicine	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
138483	Fee-for-Service	1811967433	1811967433	1	1	BUDOFF, MATTHEW J MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72496	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
138492	Fee-for-Service	1770632168	1770632168	1	1	BAE, HANNAH Y MD	12/4/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	122241	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
138506	Fee-for-Service	1497820013	1497820013	1	1	BROOKS, VICKI L	8/5/1994	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	15028 7TH ST	STE 8	VICTORVILLE	CA	92395	3857	36	06071	34.52445516	-117.3045912	San Bernardino County
138522	Fee-for-Service	1932338217	1932338217	1	1	BURTON, ELAN C MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127795	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
138542	Fee-for-Service	1396362034	1396362034	1	1	BRAR, SARTAJ S MD	7/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191621	08	Family Practice	0	In state provider	None	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	44	06087	36.962588	-122.0439201	Santa Cruz County
138544	Fee-for-Service	1962457812	1962457812	1	144	BEVERLY RADIOLOGY MEDICAL GR	11/13/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8135 PAINTER AVE	SUITE 101	WHITTIER	CA	90602	3158	19	06037	33.965829	-118.032738	Los Angeles County
138549	Fee-for-Service	1558562496	1558562496	1	1	BRAY, MACY DO	10/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
138577	Fee-for-Service	1558304840	1558304840	1	1	BAILEY, CYNTHIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	43538	07	Dermatology	0	In state provider	None	7064 CORLINE CT	STE C	SEBASTOPOL	CA	95472	4528	49	06097	38.38993034	-122.813403	Sonoma County
138591	Fee-for-Service	1508948092	1508948092	1	2	BLUE, MICHAEL D MD	1/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	83637	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
138616	Fee-for-Service	1720372774	1720372774	1	1	BALICKI, DAVID S MFT	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87584	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
138618	Fee-for-Service	1235197633	1235197633	1	1	BROWN, SANDRA J PHD	7/1/2001	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138632	Fee-for-Service	1447511753	1447511753	1	1	BERKOWITZ, JONATHAN MD	10/9/2019	174400000X	NA	Other	026	PHYSICIANS	147595	20	Orthopedic Surgery	0	In state provider	None	4955 VAN NUYS BLVD	STE 615	SHERMAN OAKS	CA	91403	1839	19	06037	34.160805	-118.4487295	Los Angeles County
138635	Fee-for-Service	1437689965	1437689965	1	1	BECK, AUSTIN J DO	10/1/2021	207P00000X	NA	Other	026	PHYSICIANS	18875	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
138644	Fee-for-Service	1770519910	1770519910	1	1	BRANDSTATER, MURRAY MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	38370	25	Physical Medicine and Rehabilitation	0	In state provider	None	11234 ANDERSON ST	STE 3401	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
138645	Fee-for-Service	1639842198	1639842198	1	1	BANAAG, DANN OMAR G NP	6/1/2022	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
138648	Fee-for-Service	1588216816	1588216816	1	1	BROOKDALE HOSPICE INC	2/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	400 W VENTURA BLVD	SUITE 110	CAMARILLO	CA	93010	9138	56	06111	34.21684652	-119.078244	Ventura County
138655	Fee-for-Service	1033723952	1033723952	1	1	BELMONT HOME HEALTH CARE	11/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	16661 VENTURA BLVD	SUITE 506	ENCINO	CA	91436	1935	19	06037	34.15820737	-118.496492	Los Angeles County
138681	Fee-for-Service	1356067037	1356067037	1	1	BROUGHAM AMBULANCE	2/22/2024	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	17430 CHATSWORTH ST	#3	GRANADA HILLS	CA	91344	5717	19	06037	34.26483231	-118.5143801	Los Angeles County
138684	Fee-for-Service	1245522440	1245522440	1	1	BUCK, CURTIS D DO	1/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12645	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
138688	Fee-for-Service	1457332439	1457332439	1	1	BYRD, ROBERT S MD	12/12/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	84192	None	None	0	In state provider	None	1970 LAKE BLVD	None	DAVIS	CA	95616	5663	57	06113	38.56083314	-121.7861904	Yolo County
138700	Fee-for-Service	1952797581	1952797581	1	1	BHATT, ANKEET MD	12/30/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	181996	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
138703	Fee-for-Service	1780639500	1780639500	1	1	BRUNSON, CHARLIE E MD JR	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	WESTERN SLOPE CARDIOLOGY	425 PATTERSON RD	STE 605	GRAND JCT	CO	81506	1910	00	None	39.0917847	-108.5642535	Mesa County
138707	Fee-for-Service	1790040087	1790040087	1	1	BAGHERI, NIKA MD	6/14/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	153884	18	Ophthalmology	0	In state provider	None	2901 N VENTURA RD	250	OXNARD	CA	93036	1150	56	06111	34.24479149	-119.1814409	Ventura County
138720	Fee-for-Service	1447261136	1447261136	1	1	BONIS, DANIEL C MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75707	01	General Practice	0	In state provider	None	1300 NORTH VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
138728	Fee-for-Service	1134201726	1134201726	1	1	BEN-MOSHE, ELI	12/1/1994	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4822 NEWPORT AVE	None	SAN DIEGO	CA	92107	3111	37	06073	32.74500125	-117.2479918	San Diego County
138739	Fee-for-Service	1740266758	1740266758	1	1	BABBITZ, JESSE D MD	4/1/1999	207T00000X	NA	General Surgery	026	PHYSICIANS	69027	14	Neurological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
138770	Fee-for-Service	1811967433	1811967433	1	1	BUDOFF, MATTHEW J MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72496	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
138776	Fee-for-Service	1851719512	1851719512	1	1	BAJWA, SAMARJEET MD	7/16/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	142456	13	Neurology (M.D. only)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
138799	Fee-for-Service	1316287147	1316287147	1	1	BECK, PAMELA J PSYD	3/25/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17075 DEVONSHIRE ST	STE 204	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
138828	Fee-for-Service	1205151412	1205151412	1	1	BASS, LUCAS A J MD	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140313	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
138836	Fee-for-Service	1003071440	1003071440	1	1	BLOCH, BENJAMIN PSYD	10/4/2024	174400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
138843	Fee-for-Service	1124039755	1124039755	1	1	BRAVERMAN, IRA R MD	3/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	37912	41	Internal Medicine	0	In state provider	None	610 EUCLID AVE	STE 201	NATIONAL CITY	CA	91950	2952	37	06073	32.68419388	-117.0829524	San Diego County
138894	Fee-for-Service	1538897947	1538897947	1	1	BAKER, SERENA N NP	9/29/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
138954	Fee-for-Service	1437343670	1437343670	1	1	BARTFELD, NOAH B MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96454	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
138970	Fee-for-Service	1366978439	1366978439	1	1	BARMAAN, BENJAMIN MD	10/1/2023	207LC0200X	NA	Other	026	PHYSICIANS	190900	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
138971	Fee-for-Service	1982634549	1982634549	1	1	BECKER, DAVID K MD	8/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76395	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138975	Fee-for-Service	1356754964	1356754964	1	1	BLANK, SAMANTHA H LMFT	1/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23147 VENTURA BLVD	SUITE 100	WOODLAND HILLS	CA	91364	1737	19	06037	34.16308568	-118.6301028	Los Angeles County
138985	Fee-for-Service	1245224849	1245224849	1	1	BOOTH, SHARON L MD	5/27/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	48864	08	Family Practice	0	In state provider	None	1041 ROSE AVE	None	SELMA	CA	93662	3240	10	06019	36.56879252	-119.596257	Fresno County
138986	Fee-for-Service	1316997505	1316997505	1	10	BALBOA NEPHROLOGY MEDICAL GR	9/20/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	340 FOURTH AVE	SUITE 4	CHULA VISTA	CA	91910	4414	37	06073	32.63831293	-117.0833536	San Diego County
138992	Fee-for-Service	1760402291	1760402291	1	1	BOHR, ROBERT J MD	1/1/1984	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	34562	20	Orthopedic Surgery	0	In state provider	None	1808 VERDUGO BLVD	STE 414	GLENDALE	CA	91208	1474	19	06037	34.2056211	-118.2154553	Los Angeles County
139014	Fee-for-Service	1427870252	1427870252	1	1	BRAD BARROWS, INC	4/29/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	S	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
139026	Fee-for-Service	1053443101	1053443101	1	1	BIO-MEDICAL APPS OF CA	11/27/2006	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4765 CARMEL MOUNTAIN RD	STE 100	SAN DIEGO	CA	92130	6657	37	06073	32.92170067	-117.2134034	San Diego County
139033	Fee-for-Service	1093212839	1093212839	1	1	BREWER, RACHEL	10/21/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
139062	Fee-for-Service	1851353205	1851353205	1	1	BLACKBURN, DENNIS C DO	5/1/1999	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	7267	20	Orthopedic Surgery	0	In state provider	None	1414 S MILLER ST	STE 9	SANTA MARIA	CA	93454	6916	42	06083	34.937433	-120.431561	Santa Barbara County
139107	Fee-for-Service	1962457812	1962457812	1	69	BEVERLY RADIOLOGY MEDICAL GR	10/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	3801 LAS POSAS RD	STE 111	CAMARILLO	CA	93010	1505	56	06111	34.24138914	-119.0191887	Ventura County
139112	Fee-for-Service	1780062869	1780062869	1	1	BAJWA, MOAZZUM N MD	5/23/2018	390200000X	NA	Other	026	PHYSICIANS	151487	08	Family Practice	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
139119	Fee-for-Service	1992270698	1992270698	1	1	BAHRAMZI, NOORSABA NP	5/20/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7850 VISTA HILL AVE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
139125	Fee-for-Service	1669095881	1669095881	1	1	BAR, AGNIESZKA DO	8/12/2024	207P00000X	NA	Other	026	PHYSICIANS	22623	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
139160	Fee-for-Service	1417297169	1417297169	1	1	BEN CONGREGATE LIVING INC	2/26/2015	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6622 BEN AVENUE	None	NORTH HOLLYWOOD	CA	91606	1511	19	06037	34.19096651	-118.3943038	Los Angeles County
139180	Fee-for-Service	1861570400	1861570400	1	1	BIBAT MARIA M MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76469	05	Anesthesiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
139209	Fee-for-Service	1902039829	1902039829	1	1	BACHMEIER-LEVY, BARBARA A	11/8/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
139211	Fee-for-Service	1952493876	1952493876	1	1	BOLTON, DENIS MD	7/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7689	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
139222	Fee-for-Service	1376644336	1376644336	1	1	BLAKEMORE, TONYA R MD	8/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105612	40	Pediatrics	0	In state provider	None	260 SAN JOSE STREET	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
139264	Fee-for-Service	1295879435	1295879435	1	1	BASTO, EDGAR A	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	1741 W ROMNEYA DR	STE D	ANAHEIM	CA	92801	1805	30	06059	33.85068349	-117.943407	Orange County
139271	Fee-for-Service	1659804649	1659804649	1	1	BI, DANSE MD	3/8/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
139273	Fee-for-Service	1316997505	1316997505	1	10	BALBOA NEPHROLOGY MEDICAL GR	9/20/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	340 FOURTH AVE	SUITE 4	CHULA VISTA	CA	91910	4414	37	06073	32.63831293	-117.0833536	San Diego County
139281	Fee-for-Service	1043672058	1043672058	1	1	BLEDSOE, TRACEY L	7/5/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
139305	Fee-for-Service	1578677431	1578677431	1	1	BERRONG, JEANETTE K DO	6/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10732	08	Family Practice	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
139332	Fee-for-Service	1780147694	1780147694	1	1	BRAGER, RHOBE DO	8/26/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19566	None	None	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
139375	Fee-for-Service	1962527606	1962527606	1	1	BASKERVILLE, BENNETT	9/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	BLOCK & LIU A MED CORP	252 GREEN VALLEY RD	None	FREEDOM	CA	95019	3138	44	06087	36.93810448	-121.7709537	Santa Cruz County
139395	Fee-for-Service	1821364852	1821364852	1	1	BEHAR, BRITTANY J MD	7/9/2024	208200000X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
139426	Fee-for-Service	1124352190	1124352190	1	1	BECKER, JAMES C MD	10/8/2018	208600000X	NA	General Surgery	026	PHYSICIANS	125855	89	Surgery-Traumatic	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
139443	Fee-for-Service	1972130284	1972130284	1	1	BRAZEL, DANIELLE M	8/14/2023	208M00000X	NA	Other	026	PHYSICIANS	182839	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
139457	Fee-for-Service	1194964171	1194964171	1	1	BABAALI, H MEDICAL INC	6/1/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	86162	70	Clinic (mixed specialty)	0	In state provider	None	2428 SANTA MONICA BLVD	SUITE 402	SANTA MONICA	CA	90404	2045	19	06037	34.0317559	-118.4762013	Los Angeles County
139487	Fee-for-Service	1346240884	1346240884	1	1	BRUMER, SUZANNE PHD	11/1/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2487 GLENDOWER AVE	None	LOS ANGELES	CA	90027	1110	19	06037	34.11411702	-118.293338	Los Angeles County
139538	Fee-for-Service	1760604367	1760604367	1	1	BRINK-CAPRIOLA, GENEVIEVE M	10/18/2016	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	LCSW	75 DECLARATION DR	STE 10	CHICO	CA	95973	4928	04	06007	39.77193449	-121.8722331	Butte County
139564	Fee-for-Service	1871911222	1871911222	1	1	BERNARDO, MARSHA K MD	1/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	141066	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
139571	Fee-for-Service	1003879743	1003879743	1	1	BHALLA, JAGMINDER S	4/24/1987	207R00000X	NA	Other	026	PHYSICIANS	25813	None	None	0	In state provider	None	1801 W ROMNEYA DR	STE 204	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
139625	Fee-for-Service	1679517460	1679517460	1	1	BINES, LAWRENCE J MD	4/30/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48792	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1316	42	06083	34.4458497	-119.779596	Santa Barbara County
139654	Fee-for-Service	1356760276	1356760276	1	1	BISSET, LOGAN C MD	5/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
139656	Fee-for-Service	1265592687	1265592687	1	1	BURDICK, TANYA	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
139663	Fee-for-Service	1639516602	1639516602	1	1	BENNETT, MELANIE B PSYD	6/3/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
139673	Fee-for-Service	1770791782	1770791782	1	1	BEAUSANG, DANA C MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116528	67	Endocrinology	0	In state provider	None	3200 KEARNEY STREET	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
139736	Fee-for-Service	1053992594	1053992594	1	1	BEBAWY, MARIANA MD	11/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
139743	Fee-for-Service	1194964171	1194964171	1	1	BABAALI, H MEDICAL INC	6/1/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	86162	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2428 SANTA MONICA BLVD	SUITE 402	SANTA MONICA	CA	90404	2045	19	06037	34.0317559	-118.4762013	Los Angeles County
139765	Fee-for-Service	1225188089	1225188089	1	1	BAHRAMI, BAHRAM MD	3/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23638	None	None	0	In state provider	None	2934 INGELOW STREET	None	SAN DIEGO	CA	92106	2311	37	06073	32.72652029	-117.2268796	San Diego County
139769	Fee-for-Service	1093709263	1093709263	1	1	BUCHANAN, DENISE L PHD	2/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	138 B AVE	None	CORONADO	CA	92118	1511	37	06073	32.69706843	-117.1704884	San Diego County
139776	Fee-for-Service	1225343189	1225343189	1	1	BEST, SASHA E PHD	6/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
139781	Fee-for-Service	1699859454	1699859454	1	1	BRUCE, JAMES M MD	4/28/1999	208600000X	NA	General Surgery	026	PHYSICIANS	42011	02	General Surgery	0	In state provider	None	7202 N MILLBROOK AVE	STE 105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
139824	Fee-for-Service	1669979134	1669979134	1	1	BALAN, NAVEEN MD	8/20/2021	208600000X	NA	General Surgery	026	PHYSICIANS	164608	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
139828	Fee-for-Service	1205272739	1205272739	1	1	BORM, NICHOLAS A MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124654	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
139848	Fee-for-Service	1619055456	1619055456	1	1	BRUNK, LLOYD S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41698	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
139853	Fee-for-Service	1174888085	1174888085	1	1	BOLAR, DIVYA S MD	7/30/2018	2085N0700X	NA	MRI Provider	026	PHYSICIANS	154915	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
139867	Fee-for-Service	1356514905	1356514905	1	1	BEN-YOUSSEF, RAMZI MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109160	25	Physical Medicine and Rehabilitation	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
139872	Fee-for-Service	1255522785	1255522785	1	1	BASSLER, SARA L MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66744	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
139875	Fee-for-Service	1609964592	1609964592	1	1	BINDRA, GURPREET K MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82510	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
139894	Fee-for-Service	1801192083	1801192083	1	1	BANIGO, DIARI M LCSW	1/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	TANTS	7498 REMINGTON AVE	102	FRESNO	CA	93711	5508	10	06019	36.84606108	-119.8032874	Fresno County
139902	Fee-for-Service	1811000573	1811000573	1	1	BRADY, SHAWN K MD	12/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52057	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MISSION BLVD	None	JACKSON	CA	95642	2564	03	06005	38.35007723	-120.7659932	Amador County
139911	Fee-for-Service	1710782842	1710782842	1	1	BLUE SKY PSYCHOLOGY GROUP, I	4/8/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	NC.	9700 EL CAMINO REAL	SUITE 300	ATASCADERO	CA	93422	5581	40	06079	35.46523281	-120.647999	San Luis Obispo County
139920	Fee-for-Service	1639562572	1639562572	1	1	BRIDER, PAMELA LCSW	1/30/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
139973	Fee-for-Service	1013528108	1013528108	1	1	BEHAVIORAL HEALTH SERVICES	10/8/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12954 HAWTHORNE BLVD	STE 100	HAWTHORNE	CA	90250	4418	19	06037	33.91447388	-118.3523875	Los Angeles County
139995	Fee-for-Service	1093786790	1093786790	1	1	BROWN, CHRISTIN MICHELE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
140031	Fee-for-Service	1194964171	1194964171	1	1	BABAALI, H MEDICAL INC	6/1/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	86162	41	Internal Medicine	0	In state provider	None	2428 SANTA MONICA BLVD	SUITE 402	SANTA MONICA	CA	90404	2045	19	06037	34.0317559	-118.4762013	Los Angeles County
140057	Fee-for-Service	1023200540	1023200540	1	1	BRANDI, LUIS H MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144195	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
140117	Fee-for-Service	1891866653	1891866653	1	1	BICKLER, STEPHEN W MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	58535	02	General Surgery	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
140148	Fee-for-Service	1184701104	1184701104	1	1	BHALLA, ASHISH	4/21/2009	207P00000X	NA	Other	026	PHYSICIANS	104992	None	None	0	In state provider	None	3110 N CHINO AVENUE	STE 150B	CHINO HILLS	CA	91709	1211	36	06071	34.01077341	-117.738406	San Bernardino County
140152	Fee-for-Service	1891032512	1891032512	1	1	BANIHASHEMI, BEHROOZ MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134421	41	Internal Medicine	0	In state provider	None	4550 CALIFORNIA AVENUE	SUITE 500	BAKERSFIELD	CA	93309	7012	15	06029	35.367903	-119.0537145	Kern County
140213	Fee-for-Service	1467741975	1467741975	1	1	BREWER, ZACHARY E MD	2/11/2019	208G00000X	NA	General Surgery	026	PHYSICIANS	121994	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
140260	Fee-for-Service	1891730479	1891730479	1	1	BASHIR, OMAR J DO	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8694	41	Internal Medicine	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
140263	Fee-for-Service	1013528108	1013528108	1	1	BEHAVIORAL HEALTH SERVICES	10/8/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12954 HAWTHORNE BLVD	STE 100	HAWTHORNE	CA	90250	4418	19	06037	33.91447388	-118.3523875	Los Angeles County
140286	Fee-for-Service	1891821948	1891821948	1	1	BLAKE, JUDIT LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
140298	Fee-for-Service	1588637037	1588637037	2	1	BRESSACK, MICHAEL A MD	8/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	32204	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
140310	Fee-for-Service	1629411228	1629411228	1	1	BACH, HUGH T MD	1/31/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144559	08	Family Practice	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
140378	Fee-for-Service	1861411753	1861411753	1	1	BENSON, EMILY MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90636	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
140423	Fee-for-Service	1740394170	1740394170	1	1	BLACK, JEROLD MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76157	40	Pediatrics	0	In state provider	None	51 HITCHCOCK WAY	None	SANTA BARBARA	CA	93105	3101	42	06083	34.43833587	-119.7444336	Santa Barbara County
140439	Fee-for-Service	1295753481	1295753481	1	1	BROOMES, STEPHEN MD	2/9/2024	207R00000X	NA	Other	026	PHYSICIANS	145762	None	None	0	In state provider	None	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	19	06037	33.98867148	-118.3837334	Los Angeles County
140451	Fee-for-Service	1104324466	1104324466	1	1	BYRNE, REBECCA LMFT	6/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
140463	Fee-for-Service	1336176072	1336176072	2	1	BAKTANIAN, ALBERT MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	41358	18	Ophthalmology	0	In state provider	None	1030 S GLENDALE AVE	SUITE 505	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
140511	Fee-for-Service	1275515579	1275515579	1	1	BROOKINGS HEALTH SYSTEM	2/14/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 22ND AVE	None	BROOKINGS	SD	57006	2496	00	None	44.30776125	-96.76819462	Brookings County
140529	Fee-for-Service	1770765869	1770765869	1	1	BORNEO, HENA T DO	12/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10188	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
140552	Fee-for-Service	1710163555	1710163555	1	1	BECKMAN-PRANIUK, CHRISTINA	12/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
140584	Fee-for-Service	1013091677	1013091677	1	1	BOLDY, MICHAEL M MD	11/1/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	24200	41	Internal Medicine	0	In state provider	None	1275 E LATHAM AVE	STE A	HEMET	CA	92543	4424	33	06065	33.74938248	-116.9589555	Riverside County
140594	Fee-for-Service	1932132578	1932132578	1	1	BRANZBURG, ALLA LCSW	5/1/2003	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	21243 VENTURA BLVD	STE 229	WOODLAND HILLS	CA	91364	2109	19	06037	34.16736368	-118.5947825	Los Angeles County
140663	Fee-for-Service	1861411753	1861411753	1	1	BENSON, EMILY MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90636	20	Orthopedic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
140671	Fee-for-Service	1952176968	1952176968	1	1	BABBITT RUGGIERO, KELSY PA-	2/14/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	C	5715 S BROADWAY AVE	None	LOS ANGELES	CA	90037	4131	19	06037	33.990273	-118.2783255	Los Angeles County
140705	Fee-for-Service	1780954982	1780954982	1	1	BERULAVA, GIORGI MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	1	Border provider	None	77 PRINGLE	None	RENO	NV	89502	1970	00	None	39.52484706	-119.7951825	Washoe County
140707	Fee-for-Service	1437349081	1437349081	1	1	BURREY, LORI P MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105155	40	Pediatrics	0	In state provider	None	2170 EAST BIDWELL STREET	STE 100	FOLSOM	CA	95630	6466	34	06067	38.667321	-121.1435865	Sacramento County
140712	Fee-for-Service	1710660691	1710660691	1	1	BEST CHOICE MED TRANS INC	3/13/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8138 FOOTHILL BLVD.	330B	SUNLAND	CA	91040	2994	19	06037	34.25963955	-118.310661	Los Angeles County
140714	Fee-for-Service	1871532275	1871532275	1	1	BRUMMER, BARRY D MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	35039	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
140719	Fee-for-Service	1336456375	1336456375	2	1	BELTRAN, GAMALIEL LCSW	5/10/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23470 OLIVE WOOD PLAZA D	110	MORENO VALLEY	CA	92553	5264	33	06065	33.94013493	-117.2532525	Riverside County
140737	Fee-for-Service	1790005353	1790005353	1	1	BENT, MELISSA A MD	8/1/2017	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	125757	20	Orthopedic Surgery	0	In state provider	None	2660 E 57TH STREET	None	HUNTINGTON PARK	CA	90255	2545	19	06037	33.9910257	-118.2236447	Los Angeles County
140757	Fee-for-Service	1346569258	1346569258	1	1	BMS HEALTHCARE INCORPORATED	9/1/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8925 MINES AVENUE	None	PICO RIVERA	CA	90660	3006	19	06037	33.99252978	-118.0906425	Los Angeles County
140776	Fee-for-Service	1386934388	1386934388	1	1	BOUTON, DANIEL	6/14/2024	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
140777	Fee-for-Service	1518993047	1518993047	1	1	BRIONES, RICHARD F MD	7/1/2001	207L00000X	NA	Other	026	PHYSICIANS	68215	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 108	LOS GATOS	CA	95032	7691	43	06085	37.25302151	-121.966891	Santa Clara County
140783	Fee-for-Service	1093876583	1093876583	1	1	BENT, THOMAS C	3/31/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38147	08	Family Practice	0	In state provider	None	361 3RD ST	None	LAGUNA BEACH	CA	92651	2306	30	06059	33.54377714	-117.7808874	Orange County
140790	Fee-for-Service	1063497691	1063497691	1	1	BERENJI, MOHAMMAD S MD	12/1/1997	207RN0300X	NA	Nephrology	026	PHYSICIANS	54336	41	Internal Medicine	0	In state provider	None	110 S 5TH ST	None	EL CENTRO	CA	92243	3011	13	06025	32.79267895	-115.5547897	Imperial County
140798	Fee-for-Service	1770912990	1770912990	1	1	BONELLA, ALICIA L NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
140842	Fee-for-Service	1295398675	1295398675	1	1	BRANDHORST, CHARLES PT	4/21/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4339 E MORADA LN STE 150	150	STOCKTON	CA	95212	1634	39	06077	38.039067	-121.259493	San Joaquin County
140849	Fee-for-Service	1164570024	1164570024	1	1	BHASIN, DIMPLE MD	12/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75138	30	Radiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
140864	Fee-for-Service	1609154103	1609154103	1	1	BAIKOVA, ELENA A PSYD	4/22/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
140867	Fee-for-Service	1225321631	1225321631	1	1	B & D HOSPICE SERVICES	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6350 LAUREL CANYON BLVD	STE 207	NORTH HOLLYWOOD	CA	91606	3273	19	06037	34.18640491	-118.3964824	Los Angeles County
140870	Fee-for-Service	1962747873	1962747873	1	1	BASHARKHAH, NADIA MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119798	05	Anesthesiology	0	In state provider	None	18300 HWY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
140889	Fee-for-Service	1033349014	1033349014	1	1	BEYDOUN, TAMMAM DO	4/10/2019	2085R0204X	NA	Other	026	PHYSICIANS	14487	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
140896	Fee-for-Service	1235181728	1235181728	1	1	BENNION, LYNN J MD	5/14/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36683	41	Internal Medicine	0	In state provider	None	1832 AVONDALE AVE	None	SACRAMENTO	CA	95825	1386	34	06067	38.597616	-121.394934	Sacramento County
140911	Fee-for-Service	1780159145	1780159145	1	1	BERGELEEN, ANDREA L	12/27/2022	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	3630 ENTERPRISE STREET	None	SAN DIEGO	CA	92110	3212	37	06073	32.74601586	-117.1985439	San Diego County
140920	Fee-for-Service	1912937186	1912937186	1	1	BIRNBAUM, ALAN M MD	3/13/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	32784	13	Neurology (M.D. only)	0	In state provider	None	4747 N 1ST ST	STE 101	FRESNO	CA	93726	0517	10	06019	36.803385	-119.7724465	Fresno County
140926	Fee-for-Service	1376755835	1376755835	1	1	BRAHMBHATT, KHYATI MD	9/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	114012	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
140951	Fee-for-Service	1396378709	1396378709	1	1	BRIDGE HOME HEALTH CENTRAL	12/13/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	COAST, LLC	6 QUAIL RUN CIR	SUITE 104	SALINAS	CA	93907	2345	27	06053	36.68655764	-121.6697976	Monterey County
140963	Fee-for-Service	1154731289	1154731289	1	1	BREWART, NADIA M LMFT	9/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
140977	Fee-for-Service	1245655869	1245655869	1	1	BOHN, NATHANIEL D NP	2/6/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
141009	Fee-for-Service	1174667075	1174667075	1	1	BUCHWALD, ALAN MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	34228	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1144 RIVERSIDE RD	None	WATSONVILLE	CA	95076	9413	44	06087	36.9187568	-121.6863356	Santa Cruz County
141038	Fee-for-Service	1972867562	1972867562	1	1	BLAIS, MICAH MD	8/10/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	153579	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
141059	Fee-for-Service	1497910632	1497910632	1	1	BAKER, GALEN E OD	12/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10237	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
141062	Fee-for-Service	1427303320	1427303320	1	1	BUCHANAN, LENNOX T LMFT	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	78884	-	NOT APPLICABLE	0	In state provider	None	2035 E BALL ROAD	STE 100A, 100P	ANAHEIM	CA	92806	5158	30	06059	33.81812448	-117.8880075	Orange County
141078	Fee-for-Service	1063497691	1063497691	1	1	BERENJI, MOHAMMAD S MD	12/1/1997	207RN0300X	NA	Nephrology	026	PHYSICIANS	54336	45	Nephrology (Renal-Kidney)	0	In state provider	None	110 S 5TH ST	None	EL CENTRO	CA	92243	3011	13	06025	32.79267895	-115.5547897	Imperial County
141092	Fee-for-Service	1801948302	1801948302	1	1	BUCCIARELLI, NANCY R MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	59322	30	Radiology	0	In state provider	None	ONE HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
141103	Fee-for-Service	1932261583	1932261583	1	1	BURTON, MARGARET E PSY	8/17/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18564	-	NOT APPLICABLE	0	In state provider	None	303 41ST STREET	None	RICHMOND	CA	94805	2221	07	06013	37.93356197	-122.3307418	Contra Costa County
141105	Fee-for-Service	1225027279	1225027279	1	1	BRIAN J FROHNA, MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
141157	Fee-for-Service	1225321631	1225321631	1	1	B & D HOSPICE SERVICES	7/22/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6350 LAUREL CANYON BLVD	STE 207	NORTH HOLLYWOOD	CA	91606	3273	19	06037	34.18640491	-118.3964824	Los Angeles County
141167	Fee-for-Service	1164983284	1164983284	1	1	BARSH, GABRIELLE R MD	3/27/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	182291	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
141181	Fee-for-Service	1558635474	1558635474	1	1	BHAMBANI, SHALINI L MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121068	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2900 WHIPPLE AVE	SUITE 225	REDWOOD CITY	CA	94065	2851	41	06081	37.4783072	-122.2551089	San Mateo County
141183	Fee-for-Service	1235181728	1235181728	1	1	BENNION, LYNN J MD	5/14/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36683	67	Endocrinology	0	In state provider	None	1832 AVONDALE AVE	None	SACRAMENTO	CA	95825	1386	34	06067	38.597616	-121.394934	Sacramento County
141187	Fee-for-Service	1417200437	1417200437	1	1	BARSI, CHRISTOPHER D MD	4/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145000	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
141199	Fee-for-Service	1649584319	1649584319	1	1	BHINDER, SUMEET MD INC	11/22/2010	207RR0500X	NA	Other	026	PHYSICIANS	97529	41	Internal Medicine	0	In state provider	None	3850 RIVERLAKES DR	SUITE B	BAKERSFIELD	CA	93312	6662	15	06029	35.39426565	-119.0936823	Kern County
141213	Fee-for-Service	1558366260	1558366260	1	1	BABEL, KAREN LEIGH MD	5/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78506	08	Family Practice	0	In state provider	None	1002 N FAIRVIEW ST	None	SANTA ANA	CA	92703	1811	30	06059	33.75346151	-117.9023004	Orange County
141225	Fee-for-Service	1437434842	1437434842	1	1	BENTIVENGA, NANCY V	6/28/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
141227	Fee-for-Service	1063433019	1063433019	2	1	BUY WELL INC	8/31/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	375 HUNTINGTON DR	#A	SAN MARINO	CA	91108	2357	19	06037	34.1067704	-118.1349621	Los Angeles County
141243	Fee-for-Service	1891038709	1891038709	1	1	BOURDON, LELAND S MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135077	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
141250	Fee-for-Service	1649915414	1649915414	1	1	BRODLEY, JULIA CCC-SLP	9/15/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
141251	Fee-for-Service	1225050453	1225050453	1	1	BASE, STEPHEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
141289	Fee-for-Service	1164818902	1164818902	1	1	BROWN, BRIANNA CCC-SLP	4/26/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
141309	Fee-for-Service	1922869114	1922869114	1	1	BARBERO, RALPH S	2/22/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5790 RIVERA RD	None	VACAVILLE	CA	95688	9728	48	06095	38.33359092	-122.0176679	Solano County
141317	Fee-for-Service	1316475759	1316475759	1	1	BAUTISTA, MARIEL B NP	11/10/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14390 PARK AVE.	None	VICTORVILLE	CA	92392	2910	36	06071	34.512453	-117.324936	San Bernardino County
141324	Fee-for-Service	1356845812	1356845812	1	1	BANDY, SOHINI S	9/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	75 ROWLAND WAY	SUITE 200	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
141357	Fee-for-Service	1417722380	1417722380	1	1	BANKS, TAMIKA L DOULA	4/18/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
141377	Fee-for-Service	1265718472	1265718472	1	1	BERHANU, MARTHA	1/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
141396	Fee-for-Service	1467449975	1467449975	1	1	BROAD, MICHELE R RN	2/19/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	WOMENS HEALTH & WELLNESS	40700 CALIFORNIA OAKS RD	STE 205	MURRIETA	CA	92562	5789	33	06065	33.57067363	-117.2045035	Riverside County
141399	Fee-for-Service	1023025186	1023025186	1	1	BARMEYER, ROBERT L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	2665	41	Internal Medicine	0	In state provider	None	1045 ATLANTIC AVE	STE 608	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
141403	Fee-for-Service	1104836618	1104836618	1	1	BOGUE, MICHAEL A MD	1/4/2016	207L00000X	NA	Other	026	PHYSICIANS	64470	05	Anesthesiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
141423	Fee-for-Service	1366429441	1366429441	1	1	BOKOSKY, JOHN E MD FACS	12/27/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EYE CARE OF SAN DIEGO	3939 3RD AVE	None	SAN DIEGO	CA	92103	3002	37	06073	32.74905668	-117.16268	San Diego County
141440	Fee-for-Service	1992723985	1992723985	1	1	BUCKHALTER, EMERSON R MD	11/30/1982	207R00000X	NA	Other	026	PHYSICIANS	44884	41	Internal Medicine	0	In state provider	None	201 S ALVARADO ST	None	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
141443	Fee-for-Service	1801832100	1801832100	1	1	BEDARD, LARRY A MD	3/1/1996	207P00000X	NA	Other	026	PHYSICIANS	28621	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
141475	Fee-for-Service	1053351221	1053351221	1	1	BRADBURY, MARK F MD	1/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	700 SOUTH J STREET	None	LAKEVIEW	OR	97630	1623	00	None	42.181335	-120.351489	Lake County
141478	Fee-for-Service	1639219355	1639219355	1	1	BLOCK, ROBERT CRNA	2/28/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
141480	Fee-for-Service	1346302601	1346302601	1	1	BINA, BABAK DO	1/17/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	9641	25	Physical Medicine and Rehabilitation	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
141486	Fee-for-Service	1649584319	1649584319	1	1	BHINDER, SUMEET MD INC	11/22/2010	207RR0500X	NA	Other	026	PHYSICIANS	97529	83	Rheumatology	0	In state provider	None	3850 RIVERLAKES DR	SUITE B	BAKERSFIELD	CA	93312	6662	15	06029	35.39426565	-119.0936823	Kern County
141505	Fee-for-Service	1861417297	1861417297	1	1	BOTTA, DAVID C MD	10/31/1990	207L00000X	NA	Other	026	PHYSICIANS	48892	01	General Practice	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
141514	Fee-for-Service	1699885624	1699885624	1	1	BRAHM, STEPHEN M DPM	8/31/1995	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1001 E LATHAM AVE	STE E	HEMET	CA	92543	4435	33	06065	33.74937254	-116.961804	Riverside County
141532	Fee-for-Service	1134277494	1134277494	1	2	BIOREFERENCE HEALTH, LLC	9/15/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	481 EDWARD H ROSS DR	None	ELMWOOD PARK	NJ	07407	3118	00	None	40.900023	-74.10858724	Bergen County
141550	Fee-for-Service	1023403185	1023403185	1	1	BESHARATI, MELODY MD	9/26/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145475	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
141570	Fee-for-Service	1942696646	1942696646	1	1	BOUHENGUEL, JASON T MD	10/1/2021	207L00000X	NA	Other	026	PHYSICIANS	160971	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
141613	Fee-for-Service	1467607655	1467607655	1	1	BANSAL, ANIP MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
141627	Fee-for-Service	1750950499	1750950499	1	1	BARTON MEDICAL FOUNDATION	10/1/2024	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1108 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3476	09	06017	38.912904	-119.998638	El Dorado County
141630	Fee-for-Service	1023053659	1023053659	2	1	BENEDICT HAEG MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	425 ELM ST N	None	SAUK CENTRE	MN	56378	1010	00	None	45.74643865	-94.95528537	Stearns County
141633	Fee-for-Service	1467421578	1467421578	1	1	BARGA, RENATO B MD INC	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40782	01	General Practice	0	In state provider	None	2701 W ALAMEDA AVE	STE 203	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
141634	Fee-for-Service	1790413177	1790413177	1	1	BUZUGBE, FRANK CRNA	11/2/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 SOUTH GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
141662	Fee-for-Service	1821665449	1821665449	1	1	BILL MASTRODIMOS MD, JD, A P	8/11/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	ROFESSIONAL CORPORATION	6699 ALVARADO RD	2309	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
141681	Fee-for-Service	1235101163	1235101163	1	1	BAUM, SHERRY K CNM	4/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92193	2410	37	06073	32.7537975	-117.1658298	San Diego County
141693	Fee-for-Service	1639576101	1639576101	1	1	BIGGS, JOHN M	3/30/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT STREET	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
141703	Fee-for-Service	1548752975	1548752975	1	1	BROWN, PAMELA LCSW	11/7/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
141715	Fee-for-Service	1366429441	1366429441	1	1	BOKOSKY, JOHN E MD FACS	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EYE CARE OF SAN DIEGO	3939 3RD AVE	None	SAN DIEGO	CA	92103	3002	37	06073	32.74905668	-117.16268	San Diego County
141720	Fee-for-Service	1962457812	1962457812	1	19	BEVERLY RADIOLOGY MEDICAL GR	7/31/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	43713 N 20TH ST WEST	STE 6	LANCASTER	CA	93534	4628	19	06037	34.67701317	-118.1657538	Los Angeles County
141733	Fee-for-Service	1508089285	1508089285	1	1	BOOKER, STEVEN W MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62338	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
141739	Fee-for-Service	1770543118	1770543118	1	1	BRAILSFORD, PAUL A MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39581	01	General Practice	0	In state provider	None	801 N TUSTIN AVE	STE 303	SANTA ANA	CA	92705	3601	30	06059	33.752286	-117.8341735	Orange County
141747	Fee-for-Service	1396096111	1396096111	1	1	BISHOP, GRACIE F LMFT	10/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
141769	Fee-for-Service	1518929876	1518929876	1	1	BASILIERE, EUGENE J MD	4/1/2003	174400000X	NA	Other	026	PHYSICIANS	42602	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	765 MEDICAL CENTER CT	STE 209	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
141778	Fee-for-Service	1972379212	1972379212	1	1	BENSON, REGINA	8/22/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
141781	Fee-for-Service	1629210679	1629210679	1	1	BOECKMANN, JESSICA M MD	10/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124361	18	Ophthalmology	0	In state provider	None	2572 ATLANTIC AVE	None	LONG BEACH	CA	90806	2751	19	06037	33.803901	-118.1850045	Los Angeles County
141786	Fee-for-Service	1962570051	1962570051	1	4	BLANK, MARCIA S	6/4/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 W 155TH ST	STE 107	GARDENA	CA	90247	4049	19	06037	33.89049013	-118.2982407	Los Angeles County
141898	Fee-for-Service	1588928402	1588928402	2	1	BIG 8 PHARMACY INC	4/6/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4318 MAINE AVE	STE C	BALDWIN PARK	CA	91706	3326	19	06037	34.090929	-117.9604215	Los Angeles County
141901	Fee-for-Service	1467607655	1467607655	1	1	BANSAL, ANIP MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
141909	Fee-for-Service	1710043328	1710043328	1	1	BLAZON YEE, MATTHEW	3/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20163	None	None	0	In state provider	None	1225 WILSHIRE BOULEVARD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
141913	Fee-for-Service	1275771131	1275771131	1	1	BROWN, JENNIFER C MD	8/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111626	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
141921	Fee-for-Service	1598784662	1598784662	1	1	BANNOUT, MIKE MD	8/8/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61793	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
141927	Fee-for-Service	1750950499	1750950499	1	1	BARTON MEDICAL FOUNDATION	8/20/2024	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1108 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3476	09	06017	38.912904	-119.998638	El Dorado County
141964	Fee-for-Service	1669637575	1669637575	1	1	BREYER, KRISTINE W MD	7/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104570	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
141984	Fee-for-Service	1730356460	1730356460	1	1	BAMBER, DANNY L MD	3/18/2019	207P00000X	NA	Other	026	PHYSICIANS	157991	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
141987	Fee-for-Service	1578843959	1578843959	1	1	BAITIS, SARAH P LMFT	2/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
141988	Fee-for-Service	1457382491	1457382491	1	1	BUREN, SUSAN E MD	6/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42951	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
142002	Fee-for-Service	1821335241	1821335241	1	1	BRADLEY, MEGAN M LMFT	3/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
142003	Fee-for-Service	1144286824	1144286824	1	1	BLANCO, ADOLFO A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	53079	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
142020	Fee-for-Service	1508089285	1508089285	1	1	BOOKER, STEVEN W MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62338	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
142029	Fee-for-Service	1770543118	1770543118	1	1	BRAILSFORD, PAUL A MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39581	41	Internal Medicine	0	In state provider	None	801 N TUSTIN AVE	STE 303	SANTA ANA	CA	92705	3601	30	06059	33.752286	-117.8341735	Orange County
142054	Fee-for-Service	1518929876	1518929876	1	1	BASILIERE, EUGENE J MD	4/1/2003	174400000X	NA	Other	026	PHYSICIANS	42602	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	765 MEDICAL CENTER CT	STE 209	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
142060	Fee-for-Service	1477601292	1477601292	1	1	BEAN, DELOIS J MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51929	20	Orthopedic Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
142102	Fee-for-Service	1043425036	1043425036	1	1	BANKER RAJESH S MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90635	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
142126	Fee-for-Service	1104259597	1104259597	1	1	BUTTERFIELD, JARON MD	12/23/2024	208600000X	NA	General Surgery	026	PHYSICIANS	191435	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
142131	Fee-for-Service	1245346741	1245346741	1	1	BHC FREMONT HOSP	12/1/1996	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	FREMONT HOSP	39001 SUNDALE DR	None	FREMONT	CA	94538	2005	01	06001	37.5461169	-121.979068	Alameda County
142132	Fee-for-Service	1205482510	1205482510	1	1	BAGDASARIAN, IZABELLA LCSW	8/25/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22777 LYONS AVE	#107	NEWHALL	CA	91324	3985	19	06037	34.38063512	-118.5316765	Los Angeles County
142134	Fee-for-Service	1609100817	1609100817	1	1	BABARE, JESSICA R DO	10/26/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	14042	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	04	06007	39.74473059	-121.8488381	Butte County
142155	Fee-for-Service	1215027446	1215027446	1	1	BERAL, RABIN DPM INC	8/20/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1300 W 155TH ST	STE 109	GARDENA	CA	90247	4049	19	06037	33.89049013	-118.2982407	Los Angeles County
142163	Fee-for-Service	1992921571	1992921571	3	1	BRITTANY'S PLACE INC	3/23/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1217 W 101ST STREET	None	LOS ANGELES	CA	90044	1802	19	06037	33.94501949	-118.296882	Los Angeles County
142164	Fee-for-Service	1558535419	1558535419	1	1	BOLLINGER, MICHAEL T MD	4/23/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	65404	20	Orthopedic Surgery	0	In state provider	A PROF CORP	555 PETALUMA AVE	STE B	SEBASTOPOL	CA	95472	4225	49	06097	38.39744712	-122.8206197	Sonoma County
142208	Fee-for-Service	1750950499	1750950499	1	1	BARTON MEDICAL FOUNDATION	6/19/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1108 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3476	09	06017	38.912904	-119.998638	El Dorado County
142227	Fee-for-Service	1285666941	1285666941	1	1	BJORKMAN, LARS L MD	2/16/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	30966	05	Anesthesiology	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
142235	Fee-for-Service	1336316355	1336316355	1	1	BRODT, JESSICA L MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129368	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
142270	Fee-for-Service	1467483719	1467483719	1	1	BOKSER, SETH MD	4/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87159	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
142315	Fee-for-Service	1770543118	1770543118	1	1	BRAILSFORD, PAUL A MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39581	18	Ophthalmology	0	In state provider	None	801 N TUSTIN AVE	STE 303	SANTA ANA	CA	92705	3601	30	06059	33.752286	-117.8341735	Orange County
142321	Fee-for-Service	1972379212	1972379212	1	2	BENSON, REGINA	11/21/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	31	06061	0	0	None
142329	Fee-for-Service	1538180666	1538180666	1	1	BOCEK,NICOLA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	504 N 40TH AVE	None	YAKIMA	WA	98908	4311	00	None	46.60561938	-120.5620157	Yakima County
142330	Fee-for-Service	1821027228	1821027228	1	1	BOWEN, DAVID MD	3/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	60193	24	Plastic Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
142332	Fee-for-Service	1790796571	1790796571	1	1	BELLINGHAUSEN, REAGAN MD	2/28/1986	207P00000X	NA	Other	026	PHYSICIANS	36234	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
142348	Fee-for-Service	1477601292	1477601292	1	1	BEAN, DELOIS J MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51929	02	General Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
142351	Fee-for-Service	1902819568	1902819568	1	1	BALFOUR, ANDREW C OD	7/30/1992	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 S BROADWAY	None	LOS ANGELES	CA	90013	2301	19	06037	34.04692027	-118.2517853	Los Angeles County
142377	Fee-for-Service	1689831380	1689831380	1	1	BATH, KIRAN K S MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	107264	13	Neurology (M.D. only)	0	In state provider	None	381 E IMPERIAL HWY	None	FULLERTON	CA	92835	1040	30	06059	33.9175203	-117.9265348	Orange County
142384	Fee-for-Service	1790766764	1790766764	1	1	BILSTROM, DAVID E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9370 SW GREENBURG RD	STE A	PORTLAND	OR	97223	5408	00	None	45.45185598	-122.7743031	Washington County
142389	Fee-for-Service	1548392632	1548392632	1	1	BLAIR, KATRINA L LMFT	1/12/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
142418	Fee-for-Service	1245346741	1245346741	1	1	BHC FREMONT HOSP	12/1/1996	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	FREMONT HOSP	39001 SUNDALE DR	None	FREMONT	CA	94538	2005	01	06001	37.5461169	-121.979068	Alameda County
142435	Fee-for-Service	1972889236	1972889236	1	1	BURGER, TIMOTHY E MD	1/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159032	41	Internal Medicine	0	In state provider	None	1 MARCELA DR	None	WILLITS	CA	95490	4225	23	06045	39.3901086	-123.339055	Mendocino County
142455	Fee-for-Service	1922328459	1922328459	1	1	BOUYER, GREGORY D MD	2/18/2021	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	131873	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
142475	Fee-for-Service	1407189541	1407189541	1	1	BAKKER, DANICA PSYD	2/15/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
142499	Fee-for-Service	1669903035	1669903035	1	1	BAUTISTA, JOANNE M MD	3/9/2021	208M00000X	NA	Other	026	PHYSICIANS	167260	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
142531	Fee-for-Service	1528042470	1528042470	1	1	BREWER, KATHRYN L MD	7/3/2023	207R00000X	NA	Other	026	PHYSICIANS	125955	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
142542	Fee-for-Service	1588709521	1588709521	1	1	BRENDER, ERIN B MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2640 E BARNETT RD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
142555	Fee-for-Service	1396570958	1396570958	1	1	BINKLOR PHARMACY & MEDICAL S	10/28/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	UPPLIES LLC	1350 E FLORENCE AVE	# B&C	LOS ANGELES	CA	90001	1963	19	06037	33.9747265	-118.250163	Los Angeles County
142563	Fee-for-Service	1487740452	1487740452	2	1	BLOOMFIELD WEST INC	2/9/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3333 E IMPERIAL HWY	None	LYNWOOD	CA	90262	3305	19	06037	33.93082832	-118.210276	Los Angeles County
142565	Fee-for-Service	1033490438	1033490438	1	1	BRAR, RANDEEP MD	8/19/2024	207SG0201X	NA	Other	026	PHYSICIANS	149179	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
142576	Fee-for-Service	1659980548	1659980548	1	1	BUENROSTRO, BRENDA LMFT	2/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
142592	Fee-for-Service	1528025749	1528025749	1	1	BLAKE, MEGHAN E MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98185	None	None	0	In state provider	None	3700 CALIFORNIA ST	# G350	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
142602	Fee-for-Service	1780018416	1780018416	1	1	BUNOSKY, ABIGAIL PT	11/4/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
142621	Fee-for-Service	1215186374	1215186374	1	1	BING, MARY L MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116670	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
142626	Fee-for-Service	1164538187	1164538187	1	1	BOGE, JANICE J. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	302 N HOSPITAL DR	None	GIRARD	KS	66743	2000	00	None	37.51462395	-94.8583732	Crawford County
142642	Fee-for-Service	1730594672	1730594672	1	1	BERTANI, LAURA A MD	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142304	01	General Practice	0	In state provider	None	255 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.3639177	-121.8490241	Santa Clara County
142673	Fee-for-Service	1629078555	1629078555	1	1	BEHRA,JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	0000	00	None	32.227209	-110.8556595	Pima County
142694	Fee-for-Service	1871627307	1871627307	1	1	BIKDELI, SARA MD	12/14/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94321	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
142704	Fee-for-Service	1316997505	1316997505	1	6	BALBOA NEPHROLOGY MEDICAL GR	10/8/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	9834 GENESEE AVE	STE 312	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
142707	Fee-for-Service	1245346741	1245346741	1	1	BHC FREMONT HOSP	12/1/1996	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	FREMONT HOSP	39001 SUNDALE DR	None	FREMONT	CA	94538	2005	01	06001	37.5461169	-121.979068	Alameda County
142724	Fee-for-Service	1336431097	1336431097	1	1	BOWLES, ERIC D CRNA	11/21/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
142741	Fee-for-Service	1518285568	1518285568	1	1	BARBER, LATOYA S MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107911	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
142744	Fee-for-Service	1083935811	1083935811	1	1	BALSIGER, ROBERT W DO	10/11/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
142746	Fee-for-Service	1205178878	1205178878	1	1	BOWKER, DEAN B MD	9/21/2018	207L00000X	NA	Other	026	PHYSICIANS	131679	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANNAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
142765	Fee-for-Service	1932829827	1932829827	1	1	BROWN, REED M PT	9/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
142796	Fee-for-Service	1962518530	1962518530	1	1	BALL, JOSHUA M MD	8/1/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186752	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
142818	Fee-for-Service	1861680712	1861680712	1	1	BIENESTAR MEDICAL CENTER	11/2/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	1125 E 17TH STREET	SUITE N 152	SANTA ANA	CA	92701	2620	30	06059	33.76004145	-117.854838	Orange County
142822	Fee-for-Service	1316352867	1316352867	1	1	BEAR MOUNTAIN MEDICAL	7/15/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	SERVICES AMC	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1619	36	06071	34.24602097	-116.8885243	San Bernardino County
142830	Fee-for-Service	1003888074	1003888074	1	1	BESSUDO, ALBERTO MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50309	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
142851	Fee-for-Service	1184038671	1184038671	1	1	BARSKY, LILI L MD	12/4/2019	207R00000X	NA	Other	026	PHYSICIANS	161163	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
142852	Fee-for-Service	1801114574	1801114574	1	1	BROWN, LAURA E MD	9/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148243	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
142867	Fee-for-Service	1144230152	1144230152	1	1	BAGUIO, EMELIE T MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68703	08	Family Practice	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
142868	Fee-for-Service	1972896140	1972896140	1	1	BILLINGSLEY, BABETTE D LCSW	6/7/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 30TH ST	SUITE 306 RM 3	SACRAMENTO	CA	95816	3359	34	06067	38.58102	-121.4628165	Sacramento County
142870	Fee-for-Service	1053457705	1053457705	1	1	BRODY, DORA L LMFT	10/16/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5855 TOPANGA CANYON BLVD	STE 510	WOODLAND HILLS	CA	91367	4681	19	06037	34.17696642	-118.605101	Los Angeles County
142886	Fee-for-Service	1699858357	1699858357	1	1	BLOOM, TRACY R NP	1/12/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3275 VILLA LANE	None	NAPA	CA	94558	3016	28	06055	38.32223637	-122.2927198	Napa County
142906	Fee-for-Service	1013919455	1013919455	1	1	BRIESKE, TIMOTHY A MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55055	08	Family Practice	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	3608	37	06073	33.1857	-117.290538	San Diego County
142921	Fee-for-Service	1922374339	1922374339	1	1	BREWER, ROSALYN MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148404	05	Anesthesiology	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
142933	Fee-for-Service	1285651166	1285651166	1	1	BHARADIA, JUMA A MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56515	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
142953	Fee-for-Service	1255382560	1255382560	1	1	BOYUM, KATHLEEN A PHD	6/20/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
142962	Fee-for-Service	1174594907	1174594907	1	1	BILLINGS ROBERT	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	322 S BIRCH ST	None	MCCLEARY	WA	98557	9522	00	None	47.05560381	-123.2607785	Grays Harbor County
142972	Fee-for-Service	1821171604	1821171604	1	1	BEZIKIAN, HAGOP G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	39946	08	Family Practice	0	In state provider	BEZIKIAN MEDICAL CENTER	1340 N VIRGIL AVE	None	LOS ANGELES	CA	90027	6026	19	06037	34.09634232	-118.2870512	Los Angeles County
142993	Fee-for-Service	1316997505	1316997505	1	6	BALBOA NEPHROLOGY MEDICAL GR	10/8/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	9834 GENESEE AVE	STE 312	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
142994	Fee-for-Service	1629094263	1629094263	1	1	BHAGAVATH, PURUSHOTHAM	9/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49681	05	Anesthesiology	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
143037	Fee-for-Service	1043320005	1043320005	1	1	BROOKS, JAMES D MD	3/31/1996	208800000X	NA	Other	026	PHYSICIANS	84191	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
143056	Fee-for-Service	1780748723	1780748723	1	1	BUTTLAIRE, STUART PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
143058	Fee-for-Service	1215379144	1215379144	1	1	BUSBY, LINDSAY MD MPH	5/3/2018	390200000X	NA	Other	026	PHYSICIANS	133958	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
143091	Fee-for-Service	1841687860	1841687860	1	1	BROWN, PHILLIP C MD	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147392	01	General Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
143104	Fee-for-Service	1982158663	1982158663	1	1	BEVERLY HILLS MIGRAINE AND P	4/5/2018	207LP2900X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	AIN MANAGEMENT INSTITUTE	436 N ROXBURY DR STE 101	None	BEVERLY HILLS	CA	90210	5016	19	06037	34.06771782	-118.4065755	Los Angeles County
143118	Fee-for-Service	1003888074	1003888074	1	1	BESSUDO, ALBERTO MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50309	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
143143	Fee-for-Service	1962465732	1962465732	1	1	BUERCHNER, CATHERINE MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61658	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
143150	Fee-for-Service	1588865463	1588865463	1	1	BAUGHMAN, SUSAN W	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
143152	Fee-for-Service	1811160484	1811160484	1	1	BARRERA, ANDRELITA D MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114092	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
143155	Fee-for-Service	1144230152	1144230152	1	1	BAGUIO, EMELIE T MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
143174	Fee-for-Service	1306320551	1306320551	1	1	BAUTISTA, FERDINAND R PT	11/23/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15725 POMERADO ROAD	115	POWAY	CA	92064	7301	37	06073	33.00037882	-117.0580735	San Diego County
143183	Fee-for-Service	1497845044	1497845044	1	2	BORGSTEDE, JAMES P MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
143193	Fee-for-Service	1205196995	1205196995	1	1	BARTH-ROGERS, ISA MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129781	01	General Practice	0	In state provider	None	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
143195	Fee-for-Service	1013919455	1013919455	1	1	BRIESKE, TIMOTHY A MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55055	41	Internal Medicine	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	3608	37	06073	33.1857	-117.290538	San Diego County
143200	Fee-for-Service	1619928892	1619928892	1	1	BADHWAR, NITISH MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76074	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
143203	Fee-for-Service	1215008115	1215008115	1	1	BAHADOSINGH, FELICIA MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61706	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
143227	Fee-for-Service	1093791014	1093791014	1	1	BEGOVIC, ADNAN MD	8/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79574	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
143234	Fee-for-Service	1891569356	1891569356	1	1	BOULGOURJIAN, ALIQUE OD	3/1/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1821 DAILY DR	None	CAMARILLO	CA	93010	6201	56	06111	34.21782879	-119.0452962	Ventura County
143260	Fee-for-Service	1821171604	1821171604	1	1	BEZIKIAN, HAGOP G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	39946	01	General Practice	0	In state provider	BEZIKIAN MEDICAL CENTER	1340 N VIRGIL AVE	None	LOS ANGELES	CA	90027	6026	19	06037	34.09634232	-118.2870512	Los Angeles County
143295	Fee-for-Service	1750783361	1750783361	1	1	BERRY, LINDA P LCSW	8/10/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
143394	Fee-for-Service	1982158663	1982158663	1	1	BEVERLY HILLS MIGRAINE AND P	4/5/2018	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	AIN MANAGEMENT INSTITUTE	436 N ROXBURY DR STE 101	None	BEVERLY HILLS	CA	90210	5016	19	06037	34.06771782	-118.4065755	Los Angeles County
143404	Fee-for-Service	1215961248	1215961248	1	1	BANNER HEART HOSPITAL	6/24/2004	284300000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6750 E BAYWOOD AVE	None	MESA	AZ	85206	1749	00	None	33.411195	-111.685365	Maricopa County
143414	Fee-for-Service	1417730946	1417730946	1	1	BREATH OF SUNSHINE INC	9/6/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8627 NORWICH AVENUE	None	NORTH HILLS	CA	91343	6091	19	06037	34.22704471	-118.4601992	Los Angeles County
143430	Fee-for-Service	1962465732	1962465732	1	1	BUERCHNER, CATHERINE MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61658	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
143437	Fee-for-Service	1407054182	1407054182	1	1	BEWLEY, ARNAUD F MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126121	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
143444	Fee-for-Service	1932253960	1932253960	1	1	BUI, HANG T MD APC	2/1/1998	207YX0901X	NA	ENT/Otolaryngology	026	PHYSICIANS	64344	None	None	0	In state provider	None	1321 N HARBOR BLVD	STE 101	FULLERTON	CA	92835	4129	30	06059	33.88346929	-117.9251709	Orange County
143447	Fee-for-Service	1821477639	1821477639	1	1	BARROW, LEAHMONTAINE S LCSW	10/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE STREET	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
143457	Fee-for-Service	1760823439	1760823439	1	1	BEASLEY, ANDREW LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
143466	Fee-for-Service	1508184334	1508184334	1	1	BLUEBEAM RADIOLOGY PC	4/27/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	92712	30	Radiology	0	In state provider	None	3902 EL CAJON BLVD	STE A	SAN DIEGO	CA	92105	1016	37	06073	32.75528161	-117.1102468	San Diego County
143497	Fee-for-Service	1538735261	1538735261	1	1	BELLAMY HOME HEALTH INC	5/15/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11336 CAMARILLO ST	SUITE 302	TOLUCA LAKE	CA	91602	3501	19	06037	34.15762023	-118.3779131	Los Angeles County
143507	Fee-for-Service	1528039799	1528039799	1	1	BENIWAL, RIPUDAMAN S MD	4/9/2004	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	67409	10	Gastroenterology (M.D. only)	0	In state provider	None	1234 E NORTH ST	STE 201	MANTECA	CA	95336	4948	39	06077	37.80105524	-121.1968581	San Joaquin County
143517	Fee-for-Service	1801846480	1801846480	1	1	BARUCH, TERRENCE MD	1/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50198	None	None	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
143524	Fee-for-Service	1598359564	1598359564	1	1	BRICKNER, SHAINA BIRTH DOUL	7/1/2024	163WL0100X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
143549	Fee-for-Service	1821171604	1821171604	1	1	BEZIKIAN, HAGOP G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	39946	41	Internal Medicine	0	In state provider	BEZIKIAN MEDICAL CENTER	1340 N VIRGIL AVE	None	LOS ANGELES	CA	90027	6026	19	06037	34.09634232	-118.2870512	Los Angeles County
143550	Fee-for-Service	1316997505	1316997505	1	28	BALBOA NEPHROLOGY MEDICAL GR	2/16/2018	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	528 G STREET	None	BRAWLEY	CA	92227	2411	13	06025	32.97748458	-115.5329928	Imperial County
143554	Fee-for-Service	1528084951	1528084951	1	1	BERNSTEIN, MARK D MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32601	36	Psychiatry	0	In state provider	None	3529 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1867	38	06075	37.78765457	-122.4508386	San Francisco County
143563	Fee-for-Service	1841739299	1841739299	1	1	BROWN, ASHLEY M MD	10/18/2022	208200000X	NA	General Surgery	026	PHYSICIANS	148464	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
143618	Fee-for-Service	1417441361	1417441361	1	1	BLOSSOM RIDGE HEALTH LLC	6/28/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1800 SUTTER ST	STE 420A	CONCORD	CA	94520	2563	07	06013	37.97358873	-122.0378568	Contra Costa County
143644	Fee-for-Service	1144490962	1144490962	1	1	BACH, LIAN DO	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10289	08	Family Practice	0	In state provider	None	2212 E 4TH ST	None	SANTA ANA	CA	92705	3811	30	06059	33.746706	-117.835191	Orange County
143651	Fee-for-Service	1720699028	1720699028	1	1	BROWN, TIFFANY C CNP	1/6/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143668	Fee-for-Service	1003148081	1003148081	1	1	BOOZER, JENNIFER R DO INC	8/19/2011	261QP2300X	NA	Other	026	PHYSICIANS	8927	18	Ophthalmology	0	In state provider	None	1601 MONTE VISTA AVENUE	SUITE 260	CLAREMONT	CA	91711	2962	19	06037	34.112259	-117.698539	Los Angeles County
143680	Fee-for-Service	1982158663	1982158663	1	1	BEVERLY HILLS MIGRAINE AND P	4/5/2018	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	AIN MANAGEMENT INSTITUTE	436 N ROXBURY DR STE 101	None	BEVERLY HILLS	CA	90210	5016	19	06037	34.06771782	-118.4065755	Los Angeles County
143685	Fee-for-Service	1063511160	1063511160	1	1	BLOOMQUIST, LESLIE A NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1200 DISCOVERY PLAZA	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
143686	Fee-for-Service	1851438329	1851438329	1	1	BOGART, GARY N DO	9/1/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6243	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	STE 360	LA MESA	CA	91942	6103	37	06073	32.78442148	-117.0073814	San Diego County
143690	Fee-for-Service	1215961248	1215961248	1	1	BANNER HEART HOSPITAL	3/6/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6750 E BAYWOOD AVE	None	MESA	AZ	85206	1749	00	None	33.411195	-111.685365	Maricopa County
143697	Fee-for-Service	1780241646	1780241646	1	1	BORROMEO, KATE A DPM	6/22/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
143698	Fee-for-Service	1700347002	1700347002	1	1	BAKER, HALEY P MD	8/28/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
143702	Fee-for-Service	1912369950	1912369950	1	1	BLUMENTHAL, LAURA Y MD	7/24/2024	207NS0135X	NA	Dermatology	026	PHYSICIANS	152647	07	Dermatology	0	In state provider	None	955 IMPERIAL HWY	SUITE 200	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
143716	Fee-for-Service	1346653490	1346653490	1	1	BOND, ALLISON R MD	8/17/2020	208M00000X	NA	Other	026	PHYSICIANS	154405	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
143723	Fee-for-Service	1962457812	1962457812	1	35	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	110 JENSEN CT	STE 1A	THOUSAND OAKS	CA	91360	5808	56	06111	34.17762314	-118.8631584	Ventura County
143814	Fee-for-Service	1902069446	1902069446	1	1	BOLAND, BRIGID S MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111250	10	Gastroenterology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
143831	Fee-for-Service	1104140029	1104140029	1	1	BASTIAN, LILY RKL CNM	8/18/2010	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	583 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	5239	49	06097	38.45268	-122.672088	Sonoma County
143840	Fee-for-Service	1316997505	1316997505	1	28	BALBOA NEPHROLOGY MEDICAL GR	2/16/2018	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	OUP INC	528 G STREET	None	BRAWLEY	CA	92227	2411	13	06025	32.97748458	-115.5329928	Imperial County
143869	Fee-for-Service	1184050882	1184050882	1	1	BASAULA, KAMALA CRNA	3/24/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
143883	Fee-for-Service	1205375615	1205375615	1	1	BUNCH MENTAL HEALTH SERVICES	10/11/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	INC	23147 VENTURA BLVD	STE 250	WOODLAND HILLS	CA	91364	0710	19	06037	34.16308568	-118.6301028	Los Angeles County
143890	Fee-for-Service	1922113877	1922113877	1	1	BUSS, KIMBERLY A MD	9/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61552	08	Family Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 101102	ELK GROVE	CA	95758	7901	34	06067	38.421054	-121.405365	Sacramento County
143896	Fee-for-Service	1861988032	1861988032	1	1	BALA, NATASHA CCC-SLP	7/1/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	187 TANK FARM RD	STE 210	SAN LUIS OBISPO	CA	93401	7081	40	06079	35.24678151	-120.670299	San Luis Obispo County
143897	Fee-for-Service	1659326783	1659326783	1	1	BALLINGER, LARRY C DPM	8/22/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
143929	Fee-for-Service	1407984800	1407984800	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	15519 CRENSHAW BOULEVARD	None	GARDENA	CA	90249	4525	19	06037	33.8896575	-118.3266105	Los Angeles County
143980	Fee-for-Service	1003839994	1003839994	1	1	BYRNE, ELIZABETH M	6/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3401 S HARBOR BLVD	None	SANTA ANA	CA	92704	7933	30	06059	33.701166	-117.9194305	Orange County
144032	Fee-for-Service	1598854846	1598854846	1	1	BASIL, SHERWIN A M.A.	1/1/1979	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	RIVERVIEW HRG/SPEECH CTR	5842 E 2ND ST	None	LONG BEACH	CA	90803	5039	19	06037	33.75626418	-118.1203171	Los Angeles County
144036	Fee-for-Service	1366929523	1366929523	1	1	BOND, KALEY LCSW	4/16/2024	390200000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
144051	Fee-for-Service	1154346377	1154346377	1	2	BLOOM, JEFFREY M MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72622	41	Internal Medicine	0	In state provider	None	1334 MARSH ST	None	SAN LUIS OBISPO	CA	93401	3316	40	06079	35.28345805	-120.6552817	San Luis Obispo County
144058	Fee-for-Service	1912224528	1912224528	1	1	BARNETT, ANN R MD	10/25/2021	207P00000X	NA	Other	026	PHYSICIANS	170665	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
144062	Fee-for-Service	1245693761	1245693761	1	1	BASILIO, EMILIA MD MPH	7/26/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152795	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
144071	Fee-for-Service	1265510176	1265510176	1	1	BRAR, PREETINDER K MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93530	34	Urology and Urological Surgery	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
144084	Fee-for-Service	1609497130	1609497130	1	1	BAHBAH, HAYA A PSYD	3/21/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1620 S GRAND AVE	None	GLENDORA	CA	91740	5433	19	06037	34.10974369	-117.872489	Los Angeles County
144089	Fee-for-Service	1457542995	1457542995	1	1	BELL-CLINICA FAMILIAR	3/7/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	4670 GAGE AVE	None	BELL GARDENS	CA	90201	1360	19	06037	33.97755768	-118.1829162	Los Angeles County
144093	Fee-for-Service	1033985171	1033985171	1	1	BENAMOR, ADRIANA	3/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
144097	Fee-for-Service	1902069446	1902069446	1	1	BOLAND, BRIGID S MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111250	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
144117	Fee-for-Service	1962935148	1962935148	1	1	BEGUM, NAZMA MD	9/17/2020	207R00000X	NA	Other	026	PHYSICIANS	166688	41	Internal Medicine	0	In state provider	None	7115 GREENBACK LN	FL 2	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
144134	Fee-for-Service	1447710470	1447710470	1	1	BLAIN, MICHELLE DO	8/17/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	12746 W JEFFERSON BLVD	FL 2-4	LOS ANGELES	CA	90094	2885	19	06037	33.97751255	-118.417598	Los Angeles County
144145	Fee-for-Service	1841789450	1841789450	1	1	BAUMAN, KRISTIE MD	7/17/2024	2084E0001X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
144196	Fee-for-Service	1376252346	1376252346	1	1	BISHNOI, ARVIND K MD	4/3/2025	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
144236	Fee-for-Service	1396909156	1396909156	1	1	BATH, KARAN K MD	9/17/2024	208600000X	NA	General Surgery	026	PHYSICIANS	123894	02	General Surgery	0	In state provider	None	1321 COTTONWOOD ST	STE 203	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
144266	Fee-for-Service	1902955594	1902955594	1	1	BANDUCCI, LEE A PT	2/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
144268	Fee-for-Service	1497758171	1497758171	1	1	BOCASH, WILLIAM D	2/28/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	58470	40	Pediatrics	0	In state provider	None	2486 N PONDEROSA DR	STE D211	CAMARILLO	CA	93010	2376	56	06111	34.24266768	-119.0228157	Ventura County
144277	Fee-for-Service	1871541748	1871541748	1	1	BISHEFF, SCOTT E MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66055	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
144278	Fee-for-Service	1861711145	1861711145	1	1	BONILLO, DANETTE MARIE B	8/30/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
144283	Fee-for-Service	1205159936	1205159936	1	1	BANKS, GINA F	11/21/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
144289	Fee-for-Service	1306118070	1306118070	1	1	BAYFRONT YOUTH & FAMILY	12/15/2015	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	324 E BIXBY ROAD	None	LONG BEACH	CA	90807	3432	19	06037	33.82669344	-118.1887246	Los Angeles County
144302	Fee-for-Service	1902068356	1902068356	1	1	BERNTHAL, NICHOLAS M MD	7/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103272	20	Orthopedic Surgery	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90034	2629	19	06037	34.02861627	-118.273964	Los Angeles County
144324	Fee-for-Service	1831565522	1831565522	1	1	BEAR VALLEY URGENT CARE INC	5/23/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12186 HESPERIA RD	None	VICTORVILLE	CA	92395	5822	36	06071	34.47264211	-117.291816	San Bernardino County
144334	Fee-for-Service	1679184535	1679184535	1	1	BLOOD AND CANCER THERAPEUTIC	2/7/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	None	None	None	0	In state provider	S	4500 MORNING DR	STE 105	BAKERSFIELD	CA	93306	7276	15	06029	35.39343836	-118.9166214	Kern County
144339	Fee-for-Service	1548299266	1548299266	1	1	BREWER, M FREDERICK MD	7/15/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	28431	40	Pediatrics	0	In state provider	None	1200 SONOMA AVE	None	SANTA ROSA	CA	95405	6664	49	06097	38.440854	-122.6985165	Sonoma County
144356	Fee-for-Service	1801383286	1801383286	1	1	BAO, GINNY W MD	5/5/2022	208M00000X	NA	Other	026	PHYSICIANS	166257	None	None	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
144414	Fee-for-Service	1649899196	1649899196	1	1	BROWN, ELISABETH A PT	4/17/2022	2251N0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
144428	Fee-for-Service	1649230368	1649230368	1	2	BRENNER, THOMAS M OD	10/30/2019	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	52 COLLEGE WAY	None	AUBURN	CA	95603	5001	31	06061	38.89639742	-121.0749335	Placer County
144443	Fee-for-Service	1609831247	1609831247	1	1	BRADDOCK HOSITAL CORPORATION	4/24/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 SETON DR	None	CUMBERLAND	MD	21502	1854	00	None	39.65465498	-78.79533762	Allegany County
144456	Fee-for-Service	1912131939	1912131939	1	1	BAHL, KAZAL MD	8/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151658	30	Radiology	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
144467	Fee-for-Service	1659429595	1659429595	1	1	BARTULIS, THERESA S NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9449 IMPERIAL HWY	STE ABCD	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
144478	Fee-for-Service	1962457812	1962457812	1	54	BEVERLY RADIOLOGY MEDICAL GR	8/21/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	415 ROLLING OAKS DR	# 160	THOUSAND OAKS	CA	91361	1038	56	06111	34.17439717	-118.8691161	Ventura County
144512	Fee-for-Service	1932446093	1932446093	1	1	BUCHHOLZ, TRICIA M CRNA	11/19/2013	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
144520	Fee-for-Service	1508139189	1508139189	1	1	BONITA HOMECARE, INC	8/19/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	319 F STREET	SUITE 205	CHULA VISTA	CA	91910	2666	37	06073	32.64113029	-117.0808109	San Diego County
144538	Fee-for-Service	1619024817	1619024817	1	1	BURNS, MARILYN A OD	11/10/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
144545	Fee-for-Service	1710945837	1710945837	1	1	BAER, EDWARD R MD	2/28/1988	207L00000X	NA	Other	026	PHYSICIANS	53623	05	Anesthesiology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
144546	Fee-for-Service	1447215116	1447215116	1	2	BURCH PHYSICAL THERAPY, INC.	1/28/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	85 HARTNELL AVE STE 300	None	REDDING	CA	96002	1888	45	06089	40.56995266	-122.3694812	Shasta County
144610	Fee-for-Service	1962457812	1962457812	1	90	BEVERLY RADIOLOGY MEDICAL GR	12/1/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	YON	16300 SAND CANYON AVE	STE 102	IRVINE	CA	92618	3704	30	06059	33.66115075	-117.7742405	Orange County
144612	Fee-for-Service	1053506147	1053506147	1	1	BLUM, FREDERICK M PHD	3/28/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
144630	Fee-for-Service	1922158724	1922158724	1	1	BLUM, MARK V MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31353	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
144636	Fee-for-Service	1306088166	1306088166	1	1	BOYE, ADELINE A PSYD	9/13/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
144637	Fee-for-Service	1215966205	1215966205	1	1	BOHART, RANDY D	5/17/2001	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	OSO HOME CARE PHARMACY	17175 GILLETTE AVE	None	IRVINE	CA	92614	5602	30	06059	33.6968002	-117.8493101	Orange County
144665	Fee-for-Service	1326764267	1326764267	1	1	BE WELL SENIOR LIVING INC	1/12/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14739 MORRISON STREET	None	SHERMAN OAKS	CA	91403	1652	19	06037	34.16033677	-118.4544278	Los Angeles County
144680	Fee-for-Service	1548828056	1548828056	1	1	BERNET, DANIEL C DO	9/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20281	None	None	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
144752	Fee-for-Service	1972947760	1972947760	1	1	BARRY, GWEN LMFT	6/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
144764	Fee-for-Service	1346583176	1346583176	1	1	BRISBANE, WAYNE G MD	6/4/2019	208800000X	NA	Other	026	PHYSICIANS	161053	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
144770	Fee-for-Service	1073697587	1073697587	1	1	BRUNDAGE, SUSAN I MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52714	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
144795	Fee-for-Service	1023177615	1023177615	1	1	BARIL, NICOLE B MD	5/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60070	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
144826	Fee-for-Service	1902386816	1902386816	1	1	BACK TO BALANCE PHYSIOTHERAP	1/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	Y	9230 MARYSVILLE RD	None	OREGON HOUSE	CA	95962	9705	58	06115	39.36447161	-121.2501344	Yuba County
144835	Fee-for-Service	1316565633	1316565633	1	1	BERGERON, MEAGAN M AU	8/31/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6060 HELLYER AVE	150	SAN JOSE	CA	95138	1046	43	06085	37.25670154	-121.7796404	Santa Clara County
144852	Fee-for-Service	1902369366	1902369366	1	1	BOCKHORN, LAUREN N MD	7/3/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
144855	Fee-for-Service	1235350380	1235350380	1	1	BRITT, DONALD R LMFT	5/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
144877	Fee-for-Service	1932293917	1932293917	1	1	BROWN, LEE K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS NE	None	ALBUQUERQUE	NM	87131	0000	00	None	35.08771808	-106.6192188	Bernalillo County
144886	Fee-for-Service	1447957949	1447957949	1	1	BIENESTAR HUMAN SERVICES INC	8/29/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	130 W MANCHESTER AVE	None	LOS ANGELES	CA	90003	3324	19	06037	33.96005417	-118.275146	Los Angeles County
144888	Fee-for-Service	1285098608	1285098608	1	1	BARRON, ADAM MD	5/29/2020	390200000X	NA	Other	026	PHYSICIANS	168342	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
144911	Fee-for-Service	1508203563	1508203563	1	1	BOEN, MONICA MD	4/27/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	149554	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
144924	Fee-for-Service	1215966205	1215966205	1	1	BOHART, RANDY D	12/16/1997	251F00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	OSO HOME CARE PHARMACY	17175 GILLETTE AVE	None	IRVINE	CA	92614	5602	30	06059	33.6968002	-117.8493101	Orange County
144933	Fee-for-Service	1720433428	1720433428	1	1	BAUDER, ANDREW MD	5/1/2024	2082S0105X	NA	General Surgery	026	PHYSICIANS	182692	02	General Surgery	0	In state provider	None	10670 WEXFORD ST	None	SAN DIEGO	CA	92131	3940	37	06073	32.93893186	-117.0982186	San Diego County
144934	Fee-for-Service	1558569970	1558569970	1	1	BRAUER, DEBORAH A MD	10/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103531	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
144972	Fee-for-Service	1962413617	1962413617	1	1	BAUR, JULIE K DO	10/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	8003	08	Family Practice	0	In state provider	None	6000 FAIRWAY DR	STE 1	ROCKLIN	CA	95677	4245	31	06061	38.79220243	-121.2621624	Placer County
145006	Fee-for-Service	1457422966	1457422966	1	1	BANZON, CHARLES A LMFT	5/3/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49126	-	NOT APPLICABLE	0	In state provider	None	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	37	06073	32.75537928	-117.1416551	San Diego County
145009	Fee-for-Service	1174635320	1174635320	1	1	BULOW, SETH D	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	57573	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 DICKINSON ST	# H210	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
145026	Fee-for-Service	1750797908	1750797908	1	2	BROWN, SHENAE N LMFT	6/3/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
145054	Fee-for-Service	1104923879	1104923879	1	1	BRANDENHOFF, PREBEN MD	8/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81697	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
145073	Fee-for-Service	1588851679	1588851679	1	1	BESNER, DEBORAH K LCSW	6/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
145082	Fee-for-Service	1023177615	1023177615	1	1	BARIL, NICOLE B MD	5/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60070	67	Endocrinology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
145104	Fee-for-Service	1316956865	1316956865	1	1	BARTLOW, BRUCE G MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	39299	66	Emergency Medicine (Urgent Care)	0	In state provider	SHASTA CRITICAL CARE SPE	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
145166	Fee-for-Service	1023190089	1023190089	1	1	BUI, DUC M OD	11/29/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	DUC BUI OPTOMETRY	4095 EVERGREEN VILLAGE S	STE 110	SAN JOSE	CA	95135	1747	43	06085	37.31425944	-121.774076	Santa Clara County
145167	Fee-for-Service	1962457812	1962457812	1	55	BEVERLY RADIOLOGY MEDICAL GR	8/12/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1687 ERRINGER RD	STE 210	SIMI VALLEY	CA	93065	6510	56	06111	34.268886	-118.761426	Ventura County
145180	Fee-for-Service	1801894266	1801894266	1	1	BARTH, MAURY C MD	1/1/1995	207L00000X	NA	Other	026	PHYSICIANS	46990	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
145188	Fee-for-Service	1881869816	1881869816	1	1	BRIGHT EXPECTATIONS	7/31/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7256 LINARES AVE	None	RIVERSIDE	CA	92509	6900	33	06065	33.97658073	-117.4420351	Riverside County
145195	Fee-for-Service	1437345337	1437345337	1	1	BONETTI, RENEE W MD	4/2/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	151641	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
145206	Fee-for-Service	1649605312	1649605312	1	1	BEDLE, MARGRET MD	11/8/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179418	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
145212	Fee-for-Service	1215966205	1215966205	1	1	BOHART, RANDY D	2/22/2005	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OSO HOME CARE PHARMACY	17175 GILLETTE AVE	None	IRVINE	CA	92614	5602	30	06059	33.6968002	-117.8493101	Orange County
145223	Fee-for-Service	1891134177	1891134177	1	1	BARRY, ALYSON M PHD	8/18/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
145224	Fee-for-Service	1184782567	1184782567	1	1	BRASHER, AIMEE E	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	42059	-	NOT APPLICABLE	0	In state provider	None	1303 WEST WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
145259	Fee-for-Service	1710971643	1710971643	1	1	BROWN, DOROTHY W MD	3/1/1998	207P00000X	NA	Other	026	PHYSICIANS	75257	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
145296	Fee-for-Service	1225102130	1225102130	1	1	BAEZ, LISA L LCSW	11/18/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
145298	Fee-for-Service	1174635320	1174635320	1	1	BULOW, SETH D	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	57573	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	225 DICKINSON ST	# H210	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
145304	Fee-for-Service	1588731707	1588731707	1	1	BROWN, MALRIE D MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63631	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
145305	Fee-for-Service	1033443916	1033443916	1	1	BALUYOT, MYLEEN B MD	11/10/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	109530	40	Pediatrics	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95341	6250	24	06047	37.29309532	-120.4748791	Merced County
145306	Fee-for-Service	1871088799	1871088799	1	1	BAKHATH, ROOHI SHAHJAHAN MD	9/20/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174575	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
145307	Fee-for-Service	1679795538	1679795538	1	1	BLOUNT, KEVIN MD	6/25/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
145317	Fee-for-Service	1093324725	1093324725	1	1	BUENA VISTA HOSPICE	10/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	146 N SAN FERNANDO BLVD	STE 208	BURBANK	CA	91502	1238	19	06037	34.18151411	-118.30954	Los Angeles County
145322	Fee-for-Service	1275685232	1275685232	1	1	BEASLEY, MARY A.	1/12/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	TLC MEDICAL SERVICES	25835 NARBONNE AVE	STE 150	LOMITA	CA	90717	7215	19	06037	33.788529	-118.3200155	Los Angeles County
145342	Fee-for-Service	1467711374	1467711374	1	1	BARAKAT, MONIQUE MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126546	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145389	Fee-for-Service	1578762712	1578762712	1	1	BURGER, MARK MD	5/8/2024	261QU0200X	NA	Other	026	PHYSICIANS	99988	01	General Practice	0	In state provider	None	1200 N COAST HIGHWAY 101	None	ENCINITAS	CA	92024	1441	37	06073	33.06951378	-117.3040606	San Diego County
145392	Fee-for-Service	1316956865	1316956865	1	1	BARTLOW, BRUCE G MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	39299	45	Nephrology (Renal-Kidney)	0	In state provider	SHASTA CRITICAL CARE SPE	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
145427	Fee-for-Service	1780078121	1780078121	1	1	BIANCO, LUKE S MD INC	5/5/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	75614	18	Ophthalmology	0	In state provider	None	505 N CHURCH ST	None	VISALIA	CA	93291	5004	54	06107	36.334017	-119.29158	Tulare County
145453	Fee-for-Service	1316107287	1316107287	1	1	BACHMANN, LISA LMFT	11/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9 CROW CANYON CT	STE 100	SAN RAMON	CA	94583	1682	07	06013	37.77732953	-121.9815076	Contra Costa County
145463	Fee-for-Service	1437419686	1437419686	1	1	BODIGE, SANDEEP DO	9/6/2024	261QU0200X	NA	Other	026	PHYSICIANS	23029	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
145518	Fee-for-Service	1073948246	1073948246	1	2	BELL, MERCEDES M MD	12/29/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	127181	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
145523	Fee-for-Service	1447797659	1447797659	1	1	BRAVO, JUAN M	4/5/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	19083 BEAR VALLEY RD	STE 3	APPLE VALLEY	CA	92308	2719	36	06071	34.47095584	-117.2472361	San Bernardino County
145564	Fee-for-Service	1275828568	1275828568	1	1	BUCHANAN, PATRICK D MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135551	25	Physical Medicine and Rehabilitation	0	In state provider	None	1100 PASEO CAMARILLO	None	CAMARILLO	CA	93010	6073	56	06111	34.22086527	-119.0555438	Ventura County
145593	Fee-for-Service	1871731414	1871731414	1	1	BYRI, SWARNA MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131314	41	Internal Medicine	0	In state provider	None	1140 NORMAN DRIVE	STE 104	MANTECA	CA	95336	5900	39	06077	37.79425988	-121.1998134	San Joaquin County
145607	Fee-for-Service	1093324725	1093324725	1	1	BUENA VISTA HOSPICE	10/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	146 N SAN FERNANDO BLVD	STE 208	BURBANK	CA	91502	1238	19	06037	34.18151411	-118.30954	Los Angeles County
145630	Fee-for-Service	1467711374	1467711374	1	1	BARAKAT, MONIQUE MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126546	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145636	Fee-for-Service	1639740582	1639740582	1	1	BUCHANAN, MEGHAN P CCC-SLP	11/10/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3002 DOW AVE	314	TUSTIN	CA	92780	7234	30	06059	33.70954889	-117.8043627	Orange County
145655	Fee-for-Service	1396894176	1396894176	1	1	BANG, MARILOU I PT	5/29/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
145660	Fee-for-Service	1780878967	1780878967	1	1	BERTA, SCOTT C MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	91971	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
145671	Fee-for-Service	1962864314	1962864314	1	1	BODANSKY, AARON MD	5/29/2024	2080P0203X	NA	Other	026	PHYSICIANS	170261	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
145677	Fee-for-Service	1316956865	1316956865	1	1	BARTLOW, BRUCE G MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	39299	35	Pediatric Cardiology (M.D. only)	0	In state provider	SHASTA CRITICAL CARE SPE	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
145684	Fee-for-Service	1619055795	1619055795	1	1	BHUTANI, RAKESH MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36433	01	General Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
145687	Fee-for-Service	1942303367	1942303367	1	1	BAKHTAVAR, MOHAMMAD A MD	6/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52164	None	None	0	In state provider	None	205 N 1ST ST	STE D	BLYTHE	CA	92225	1777	33	06065	33.613155	-114.595559	Riverside County
145691	Fee-for-Service	1689766354	1689766354	1	1	BART, ROBERT D III MD	6/1/1999	207VC0200X	NA	Obstetrics & Gynecology	026	PHYSICIANS	85408	01	General Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
145699	Fee-for-Service	1306887948	1306887948	1	1	BROWN, STEFFAN C	5/31/1991	207P00000X	NA	Other	026	PHYSICIANS	44534	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
145738	Fee-for-Service	1144248477	1144248477	1	1	BEAUCLAIR, JOHN P MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	17614	66	Emergency Medicine (Urgent Care)	0	In state provider	None	622 W DUARTE RD	STE 103	ARCADIA	CA	91007	9268	19	06037	34.12645266	-118.0521552	Los Angeles County
145752	Fee-for-Service	1366856544	1366856544	1	1	BRADLEY, JOSEPH J DO	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15174	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
145820	Fee-for-Service	1972201010	1972201010	1	1	BROWN, JOCELYN E CRNA	11/30/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
145829	Fee-for-Service	1497269682	1497269682	1	1	BERENSCHOT, DAVID B LCSW	1/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12555 MARIPOSA ROAD	SUITE J	VICTORVILLE	CA	92395	6010	36	06071	34.47849471	-117.3394137	San Bernardino County
145838	Fee-for-Service	1598909764	1598909764	1	1	BYTHADKA, LAKSHMI J MD	4/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105735	41	Internal Medicine	0	In state provider	None	36485 INDIAN VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.631929	-117.273816	Riverside County
145839	Fee-for-Service	1639411564	1639411564	1	1	BURNS, LLOYD	1/16/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
145852	Fee-for-Service	1427060011	1427060011	1	1	BROCK, BARRY J MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36218	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
145883	Fee-for-Service	1871731414	1871731414	1	1	BYRI, SWARNA MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131314	45	Nephrology (Renal-Kidney)	0	In state provider	None	1140 NORMAN DRIVE	STE 104	MANTECA	CA	95336	5900	39	06077	37.79425988	-121.1998134	San Joaquin County
145891	Fee-for-Service	1922596725	1922596725	1	1	BERK-KRAUSS, JULIANA MD	3/6/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	191383	07	Dermatology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
145895	Fee-for-Service	1275936270	1275936270	1	1	BENSON, JIMI O MD INC	11/13/2014	193400000X	NA	Other	026	PHYSICIANS	116611	None	None	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2098	37	06073	32.68637926	-117.0828839	San Diego County
145915	Fee-for-Service	1013231828	1013231828	1	1	BAIK, JOHN C CRNA	6/15/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
145917	Fee-for-Service	1326815549	1326815549	1	1	BLINK EYE CARE	1/10/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2656 W LA PALMA AVE	None	ANAHEIM	CA	92801	2601	30	06059	33.84680804	-117.9779497	Orange County
145921	Fee-for-Service	1720596992	1720596992	1	1	BALACONIS, ELIZABETH C CNP	12/21/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145924	Fee-for-Service	1265410146	1265410146	1	1	BALFE,DAVID L MD	3/1/2000	174400000X	NA	Other	026	PHYSICIANS	66798	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	# 6732	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
145940	Fee-for-Service	1114151271	1114151271	1	1	BHOLAT, TASNEEM A MD	6/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113309	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
145955	Fee-for-Service	1699545905	1699545905	1	1	BROWN, DANIELLE DOULA	5/17/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
145961	Fee-for-Service	1174691430	1174691430	1	1	BUI, BAO-THUONG K MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86884	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
145967	Fee-for-Service	1023057536	1023057536	1	1	BAKER, EDWARD L MD	9/30/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33965	None	None	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
145970	Fee-for-Service	1891130993	1891130993	1	1	BRUNO, KELLY A MD	2/13/2018	207L00000X	NA	Other	026	PHYSICIANS	147881	05	Anesthesiology	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
145971	Fee-for-Service	1619055795	1619055795	1	1	BHUTANI, RAKESH MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36433	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
145974	Fee-for-Service	1083709653	1083709653	1	5	BHC HERITAGE OAKS HOSP	8/11/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	4300 AUBURN BLVD	STE 203	SACRAMENTO	CA	95841	4103	34	06067	38.643939	-121.3640415	Sacramento County
146013	Fee-for-Service	1861428112	1861428112	1	1	BERENTER, JAY S DPM	8/19/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9850 GENESEE AVE	510	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
146026	Fee-for-Service	1144248477	1144248477	1	1	BEAUCLAIR, JOHN P MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	17614	18	Ophthalmology	0	In state provider	None	622 W DUARTE RD	STE 103	ARCADIA	CA	91007	9268	19	06037	34.12645266	-118.0521552	Los Angeles County
146056	Fee-for-Service	1093875395	1093875395	1	1	BLANCO, REMEDIOS G	10/2/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	UNITED HLTHCARE DISTRIB	25835 NARBONNE AVE.	SUITE 140	LOMITA	CA	90717	7207	19	06037	33.788529	-118.3200155	Los Angeles County
146117	Fee-for-Service	1952384133	1952384133	1	1	BAY AREA CARDIOLOGY MED	8/15/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	GRP	5565 W LAS POSITAS BLVD	STE 250	PLEASANTON	CA	94588	5807	01	06001	37.69215143	-121.8800337	Alameda County
146152	Fee-for-Service	1679699300	1679699300	1	1	BERGMAN, KEVIN L MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93199	08	Family Practice	0	In state provider	None	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
146180	Fee-for-Service	1134550213	1134550213	1	1	BROWN, VANESSA K NP	7/20/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
146211	Fee-for-Service	1265410146	1265410146	1	1	BALFE,DAVID L MD	3/1/2000	174400000X	NA	Other	026	PHYSICIANS	66798	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	# 6732	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
146239	Fee-for-Service	1457441990	1457441990	1	1	BROWN, FRANK O	7/2/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40703	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2901 ADELINE ST	None	BERKELEY	CA	94703	2502	01	06001	37.85642872	-122.2683173	Alameda County
146244	Fee-for-Service	1891038006	1891038006	1	2	BURNS, JULIANNE E MD	8/11/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	132463	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
146247	Fee-for-Service	1134224066	1134224066	1	1	BAUTISTA, NORMAN C MD	11/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	60200	02	General Surgery	0	In state provider	None	328 S 1ST ST	STE F-G	ALHAMBRA	CA	91801	3789	19	06037	34.09104553	-118.1252904	Los Angeles County
146255	Fee-for-Service	1194007484	1194007484	1	1	BURNETTE, REGINA LCSW	9/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
146302	Fee-for-Service	1457743239	1457743239	1	1	BENNION, MATTHEW B	3/13/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	844 BRIDGE STREET	SUITE C	COLUSA	CA	95932	2836	06	06011	39.20645023	-122.0035419	Colusa County
146309	Fee-for-Service	1841552833	1841552833	1	1	BEYDOUN, ALAA MD	2/5/2020	208600000X	NA	General Surgery	026	PHYSICIANS	148525	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
146353	Fee-for-Service	1568815611	1568815611	1	1	BENJAMIN, JESSIKA E OD	1/5/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	471 N CENTRAL AVE	None	UPLAND	CA	91786	4219	36	06071	34.099308	-117.689689	San Bernardino County
146374	Fee-for-Service	1750428918	1750428918	1	1	BEHREND, ALBERT J MD	3/29/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40277	02	General Surgery	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
146383	Fee-for-Service	1700986635	1700986635	1	1	BRAD MYERS	6/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
146410	Fee-for-Service	1831605781	1831605781	1	1	BORGO, TALIA M CNM	5/28/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
146437	Fee-for-Service	1689097065	1689097065	1	1	BEVERLY, IJOSE CNP	9/16/2024	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	37	06073	32.75065153	-117.2126147	San Diego County
146450	Fee-for-Service	1457747727	1457747727	1	1	BURNETT, CRYSTAL P	7/31/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
146456	Fee-for-Service	1891083978	1891083978	1	1	BAJWA, MANDEEP K MD	4/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	122291	None	None	0	In state provider	None	100 S. SAN MATEO DR.	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
146462	Fee-for-Service	1922186642	1922186642	1	1	BALASUBRAMANIAN, SRIPRIY	6/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74964	10	Gastroenterology (M.D. only)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
146466	Fee-for-Service	1316930548	1316930548	1	1	BUNTUYAN, ERROL T MD	3/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66602	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
146497	Fee-for-Service	1588678973	1588678973	1	2	BLAIR, GEORGE	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	41463	36	Psychiatry	0	In state provider	None	5970 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1150	19	06037	33.985584	-118.256433	Los Angeles County
146505	Fee-for-Service	1447771688	1447771688	1	1	BARNETT, ANNE M MD	9/8/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	188756	None	None	0	In state provider	None	782 EAST HARDING WAY	None	STOCKTON	CA	95204	6101	39	06077	37.96910043	-121.284224	San Joaquin County
146508	Fee-for-Service	1225526130	1225526130	1	1	BUHAY, SAMANTHA A PT	10/18/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
146522	Fee-for-Service	1588011860	1588011860	1	1	BAINS, NAVPREET DO	7/15/2024	2084V0102X	NA	Neurology	026	PHYSICIANS	22379	14	Neurological Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
146524	Fee-for-Service	1700044187	1700044187	1	1	BENITEZ, MARIA T MD	1/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55826	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 N PALM CANYON DR	SUITE 212	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
146530	Fee-for-Service	1134688047	1134688047	1	1	BHATTACHARJEE, ARLIN MD	3/24/2022	390200000X	NA	Other	026	PHYSICIANS	176614	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
146554	Fee-for-Service	1316444037	1316444037	1	1	BLEYAN, DIANA MD	9/30/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	181062	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
146567	Fee-for-Service	1437855749	1437855749	1	1	BETTY'S PLACE LLC	9/29/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	37182 SIERRA GROVE DRIVE	None	MURRIETA	CA	92563	1887	33	06065	33.58100949	-117.1038004	Riverside County
146593	Fee-for-Service	1497121461	1497121461	1	1	BYERS, FRANCINE LMFT	10/12/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125434	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVE	SUITE 150	SAN JOSE	CA	95119	1371	43	06085	37.23598537	-121.7783065	Santa Clara County
146596	Fee-for-Service	1326130956	1326130956	1	1	BORZUTZKY, CLAUDIA R	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77479	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
146598	Fee-for-Service	1609941772	1609941772	1	1	BARCELLO, DANIELLE LCSW	8/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
146599	Fee-for-Service	1841057379	1841057379	1	1	BAKDACHE, NICOLE	4/24/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
146603	Fee-for-Service	1053329466	1053329466	1	1	BOLTON, JONATHAN AE MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61287	None	None	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
146605	Fee-for-Service	1194084525	1194084525	1	1	BENEVOLENCE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14547 TITUS ST	SUITE 204	PANORAMA CITY	CA	91402	4929	19	06037	34.21973977	-118.4503255	Los Angeles County
146613	Fee-for-Service	1962457812	1962457812	1	67	BEVERLY RADIOLOGY MEDICAL GR	10/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4516 MARKET ST	#1A	VENTURA	CA	93003	8087	56	06111	34.25723931	-119.2319892	Ventura County
146651	Fee-for-Service	1912084542	1912084542	1	1	BROWN, JANICE M MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	64476	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
146658	Fee-for-Service	1750428918	1750428918	1	1	BEHREND, ALBERT J MD	3/29/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40277	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
146678	Fee-for-Service	1841324696	1841324696	1	1	BLODGETT, CAROLYN M S LCSW	12/8/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
146705	Fee-for-Service	1356668701	1356668701	1	1	BECKETT, KATRINA R MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111068	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
146724	Fee-for-Service	1346709524	1346709524	1	1	BARAJAS, ELISEO J MD	7/19/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176956	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
146739	Fee-for-Service	1205843786	1205843786	1	1	BALDWIN, LARRY B MD	4/29/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	64919	18	Ophthalmology	0	In state provider	None	1304 ELLA ST	STE B	SAN LUIS OBISPO	CA	93401	4166	40	06079	35.27704692	-120.6496857	San Luis Obispo County
146748	Fee-for-Service	1548329261	1548329261	1	1	BOWEN, JILL H CRNA	9/6/1996	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
146755	Fee-for-Service	1245674217	1245674217	1	1	BEACON HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	221 W F ST	None	ONTARIO	CA	91762	3203	36	06071	34.069302	-117.6532335	San Bernardino County
146757	Fee-for-Service	1780758250	1780758250	1	1	BOKSER, JULIE M MD	4/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82447	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
146773	Fee-for-Service	1306463260	1306463260	1	1	BETTER CHOICE HOSPICE INC	6/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2704 MERCANTILE DR	None	RANCHO CORDOVA	CA	95742	6518	34	06067	38.603421	-121.261554	Sacramento County
146812	Fee-for-Service	1497140370	1497140370	1	1	BOWLES, ZACHARY C MD	6/29/2019	207P00000X	NA	Other	026	PHYSICIANS	159259	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 EAST ALMOND AVENUE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
146892	Fee-for-Service	1962457812	1962457812	1	27	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	230 S MAIN ST	#205	ORANGE	CA	92868	3851	30	06059	33.785154	-117.867318	Orange County
146899	Fee-for-Service	1194084525	1194084525	1	1	BENEVOLENCE HOSPICE INC	6/22/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14547 TITUS ST	SUITE 204	PANORAMA CITY	CA	91402	4929	19	06037	34.21973977	-118.4503255	Los Angeles County
146915	Fee-for-Service	1346206000	1346206000	1	1	BREWER, BRIAN E MD	4/22/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
146919	Fee-for-Service	1821155912	1821155912	1	1	BAPTIST MEDICAL CTR BEACHES	11/26/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1350 13TH AVE S	None	JACKSONVILLE	FL	32250	0000	00	None	30.27455464	-81.39835697	Duval County
146939	Fee-for-Service	1912084542	1912084542	1	1	BROWN, JANICE M MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	64476	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
146941	Fee-for-Service	1033299110	1033299110	1	1	BARAM, TALLIE Z MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61522	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
146949	Fee-for-Service	1740495654	1740495654	1	1	BEESON, DONN K MD	9/23/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161598	30	Radiology	0	In state provider	None	29101 HOSPITAL RD.	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
146960	Fee-for-Service	1700077245	1700077245	1	1	BUI, DIANE T MD	12/26/2007	207R00000X	NA	Other	026	PHYSICIANS	9296	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
147008	Fee-for-Service	1609332618	1609332618	1	2	BARTLETT, MARIA	10/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
147023	Fee-for-Service	1912970609	1912970609	1	1	BLICK, SHAWN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3815 E BELL RD	STE 3600	PHOENIX	AZ	85032	2166	00	None	33.638571	-111.9990015	Maricopa County
147034	Fee-for-Service	1609485937	1609485937	1	1	BEHNKE, ERIKA LMFT	1/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28605 TAMARACK LN	None	SANTA CLARITA	CA	91390	4217	19	06037	34.46889039	-118.529566	Los Angeles County
147040	Fee-for-Service	1245674217	1245674217	1	1	BEACON HOSPICE CARE INC	11/12/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	221 W F ST	None	ONTARIO	CA	91762	3203	36	06071	34.069302	-117.6532335	San Bernardino County
147048	Fee-for-Service	1760530745	1760530745	1	1	BRYANT, ROMMELL D MD	3/1/1984	207P00000X	NA	Other	026	PHYSICIANS	38073	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
147059	Fee-for-Service	1316155781	1316155781	1	1	BROOKS, REBECCA A MD	9/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113741	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
147060	Fee-for-Service	1306463260	1306463260	1	1	BETTER CHOICE HOSPICE INC	6/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2704 MERCANTILE DR	None	RANCHO CORDOVA	CA	95742	6518	34	06067	38.603421	-121.261554	Sacramento County
147065	Fee-for-Service	1376699504	1376699504	1	1	BRAVERMAN, JUSTIN D MD	5/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	96004	02	General Surgery	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
147089	Fee-for-Service	1073619789	1073619789	1	1	BAGHERI, ABES S MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30889	36	Psychiatry	0	In state provider	None	3801 KATELLA AVE	STE 210	LOS ALAMITOS	CA	90720	3378	30	06059	33.80318951	-118.066068	Orange County
147120	Fee-for-Service	1306298849	1306298849	1	1	BATES, CARRIE LCSW	5/6/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
147127	Fee-for-Service	1518108950	1518108950	1	1	BLUE HEAVEN HOSPICE &	12/5/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	16200 VENTURA BLVD	SUITE 306	ENCINO	CA	91436	5063	19	06037	34.15659457	-118.485532	Los Angeles County
147130	Fee-for-Service	1568454536	1568454536	1	1	BRENNAN, JOHN T DC	1/1/1995	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	190 S OAK AVE	STE 4	OAKDALE	CA	95361	3528	50	06099	37.75958945	-120.8613916	Stanislaus County
147193	Fee-for-Service	1023117124	1023117124	1	1	BRYANT, DUANE M MD	1/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	155562	18	Ophthalmology	0	In state provider	None	342 F STREET	None	CHULA VISTA	CA	91910	2625	37	06073	32.64073026	-117.0815293	San Diego County
147206	Fee-for-Service	1104024181	1104024181	1	1	BRYANT, JEFFREY S LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
147231	Fee-for-Service	1033299110	1033299110	1	1	BARAM, TALLIE Z MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61522	79	Neurology-Child	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
147237	Fee-for-Service	1033430855	1033430855	1	1	BANERJEE, RAHTNA S MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118393	05	Anesthesiology	0	In state provider	None	300 W HUNTINGTON DRIVE	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
147246	Fee-for-Service	1043512742	1043512742	1	1	BORES, NICOLE L MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121051	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
147251	Fee-for-Service	1972681039	1972681039	1	1	BRONSTEIN, IRINA MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81647	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
147252	Fee-for-Service	1598953291	1598953291	1	1	BEATON, ALINA C MD	1/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107265	41	Internal Medicine	0	In state provider	None	4314 W VICTORY BLVD	None	BURBANK	CA	91505	1334	19	06037	34.18483654	-118.3581315	Los Angeles County
147261	Fee-for-Service	1104389113	1104389113	1	1	BUSHONG, TREVOR MD	8/27/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	178457	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
147268	Fee-for-Service	1932356664	1932356664	1	1	BURRIS, ERIN C MD	8/27/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
147278	Fee-for-Service	1184811283	1184811283	1	1	BULGARELLI, TIMOTHY CPO	11/3/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	PACIFIC PROSTHETICS & OR	454 N CRAIG AVE	None	PASADENA	CA	91107	2460	19	06037	34.1540609	-118.1062307	Los Angeles County
147289	Fee-for-Service	1174665756	1174665756	1	1	BANSAL, VIJAYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69278	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	407 E GILBERT ST	STE 4	SAN BERNARDINO	CA	92404	5325	36	06071	34.12675051	-117.2758095	San Bernardino County
147303	Fee-for-Service	1104127554	1104127554	1	1	BIOSPORT PHYSICAL THERAPY IN	2/21/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4341 SPYRES	None	MODESTO	CA	95356	9259	50	06099	37.70172145	-120.9995081	Stanislaus County
147307	Fee-for-Service	1861454993	1861454993	1	1	BEYENE, SOPHIA DO	3/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7687	08	Family Practice	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
147369	Fee-for-Service	1588776603	1588776603	1	1	BETTY C WU MD	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
147372	Fee-for-Service	1942326517	1942326517	1	1	BHINDER, MANDEEP MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98472	41	Internal Medicine	0	In state provider	None	1180 EAST SHAW AVE	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
147378	Fee-for-Service	1497249213	1497249213	1	1	BIG BEAR FIRE AUTHORITY	4/5/2021	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	41090 BIG BEAR BOULEVARD	None	BIG BEAR LAKE	CA	92315	2830	36	06071	34.24365046	-116.905284	San Bernardino County
147382	Fee-for-Service	1811208242	1811208242	1	1	BAILEY, STEVEN N MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107344	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
147385	Fee-for-Service	1083604920	1083604920	1	2	BIFANO, GEORGE M DO	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	3983	-	NOT APPLICABLE	0	In state provider	None	222 WEST VALERIO STREET	REAR BUILDING	SANTA BARBARA	CA	93101	2930	42	06083	34.42532284	-119.7137898	Santa Barbara County
147391	Fee-for-Service	1447281704	1447281704	2	1	BHATIA, RAJAN MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61991	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
147415	Fee-for-Service	1518108950	1518108950	1	1	BLUE HEAVEN HOSPICE &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	16200 VENTURA BLVD	SUITE 306	ENCINO	CA	91436	5063	19	06037	34.15659457	-118.485532	Los Angeles County
147425	Fee-for-Service	1699859496	1699859496	1	1	BJEKIC, GORDANA MD	6/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79612	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2351 CLAY ST	STE 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
147426	Fee-for-Service	1649241886	1649241886	1	1	BENNER, JON W MD	1/1/1982	208600000X	NA	General Surgery	026	PHYSICIANS	41631	02	General Surgery	0	In state provider	None	950 CASS ST	None	MONTEREY	CA	93940	4546	27	06053	36.59271384	-121.8962446	Monterey County
147479	Fee-for-Service	1124340823	1124340823	1	1	BRIAN, IRIT CCC-SLP	3/16/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
147485	Fee-for-Service	1538273933	1538273933	1	1	BEAMER, THOMAS L MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	37243	08	Family Practice	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
147518	Fee-for-Service	1912055807	1912055807	1	1	BIRNBAUM, GARY J MD	12/27/2007	207R00000X	NA	Other	026	PHYSICIANS	46249	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
147531	Fee-for-Service	1730310665	1730310665	1	1	BAGRODIA, ADITYA MD	9/10/2021	208800000X	NA	Other	026	PHYSICIANS	173085	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
147546	Fee-for-Service	1730594235	1730594235	1	1	BOWERS, JESSIE S MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138429	40	Pediatrics	0	In state provider	None	12395 EL CAMINO REAL	SUITE 219	SAN DIEGO	CA	92130	3084	37	06073	32.94324259	-117.2396525	San Diego County
147558	Fee-for-Service	1326306341	1326306341	1	1	BUSS, ALEX R MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141067	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
147605	Fee-for-Service	1912112897	1912112897	1	1	BURSELL, BENJAMIN MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100030	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
147617	Fee-for-Service	1366478414	1366478414	1	1	BELSKI, KRYSTYNA TERESA	4/30/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45854	40	Pediatrics	0	In state provider	None	1425 WEST H STREET	STE 330	OAKDALE	CA	95361	3557	50	06099	37.75771796	-120.8627767	Stanislaus County
147623	Fee-for-Service	1144483124	1144483124	1	1	BHUTANI, TINA MD	8/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108915	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
147654	Fee-for-Service	1750499778	1750499778	1	1	BACCI AND GLINN PHYSICAL THE	7/9/2019	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RAPY INC	331 N 11TH AVE	None	HANFORD	CA	93230	4511	16	06031	36.32682132	-119.6548811	Kings County
147657	Fee-for-Service	1861410003	1861410003	1	1	BOYD KYLE A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	79-1019 HAUKAPILA ST	None	KEALAKEKUA	HI	96750	7920	00	None	19.519965	-155.918154	Hawaii County
147686	Fee-for-Service	1114927308	1114927308	1	1	BISHAY, NAZIUH N MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85839	08	Family Practice	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
147712	Fee-for-Service	1649241886	1649241886	1	1	BENNER, JON W MD	1/1/1982	208600000X	NA	General Surgery	026	PHYSICIANS	41631	66	Emergency Medicine (Urgent Care)	0	In state provider	None	950 CASS ST	None	MONTEREY	CA	93940	4546	27	06053	36.59271384	-121.8962446	Monterey County
147729	Fee-for-Service	1962069245	1962069245	1	1	BEILSTEIN, ALANA M NP	10/11/2019	2080N0001X	NA	Pediatric Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
147755	Fee-for-Service	1932463478	1932463478	1	1	BALLAH-LEAHEY, DEDDEH M MD	10/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129332	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
147756	Fee-for-Service	1891801122	1891801122	2	1	BAY AREA GYNECOLOGY ONCOLOGY	6/12/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	, INC.	910 CAMPISI WAY	STE 2A	CAMPBELL	CA	95008	2340	43	06085	37.29090718	-121.9337266	Santa Clara County
147757	Fee-for-Service	1073072864	1073072864	1	1	BARBER, LUCY CNP	5/30/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
147761	Fee-for-Service	1568577997	1568577997	1	1	BAY AREA PEDIATRIC	6/3/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	PULMONARY MEDICAL GRP	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
147762	Fee-for-Service	1427253699	1427253699	1	1	BAAS, ERIN M	3/18/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5061 SHASTA DAM BLVD	None	SHASTA LAKE	CA	96019	9422	45	06089	40.68027851	-122.3557875	Shasta County
147767	Fee-for-Service	1245443175	1245443175	1	1	BERDJIS, VAHID MD	7/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99489	41	Internal Medicine	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
147800	Fee-for-Service	1922269604	1922269604	1	1	BHASKAR, NUTAN MD	3/24/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	181400	None	None	0	In state provider	None	415 W CARROLL AVE	STE 100	GLENDORA	CA	91741	4208	19	06037	34.13420945	-117.870876	Los Angeles County
147829	Fee-for-Service	1225037500	1225037500	1	1	BETTINGER, JOHN R MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64202	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
147856	Fee-for-Service	1538244918	1538244918	1	1	BAPTIST HEALTHCARE	4/30/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1740 NICHOLASVILLE RD	None	LEXINGTON	KY	40503	1431	00	None	38.01867682	-84.51400197	Fayette County
147889	Fee-for-Service	1851657936	1851657936	1	1	BOCO, ERWIN V S MD	1/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120032	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
147892	Fee-for-Service	1164500781	1164500781	1	1	BRANCH, KIERAN R MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63803	41	Internal Medicine	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
147901	Fee-for-Service	1134321557	1134321557	1	1	BARNES, JEREMY G DO	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
147927	Fee-for-Service	1326235136	1326235136	1	1	BOUZ, NAHEL AL MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101427	41	Internal Medicine	0	In state provider	None	8263 GROVE AVE	SUITE 203	RANCHO CUCAMONGA	CA	91730	3107	36	06071	34.10436536	-117.6285141	San Bernardino County
147956	Fee-for-Service	1417942269	1417942269	1	1	BELL, JAMES MD	12/15/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52882	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
147959	Fee-for-Service	1861494569	1861494569	2	1	BERRY, MICHAEL K MD	1/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72558	08	Family Practice	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
147966	Fee-for-Service	1649310780	1649310780	1	1	BLACKBURN, ALLIE K MD	7/15/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89524	30	Radiology	0	In state provider	None	4334 CENTRAL AVENUE	None	RIVERSIDE	CA	92506	2917	33	06065	33.95346346	-117.3993495	Riverside County
147969	Fee-for-Service	1386914067	1386914067	1	1	BATTH, AMTINDER S MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118675	41	Internal Medicine	0	In state provider	None	1180 E SHAW	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
147977	Fee-for-Service	1508062431	1508062431	1	1	BELLINGHAM, JANET M MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56114	02	General Surgery	0	In state provider	None	2340 CLAY STREET	4TH FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
147991	Fee-for-Service	1093592172	1093592172	1	1	BARZELAY WOLLMAN, AYA MD	10/9/2024	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
148016	Fee-for-Service	1649461120	1649461120	1	1	BREMNER, AMY K MD	7/21/2009	208600000X	NA	General Surgery	026	PHYSICIANS	90315	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
148020	Fee-for-Service	1912085762	1912085762	1	1	BAKER, LEWIS D MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37505	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
148026	Fee-for-Service	1518350321	1518350321	1	1	BABALOLA, ERICA NP	1/12/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
148048	Fee-for-Service	1568577997	1568577997	1	1	BAY AREA PEDIATRIC	6/3/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PULMONARY MEDICAL GRP	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
148054	Fee-for-Service	1740310986	1740310986	1	1	BERNHARD, ANDREA	5/21/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2658 GRIFFITH BLVD	SUITE 301	LOS ANGELES	CA	90039	2520	19	06037	34.0191728	-118.2578624	Los Angeles County
148056	Fee-for-Service	1477323806	1477323806	1	1	BENNETT-JACKSON, YASMIN BIR	3/21/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
148073	Fee-for-Service	1295171999	1295171999	1	1	BLOK-ANDERSEN, CAMERON F	11/16/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	5900 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
148077	Fee-for-Service	1306830609	1306830609	2	1	BK PHARMACY CORP	1/26/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1129 W. FOURTH STREET	SUITE A	MADERA	CA	93637	4477	20	06039	36.95565996	-120.0736177	Madera County
148080	Fee-for-Service	1801019534	1801019534	1	1	BEHRENDTSEN, OLE MD	6/6/2022	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	111247	-	NOT APPLICABLE	0	In state provider	None	315 CAMINO DEL REMEDIO	BLDG 3, SUITE GF-3	SANTA BARBARA	CA	93110	1332	42	06083	34.444881	-119.7793725	Santa Barbara County
148116	Fee-for-Service	1326419425	1326419425	1	1	BENNETT, NELL LCSW	6/16/2016	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	956 WALNUT ST	STE 200	SAN LUIS OBISPO	CA	93401	1707	40	06079	35.28465529	-120.6650693	San Luis Obispo County
148124	Fee-for-Service	1184858797	1184858797	1	1	BUI, ERIC H MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128843	02	General Surgery	0	In state provider	None	1510 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
148144	Fee-for-Service	1538244918	1538244918	1	1	BAPTIST HEALTHCARE	4/30/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1740 NICHOLASVILLE RD	None	LEXINGTON	KY	40503	1431	00	None	38.01867682	-84.51400197	Fayette County
148155	Fee-for-Service	1619315744	1619315744	2	1	BIOSCRIP INFUSION SERVICES,	2/6/2020	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	199 TECHNOLOGY DRIVE	SUITES 140 & 150	IRVINE	CA	92618	2449	30	06059	33.66638394	-117.7490734	Orange County
148171	Fee-for-Service	1164919791	1164919791	1	1	BATTAGLIA, JANINE M NP	12/3/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1288 CAMINO DEL RIO N	None	SAN DIEGO	CA	92108	1511	37	06073	32.7668181	-117.150708	San Diego County
148176	Fee-for-Service	1851657936	1851657936	1	1	BOCO, ERWIN V S MD	1/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120032	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
148206	Fee-for-Service	1467874800	1467874800	1	1	BANSAL, MANU MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134672	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LN	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
148232	Fee-for-Service	1316937014	1316937014	1	1	BHATTACHARYA, DEBIKA MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73524	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
148248	Fee-for-Service	1861494569	1861494569	2	1	BERRY, MICHAEL K MD	1/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72558	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
148254	Fee-for-Service	1013239060	1013239060	1	1	BAIRD, CARINA H MD	4/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110560	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM SH22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
148305	Fee-for-Service	1033890454	1033890454	1	1	BAY AREA DOULA SERVICES LLC	8/10/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
148336	Fee-for-Service	1568577997	1568577997	1	1	BAY AREA PEDIATRIC	6/3/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	PULMONARY MEDICAL GRP	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
148373	Fee-for-Service	1942438205	1942438205	1	1	BENNETT, ASHLEY G MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121634	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
148421	Fee-for-Service	1063900520	1063900520	1	1	BARNES, NANA A MD	1/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173974	None	None	0	In state provider	None	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
148433	Fee-for-Service	1083604920	1083604920	1	1	BIFANO, GEORGE M DO	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	3983	36	Psychiatry	0	In state provider	None	504 W PUEBLO ST	STE 304	SANTA BARBARA	CA	93105	6211	42	06083	34.42829882	-119.7243868	Santa Barbara County
148447	Fee-for-Service	1871818385	1871818385	1	1	BHATHEJA, SAMIT MD	9/8/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	188373	None	None	0	In state provider	None	685 N 13TH AVE	STE 7,8,9	UPLAND	CA	91786	4963	36	06071	34.10202219	-117.6339091	San Bernardino County
148448	Fee-for-Service	1548792161	1548792161	1	1	BUXTON, LUKE DO	9/22/2023	207R00000X	NA	Other	026	PHYSICIANS	18899	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
148477	Fee-for-Service	1578739637	1578739637	1	1	BAY BREEZE CARE	10/3/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1653 SANTA FE AVENUE	None	LONG BEACH	CA	90813	1240	19	06037	33.78744	-118.2155075	Los Angeles County
148483	Fee-for-Service	1144311044	1144311044	1	1	BISHARA, MICHAEL F MD	2/8/2015	193200000X	NA	Other	026	PHYSICIANS	43206	41	Internal Medicine	0	In state provider	ST LUKE CLINIC AND NARCO	6896 MAGNOLIA AVE	None	RIVERSIDE	CA	92506	2843	33	06065	33.9488294	-117.3993884	Riverside County
148533	Fee-for-Service	1578560389	1578560389	1	1	BELL, ANGELA F MD	1/31/1991	207P00000X	NA	Other	026	PHYSICIANS	69720	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
148534	Fee-for-Service	1639234362	1639234362	1	1	BENJAMIN BEHROOZAN MD INC	12/18/2007	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2221 LINCOLN BLVD	STE 200	SANTA MONICA	CA	90405	1320	19	06037	34.00977424	-118.479803	Los Angeles County
148558	Fee-for-Service	1881683944	1881683944	1	1	BERGER, DAVID MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27322	67	Endocrinology	0	In state provider	None	11480 BROOKSHIRE AVE	STE 110	DOWNEY	CA	90241	5022	19	06037	33.93622932	-118.1311752	Los Angeles County
148568	Fee-for-Service	1922679869	1922679869	1	1	BC-HARVEY, JO CRNA	6/13/2024	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1515 E OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
148575	Fee-for-Service	1982751988	1982751988	1	1	BRAWLEY ELEMENTARY SCH	2/26/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	261 D ST	None	BRAWLEY	CA	92227	1912	13	06025	32.98087936	-115.5381517	Imperial County
148608	Fee-for-Service	1205196417	1205196417	1	1	BACOLOD, RAMESIS J MD	4/19/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171397	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
148611	Fee-for-Service	1922665686	1922665686	1	1	BARNETT, MICHAEL NP	9/7/2022	163WE0003X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
148652	Fee-for-Service	1831532266	1831532266	1	1	BELACHEW, WOSSEN MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145546	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 450, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
148678	Fee-for-Service	1841206844	1841206844	1	1	BISHOP, CLARK T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N 300 W	STE 500	PROVO	UT	84604	3312	00	None	40.24788856	-111.6640034	Utah County
148700	Fee-for-Service	1235405655	1235405655	1	1	BAIG, NABIL A DO	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13045	41	Internal Medicine	0	In state provider	None	1303 EAST HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
148728	Fee-for-Service	1255372223	1255372223	1	1	BROWN, ROBERT F JR MD	2/23/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32497	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
148751	Fee-for-Service	1013358845	1013358845	1	1	BUI, ALICE LMFT	8/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1769 PARK AVE	STE 250	SAN JOSE	CA	95126	2029	43	06085	37.33457692	-121.9248572	Santa Clara County
148753	Fee-for-Service	1588675094	1588675094	1	1	BRANSCOMB PHARMACY INC	9/8/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	51 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0000	23	06045	39.68776653	-123.4841265	Mendocino County
148765	Fee-for-Service	1316997505	1316997505	1	15	BALBOA NEPHROLOGY MEDICAL GR	7/25/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2205 ROSS AVENUE	SUITE 101	EL CENTRO	CA	92243	3623	13	06025	32.78143643	-115.5804952	Imperial County
148766	Fee-for-Service	1982937892	1982937892	1	1	BERG-MARTINEZ, RACHAEL D PSY	3/27/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	11800 CENTRAL AVE	STE 225	CHINO	CA	91710	7200	36	06071	34.0388092	-117.689654	San Bernardino County
148787	Fee-for-Service	1457366965	1457366965	1	1	BONAZZOLA,MICHAEL F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PK	RD	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
148806	Fee-for-Service	1346778909	1346778909	1	1	BAKSHI, ANUSHA MD	10/16/2020	207R00000X	NA	Other	026	PHYSICIANS	165277	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
148835	Fee-for-Service	1013943331	1013943331	1	1	BENCHARIT, SITTIPORN MD	6/1/1998	174400000X	NA	Other	026	PHYSICIANS	56112	10	Gastroenterology (M.D. only)	0	In state provider	None	25775 MCBEAN PKWY	None	VALENCIA	CA	91355	3708	19	06037	34.40042013	-118.5511416	Los Angeles County
148845	Fee-for-Service	1881683944	1881683944	1	1	BERGER, DAVID MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27322	41	Internal Medicine	0	In state provider	None	11480 BROOKSHIRE AVE	STE 110	DOWNEY	CA	90241	5022	19	06037	33.93622932	-118.1311752	Los Angeles County
148869	Fee-for-Service	1043488414	1043488414	1	1	BOOTHE, KRYSTAL M	4/13/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	71811	-	NOT APPLICABLE	0	In state provider	None	30500 ARRASTRE CANYON RD	None	ACTON	CA	93510	2160	19	06037	34.449291	-118.1973465	Los Angeles County
148883	Fee-for-Service	1427511773	1427511773	1	1	BORECKY, DANIELA M MD	9/30/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178275	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
148902	Fee-for-Service	1780887166	1780887166	1	1	BOTKER, JESSE C MD	7/3/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	107192	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO ROAD	SUITE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
148914	Fee-for-Service	1265448195	1265448195	1	1	BOHLMANN, THOMAS D MD	3/31/1989	207L00000X	NA	Other	026	PHYSICIANS	61792	05	Anesthesiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
148923	Fee-for-Service	1114554334	1114554334	1	1	BOGABATHINA, RAGHAVENDRA AKH	7/10/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	IL MD	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
148953	Fee-for-Service	1568668143	1568668143	1	1	BOTTOMLEY, RACHEL A	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
148987	Fee-for-Service	1184668469	1184668469	1	1	BAYSIDE ANESTHESIA MED	9/12/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
149014	Fee-for-Service	1316997505	1316997505	1	31	BALBOA NEPHROLOGY MEDICAL GR	4/11/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	416 BROADWAY	None	CHULA VISTA	CA	91910	4304	37	06073	32.63377774	-117.0906044	San Diego County
149054	Fee-for-Service	1316997505	1316997505	1	15	BALBOA NEPHROLOGY MEDICAL GR	7/25/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	2205 ROSS AVENUE	SUITE 101	EL CENTRO	CA	92243	3623	13	06025	32.78143643	-115.5804952	Imperial County
149081	Fee-for-Service	1801020334	1801020334	1	1	BOLLIN, KATHRYN B MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131480	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
149110	Fee-for-Service	1164764080	1164764080	1	1	BALITZER, DANA J MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134842	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
149146	Fee-for-Service	1679620751	1679620751	1	1	BOBLETT, BENJAMIN F MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69903	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
149221	Fee-for-Service	1528387172	1528387172	1	1	BENNETT, TARA LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
149231	Fee-for-Service	1629031299	1629031299	1	1	BELLE, TROY A MD	4/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	95412	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
149234	Fee-for-Service	1518295799	1518295799	1	1	BADER, MATTHEW LMFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41790	-	NOT APPLICABLE	0	In state provider	None	2731 NUGGET AVENUE	None	LAKE ISABELLA	CA	93240	9456	15	06029	35.62655748	-118.4731192	Kern County
149281	Fee-for-Service	1871545038	1871545038	1	1	BATRA, ROMILLA A MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72357	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
149302	Fee-for-Service	1316997505	1316997505	1	31	BALBOA NEPHROLOGY MEDICAL GR	4/11/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	416 BROADWAY	None	CHULA VISTA	CA	91910	4304	37	06073	32.63377774	-117.0906044	San Diego County
149312	Fee-for-Service	1477571834	1477571834	2	1	BAUMGARTEN, MORRIS MD	3/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	43156	20	Orthopedic Surgery	0	In state provider	None	931 BUENA VISTA STREET	SUITE 505	DUARTE	CA	91010	1727	19	06037	34.141635	-117.9775755	Los Angeles County
149324	Fee-for-Service	1689761231	1689761231	1	1	BARRETTO, KAREN T MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98299	40	Pediatrics	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
149330	Fee-for-Service	1487066841	1487066841	1	1	BACKER, KYLE N MD	8/18/2020	207ZP0102X	NA	Other	026	PHYSICIANS	155221	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
149361	Fee-for-Service	1609866649	1609866649	1	1	BIANCHI ANTHONY S MD	1/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63365	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	521 E ELDER ST	STE 207	FALLBROOK	CA	92028	3083	37	06073	33.38015149	-117.246267	San Diego County
149389	Fee-for-Service	1376827501	1376827501	2	1	BARWICK, FIONA H PHD	12/1/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
149394	Fee-for-Service	1225222367	1225222367	1	1	BEKKERS, ERIK J MD	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101020	None	None	0	In state provider	None	200 W ARBOR BLVD	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
149437	Fee-for-Service	1154626398	1154626398	1	1	BOWSER, ANNA M MD	6/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122517	40	Pediatrics	0	In state provider	None	220 E 13TH STREET	None	MERCED	CA	95341	6250	24	06047	37.29309532	-120.4748791	Merced County
149442	Fee-for-Service	1477606077	1477606077	1	1	BARCENAS, OLIVIA S LMFT	6/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
149468	Fee-for-Service	1588088215	1588088215	1	1	BENEDICTO, CHRISTIENNE NP	12/3/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
149488	Fee-for-Service	1346791852	1346791852	1	2	BERMUDEZ, CARLOS H CNP	7/13/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
149505	Fee-for-Service	1316352867	1316352867	1	2	BEAR MOUNTAIN MEDICAL	11/12/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9449 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
149548	Fee-for-Service	1972614238	1972614238	1	1	BRY, JOHN D MD	1/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79513	33	Thoracic Surgery	0	In state provider	None	365 HAWTHORNE AVE	STE 103	OAKLAND	CA	94609	3115	01	06001	37.82079728	-122.2633226	Alameda County
149591	Fee-for-Service	1316997505	1316997505	1	31	BALBOA NEPHROLOGY MEDICAL GR	4/11/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	416 BROADWAY	None	CHULA VISTA	CA	91910	4304	37	06073	32.63377774	-117.0906044	San Diego County
149595	Fee-for-Service	1942623657	1942623657	1	1	BORREGO COMMUNITY HEALTH	7/16/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	58581 US HIGHWAY 371	SUITE F, G, H	ANZA	CA	92539	9331	33	06065	33.5569201	-116.6397862	Riverside County
149611	Fee-for-Service	1912060385	1912060385	1	1	BASNYAT, PUSHPANJALI MD	2/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94100	41	Internal Medicine	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
149637	Fee-for-Service	1538566534	1538566534	1	1	BASCONCILLO, JANEINE T MD	12/14/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153935	None	None	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
149657	Fee-for-Service	1477935880	1477935880	1	1	BARRIGA, VANESSA J LMFT	8/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
149662	Fee-for-Service	1659338952	1659338952	1	1	BAREZ, SHIRIN MD	6/21/2000	207W00000X	NA	Ophthalmology	026	PHYSICIANS	75048	18	Ophthalmology	0	In state provider	None	1580 VALENCIA ST	STE 106	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
149664	Fee-for-Service	1023501715	1023501715	1	1	BATCHELOR, TIMOTHY J MD	7/14/2022	207P00000X	NA	Other	026	PHYSICIANS	179172	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
149673	Fee-for-Service	1396005849	1396005849	1	1	BOUDAKIAN, CHRISTOPHER V DO	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13915	25	Physical Medicine and Rehabilitation	0	In state provider	None	2080 CENTURY PARK E	STE 300	LOS ANGELES	CA	90067	2006	19	06037	34.05887194	-118.4122914	Los Angeles County
149674	Fee-for-Service	1164760823	1164760823	1	1	BEVERLY RADIOLOGY MEDICAL	12/16/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	15243 VANOWEN ST	STE 106	VAN NUYS	CA	91405	3632	19	06037	34.19394848	-118.4654115	Los Angeles County
149675	Fee-for-Service	1164530622	1164530622	1	1	BIK, LYMAR G MD	12/4/2018	207R00000X	NA	Other	026	PHYSICIANS	56516	41	Internal Medicine	0	In state provider	None	959 LAS TABLAS RD	SUITE B3	TEMPLETON	CA	93465	9703	40	06079	35.55436153	-120.7148265	San Luis Obispo County
149693	Fee-for-Service	1477542173	1477542173	1	1	BROOKS, STEWART I MD	11/3/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	21224	40	Pediatrics	0	In state provider	None	2950 SYCAMORE DR	STE 200	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
149699	Fee-for-Service	1578096764	1578096764	1	1	BRIZUELA, MELISSA A MD	9/11/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158709	08	Family Practice	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
149724	Fee-for-Service	1588178867	1588178867	1	1	BENEVOLENT HOME HEALTH, INC	9/26/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2405 W BURBANK BLVD	None	BURBANK	CA	91506	1237	19	06037	34.17893214	-118.3376034	Los Angeles County
149749	Fee-for-Service	1811929367	1811929367	1	1	BOLIVAR, EUNICE N MD	1/1/1979	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	33374	08	Family Practice	0	In state provider	None	598 N F ST	None	SAN BERNARDINO	CA	92410	3110	36	06071	34.109865	-117.296439	San Bernardino County
149767	Fee-for-Service	1376901447	1376901447	1	1	BRASWELLS MEDITERRANEAN	3/23/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	GARDENS	12295 FOURTH STREET	None	YUCAIPA	CA	92399	4120	36	06071	34.03052497	-117.0518504	San Bernardino County
149806	Fee-for-Service	1144497306	1144497306	1	1	BENNETT, MATTHEW	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH RD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
149815	Fee-for-Service	1558891101	1558891101	1	1	BUCKNER, KATIE D MD	4/27/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18433	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
149872	Fee-for-Service	1033298625	1033298625	1	1	BURKE, BEATRICE A MD INC	10/8/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71260	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	50 S SAN MATEO DR	None	SAN MATEO	CA	94401	3857	41	06081	37.56634141	-122.3261145	San Mateo County
149880	Fee-for-Service	1942623657	1942623657	1	1	BORREGO COMMUNITY HEALTH	6/9/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	58581 US HIGHWAY 371	SUITE F, G, H	ANZA	CA	92539	9331	33	06065	33.5569201	-116.6397862	Riverside County
149885	Fee-for-Service	1215424106	1215424106	1	1	BASIAGO, KEVIN A DO	6/30/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	18017	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
149902	Fee-for-Service	1174695910	1174695910	1	1	BARZAGA,PEARL A MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69491	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
149911	Fee-for-Service	1962604264	1962604264	1	1	BANGSIL, RONALD Y MD PC	3/28/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66106	08	Family Practice	0	In state provider	None	10881 BEACH BLVD	None	STANTON	CA	90680	3053	30	06059	33.80424669	-117.9932758	Orange County
149914	Fee-for-Service	1568572634	1568572634	1	1	BARRY, GREGORY T PHD	9/11/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	770 MAGNOLIA AVE	STE 1F	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
149970	Fee-for-Service	1134418007	1134418007	1	1	BOLLENBACHER, SHELBY H LCSW	12/3/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4510 E PACIFIC COAST	STE 120	LONG BEACH	CA	90804	6939	19	06037	33.78815204	-118.1400821	Los Angeles County
149971	Fee-for-Service	1033279633	1033279633	1	1	BAUMAN, BEVERLY H MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	2865 DAGGETT AVENUE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
149973	Fee-for-Service	1265830616	1265830616	1	1	BANJO, OLUBUNMI F NP	6/29/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
150040	Fee-for-Service	1235653668	1235653668	1	1	BRIDGEMAN, BRANDON LMFT	5/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
150063	Fee-for-Service	1255378022	1255378022	1	1	BROWNE, PAT M DO	12/31/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	5364	07	Dermatology	0	In state provider	None	740 N IRWIN ST	None	HANFORD	CA	93230	3814	16	06031	36.3327501	-119.6477054	Kings County
150065	Fee-for-Service	1588060081	1588060081	1	1	BORJA, MARIA S LMFT	9/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
150165	Fee-for-Service	1376649269	1376649269	1	1	BOCK, GERALD N	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	24211	None	None	0	In state provider	None	1617 ST MARKS PLAZA	SUITE C	STOCKTON	CA	95207	6423	39	06077	37.98864819	-121.3268062	San Joaquin County
150170	Fee-for-Service	1942623657	1942623657	1	1	BORREGO COMMUNITY HEALTH	5/19/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	58581 US HIGHWAY 371	SUITE F, G, H	ANZA	CA	92539	9331	33	06065	33.5569201	-116.6397862	Riverside County
150191	Fee-for-Service	1174695910	1174695910	1	1	BARZAGA,PEARL A MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69491	03	Allergy	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
150195	Fee-for-Service	1508803529	1508803529	1	1	BEALL, BROOK D MD	9/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96186	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
150221	Fee-for-Service	1215542394	1215542394	1	1	BUGG, MARY SCOTT NP	1/11/2024	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
150224	Fee-for-Service	1821437567	1821437567	1	1	BALDONADO, ESTHER N CNP	12/3/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2700 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5353	43	06085	37.33899611	-121.9746975	Santa Clara County
150260	Fee-for-Service	1033279633	1033279633	1	1	BAUMAN, BEVERLY H MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2865 DAGGETT AVENUE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
150267	Fee-for-Service	1487603452	1487603452	1	1	BRISTOL HOSPICE-	3/8/2007	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, LLC	374 E YOSEMITE AVE	STE 200	MERCED	CA	95340	9100	24	06047	37.33211655	-120.463713	Merced County
150294	Fee-for-Service	1720827579	1720827579	1	1	BARRIGA, ANGELICA OT	7/1/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2895 LOMA VISTA ROAD	SUITE H	VENTURA	CA	93003	1542	56	06111	34.27543868	-119.2574459	Ventura County
150299	Fee-for-Service	1346641370	1346641370	1	1	BOWMAN, HEATHER N OD	3/9/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
150304	Fee-for-Service	1972907681	1972907681	1	1	BRAVO, DANIELA LCSW	10/31/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4415 SONOMA HWY	SUITE A, E/F	SANTA ROSA	CA	95409	4165	49	06097	38.45819154	-122.6759063	Sonoma County
150350	Fee-for-Service	1902251143	1902251143	1	1	BRYAN, MATTHEW S DO	7/7/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	15742	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
150352	Fee-for-Service	1073848123	1073848123	1	1	BHUTRA, JONI A MD	3/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107601	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
150362	Fee-for-Service	1184799124	1184799124	1	1	BANSIL, SANDEEP K MD	6/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74966	77	Infectious Disease	0	In state provider	None	8333 IOWA ST	STE 200	DOWNEY	CA	90241	4994	19	06037	33.93744359	-118.1339382	Los Angeles County
150381	Fee-for-Service	1679104335	1679104335	1	1	BUSH, CHARIS K DO	3/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20441	None	None	0	In state provider	None	1187 COAST VILLAGE ROAD	10A	MONTECITO	CA	93108	2764	42	06083	34.4210386	-119.6449357	Santa Barbara County
150396	Fee-for-Service	1891413456	1891413456	1	1	BASTARDI, CHRISTOPHER PT	2/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13313 PALM DR.	B - C	DESERT HOT SPRING	CA	92240	5980	33	06065	33.951663	-116.501339	Riverside County
150430	Fee-for-Service	1457434409	1457434409	1	1	BEASLEY, JESSE C OD	3/31/1992	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MANCHESTER OPT EYE	10024 S VERMONT AVE	# 2	LOS ANGELES	CA	90044	3112	19	06037	33.944832	-118.291573	Los Angeles County
150440	Fee-for-Service	1003375155	1003375155	1	1	BOUZ, GABRIEL MD	3/18/2025	2086S0105X	NA	General Surgery	026	PHYSICIANS	180495	20	Orthopedic Surgery	0	In state provider	None	627 E. FOOTHILL BLVD	None	SAN DIMAS	CA	91773	1208	19	06037	34.12276912	-117.7952106	Los Angeles County
150443	Fee-for-Service	1699385971	1699385971	1	1	BEHAVIORAL HEALTH SERVICES I	6/22/2021	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2180 W VALLEY BOULEVARD	FLOOR 200	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
150447	Fee-for-Service	1063842920	1063842920	1	1	BERTRAND, BRAD D CNP	2/14/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
150453	Fee-for-Service	1124096656	1124096656	1	1	BRANTZ, EDWARD A MD	1/1/1979	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31523	08	Family Practice	0	In state provider	None	3949 CLAIREMONT DR	None	SAN DIEGO	CA	92117	5513	37	06073	32.81297886	-117.2009112	San Diego County
150459	Fee-for-Service	1942623657	1942623657	1	1	BORREGO COMMUNITY HEALTH	6/9/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	58581 US HIGHWAY 371	SUITE F, G, H	ANZA	CA	92539	9331	33	06065	33.5569201	-116.6397862	Riverside County
150481	Fee-for-Service	1184821977	1184821977	1	1	BEFFA, DAVID C MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	98146	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
150490	Fee-for-Service	1164885158	1164885158	1	1	BHATIA, SUBIR MD	8/21/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161812	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
150500	Fee-for-Service	1346349891	1346349891	1	1	BALKIAN, ARA MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75134	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
150510	Fee-for-Service	1487159489	1487159489	2	1	BEKARIAN, ROSINE DO	5/18/2023	207R00000X	NA	Other	026	PHYSICIANS	18402	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
150519	Fee-for-Service	1891722575	1891722575	1	1	BOYLE, CRAIG M DC	7/19/2007	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	6585 CLARK RD	STE 300	PARADISE	CA	95969	3500	04	06007	39.77567026	-121.5925667	Butte County
150534	Fee-for-Service	1295889509	1295889509	1	1	BHARGAN C PATEL	5/7/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1607 N MOUNTAIN AVE	None	UPLAND	CA	91784	1732	36	06071	34.1217971	-117.6704387	San Bernardino County
150554	Fee-for-Service	1487603452	1487603452	1	1	BRISTOL HOSPICE-	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, LLC	374 E YOSEMITE AVE	STE 200	MERCED	CA	95340	9100	24	06047	37.33211655	-120.463713	Merced County
150578	Fee-for-Service	1669867479	1669867479	1	1	BECHTOLD, HANNAH M MD	8/4/2019	207L00000X	NA	Other	026	PHYSICIANS	144251	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150592	Fee-for-Service	1982613501	1982613501	1	1	BAKER, ARTHUR D LMFT	7/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 SUNRISE AVE	STE 7B	MODESTO	CA	95350	4679	50	06099	37.66738394	-120.9848263	Stanislaus County
150602	Fee-for-Service	1578909776	1578909776	1	1	BIRDSONG, JULIE A CNP	5/1/2020	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
150657	Fee-for-Service	1588070346	1588070346	1	1	BOSU, OLATUNDE MD	3/4/2023	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	177863	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
150684	Fee-for-Service	1740218668	1740218668	1	1	BENSON, MARVIN MD	7/31/1988	207L00000X	NA	Other	026	PHYSICIANS	25243	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
150696	Fee-for-Service	1992975981	1992975981	1	1	BERGSTEIN, DEBORAH T CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
150733	Fee-for-Service	1003375155	1003375155	1	1	BOUZ, GABRIEL MD	3/18/2025	2086S0105X	NA	General Surgery	026	PHYSICIANS	180495	46	Hand Surgery	0	In state provider	None	627 E. FOOTHILL BLVD	None	SAN DIMAS	CA	91773	1208	19	06037	34.12276912	-117.7952106	Los Angeles County
150734	Fee-for-Service	1699385971	1699385971	1	1	BEHAVIORAL HEALTH SERVICES I	6/22/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2180 W VALLEY BOULEVARD	FLOOR 200	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
150775	Fee-for-Service	1871849620	1871849620	1	1	BRITTANY WYGER MD	11/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1990 INDUSTRIAL BLVD	None	HOUMA	LA	70363	7055	00	None	29.57007888	-90.68782355	Terrebonne Parish
150788	Fee-for-Service	1346349891	1346349891	1	1	BALKIAN, ARA MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75134	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
150825	Fee-for-Service	1154732816	1154732816	1	1	BRACKEN, NELLA T	10/1/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
150827	Fee-for-Service	1437631405	1437631405	1	1	BENAVIDEZ, CLORINDA G RCP	11/30/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
150837	Fee-for-Service	1316997505	1316997505	1	14	BALBOA NEPHROLOGY MEDICAL GR	5/5/2014	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4060 FOURTH AVE	STE 220	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
150917	Fee-for-Service	1013951870	1013951870	1	1	BADDAY, JALAL M MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	42224	41	Internal Medicine	0	In state provider	None	1004 W FOOTHILL BLVD	STE 102	UPLAND	CA	91786	3790	36	06071	34.10647255	-117.665541	San Bernardino County
150941	Fee-for-Service	1225551625	1225551625	1	1	BABAYAN, EDWARD LMFT	9/19/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
150972	Fee-for-Service	1962860866	1962860866	1	1	BAY, DEANNA LPCC	5/10/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	734 RUSS STREET	SUITES 104,106,107,110	EUREKA	CA	95501	4540	12	06023	40.7819667	-124.1609055	Humboldt County
150997	Fee-for-Service	1538107230	1538107230	1	1	BRICKMAN, MARIA MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73153	13	Neurology (M.D. only)	0	In state provider	None	6333 WILSHIRE BLVD	STE 402	LOS ANGELES	CA	90048	5722	19	06037	34.06355697	-118.366413	Los Angeles County
151056	Fee-for-Service	1881872851	1881872851	1	1	BOSE, DIWATA H A MD	5/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106760	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 TACHEVAH DR	3W105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
151059	Fee-for-Service	1881871754	1881871754	1	1	BHAVSAR, ASHISH A MD	4/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117360	01	General Practice	0	In state provider	None	3883 AIRWAY DR	SUITE 202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
151085	Fee-for-Service	1730178922	1730178922	1	1	BEZWADA, VISHNU V MD	3/22/2017	207R00000X	NA	Other	026	PHYSICIANS	134770	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
151090	Fee-for-Service	1962736926	1962736926	1	2	BUI, GINA N MD	6/4/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	121457	None	None	0	In state provider	None	1340 TULLY ROAD	309	SAN JOSE	CA	95122	3055	43	06085	37.31710924	-121.8334186	Santa Clara County
151101	Fee-for-Service	1386674059	1386674059	1	1	BENAVIDES, ROBERT JR PHD	2/1/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2455 BENNETT VALLEY RD	STE C210	SANTA ROSA	CA	95404	5671	49	06097	38.434284	-122.6918565	Sonoma County
151125	Fee-for-Service	1316997505	1316997505	1	14	BALBOA NEPHROLOGY MEDICAL GR	5/5/2014	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	4060 FOURTH AVE	STE 220	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
151129	Fee-for-Service	1053424713	1053424713	1	1	BLOOMFIELD, PETER J MD	11/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92877	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
151143	Fee-for-Service	1376590927	1376590927	1	1	BULLARD, ANTHONY B MD	6/28/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177768	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
151155	Fee-for-Service	1659461465	1659461465	1	1	BARNHART, LARRY C MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	37012	01	General Practice	0	In state provider	None	25733 RYE CANYON RD	None	VALENCIA	CA	91355	1135	19	06037	34.43192984	-118.5872949	Los Angeles County
151204	Fee-for-Service	1386058410	1386058410	1	1	BAUGHMAN, SUSAN CCC-SLP	10/18/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
151205	Fee-for-Service	1891012019	1891012019	1	1	BAUGHER, KATHERINE DO	7/16/2024	207P00000X	NA	Other	026	PHYSICIANS	22213	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
151222	Fee-for-Service	1265435325	1265435325	1	1	BYLSMA, STEPHEN S MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71086	18	Ophthalmology	0	In state provider	None	1414 E MAIN ST	None	SANTA MARIA	CA	93454	4806	42	06083	34.95286853	-120.4139295	Santa Barbara County
151242	Fee-for-Service	1861856932	1861856932	1	1	BERNETICH, MATTHEW DO	7/21/2023	208M00000X	NA	Other	026	PHYSICIANS	20634	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
151252	Fee-for-Service	1558438044	1558438044	1	1	BREWER, TANYA M CNP	3/13/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
151254	Fee-for-Service	1083142913	1083142913	1	1	BABUR, SHAWN MD	11/16/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	163761	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
151261	Fee-for-Service	1043278062	1043278062	1	1	BIRNS, JEFFREY W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31963	04	Otology, Laryngology, Rhinology	0	In state provider	None	5400 BALBOA BLVD	STE 126	ENCINO	CA	91316	5202	19	06037	34.169283	-118.501072	Los Angeles County
151268	Fee-for-Service	1114267598	1114267598	1	1	BAKEER-PULLUM, AKILAH LCSW	9/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
151346	Fee-for-Service	1528031333	1528031333	1	1	BARSUK, JEFFREY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	680 N LAKE SHORE DR	STE 1000	CHICAGO	IL	60611	8709	00	None	41.89498774	-87.61585515	Cook County
151347	Fee-for-Service	1881871754	1881871754	1	1	BHAVSAR, ASHISH A MD	4/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117360	08	Family Practice	0	In state provider	None	3883 AIRWAY DR	SUITE 202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
151353	Fee-for-Service	1386832848	1386832848	1	1	BOATENG, FREDA MD	12/16/2019	207R00000X	NA	Other	026	PHYSICIANS	159881	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
151400	Fee-for-Service	1275266264	1275266264	1	1	BRIDGE TELEHEALTH PC	10/5/2022	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
151411	Fee-for-Service	1174100010	1174100010	1	1	BUTALID, SAMANTHA NP	1/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
151455	Fee-for-Service	1194942714	1194942714	1	1	BROWN, SAGHI S MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94574	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
151475	Fee-for-Service	1801214507	1801214507	1	1	BARTELS, BRETT K MD	10/6/2022	207P00000X	NA	Other	026	PHYSICIANS	176290	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
151485	Fee-for-Service	1134216625	1134216625	1	1	BERG, RENATA J MD	2/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83787	05	Anesthesiology	0	In state provider	None	2000 VALE ROAD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
151547	Fee-for-Service	1043278062	1043278062	1	1	BIRNS, JEFFREY W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31963	84	Surgery-Head and Neck	0	In state provider	None	5400 BALBOA BLVD	STE 126	ENCINO	CA	91316	5202	19	06037	34.169283	-118.501072	Los Angeles County
151556	Fee-for-Service	1396821880	1396821880	1	1	BELL, DWIGHT S MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	57495	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
151557	Fee-for-Service	1710055272	1710055272	1	2	BEASLEY, SCOTT A MD	12/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	37825	40	Pediatrics	0	In state provider	None	1401 S GRAND AVE	None	L0S ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
151563	Fee-for-Service	1083885768	1083885768	1	1	BEACHWOOD MEDICAL SUPPLY INC	10/18/2011	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5027 HEINTZ ST	STE A1	BALDWIN PARK	CA	91706	1817	19	06037	34.10404552	-117.9529218	Los Angeles County
151587	Fee-for-Service	1538296967	1538296967	1	1	BERMAN, DANIEL S MD	11/1/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23844	None	None	0	In state provider	CEDARS-SANAI MED CTR	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
151614	Fee-for-Service	1669631644	1669631644	1	1	BUCK, MICHAEL J LCSW	8/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	68081	-	NOT APPLICABLE	0	In state provider	None	101 CIRBY HILLS DRIVE	None	ROSEVILLE	CA	95678	4360	31	06061	38.7303989	-121.2872592	Placer County
151634	Fee-for-Service	1841685401	1841685401	1	1	BURTON, CLAIRE S MD	7/20/2023	2088F0040X	NA	Other	026	PHYSICIANS	145875	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
151646	Fee-for-Service	1093998122	1093998122	1	4	BEVERLY RADIOLOGY MED GR	12/15/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
151649	Fee-for-Service	1104903053	1104903053	1	1	BLOOM, RICHARD J MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	47974	02	General Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
151672	Fee-for-Service	1760564702	1760564702	1	1	BARKHORDARIAN, SIAMAK MD	4/15/2008	2086S0129X	NA	General Surgery	026	PHYSICIANS	94148	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8635 W 3RD STREET	SUITE 865-W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
151675	Fee-for-Service	1184755134	1184755134	1	1	BROWN, AIIESHA LMFT	9/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
151684	Fee-for-Service	1982742573	1982742573	1	1	BORDSON, MARTIN B LMFT	12/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
151688	Fee-for-Service	1922025519	1922025519	1	1	BROWN, YOLANDA F MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114422	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
151705	Fee-for-Service	1003197294	1003197294	1	1	BUI MUTURI THUO	2/3/2012	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	20535 LAKERIDGE DR	None	PERRIS	CA	92570	8380	33	06065	33.82032346	-117.4060666	Riverside County
151751	Fee-for-Service	1568723922	1568723922	1	1	BARVALIA, MIHIR M MD	3/16/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	156332	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
151773	Fee-for-Service	1952518235	1952518235	1	1	BARCHIE, MATTHEW F MD	6/13/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159602	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
151787	Fee-for-Service	1649264847	1649264847	1	1	BUCKHORN, CARL W MD	3/31/1992	207R00000X	NA	Other	026	PHYSICIANS	73630	41	Internal Medicine	0	In state provider	None	1041 E YORBA LINDA BLVD	STE 5	PLACENTIA	CA	92870	3736	30	06059	33.88848865	-117.8451029	Orange County
151795	Fee-for-Service	1033219878	1033219878	1	1	BENJAMIN SHUKERT	11/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
151803	Fee-for-Service	1396754636	1396754636	1	1	BALAKUMARAN, GOWTHAMY MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67113	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
151805	Fee-for-Service	1326356213	1326356213	1	1	BIODATA RADIOLOGY SERVICES	11/10/2011	261QR0208X	NA	Mammography Provider	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	5494 ARROW HIGHWAY	None	MONTCLAIR	CA	91763	1604	36	06071	34.09237045	-117.68544	San Bernardino County
151830	Fee-for-Service	1487207627	1487207627	1	1	BURNETT, COLLIN LMFT	2/2/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	922 STATE STREET	STE A, OFFICE #2	SANTA BARBARA	CA	93101	6795	42	06083	34.42108289	-119.7013175	Santa Barbara County
151857	Fee-for-Service	1972061216	1972061216	1	1	BARAJAS, REBECCA NP	5/21/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
151876	Fee-for-Service	1396786935	1396786935	1	1	BLOOM, ROBERT D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31588	30	Radiology	0	In state provider	None	2557 MOWRY AVE	STE 10	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
151896	Fee-for-Service	1750950499	1750950499	1	3	BARTON MEDICAL FOUNDATION	8/20/2024	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1067 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3459	09	06017	38.91384447	-119.9985861	El Dorado County
151907	Fee-for-Service	1720166358	1720166358	1	1	BAINTON, JAMES H MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62198	22	Pathology (M.D. only)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
151914	Fee-for-Service	1902801939	1902801939	1	1	BABAD, JOSHUA N MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	22841	18	Ophthalmology	0	In state provider	None	515 SOQUEL AVE	None	SANTA CRUZ	CA	95062	2309	44	06087	36.9755839	-122.0175832	Santa Cruz County
151937	Fee-for-Service	1558697375	1558697375	1	1	BRAXTON, ANEKA J M MD	10/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107347	08	Family Practice	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
151950	Fee-for-Service	1689019200	1689019200	1	1	BOZORGMEHR, ANOOSHIRVAN DO	1/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12364	08	Family Practice	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
151962	Fee-for-Service	1376531053	1376531053	1	1	BINDRA, PAVELJIT S MD	3/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85207	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	301 W HUNTINGTON DR	#301	ARCADIA	CA	91007	3478	19	06037	34.13481053	-118.0425638	Los Angeles County
151991	Fee-for-Service	1003197294	1003197294	1	1	BUI MUTURI THUO	2/3/2012	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	20535 LAKERIDGE DR	None	PERRIS	CA	92570	8380	33	06065	33.82032346	-117.4060666	Riverside County
151993	Fee-for-Service	1134408883	1134408883	1	1	BOGARDUS, ARGENTINA C CRNA	4/16/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
152005	Fee-for-Service	1225079924	1225079924	1	1	BOODY, ANTONY R MD	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80813	20	Orthopedic Surgery	0	In state provider	None	4300 GOLDEN CENTER DR	STE C	PLACERVILLE	CA	95667	6278	09	06017	38.70657265	-120.82856	El Dorado County
152031	Fee-for-Service	1710045422	1710045422	2	1	BURKE, MARY ANN PT	2/11/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1191 CRESTON RD	STE 115	PASO ROBLES	CA	93446	3033	40	06079	35.6227971	-120.6606503	San Luis Obispo County
152038	Fee-for-Service	1427083963	1427083963	1	1	BRUNS, BRYAN E MD A MEDICAL	1/11/2011	2084P0804X	NA	Psychiatry	026	PHYSICIANS	29642	36	Psychiatry	0	In state provider	CORP	9255 TOWNE CENTRE DR	STE 370	SAN DIEGO	CA	92121	3033	37	06073	32.875434	-117.2074325	San Diego County
152042	Fee-for-Service	1619514015	1619514015	1	1	BARNES, CYNTHIA D LMFT	4/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CONSULTING	21171 S. WESTERN AVE,	SUITE 2802	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
152062	Fee-for-Service	1235246117	1235246117	1	1	BASULTO, ANABEL LMFT	2/26/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
152084	Fee-for-Service	1326336637	1326336637	1	1	BHATT, ALOK B MD	12/1/2017	2085R0204X	NA	Other	026	PHYSICIANS	124548	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
152101	Fee-for-Service	1083640379	1083640379	1	1	BERHOW, MELISSA T MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65999	05	Anesthesiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
152114	Fee-for-Service	1710478060	1710478060	1	1	BLACK, BENJAMIN R LCSW	8/4/2021	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
152120	Fee-for-Service	1023346277	1023346277	1	1	BHOLA, RAKESH K M D INC	4/22/2011	207R00000X	NA	Other	026	PHYSICIANS	39683	41	Internal Medicine	0	In state provider	None	1781 W ROMNEYA DR	STE C	ANAHEIM	CA	92801	1818	30	06059	33.85067272	-117.9447342	Orange County
152121	Fee-for-Service	1871516203	1871516203	1	1	BIONESS INC	11/24/2009	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	25103 RYE CANYON LOOP	None	VALENCIA	CA	91355	5004	19	06037	34.45685567	-118.5807441	Los Angeles County
152143	Fee-for-Service	1356746929	1356746929	1	1	BERKELEY PINES SKILLED	1/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	NURSING GROUP INC	2223 ASHBY AVE	None	BERKELEY	CA	94705	1907	01	06001	37.85583539	-122.2626889	Alameda County
152172	Fee-for-Service	1366834285	1366834285	1	1	BIO MEDICAL APPLICATIONS OF	1/12/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	499 RAVEN STREET	None	SAN DIEGO	CA	92102	4525	37	06073	32.710608	-117.1076045	San Diego County
152180	Fee-for-Service	1295314805	1295314805	1	1	BAH, FATIMATOU MD	10/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
152186	Fee-for-Service	1750950499	1750950499	1	3	BARTON MEDICAL FOUNDATION	8/20/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1067 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3459	09	06017	38.91384447	-119.9985861	El Dorado County
152219	Fee-for-Service	1487105243	1487105243	1	1	BARRAZA, EILEEN MAY N NP	5/21/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
152237	Fee-for-Service	1134393887	1134393887	1	1	BERMAN, DAVID H MD AMC	6/27/2008	207R00000X	NA	Other	026	PHYSICIANS	20952	41	Internal Medicine	0	In state provider	None	326 MISSION AVENUE	None	SAN RAFAEL	CA	94901	3425	21	06041	37.9726649	-122.5168204	Marin County
152253	Fee-for-Service	1275893190	1275893190	1	1	BENNETT, SIMONE C MD	8/28/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	137988	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
152264	Fee-for-Service	1316997505	1316997505	1	26	BALBOA NEPHROLOGY MEDICAL GR	10/5/2016	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	37	06073	33.18081595	-117.3156434	San Diego County
152265	Fee-for-Service	1326495102	1326495102	1	1	BEKINS, DREW DPM	2/8/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
152286	Fee-for-Service	1205933934	1205933934	1	1	BLOCK, DONALD A MD	2/28/1982	207RN0300X	NA	Nephrology	026	PHYSICIANS	34174	45	Nephrology (Renal-Kidney)	0	In state provider	None	3001 COLBY ST	None	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
152287	Fee-for-Service	1053363663	1053363663	1	1	BRAR, HARJEET S MD	4/16/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	94530	45	Nephrology (Renal-Kidney)	0	In state provider	None	3850 RIVERLAKES DRIVE	SUITE B	BAKERSFIELD	CA	93312	6662	15	06029	35.39426565	-119.0936823	Kern County
152291	Fee-for-Service	1417306523	1417306523	1	1	BAMDAD, MICHAELA C MD	7/25/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
152321	Fee-for-Service	1427083963	1427083963	1	1	BRUNS, BRYAN E MD A MEDICAL	1/11/2011	2084P0804X	NA	Psychiatry	026	PHYSICIANS	29642	26	Psychiatry (child)	0	In state provider	CORP	9255 TOWNE CENTRE DR	STE 370	SAN DIEGO	CA	92121	3033	37	06073	32.875434	-117.2074325	San Diego County
152322	Fee-for-Service	1316114762	1316114762	1	1	BLAINE, REGINA R LCSW	12/14/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
152343	Fee-for-Service	1427151935	1427151935	1	1	BATIN-VAN ROOYAN	3/18/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	78300	20	Orthopedic Surgery	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
152352	Fee-for-Service	1437127560	1437127560	1	1	BEG, SUMBUL N MD	9/30/2008	207R00000X	NA	Other	026	PHYSICIANS	78806	67	Endocrinology	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
152357	Fee-for-Service	1245804855	1245804855	1	1	BRAGDON, NIECOLE LPCC	3/26/2025	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 CARNEGIE DR	SUITE 200	SAN BERNARDINO	CA	92408	4207	36	06071	34.06796019	-117.2749922	San Bernardino County
152362	Fee-for-Service	1396239380	1396239380	1	1	BADDIGAM, RAMYA R MD	9/17/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
152394	Fee-for-Service	1255697850	1255697850	1	1	BAUMAN, LAURA E MD	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157981	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798889	-117.150826	San Diego County
152396	Fee-for-Service	1083640379	1083640379	1	1	BERHOW, MELISSA T MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65999	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
152402	Fee-for-Service	1598290645	1598290645	1	1	BROBST, TYLER D MD	8/24/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157353	40	Pediatrics	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
152405	Fee-for-Service	1942887971	1942887971	1	1	BHOWMICK, KUNTAL	1/8/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
152406	Fee-for-Service	1023346277	1023346277	1	1	BHOLA, RAKESH K M D INC	4/22/2011	207R00000X	NA	Other	026	PHYSICIANS	39683	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1781 W ROMNEYA DR	STE C	ANAHEIM	CA	92801	1818	30	06059	33.85067272	-117.9447342	Orange County
152421	Fee-for-Service	1194837732	1194837732	1	1	BISHARA, RIMA B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2115 N 34TH ST	None	WACO	TX	76708	3114	00	None	31.55382612	-97.17738818	McLennan County
152446	Fee-for-Service	1104175249	1104175249	1	1	BAGHERI, RAMIN D MD	6/1/2023	163WG0100X	NA	Other	026	PHYSICIANS	156043	None	None	0	In state provider	None	1160 SUNSET BLVD	None	ROCKLIN	CA	95677	3772	31	06061	38.8125	-121.2848698	Placer County
152448	Fee-for-Service	1336605682	1336605682	1	1	BESERRA, JON D CRNA	8/26/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
152459	Fee-for-Service	1801207444	1801207444	1	1	BEARD, TIANA D LMFT	6/1/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104023	-	NOT APPLICABLE	0	In state provider	None	101 GOUGH ST	None	SAN FRANCISCO	CA	94102	5903	38	06075	37.77425761	-122.4224731	San Francisco County
152489	Fee-for-Service	1790292100	1790292100	1	1	BARMINOVA, ANNA MD	4/19/2021	2084V0102X	NA	Neurology	026	PHYSICIANS	167612	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
152493	Fee-for-Service	1235544834	1235544834	1	1	BELKNAP, KAYA S MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142933	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
152511	Fee-for-Service	1922444660	1922444660	1	1	BONISKE, TANIA M MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134213	41	Internal Medicine	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
152512	Fee-for-Service	1740667161	1740667161	1	1	BARKER, KRISTY R MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156116	41	Internal Medicine	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
152515	Fee-for-Service	1013207547	1013207547	1	1	BADHEKA, SONIA L DO	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12502	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	20101 LAKE CHABOT ROAD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
152553	Fee-for-Service	1316997505	1316997505	1	26	BALBOA NEPHROLOGY MEDICAL GR	10/5/2016	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	37	06073	33.18081595	-117.3156434	San Diego County
152575	Fee-for-Service	1205933934	1205933934	1	1	BLOCK, DONALD A MD	2/28/1982	207RN0300X	NA	Nephrology	026	PHYSICIANS	34174	41	Internal Medicine	0	In state provider	None	3001 COLBY ST	None	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
152577	Fee-for-Service	1225511835	1225511835	1	1	BRENDAN BOLAND MD INC	12/6/2018	2086X0206X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	15031 RINALDI ST.	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
152590	Fee-for-Service	1164559480	1164559480	1	1	BUCH, DHAVAL P	12/2/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1002 CALLOWAY DR	None	BAKERSFIELD	CA	93312	6337	15	06029	35.36711975	-119.1118605	Kern County
152640	Fee-for-Service	1437127560	1437127560	1	1	BEG, SUMBUL N MD	9/30/2008	207R00000X	NA	Other	026	PHYSICIANS	78806	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
152648	Fee-for-Service	1376639823	1376639823	1	1	BOST, FREDERICK W MD	12/1/1987	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	12889	20	Orthopedic Surgery	0	In state provider	None	3838 CALIFORNIA ST	RM 715	SAN FRANCISCO	CA	94118	1509	38	06075	37.78591809	-122.4575439	San Francisco County
152653	Fee-for-Service	1407425929	1407425929	1	1	BOQUIREN, EMMANUEL C PT	9/7/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
152668	Fee-for-Service	1982713756	1982713756	1	1	BEALL, THOMAS E	7/1/1996	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3520 E SHIELDS AVE	STE 102	FRESNO	CA	93726	6923	10	06019	36.77947947	-119.765781	Fresno County
152716	Fee-for-Service	1912257163	1912257163	1	1	BEHAVIORAL HEALTH SERVICES	3/22/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	615 ELM AVE	None	LONG BEACH	CA	90802	1406	19	06037	33.774381	-118.1876775	Los Angeles County
152720	Fee-for-Service	1417985334	1417985334	1	1	BRANDES, JAMES L MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72076	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
152801	Fee-for-Service	1619100773	1619100773	1	1	BANSAL, NIDHI MD	6/5/2021	2080P0205X	NA	Endocrinology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
152829	Fee-for-Service	1104977636	1104977636	1	1	BUI, DAVID P MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	63926	18	Ophthalmology	0	In state provider	None	2241 CENTRAL AVE	STE A	ALAMEDA	CA	94501	4430	01	06001	37.76537189	-122.2454213	Alameda County
152855	Fee-for-Service	1356514624	1356514624	1	1	BOCK, MATTHEW J MD	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112611	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
152863	Fee-for-Service	1467890590	1467890590	1	1	BURKARD, GREGORY P JR DO	2/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16079	25	Physical Medicine and Rehabilitation	0	In state provider	None	1139 THIRD ST	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
152864	Fee-for-Service	1609088269	1609088269	1	1	BENJAMIN, HILMA R MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99339	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
152903	Fee-for-Service	1053977520	1053977520	1	1	BOADU, OSEI B MD	7/18/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
152917	Fee-for-Service	1528402682	1528402682	1	1	BORNO, HALA T MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133388	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
152922	Fee-for-Service	1861499709	1861499709	1	1	BOTTO, RICHARD D MD	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	44573	08	Family Practice	0	In state provider	None	2130 LAKE TAHOE BLVD	None	SOUTH LAKE TAHOE	CA	96150	6405	09	06017	38.91603139	-120.0001807	El Dorado County
152952	Fee-for-Service	1396738829	1396738829	1	1	BAHRE, BONITA M MD	2/28/1988	207L00000X	NA	Other	026	PHYSICIANS	47417	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
153004	Fee-for-Service	1346716388	1346716388	1	1	BEST IN TOWN HOME HEALTH	3/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1110 S GLENDALE AVE	STE B	GLENDALE	CA	91205	5620	19	06037	34.13303677	-118.2520389	Los Angeles County
153040	Fee-for-Service	1770685265	1770685265	1	1	BENJI KITAGAWA DO	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
153046	Fee-for-Service	1144239567	1144239567	1	1	BROWN, JESSICA MD	4/30/1993	2086S0105X	NA	General Surgery	026	PHYSICIANS	65372	20	Orthopedic Surgery	0	In state provider	None	317 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4355	42	06083	34.42967671	-119.7228362	Santa Barbara County
153088	Fee-for-Service	1104889054	1104889054	1	1	BEROS, ANDREW D MD	8/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68077	04	Otology, Laryngology, Rhinology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
153109	Fee-for-Service	1245389287	1245389287	1	1	BURGER, SUSAN E CFNP	8/8/2002	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	WESTWIND WOMEN'S SERVICE	22110 ROSCOE BLVD	STE 104	WEST HILLS	CA	91304	3866	19	06037	34.21957849	-118.6082685	Los Angeles County
153161	Fee-for-Service	1659727154	1659727154	1	1	BEAIRD, DALLAS	7/26/2019	207P00000X	NA	Other	026	PHYSICIANS	152648	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
153201	Fee-for-Service	1962580506	1962580506	1	1	BORIRAKCHANYAVAT, K MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76396	07	Dermatology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
153202	Fee-for-Service	1962609982	1962609982	1	1	BENGISU, AYDIN M LAC	10/26/2007	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	133 E HALEY ST	None	SANTA BARBARA	CA	93101	2330	42	06083	34.41883725	-119.6933889	Santa Barbara County
153206	Fee-for-Service	1366462293	1366462293	1	1	BUENA VISTA ANESTHESIA	10/1/1998	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
153216	Fee-for-Service	1396928362	1396928362	1	1	BIR, NATASHA D MD	10/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95167	02	General Surgery	0	In state provider	None	632 W GIBSON ROAD	None	WOODLAND	CA	95695	5143	57	06113	38.66314048	-121.794696	Yolo County
153217	Fee-for-Service	1346291549	1346291549	1	1	BRODSKY, ANATOLY G MD	5/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	72800	08	Family Practice	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
153225	Fee-for-Service	1619405867	1619405867	1	1	BALYAN, TARIKA S NP	9/20/2021	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14671 RINALDI ST	None	SAN FERNANDO	CA	91340	4199	19	06037	34.28086005	-118.4532148	Los Angeles County
153229	Fee-for-Service	1417035577	1417035577	1	1	BAITOO, ANDRE H MD	2/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80588	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
153275	Fee-for-Service	1073750014	1073750014	1	1	BANNOUT, FIRAS MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100375	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON STREET	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
153311	Fee-for-Service	1639301799	1639301799	1	1	BHAMIDIPATY, SUNITA V MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	73921	None	None	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
153320	Fee-for-Service	1013163542	1013163542	1	1	BRADDOCK, ADAM L MD	3/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114671	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
153401	Fee-for-Service	1194804229	1194804229	1	1	BAKER, ROBIN J MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60401	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
153405	Fee-for-Service	1952559353	1952559353	1	1	BRAMBILA, MAXIMINO J MD	10/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110773	20	Orthopedic Surgery	0	In state provider	None	1855 E ALLUVIAL AVE	STE 101	FRESNO	CA	93720	3854	10	06019	36.84476453	-119.748843	Fresno County
153433	Fee-for-Service	1053355941	1053355941	1	1	BROWN, JOHN F MD	10/31/1995	207P00000X	NA	Other	026	PHYSICIANS	57855	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
153451	Fee-for-Service	1083709653	1083709653	1	4	BHC HERITAGE OAKS HOSP	2/14/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2945 RAMCO STREET	SUITE 180	WEST SACRAMENTO	CA	95691	5995	57	06113	38.55460926	-121.562961	Yolo County
153455	Fee-for-Service	1780085209	1780085209	1	1	BV HOME HEALTH LLC	10/18/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD	STE 203	SANTA CLARITA	CA	91350	9098	19	06037	34.45052733	-118.497654	Los Angeles County
153516	Fee-for-Service	1790977809	1790977809	1	1	BAGDASARYAN, ANNA MD	10/20/2008	207R00000X	NA	Other	026	PHYSICIANS	101146	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
153520	Fee-for-Service	1033844527	1033844527	1	1	BORO, SARAH E LMSW	8/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2020 MEZES AVE	None	BELMONT	CA	94002	1745	41	06081	37.52182269	-122.2961253	San Mateo County
153524	Fee-for-Service	1770842056	1770842056	1	1	BURKE, SARAH M PA	5/21/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148842	None	None	0	In state provider	None	1665 ESPLANADE	None	CHICO	CA	95926	3312	04	06007	39.74388808	-121.8503372	Butte County
153534	Fee-for-Service	1033344882	1033344882	1	1	BARACAN, ALEXANDRA MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135896	05	Anesthesiology	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
153580	Fee-for-Service	1295837292	1295837292	1	1	BERKOWITZ, BARRY J MD	5/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	57226	30	Radiology	0	In state provider	None	25775 W MCBEAN PKWY	STE 100	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
153587	Fee-for-Service	1316997505	1316997505	1	9	BALBOA NEPHROLOGY MEDICAL GR	9/23/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	8851 CENTER DR	STE 505	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
153596	Fee-for-Service	1720423882	1720423882	1	1	BANK, ERIC M MD	8/26/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	133681	68	Hematology	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
153601	Fee-for-Service	1083989164	1083989164	1	1	BIRCH, CHRISTOPHER E MD	12/11/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	155897	20	Orthopedic Surgery	0	In state provider	None	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
153603	Fee-for-Service	1184687782	1184687782	1	3	BHANGOO, SARUPINDER S MD	8/17/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	40294	-	NOT APPLICABLE	0	In state provider	None	1124 BAKER ST	None	BAKERSFIELD	CA	93312	4322	15	06029	35.38059062	-118.9915812	Kern County
153647	Fee-for-Service	1992770184	1992770184	1	1	BOTTE, MICHAEL J MD	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44325	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
153659	Fee-for-Service	1841617529	1841617529	1	1	BOOHER, CHIP NP	9/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	426570	-	NOT APPLICABLE	0	In state provider	None	535 W CESAR CHAVEZ BLVD	None	CALEXICO	CA	92231	2103	13	06025	32.67021337	-115.5022183	Imperial County
153707	Fee-for-Service	1013473446	1013473446	1	1	BROADUS, AARON	1/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
153709	Fee-for-Service	1275826398	1275826398	1	1	BARROW, ANDREW J MD	8/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	156011	30	Radiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
153715	Fee-for-Service	1912032681	1912032681	1	1	BRESSAN, JOHN W	6/9/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
153720	Fee-for-Service	1255373528	1255373528	1	1	BARAMI, KAVEH MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	86867	14	Neurological Surgery	0	In state provider	None	280 WEST MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
153727	Fee-for-Service	1326246117	1326246117	1	1	BANGALORE, SUMANA MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144381	38	Geriatrics	0	In state provider	None	1825 BELL ST	None	SACRAMENTO	CA	95825	1020	34	06067	38.599137	-121.4119485	Sacramento County
153729	Fee-for-Service	1811221211	1811221211	1	1	BRIESE, BEAU MD	7/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115999	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
153736	Fee-for-Service	1336471085	1336471085	1	1	BOTELHO, RONALD J MD LTD	10/14/2013	193400000X	NA	Other	026	PHYSICIANS	53308	None	None	0	In state provider	None	525 DOYLE PARK DRIVE	SUITE 102	SANTA ROSA	CA	95405	4562	49	06097	38.442636	-122.69889	Sonoma County
153740	Fee-for-Service	1023180775	1023180775	1	1	BACHICHA, JOSEPH A MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	41431	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
153756	Fee-for-Service	1336536085	1336536085	1	1	BEAL, ANGELA	6/1/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	34068 CRENSHAW STREET	None	BEAUMONT	CA	92223	7444	33	06065	33.96385069	-117.0699213	Riverside County
153764	Fee-for-Service	1881259901	1881259901	1	1	BREAST CENTER OF IRVINE INC	1/23/2020	261QR0206X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	16100 SAND CANYON AVE	100	IRVINE	CA	92618	3721	30	06059	33.6632187	-117.7721984	Orange County
153797	Fee-for-Service	1861527087	1861527087	1	1	BAKER, DIANA G LMFT	11/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1740 PLUM LN	STE B	REDLANDS	CA	92374	0109	36	06071	34.06899169	-117.2145582	San Bernardino County
153800	Fee-for-Service	1548653199	1548653199	1	1	BHANJI, YASIN MD	6/21/2023	208800000X	NA	Other	026	PHYSICIANS	187043	None	None	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
153817	Fee-for-Service	1770783896	1770783896	1	1	BENYAMIN-AJAIPI, HANI A MD	2/15/2023	207R00000X	NA	Other	026	PHYSICIANS	89899	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
153822	Fee-for-Service	1790855195	1790855195	1	1	BHAMBI, BRIJESH K MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49483	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
153852	Fee-for-Service	1740296904	1740296904	1	1	BROADDUS, V COURTNEY MD	9/30/1985	207RP1001X	NA	Pulmonology	026	PHYSICIANS	49379	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
153869	Fee-for-Service	1306185293	1306185293	1	1	BLANCHARD, KALLE E NP	5/25/2020	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
153874	Fee-for-Service	1265535561	1265535561	1	1	BANNERMAN, MARGARET A MD	2/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	47125	05	Anesthesiology	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
153875	Fee-for-Service	1316997505	1316997505	1	9	BALBOA NEPHROLOGY MEDICAL GR	9/23/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	STE 505	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
153915	Fee-for-Service	1568050201	1568050201	1	1	BOWIE RUSS, DASHAMELLE LCSW	2/19/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
153951	Fee-for-Service	1235767039	1235767039	1	1	BEKO, ZACHARY C CRNA	8/12/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
153956	Fee-for-Service	1811970072	1811970072	1	1	BENJAMIN, LLOYD	1/1/1989	2084P0800X	NA	Psychiatry	026	PHYSICIANS	44478	36	Psychiatry	0	In state provider	None	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	34	06067	38.642832	-121.3649325	Sacramento County
153969	Fee-for-Service	1346470275	1346470275	1	1	BERG, CAROLINA S CNP	8/24/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
153977	Fee-for-Service	1316997505	1316997505	1	25	BALBOA NEPHROLOGY MEDICAL GR	11/1/2016	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11100 WARNER AVENUE	SUITE 218	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.716291	-117.9355051	Orange County
154014	Fee-for-Service	1396721916	1396721916	1	1	BADIE, BAHMAN MD	1/1/2000	207R00000X	NA	Other	026	PHYSICIANS	55163	41	Internal Medicine	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
154036	Fee-for-Service	1962725408	1962725408	1	1	BANTA, MARLYNN E LMFT	9/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
154044	Fee-for-Service	1336536085	1336536085	1	1	BEAL, ANGELA	6/1/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	34068 CRENSHAW STREET	None	BEAUMONT	CA	92223	7444	33	06065	33.96385069	-117.0699213	Riverside County
154049	Fee-for-Service	1669124996	1669124996	1	1	BEHAVIORAL HEALTH CENTERS OF	3/14/2024	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA PSYCHOLOGICA	27201 TOURNEY RD	STE 200D	VALENCIA	CA	91381	1016	19	06037	34.41741018	-118.5770409	Los Angeles County
154092	Fee-for-Service	1679874127	1679874127	1	1	BERNIKER, ABIGAIL V MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136983	30	Radiology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
154102	Fee-for-Service	1255489050	1255489050	1	1	BURKES, JOSEPH B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35116	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
154136	Fee-for-Service	1033505466	1033505466	1	1	BATTAGLIA, KELLY LMFT	2/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45445 PORTOLA AVE	SUITE 1	PALM DESERT	CA	92260	4844	33	06065	33.7186073	-116.3737698	Riverside County
154139	Fee-for-Service	1437220498	1437220498	1	1	BRARA, HARSIMRAN S	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85335	14	Neurological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
154167	Fee-for-Service	1417217993	1417217993	1	1	BOLAJI, RANTI S MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
154169	Fee-for-Service	1609295096	1609295096	1	1	BAKER, KENDRA DO MD	8/28/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16198	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	415 OLD NEWPORT BLVD	SUITE 100	NEWPORT BEACH	CA	92663	4248	30	06059	33.62621345	-117.9266745	Orange County
154175	Fee-for-Service	1750644944	1750644944	1	1	BHOGIREDDY, VARIJA MD	10/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137452	41	Internal Medicine	0	In state provider	None	2710 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
154267	Fee-for-Service	1316997505	1316997505	1	25	BALBOA NEPHROLOGY MEDICAL GR	11/1/2016	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	11100 WARNER AVENUE	SUITE 218	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.716291	-117.9355051	Orange County
154293	Fee-for-Service	1033114061	1033114061	1	1	BUCHANAN, FRANK T MD	1/1/1979	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	26659	01	General Practice	0	In state provider	None	1320 BAILEY DR	STE 102	HANFORD	CA	93230	4378	16	06031	36.32737153	-119.665747	Kings County
154333	Fee-for-Service	1851958052	1851958052	1	1	BARATI, PARVANE DO	12/4/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19320	None	None	0	In state provider	None	1135 S SUNSET AVENUE	SUITE 401	WEST COVINA	CA	91790	3921	19	06037	34.06215064	-117.9453997	Los Angeles County
154338	Fee-for-Service	1669124996	1669124996	1	1	BEHAVIORAL HEALTH CENTERS OF	3/14/2024	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA PSYCHOLOGICA	27201 TOURNEY RD	STE 200D	VALENCIA	CA	91381	1016	19	06037	34.41741018	-118.5770409	Los Angeles County
154368	Fee-for-Service	1467713867	1467713867	1	1	BURBANK, RUBEN L MD	10/29/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
154374	Fee-for-Service	1558873786	1558873786	1	1	BIRKHOLZ, SAMUEL C CRNA	3/15/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	444 BRUCE STREET	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
154391	Fee-for-Service	1811441462	1811441462	1	1	BERASALUCE, SUSANA MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	71319	36	Psychiatry	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
154395	Fee-for-Service	1962457812	1962457812	1	30	BEVERLY RADIOLOGY MEDICAL GR	8/1/2007	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
154428	Fee-for-Service	1205168309	1205168309	1	1	BRONSHTEIN, ELENA MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102919	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
154437	Fee-for-Service	1588600746	1588600746	1	1	BOYD, KATHLEEN M MD	6/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139980	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
154457	Fee-for-Service	1609295096	1609295096	1	1	BAKER, KENDRA DO MD	8/28/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16198	15	Obstetrics (D.O. only)	0	In state provider	None	415 OLD NEWPORT BLVD	SUITE 100	NEWPORT BEACH	CA	92663	4248	30	06059	33.62621345	-117.9266745	Orange County
154461	Fee-for-Service	1558326603	1558326603	1	1	BARON. ROBERT B MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	41928	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154489	Fee-for-Service	1336105675	1336105675	1	1	BROWN, MARK W MD	4/30/1983	207P00000X	NA	Other	026	PHYSICIANS	50087	01	General Practice	0	In state provider	None	3939 IOWA ST	None	SAN DIEGO	CA	92104	3008	37	06073	32.749398	-117.1264015	San Diego County
154520	Fee-for-Service	1184620411	1184620411	1	1	BARTLEY, JAMES MD	9/1/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31441	40	Pediatrics	0	In state provider	None	4000 14TH ST	STE 502	RIVERSIDE	CA	92501	4000	33	06065	33.97771007	-117.3818381	Riverside County
154532	Fee-for-Service	1538629266	1538629266	1	1	BAYATI, JULIAN	4/15/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2975 NORTH SYCAMORE DR.	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
154549	Fee-for-Service	1295091858	1295091858	1	1	BEDARD, ALEXANDER F MD	5/30/2020	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
154557	Fee-for-Service	1346721776	1346721776	1	1	BARENBAUM, JULIETA LMFT	7/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 E THOUSAND OAKS BLVD	176	THOUSAND OAKS	CA	91360	5713	56	06111	34.17902886	-118.8749335	Ventura County
154567	Fee-for-Service	1649472606	1649472606	1	1	BALBUENA, ARNEL A MD	4/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93158	08	Family Practice	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
154571	Fee-for-Service	1154825131	1154825131	1	1	BALARAM, KRIPA MD	10/2/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	185580	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154574	Fee-for-Service	1437294683	1437294683	1	1	BUCKLES, THERESA ANN	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	304 N VILLA ST	None	PORTERVILLE	CA	93257	3211	54	06107	36.07136335	-119.0306374	Tulare County
154589	Fee-for-Service	1659534188	1659534188	1	1	BENSON, RENEE C MD	4/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97674	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
154592	Fee-for-Service	1144311044	1144311044	1	2	BISHARA, MICHAEL F MD	8/27/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	43206	-	NOT APPLICABLE	0	In state provider	None	331 E ADAMS STREET	None	SANTA ANA	CA	92868	3509	30	06059	33.71286994	-117.8638575	Orange County
154622	Fee-for-Service	1669124996	1669124996	1	1	BEHAVIORAL HEALTH CENTERS OF	3/14/2024	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CALIFORNIA PSYCHOLOGICA	27201 TOURNEY RD	STE 200D	VALENCIA	CA	91381	1016	19	06037	34.41741018	-118.5770409	Los Angeles County
154640	Fee-for-Service	1215216965	1215216965	1	1	BOLONDURO, OLUWAMUYIWA MD	6/6/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168133	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	36	06071	34.109001	-117.4357835	San Bernardino County
154659	Fee-for-Service	1609649144	1609649144	1	1	BIN-BILAL, FATIMA DOULA	2/29/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
154662	Fee-for-Service	1063674406	1063674406	1	1	BAYANI, LISA L NP	3/23/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	5671	34	06067	38.470392	-121.4223975	Sacramento County
154668	Fee-for-Service	1548299035	1548299035	1	1	BRENNER, CHARLES S MD	1/1/1982	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	29638	20	Orthopedic Surgery	0	In state provider	None	340 W CENTRAL AVE	STE 124	BREA	CA	92821	3006	30	06059	33.93198898	-117.9008269	Orange County
154682	Fee-for-Service	1457313967	1457313967	1	1	BRASKETT, MELINDA J MD	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83104	03	Allergy	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
154684	Fee-for-Service	1205134301	1205134301	1	1	BOEING, KRISTINA K CRNA	2/6/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
154691	Fee-for-Service	1164884326	1164884326	1	1	BUI, SAN T MD	9/13/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166867	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
154706	Fee-for-Service	1558133108	1558133108	1	1	BRIAN P. MILLER MEDICAL DOCT	12/30/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	OR INC.	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
154730	Fee-for-Service	1083838627	1083838627	1	1	BANNYKH, GALINA I MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76585	22	Pathology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
154744	Fee-for-Service	1255705059	1255705059	1	1	BEST CARE NURSING HOME	10/11/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	6350 LAUREL CANYON BLVD	STE 370	NORTH HOLLYWOOD	CA	91606	3208	19	06037	34.18640491	-118.3964824	Los Angeles County
154746	Fee-for-Service	1417417692	1417417692	1	1	BUSH, WESTON J MD MPH	7/30/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	44151 15TH ST W	101	LANCASTER	CA	93534	4079	19	06037	34.68551775	-118.1568686	Los Angeles County
154767	Fee-for-Service	1740307552	1740307552	1	1	BRIN, MITCHELL F MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86249	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
154775	Fee-for-Service	1225116726	1225116726	1	1	BEAN, MEREDITH A MD	12/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78993	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
154778	Fee-for-Service	1285189894	1285189894	1	1	BRANTLEY, GINA M CRNA	11/14/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
154856	Fee-for-Service	1790729135	1790729135	1	1	BRICHTA, KAREN MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	67562	05	Anesthesiology	0	In state provider	None	2377 W FOOTHILL BLVD	STE 20	UPLAND	CA	91786	3584	36	06071	34.10690963	-117.6975663	San Bernardino County
154865	Fee-for-Service	1467563353	1467563353	1	1	BARON, BARRY C MD	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	32696	04	Otology, Laryngology, Rhinology	0	In state provider	None	2100 WEBSTER ST	STE 329	SAN FRANCISCO	CA	94115	2378	38	06075	37.7904826	-122.4324477	San Francisco County
154875	Fee-for-Service	1780637173	1780637173	1	1	BOSS, PETER S MD	8/31/1982	207P00000X	NA	Other	026	PHYSICIANS	37988	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1116 E LATHAM AVE	None	HEMET	CA	92543	0000	33	06065	33.74938485	-116.9604355	Riverside County
154892	Fee-for-Service	1912966318	1912966318	1	1	BHARAT PATEL MD	11/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 TAMPA GENERAL CIR	None	TAMPA	FL	33606	3571	00	None	27.93877409	-82.4600674	Hillsborough County
154941	Fee-for-Service	1801903489	1801903489	1	1	BYRNES, CHELSIE E MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125485	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
154944	Fee-for-Service	1033200688	1033200688	1	1	BROWN, ELISABETH D MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	73809	08	Family Practice	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
154949	Fee-for-Service	1639639560	1639639560	1	1	BLANCHARD, JOHNNY MD	11/27/2022	207R00000X	NA	Other	026	PHYSICIANS	180043	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
154968	Fee-for-Service	1457313967	1457313967	1	1	BRASKETT, MELINDA J MD	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83104	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
154972	Fee-for-Service	1245422559	1245422559	1	1	BASRAON, RAJVIR K MD	9/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122530	41	Internal Medicine	0	In state provider	None	1180 E SHAW	SUITE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
154976	Fee-for-Service	1073079737	1073079737	1	1	BARKOPOULOS, NICOLE M LMFT	9/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
154994	Fee-for-Service	1558133108	1558133108	1	1	BRIAN P. MILLER MEDICAL DOCT	12/30/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	OR INC.	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
155007	Fee-for-Service	1588643647	1588643647	1	1	BLEIFER, KENNETH H MD	3/22/1971	No Taxonomy Provided	NA	None	026	PHYSICIANS	17238	45	Nephrology (Renal-Kidney)	0	In state provider	None	15243 VANOWEN ST	None	VAN NUYS	CA	91405	3605	19	06037	34.19394848	-118.4654115	Los Angeles County
155035	Fee-for-Service	1699747337	1699747337	1	1	BESKIND,DANIEL L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV PHYS HOSPITAL KINO	2800 E AJO WAY	None	TUCSON	AZ	85713	0000	00	None	32.175801	-110.9306925	Pima County
155055	Fee-for-Service	1710108485	1710108485	1	1	BERRY, LINDA LCSW	4/3/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
155066	Fee-for-Service	1891174058	1891174058	1	1	BENITEZ, LETICIA	10/23/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
155072	Fee-for-Service	1841447950	1841447950	1	1	BALLARD, BROOKE L MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104161	46	Hand Surgery	0	In state provider	None	5555 RESERVOIR DR	# 104	SAN DIEGO	CA	92120	5134	37	06073	32.77628471	-117.0563688	San Diego County
155077	Fee-for-Service	1851362792	1851362792	1	1	BLAKE, CHARLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2102 N COUNTRY CLUB RD	STE B	TUCSON	AZ	85716	2831	00	None	32.247675	-110.9261655	Pima County
155090	Fee-for-Service	1356344196	1356344196	1	1	BAYAT, HAMED MD	12/1/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	61356	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
155098	Fee-for-Service	1174598932	1174598932	1	1	BAHUGUNA, PRANAY MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55727	41	Internal Medicine	0	In state provider	None	726 4TH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
155114	Fee-for-Service	1063467595	1063467595	1	1	BENFORD, JACOB MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60475	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
155134	Fee-for-Service	1689634503	1689634503	1	1	BOYD, WALTER D MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53754	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
155135	Fee-for-Service	1811922768	1811922768	1	1	BROWN, DAVID L MD	1/26/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44720	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
155137	Fee-for-Service	1376956300	1376956300	1	1	BEUERMAN, DAVID R JR LCSW	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18137	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	WARD 93/95	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
155142	Fee-for-Service	1437123312	1437123312	1	1	BALLINGER, KATHARINE A MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88464	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
155144	Fee-for-Service	1659550176	1659550176	2	1	BROTHERS HEALTHCARE INC	10/22/2015	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11705 SLATE AVE	SUITE 250	RIVERSIDE	CA	92505	7120	33	06065	33.9027276	-117.4928061	Riverside County
155160	Fee-for-Service	1073776761	1073776761	1	1	BERNAL, RAYMOND M MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138060	34	Urology and Urological Surgery	0	In state provider	None	1789 W YOSEMITE AVENUE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
155180	Fee-for-Service	1477969970	1477969970	1	1	BH-SD OPCO LLC	12/2/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7050 PARKWAY DR	None	LA MESA	CA	91942	1535	37	06073	32.77442023	-117.0445607	San Diego County
155195	Fee-for-Service	1063660538	1063660538	1	1	BUI, PETER Q MD	12/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108673	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
155213	Fee-for-Service	1215291034	1215291034	1	1	BLAIR, ALBERT E MD	6/16/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
155231	Fee-for-Service	1801903489	1801903489	1	1	BYRNES, CHELSIE E MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125485	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
155233	Fee-for-Service	1326386681	1326386681	1	1	BEROUKHIM AFRAHIMI, SHIVA DO	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12606	01	General Practice	0	In state provider	None	12660 RIVERSIDE DR	STE 310/320	NORTH HOLLYWOOD	CA	91607	5810	19	06037	34.1575795	-118.409499	Los Angeles County
155256	Fee-for-Service	1588272124	1588272124	1	1	BUTKUS, MADELINE OT	10/15/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	151 N SUNRISE AVE	SUITE 1105	ROSEVILLE	CA	95661	2924	31	06061	38.74746043	-121.2655348	Placer County
155272	Fee-for-Service	1679720007	1679720007	1	1	BURLEY, LATANYA LCSW	2/28/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
155276	Fee-for-Service	1932104841	1932104841	1	1	BORREGO SPRINGS FIRE DEP	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2324 STIRRUP RD	None	BORREGO SPRINGS	CA	92004	0898	37	06073	33.26157627	-116.3712722	San Diego County
155285	Fee-for-Service	1073838280	1073838280	1	1	BHAIJEE, MARIA A MD	5/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119312	40	Pediatrics	0	In state provider	None	3490 CALIFORNIA STREET	STE 200	SAN FRANCISCO	CA	94118	1892	38	06075	37.78668333	-122.4514243	San Francisco County
155295	Fee-for-Service	1588643647	1588643647	1	1	BLEIFER, KENNETH H MD	3/22/1971	No Taxonomy Provided	NA	None	026	PHYSICIANS	17238	41	Internal Medicine	0	In state provider	None	15243 VANOWEN ST	None	VAN NUYS	CA	91405	3605	19	06037	34.19394848	-118.4654115	Los Angeles County
155332	Fee-for-Service	1407498413	1407498413	1	1	BRAMASCO, GABRIELLE M LCSW	6/1/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
155339	Fee-for-Service	1891777512	1891777512	1	1	BOROWSKY, ALEXANDER D M	11/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77194	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
155352	Fee-for-Service	1962402800	1962402800	1	1	BENNETT, RANDALL L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY ROOM ASSOCIATE	350 N WILMOT	None	TUCSON	AZ	85711	0000	00	None	32.227209	-110.8556595	Pima County
155360	Fee-for-Service	1841447950	1841447950	1	1	BALLARD, BROOKE L MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104161	20	Orthopedic Surgery	0	In state provider	None	5555 RESERVOIR DR	# 104	SAN DIEGO	CA	92120	5134	37	06073	32.77628471	-117.0563688	San Diego County
155375	Fee-for-Service	1205222445	1205222445	1	1	BHANDAL, NUVPREET S	10/12/2021	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	172631	None	None	0	In state provider	None	6620 COYLE AVE	STE 202	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
155405	Fee-for-Service	1679644926	1679644926	1	1	BEYER, TIMOTHY J PHD	11/22/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.07067	-118.4432445	Los Angeles County
155424	Fee-for-Service	1316024268	1316024268	1	1	BADER, CHERYL L MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65824	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
155448	Fee-for-Service	1255366142	1255366142	1	1	BUTLER, PETER C MD	2/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50362	67	Endocrinology	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
155457	Fee-for-Service	1932166790	1932166790	1	1	BOWERS, JASMINE A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42964	05	Anesthesiology	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
155470	Fee-for-Service	1477969970	1477969970	1	1	BH-SD OPCO LLC	12/5/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7050 PARKWAY DR	None	LA MESA	CA	91942	1535	37	06073	32.77442023	-117.0445607	San Diego County
155479	Fee-for-Service	1013239037	1013239037	1	5	BARTLETT'S HEARING AID CENTE	11/18/2020	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	R	331 ELM STREET	None	RED BLUFF	CA	96080	0301	52	06103	40.17542475	-122.2340147	Tehama County
155521	Fee-for-Service	1528608403	1528608403	1	1	BOLDEN, LISA J CCC-SLP	3/23/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
155534	Fee-for-Service	1639210107	1639210107	1	1	BARDIA, ADITYA MD	5/10/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
155537	Fee-for-Service	1245255207	1245255207	1	1	BERNHEIMER, JONATHAN M MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88386	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
155561	Fee-for-Service	1356665293	1356665293	1	1	BOMMIREDDY, CHANDANA MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128148	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95381	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
155565	Fee-for-Service	1407965692	1407965692	1	1	BARRY, THOMAS P MD	9/30/1987	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	34935	20	Orthopedic Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	STE 201-W	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
155571	Fee-for-Service	1376060343	1376060343	1	1	BURNELL, DESHAWN OT	6/21/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
155576	Fee-for-Service	1336885367	1336885367	1	1	BATTLE ONIHA, VANESSA R C	5/26/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	906 E 23RD ST	None	LOS ANGELES	CA	90011	1265	19	06037	34.02314589	-118.257681	Los Angeles County
155579	Fee-for-Service	1134359466	1134359466	1	1	BRAND, JENNIE MD	8/31/2009	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5842 E NAPLES PLAZA	None	LONG BEACH	CA	90803	5039	19	06037	33.75610548	-118.1200075	Los Angeles County
155589	Fee-for-Service	1518346162	1518346162	2	1	BUONO, JOHN MD	5/19/2023	207L00000X	NA	Other	026	PHYSICIANS	159853	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
155593	Fee-for-Service	1023275526	1023275526	1	1	BAIG, MIRZA S MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79653	02	General Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
155644	Fee-for-Service	1104972140	1104972140	2	1	BALL, BLAIR M OD	10/10/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1659 EAST SIXTH STREET	SUITE A	BEAUMONT	CA	92223	5765	33	06065	33.92928054	-116.94987	Riverside County
155663	Fee-for-Service	1376520437	1376520437	1	1	BEER, THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74347	05	Anesthesiology	0	In state provider	None	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	30	06059	33.746805	-117.834147	Orange County
155704	Fee-for-Service	1316997505	1316997505	1	24	BALBOA NEPHROLOGY MEDICAL GR	9/28/2016	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP, INC.	1955 CITRACADO PKWY	#301	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
155752	Fee-for-Service	1255567939	1255567939	1	1	BRODY, DAVID	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111107	41	Internal Medicine	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
155756	Fee-for-Service	1477969970	1477969970	1	1	BH-SD OPCO LLC	12/5/2014	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7050 PARKWAY DR	None	LA MESA	CA	91942	1535	37	06073	32.77442023	-117.0445607	San Diego County
155781	Fee-for-Service	1003815515	1003815515	1	1	BLANKENSHIP, KEVIN MD	4/22/2024	207P00000X	NA	Other	026	PHYSICIANS	186856	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14614 VICTORY BLVD.	None	VAN NUYS	CA	91411	1621	19	06037	34.18663148	-118.451421	Los Angeles County
155790	Fee-for-Service	1679683338	1679683338	1	1	BOYAN, LISA M	3/3/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10255 LIVE OAK BLVD	None	LIVE OAK	CA	95953	2015	51	06101	39.28004385	-121.661271	Sutter County
155812	Fee-for-Service	1366621807	1366621807	1	1	BODNER, JOHANNES MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
155821	Fee-for-Service	1053936948	1053936948	1	1	BASS, KOURTNEY M NP	4/22/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
155823	Fee-for-Service	1639210107	1639210107	1	1	BARDIA, ADITYA MD	5/10/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
155849	Fee-for-Service	1003855545	1003855545	1	1	BISHOP, GREGORY F MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61181	36	Psychiatry	0	In state provider	None	754 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6654	37	06073	32.61778462	-117.0228924	San Diego County
155855	Fee-for-Service	1407035108	1407035108	1	1	BAGUE, JENNIFER I LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
155862	Fee-for-Service	1336885367	1336885367	1	1	BATTLE ONIHA, VANESSA R C	5/26/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	906 E 23RD ST	None	LOS ANGELES	CA	90011	1265	19	06037	34.02314589	-118.257681	Los Angeles County
155888	Fee-for-Service	1255997763	1255997763	1	1	BROAD MEDICAL GROUP INC	7/23/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	351 HOSPITAL RD	611	NEWPORT BEACH	CA	92663	3509	30	06059	33.62579141	-117.9299554	Orange County
155891	Fee-for-Service	1407302243	1407302243	1	1	BE WELL PHARMACY INC	9/30/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	105 N LAWRENCE AVE	None	FULLERTON	CA	92832	2022	30	06059	33.87074464	-117.9177395	Orange County
155955	Fee-for-Service	1619219490	1619219490	1	1	BETHKE, DARLA K	5/16/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
155958	Fee-for-Service	1093490112	1093490112	1	1	BIOGENE DIAGNOSTICS INC.	11/22/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	10842 NOEL ST	UNIT 111A	LOS ALAMITOS	CA	90720	2555	30	06059	33.8049312	-118.0584384	Orange County
155992	Fee-for-Service	1316997505	1316997505	1	24	BALBOA NEPHROLOGY MEDICAL GR	9/28/2016	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	OUP, INC.	1955 CITRACADO PKWY	#301	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
156018	Fee-for-Service	1710900634	1710900634	1	2	BAZ ALLERGY ASTHMA & SINUS C	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ENTER INC.	2021 HERNDON AVE	102	CLOVIS	CA	93611	6316	10	06019	36.83757551	-119.6792955	Fresno County
156032	Fee-for-Service	1275078958	1275078958	1	1	BLASCO, CALVIN	6/7/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
156062	Fee-for-Service	1164947594	1164947594	1	1	BELLEVILLE, MICHELLE CCC-SL	4/3/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	357 PIERCY RD	None	SAN JOSE	CA	95138	1403	43	06085	37.25708275	-121.7826703	Santa Clara County
156064	Fee-for-Service	1245307859	1245307859	1	1	BELZ, ROBYN L	6/18/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
156078	Fee-for-Service	1821307018	1821307018	1	1	BURKS, ALISON E	8/25/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1240 WESTLAKE BLVD	#117	WESTLAKE VILLAGE	CA	91361	1978	56	06111	34.14966879	-118.8378084	Ventura County
156080	Fee-for-Service	1235106246	1235106246	1	1	BOWEN, RICHARD EARL MD	12/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61613	20	Orthopedic Surgery	0	In state provider	None	2400 S FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
156087	Fee-for-Service	1013062660	1013062660	1	1	BOURNE, JONATHAN C MD	1/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	48548	05	Anesthesiology	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0000	26	06051	37.64575895	-118.9638914	Mono County
156088	Fee-for-Service	1033181326	1033181326	1	1	BENFIELD, RODD J MD	3/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52420	02	General Surgery	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
156115	Fee-for-Service	1811929243	1811929243	1	1	BESETH, BRYCE D MD	12/1/1998	2086S0129X	NA	General Surgery	026	PHYSICIANS	65402	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
156172	Fee-for-Service	1558865238	1558865238	1	1	BARBER, JOHN G MD	5/18/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165265	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
156178	Fee-for-Service	1255997763	1255997763	1	1	BROAD MEDICAL GROUP INC	7/23/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	351 HOSPITAL RD	611	NEWPORT BEACH	CA	92663	3509	30	06059	33.62579141	-117.9299554	Orange County
156222	Fee-for-Service	1851002679	1851002679	1	1	BRAVEMIND COUNSELING, LICENS	12/21/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ED CLINICAL SOCIAL WORKE	55 SCHOOL STREET	SUITE S	COLFAX	CA	95713	1598	31	06061	39.10263019	-120.9536588	Placer County
156229	Fee-for-Service	1811161078	1811161078	1	1	BILLINGS, TAMARA L	5/5/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 DISCOVERY PLAZA	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
156236	Fee-for-Service	1306392857	1306392857	1	1	BU, AMY M OT	3/26/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
156254	Fee-for-Service	1609264704	1609264704	1	1	BEZWADA, PREMA R MD	8/24/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	167422	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6347 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668257	-121.316301	Sacramento County
156284	Fee-for-Service	1942283569	1942283569	1	1	BURCHAM, GREGORY W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
156287	Fee-for-Service	1811700669	1811700669	1	1	BRESHEARS, ASHLEY D CNP	2/13/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2830 EAST ST	None	ANDERSON	CA	96007	3408	45	06089	40.45039337	-122.2969771	Shasta County
156290	Fee-for-Service	1962563163	1962563163	1	1	BASRA, NARINDER S MD	9/8/2004	207R00000X	NA	Other	026	PHYSICIANS	62968	41	Internal Medicine	0	In state provider	None	1481 PLUMAS ST	None	YUBA CITY	CA	95991	2962	51	06101	39.1523234	-121.6181755	Sutter County
156292	Fee-for-Service	1306852975	1306852975	1	1	BINDU, SHANTALA MD	5/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72942	22	Pathology (M.D. only)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
156351	Fee-for-Service	1982718995	1982718995	1	1	BLUMENTHAL, RICHARD A MD	3/6/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	75986	40	Pediatrics	0	In state provider	None	3772 KATELLA AVE	STE 101	LOS ALAMITOS	CA	90720	6420	30	06059	33.8029895	-118.0670445	Orange County
156372	Fee-for-Service	1831145374	1831145374	1	1	BALLOU, KENNETH A MD	8/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85841	41	Internal Medicine	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
156376	Fee-for-Service	1538107248	1538107248	1	1	BIANCO, LUKE S MD	8/1/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	75614	18	Ophthalmology	0	In state provider	None	1827 S COURT ST	STE D	VISALIA	CA	93277	5469	54	06107	36.314424	-119.2922235	Tulare County
156385	Fee-for-Service	1659418747	1659418747	1	1	BERLINER, ROSS A DPM INC	7/1/1998	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3545 GRIFFITH PARK BLVD	None	LOS ANGELES	CA	90027	1404	19	06037	34.11650564	-118.2745901	Los Angeles County
156404	Fee-for-Service	1417914375	1417914375	1	1	BEUTLER, DEBORAH A MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	67367	41	Internal Medicine	0	In state provider	None	55 E CALIFORNIA BLVD	FL 3	PASADENA	CA	91105	3944	19	06037	34.13582278	-118.1491634	Los Angeles County
156423	Fee-for-Service	1437167863	1437167863	1	1	BAKER, GARY L MD	1/3/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	78404	05	Anesthesiology	0	In state provider	None	5750 DOWNEY AVE	STE 306	LAKEWOOD	CA	90712	1408	19	06037	33.859611	-118.1511435	Los Angeles County
156426	Fee-for-Service	1780942599	1780942599	1	1	BRANDEHOFF, NICKLAUS P MD	1/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127500	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
156443	Fee-for-Service	1922193275	1922193275	1	1	BABA, AMY E	3/31/1990	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	602 HUNTLEIGH DR	None	LAFAYETTE	CA	94549	5518	07	06013	37.86644406	-122.0908606	Contra Costa County
156487	Fee-for-Service	1114307477	1114307477	1	1	BACH, ANDREW DO	6/21/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
156495	Fee-for-Service	1427199041	1427199041	1	1	BRADSHAW, ROLANDA R LMFT	2/15/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
156511	Fee-for-Service	1467510040	1467510040	1	2	BUSTOS, ADELAIDA E MD	2/8/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36348	01	General Practice	0	In state provider	None	7862 FIRESTONE BLVD	None	DOWNEY	CA	90241	4221	19	06037	33.94382457	-118.1402202	Los Angeles County
156528	Fee-for-Service	1891837480	1891837480	1	1	BYERS, ROBERT D MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	36957	41	Internal Medicine	0	In state provider	None	2323 DE LA VINA ST	STE 303	SANTA BARBARA	CA	93105	3876	42	06083	34.43202913	-119.7212339	Santa Barbara County
156533	Fee-for-Service	1407894074	1407894074	1	1	BADRESHIA, SONIA P MD	8/14/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	99366	07	Dermatology	0	In state provider	None	28212 KELLY JOHNSON PKWY	SUITE 245	VALENCIA	CA	91355	5084	19	06037	34.44856821	-118.5794922	Los Angeles County
156549	Fee-for-Service	1245442714	1245442714	1	1	BLACK, MARLON D MD	4/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84822	30	Radiology	0	In state provider	None	250 W PUEBLO ST	None	SANTA BARBARA	CA	93105	3805	42	06083	34.43089516	-119.7216367	Santa Barbara County
156561	Fee-for-Service	1508932500	1508932500	1	1	BASTA, FAWZY MD A	9/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42961	None	None	0	In state provider	PROFESSIONAL CORPORATION	17075 DEVONSHIRE STREET	SUITE 204	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
156569	Fee-for-Service	1124227772	1124227772	1	1	BOTROS, ISSA M MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106987	08	Family Practice	0	In state provider	None	1499 W 1ST ST	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
156621	Fee-for-Service	1588667729	1588667729	1	1	BECKER,JEFFREY A DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2423 W DUNLAP AVE	STE 130	PHOENIX	AZ	85021	5818	00	None	33.56694	-112.1117265	Maricopa County
156625	Fee-for-Service	1235372335	1235372335	1	1	BERKE, DAVID J DO	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10716	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
156630	Fee-for-Service	1376581967	1376581967	1	1	BHALLA-REGEV, SANDHYA K	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96187	41	Internal Medicine	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
156640	Fee-for-Service	1154517225	1154517225	1	1	BOGHOSSIAN, FREDERICK A	1/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64878	41	Internal Medicine	0	In state provider	MD INC	1560 E CHEVY CHASE DR	STE 320	GLENDALE	CA	91206	4197	19	06037	34.15290734	-118.2302295	Los Angeles County
156661	Fee-for-Service	1215666060	1215666060	1	1	BREWSTER, REBECCA LMFT	11/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26 W MISSION ST	STE. 7	SANTA BARBARA	CA	93101	0403	42	06083	34.42998638	-119.7156355	Santa Barbara County
156727	Fee-for-Service	1609953256	1609953256	2	1	BOSTON, KEITH J MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53553	01	General Practice	0	In state provider	None	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	34	06067	38.568402	-121.418019	Sacramento County
156730	Fee-for-Service	1477631208	1477631208	1	1	BALELLA, GEORGE A	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	65323	40	Pediatrics	0	In state provider	None	1101 B GALE WILSON BLVD	STE 204	FAIRFIELD	CA	94533	3771	48	06095	38.26103575	-122.0462501	Solano County
156735	Fee-for-Service	1912103011	1912103011	1	1	BAMMIDI, NORA MD	8/14/2017	2084P0800X	NA	Psychiatry	026	PHYSICIANS	149160	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
156736	Fee-for-Service	1831805985	1831805985	1	1	BUSH, SIERRA LCSW	3/17/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
156742	Fee-for-Service	1386312221	1386312221	1	1	BENAVENTE, JUSTINE M OT	11/19/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
156747	Fee-for-Service	1063720894	1063720894	1	1	BURGERT, RALF NP	5/10/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
156755	Fee-for-Service	1346645785	1346645785	1	1	BAJPAI, SAURABH A DO	10/1/2020	208M00000X	NA	Other	026	PHYSICIANS	17274	41	Internal Medicine	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
156776	Fee-for-Service	1871778803	1871778803	1	1	BEAR VALLEY COMMUNITY	9/30/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE DISTRICT	1028 W BIG BEAR BLVD	None	BIG BEAR CITY	CA	92314	9562	36	06071	34.26043406	-116.8635389	San Bernardino County
156778	Fee-for-Service	1164085916	1164085916	1	1	BATAVIA, NEEV B MD	7/25/2022	207P00000X	NA	Other	026	PHYSICIANS	177189	None	None	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
156782	Fee-for-Service	1962581454	1962581454	1	1	BESSER, GEORGE S	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9041	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
156784	Fee-for-Service	1265003081	1265003081	1	1	BARDOS, RACHEL L CNP	1/11/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
156788	Fee-for-Service	1811126329	1811126329	1	1	BRONSON, MICHAEL P MD	7/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113905	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
156797	Fee-for-Service	1811064777	1811064777	1	1	BHOOPAT, MITCHELL MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74263	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
156805	Fee-for-Service	1871504704	1871504704	1	1	BUDA, DANIEL C	6/30/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HEALTHRAX PHYSICAL THRPY	12558 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	2006	30	06059	33.78049752	-118.0307808	Orange County
156809	Fee-for-Service	1801070883	1801070883	1	1	BRECKENRIDGE, AMELIA J MD	3/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127903	08	Family Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
156836	Fee-for-Service	1750975140	1750975140	1	1	BLUE SKIES PHYSICAL THERAPY	2/1/2022	2251S0007X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	20701 CEREAL ST	SKYDIVE ELSINORE, TEAM R	LAKE ELSINORE	CA	92530	9650	33	06065	33.6314242	-117.2959818	Riverside County
156844	Fee-for-Service	1710088729	1710088729	1	1	BARTLEY, ISAAC A MD	5/26/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	50351	None	None	0	In state provider	None	55 E CALIFORNIA BLVD	STE 240	PASADENA	CA	91105	3936	19	06037	34.13582278	-118.1491634	Los Angeles County
156854	Fee-for-Service	1124227772	1124227772	1	1	BOTROS, ISSA M MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106987	01	General Practice	0	In state provider	None	1499 W 1ST ST	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
156855	Fee-for-Service	1558315390	1558315390	1	1	BORER, MICHAEL J MD	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	12589	-	NOT APPLICABLE	0	In state provider	None	8898 CLAIREMONT MESA BLV	SUITE H	SAN DIEGO	CA	92123	1147	37	06073	32.83151508	-117.1370233	San Diego County
156869	Fee-for-Service	1013239037	1013239037	1	3	BARTLETT'S HEARING AID CENTE	6/3/2014	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	6573 CLARK RD	SUITE B	PARADISE	CA	95969	3522	04	06007	39.77512425	-121.5931878	Butte County
156898	Fee-for-Service	1518295799	1518295799	1	2	BADER, MATTHEW LMFT	5/2/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
156899	Fee-for-Service	1700181815	1700181815	1	1	BALSOM, JASON G	7/19/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	17972 SKY PARK CIR	D	IRVINE	CA	92614	4402	30	06059	33.68947173	-117.8600093	Orange County
156904	Fee-for-Service	1740346352	1740346352	1	1	BECERRA, TERESA I LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
156927	Fee-for-Service	1154517225	1154517225	1	1	BOGHOSSIAN, FREDERICK A	1/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64878	10	Gastroenterology (M.D. only)	0	In state provider	MD INC	1560 E CHEVY CHASE DR	STE 320	GLENDALE	CA	91206	4197	19	06037	34.15290734	-118.2302295	Los Angeles County
156930	Fee-for-Service	1164975330	1164975330	1	1	BOLIVAR RINCON, FELIPE MD	8/27/2023	207RA0401X	NA	Other	026	PHYSICIANS	165843	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
156945	Fee-for-Service	1215050190	1215050190	1	1	BRUCH, SUZANNE M	9/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84611	36	Psychiatry	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
156994	Fee-for-Service	1942238704	1942238704	1	1	BRENNAN, JAMES F MD	9/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88125	34	Urology and Urological Surgery	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
157006	Fee-for-Service	1730209784	1730209784	1	1	BURGNER, JOY L LCSW	1/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
157010	Fee-for-Service	1093901639	1093901639	1	1	BALSTER, DOUGLAS A MD	7/15/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	89930	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
157063	Fee-for-Service	1871778803	1871778803	1	1	BEAR VALLEY COMMUNITY	9/30/2005	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE DISTRICT	1028 W BIG BEAR BLVD	None	BIG BEAR CITY	CA	92314	9562	36	06071	34.26043406	-116.8635389	San Bernardino County
157076	Fee-for-Service	1598366809	1598366809	1	1	BAKER, KARLI R PT	3/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	949 S STATE ST	None	HEMET	CA	92543	7182	33	06065	33.73230496	-116.9716029	Riverside County
157079	Fee-for-Service	1407386311	1407386311	1	1	BETTER CHOICE HOME CARE INC	2/5/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2706 MERCANTILE DR	None	RANCHO CORDOVA	CA	95742	6518	34	06067	38.603313	-121.2615495	Sacramento County
157086	Fee-for-Service	1639759822	1639759822	1	1	BODLA, ANU MD	9/25/2024	390200000X	NA	Other	026	PHYSICIANS	187749	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
157122	Fee-for-Service	1679033625	1679033625	1	1	BHATT, DRUMIL P MD	8/30/2022	207R00000X	NA	Other	026	PHYSICIANS	178134	None	None	0	In state provider	None	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
157139	Fee-for-Service	1558359075	1558359075	1	1	BRICCA, BARRY S	1/22/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2295 S VINEYARD AVE	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
157154	Fee-for-Service	1033479894	1033479894	1	1	BOYD, ALLISON B C MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142672	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
157157	Fee-for-Service	1518521293	1518521293	1	1	BREATHING SOL	11/4/2020	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AMILY THERAPY, INK	29970 TECHNOLOGY DR	STE 117B	MURRIETA	CA	92563	2647	33	06065	33.5604702	-117.1370275	Riverside County
157176	Fee-for-Service	1346330750	1346330750	1	1	BALBERONA, DENNIS L PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
157185	Fee-for-Service	1528206752	1528206752	1	1	BRADLEY, KELLY L LMFT	12/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	815 FIRST STREET	SUITE 2	BRENTWOOD	CA	94513	1106	07	06013	37.93394493	-121.6960606	Contra Costa County
157187	Fee-for-Service	1356508048	1356508048	1	1	BERRY, MARK F MD	8/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131436	33	Thoracic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157213	Fee-for-Service	1992962534	1992962534	1	1	BANAYAN, SHAHAB R MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101100	08	Family Practice	0	In state provider	None	6330 VAN NUYS BLVD	None	VAN NUYS	CA	91401	2610	19	06037	34.18546095	-118.4487065	Los Angeles County
157221	Fee-for-Service	1407389984	1407389984	1	1	BASSETT, WILLIAM C MD	9/12/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	170195	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
157281	Fee-for-Service	1679612907	1679612907	1	1	BRENNAN, TODD V MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75140	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
157291	Fee-for-Service	1891924627	1891924627	1	1	BATAAN, ANDREA T MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114152	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95661	2912	31	06061	38.74730831	-121.2613758	Placer County
157308	Fee-for-Service	1659893345	1659893345	1	1	BERLA, NISHITA A PSYD	4/27/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
157309	Fee-for-Service	1275696270	1275696270	1	1	BALE, RONALD PHD	5/20/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
157339	Fee-for-Service	1396172672	1396172672	1	1	BUENCONSEJO, KEISHA LCSW	2/6/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
157350	Fee-for-Service	1417949116	1417949116	1	1	BREITKREUT,LAWRENCE R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1680 ANTILLEY RD	STE 260	ABILENE	TX	79606	5247	00	None	32.37284685	-99.74430295	Taylor County
157374	Fee-for-Service	1396500823	1396500823	1	1	BEAMAN, CRAIG MD	7/8/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
157391	Fee-for-Service	1245317197	1245317197	1	1	BUCKLIN, THEODORE S MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86557	20	Orthopedic Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
157429	Fee-for-Service	1871997692	1871997692	1	1	BULLOCK, AMY M LCSW	9/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	222 E COLE BLVD	STE C	CALEXICO	CA	92231	3211	13	06025	32.69391949	-115.495038	Imperial County
157464	Fee-for-Service	1477712859	1477712859	1	1	BROWN BETTY J LMFT	7/7/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	720 SOUTHPOINT BLVD	STE #202	PETALUMA	CA	94954	8017	49	06097	38.25846424	-122.6470803	Sonoma County
157477	Fee-for-Service	1285894931	1285894931	1	1	BLOOM, EVAN D MD	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108485	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
157478	Fee-for-Service	1851576888	1851576888	1	1	BEAR VALLEY COMMUNITY	11/1/1999	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE DISTRICT	41820 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24651473	-116.8897879	San Bernardino County
157558	Fee-for-Service	1831455328	1831455328	1	1	BESWICK, DANIEL M MD	8/7/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	126429	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
157560	Fee-for-Service	1962461723	1962461723	1	1	BROWN, SHAWNA M LMFT	8/28/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1150 BROOKSIDE AVE	STE J-3	REDLANDS	CA	92373	6300	36	06071	34.04884441	-117.1975972	San Bernardino County
157586	Fee-for-Service	1043274566	1043274566	1	1	BLOOM, BARRY T MD	8/26/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	52444	40	Pediatrics	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
157591	Fee-for-Service	1932439288	1932439288	1	1	BHAMBANI, SHILONI D MD	11/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123002	40	Pediatrics	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
157596	Fee-for-Service	1083607667	1083607667	1	1	BORNFLETH, BRUCE A MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	88125	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
157606	Fee-for-Service	1780977595	1780977595	1	1	BODUKAM, VIJAY K MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131523	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
157607	Fee-for-Service	1467439331	1467439331	1	1	BOGGS, SCOTT I DPM	4/23/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	1	Border provider	None	5221 HWY 95	STE 10	FORT MOHAVE	AZ	86426	9244	00	None	35.004816	-114.5985435	Mohave County
157638	Fee-for-Service	1477627594	1477627594	1	1	BAAS & WOOD PHYSICAL THERAPY	2/11/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22038 OLD 44 DR	None	PALO CEDRO	CA	96073	8707	45	06089	40.56384214	-122.2377098	Shasta County
157658	Fee-for-Service	1316997505	1316997505	1	20	BALBOA NEPHROLOGY MEDICAL GR	11/17/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC	15708 POMERADO ROAD	SUITE N 205	POWAY	CA	92064	2419	37	06073	32.99948815	-117.0580342	San Diego County
157667	Fee-for-Service	1740443621	1740443621	1	1	BARRIOS-LUCERO, ANGELA LMFT	11/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
157677	Fee-for-Service	1295792729	1295792729	1	1	BERGSLAND, EMILY K MD	12/31/1990	207RX0202X	NA	Oncology	026	PHYSICIANS	70524	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	# A540	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
157701	Fee-for-Service	1164630026	1164630026	1	1	BRUCH, DANIEL L DO	2/25/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	9501	None	None	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
157705	Fee-for-Service	1962641019	1962641019	1	1	BROWN, JENNIFER CRNA	8/22/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
157732	Fee-for-Service	1497925143	1497925143	1	1	BREGER, KEVIN S MD	4/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98474	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	# 365	LOS ANGELES	CA	90095	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
157748	Fee-for-Service	1710750039	1710750039	1	1	BONNER, JOEVONNA POSTPARTUM	1/16/2024	172V00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	10	06019	0	0	None
157767	Fee-for-Service	1851576888	1851576888	1	1	BEAR VALLEY COMMUNITY	11/1/1999	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE DISTRICT	41820 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24651473	-116.8897879	San Bernardino County
157795	Fee-for-Service	1497717748	1497717748	1	1	BOLLYKY, JENNIFER B MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55872	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157802	Fee-for-Service	1710125893	1710125893	1	1	BRENT WILLIAMS M.D.	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
157816	Fee-for-Service	1639238223	1639238223	1	1	BANDA, MARCO A MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61355	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
157817	Fee-for-Service	1700050770	1700050770	1	1	BREWER, MELODY L MD	1/28/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	157089	41	Internal Medicine	0	In state provider	None	2220 GLADSTONE DRIVE	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
157835	Fee-for-Service	1821032202	1821032202	1	1	BENDER, GIL	9/11/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	79285	None	None	0	In state provider	None	11637 THE PLZ	None	NORWALK	CA	90650	3930	19	06037	33.90431046	-118.0843459	Los Angeles County
157863	Fee-for-Service	1548265069	1548265069	1	1	BOOKER, CHERIE L RN	11/18/2004	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	YOUR NEIGHBORHOOD HEALTH	3330 CHURN CREEK RD	STE D1	REDDING	CA	96002	2532	45	06089	40.55890497	-122.3530646	Shasta County
157868	Fee-for-Service	1497187801	1497187801	1	1	BOGEY, MICHAEL MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137945	None	None	0	In state provider	None	150 WEST ROUTE 66	None	GLENDORA	CA	91740	6207	19	06037	34.12866152	-117.86535	Los Angeles County
157885	Fee-for-Service	1134197858	1134197858	1	1	BANERJEE, SWATI G MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65826	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
157886	Fee-for-Service	1285159871	1285159871	1	1	BROUSSARD, JANESSA M NP	12/14/2022	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
157918	Fee-for-Service	1417262957	1417262957	1	1	BLANTON, LEE E JR MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121150	20	Orthopedic Surgery	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
157930	Fee-for-Service	1073801544	1073801544	1	1	BRUZZONE, CRISTINE E PHD	6/12/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2790 SKYPARK DRIVE	215	TORRANCE	CA	90505	5388	19	06037	33.80456075	-118.3357569	Los Angeles County
157931	Fee-for-Service	1053304634	1053304634	1	1	BATRA, MONA MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150161	None	None	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
157946	Fee-for-Service	1316997505	1316997505	1	20	BALBOA NEPHROLOGY MEDICAL GR	11/17/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	15708 POMERADO ROAD	SUITE N 205	POWAY	CA	92064	2419	37	06073	32.99948815	-117.0580342	San Diego County
157957	Fee-for-Service	1861256901	1861256901	1	1	BLUE HORIZON MARRIAGE AND FA	2/13/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	41880 KALMIA STREET	SUITE 115	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
157969	Fee-for-Service	1952379893	1952379893	1	1	BRUNSON, JOHN MD	1/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	169438	None	None	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
157976	Fee-for-Service	1750600961	1750600961	1	1	BREGAND-WHITE, JULIA M MD	11/5/2020	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169927	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
157983	Fee-for-Service	1487850244	1487850244	1	1	BELL, AMY M NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6640 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65911992	-117.7737909	Orange County
157995	Fee-for-Service	1689038291	1689038291	1	1	BATLAWALA, DAVIT A MD	1/26/2023	207R00000X	NA	Other	026	PHYSICIANS	173457	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
158045	Fee-for-Service	1407839764	1407839764	1	1	BOE, NINA M MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	77583	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
158049	Fee-for-Service	1639479041	1639479041	1	1	BROWNE, DEREK M DO	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10903	01	General Practice	0	In state provider	None	2683 PACIFIC AVE	None	LONG BEACH	CA	90806	2350	19	06037	33.805926	-118.193738	Los Angeles County
158070	Fee-for-Service	1114392545	1114392545	1	1	BRADLEY, KRISTEN S CRNA	5/11/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
158091	Fee-for-Service	1386983526	1386983526	1	1	BETTER LIFE MEDICAL CLINIC	11/26/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	3001 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5827	19	06037	33.97319307	-118.2152733	Los Angeles County
158105	Fee-for-Service	1194286773	1194286773	1	1	BLOOM, JEFFREY DO	7/1/2023	390200000X	NA	Other	026	PHYSICIANS	21241	None	None	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
158106	Fee-for-Service	1700050770	1700050770	1	1	BREWER, MELODY L MD	1/28/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	157089	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2220 GLADSTONE DRIVE	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
158107	Fee-for-Service	1780997064	1780997064	1	1	BARAS SHREIBATI, JACQUELINE	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117669	06	Cardiovascular Disease (M.D. only)	0	In state provider	D MD	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
158153	Fee-for-Service	1376505941	1376505941	1	1	BLUSTEIN, ARNOLD J MD INC	3/29/2012	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1235 HARRISON STREET	None	SAN LEANDRO	CA	94577	4515	01	06001	37.72577467	-122.1544541	Alameda County
158168	Fee-for-Service	1427184571	1427184571	1	1	BRUST, JAMES S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23423	36	Psychiatry	0	In state provider	None	2403 S MORAY AVE	STE 4	SAN PEDRO	CA	90732	4356	19	06037	33.72448582	-118.3146015	Los Angeles County
158172	Fee-for-Service	1134197858	1134197858	1	1	BANERJEE, SWATI G MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65826	67	Endocrinology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
158266	Fee-for-Service	1124002191	1124002191	1	1	BELL,DON A MD	5/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
158270	Fee-for-Service	1609258516	1609258516	1	1	BOWEN, KRYSTAL M PSYD	4/15/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
158301	Fee-for-Service	1902828742	1902828742	1	1	BANERJEE, DILIP MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39435	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
158307	Fee-for-Service	1013065044	1013065044	1	1	BUSH, JEFFREY A MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87448	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
158337	Fee-for-Service	1639479041	1639479041	1	1	BROWNE, DEREK M DO	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10903	08	Family Practice	0	In state provider	None	2683 PACIFIC AVE	None	LONG BEACH	CA	90806	2350	19	06037	33.805926	-118.193738	Los Angeles County
158341	Fee-for-Service	1154348142	1154348142	1	1	BARANOWSKA,ELZBIETE-DACA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7777 SOUTHWEST FWY	STE 1052	HOUSTON	TX	77074	1813	00	None	29.693502	-95.5213695	Harris County
158346	Fee-for-Service	1073780748	1073780748	1	1	BENDECK, KIRSTEN H MD	6/16/2023	207P00000X	NA	Other	026	PHYSICIANS	119435	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4900	39	06077	37.80110374	-121.1974853	San Joaquin County
158349	Fee-for-Service	1346289824	1346289824	1	1	BOSSERMAN, LINDA D MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49004	78	Neoplastic Diseases/Oncology	0	In state provider	None	50 BELLEFONTAINE ST	STE 304	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
158383	Fee-for-Service	1386983526	1386983526	1	1	BETTER LIFE MEDICAL CLINIC	11/26/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	3001 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5827	19	06037	33.97319307	-118.2152733	Los Angeles County
158403	Fee-for-Service	1578726683	1578726683	1	1	BLAKE NIEDERHAUSER	1/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	645 E 5TH ST	None	WEISER	ID	83672	2202	00	None	44.248716	-116.9617265	Washington County
158461	Fee-for-Service	1528196185	1528196185	1	1	BEYER, ANNA T MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	91747	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2100 WEBSTER ST	#516	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
158504	Fee-for-Service	1225215627	1225215627	1	1	BARRA, QASIM A MD	8/10/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	94633	30	Radiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
158515	Fee-for-Service	1366608226	1366608226	1	1	BROWN, SHELLEY R CNP	4/10/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
158567	Fee-for-Service	1386701621	1386701621	1	1	BURNETTE, KREG A MD	7/9/2008	2080P0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
158572	Fee-for-Service	1629567227	1629567227	1	1	BUI, DANIEL L MD	9/19/2023	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	190116	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
158585	Fee-for-Service	1144209693	1144209693	1	1	BERKOWITZ, CAROL MD	10/31/1986	207PP0204X	NA	Other	026	PHYSICIANS	26068	40	Pediatrics	0	In state provider	None	1124 W CARSON ST	# BLA1	TORRANCE	CA	90502	2006	19	06037	33.83154152	-118.2954105	Los Angeles County
158594	Fee-for-Service	1740487917	1740487917	1	1	BEELER, LAUREN M	5/29/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11105 KNOTT AVE	STE B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
158621	Fee-for-Service	1992104715	1992104715	1	1	BENEDICT, BREANNE MD	7/12/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
158634	Fee-for-Service	1356344683	1356344683	1	1	BLOOM, DAVID M MD	4/28/1999	207RN0300X	NA	Nephrology	026	PHYSICIANS	29631	41	Internal Medicine	0	In state provider	DAVID M BLOOM MD INC	510 N PROSPECT AVE	STE 307	REDONDO BEACH	CA	90277	3032	19	06037	33.85259344	-118.379739	Los Angeles County
158637	Fee-for-Service	1720016942	1720016942	1	1	BROWN, PETER W MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26911	01	General Practice	0	In state provider	None	747 ALTOS OAKS DR	STE 2	LOS ALTOS	CA	94024	5433	43	06085	37.35937158	-122.0942014	Santa Clara County
158638	Fee-for-Service	1346289824	1346289824	1	1	BOSSERMAN, LINDA D MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49004	68	Hematology	0	In state provider	None	50 BELLEFONTAINE ST	STE 304	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
158648	Fee-for-Service	1336525088	1336525088	1	1	BOYLE, JENNIFER W LMFT	10/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10801 NATIONAL BLVD	STE. 251	LOS ANGELES	CA	90064	4139	19	06037	34.03101398	-118.4202342	Los Angeles County
158667	Fee-for-Service	1073693800	1073693800	1	1	BARKER, JOHN C MS	6/29/1978	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	15995 TUSCOLA RD	STE 202	APPLE VALLEY	CA	92307	2159	36	06071	34.54161034	-117.2692275	San Bernardino County
158684	Fee-for-Service	1487159513	1487159513	1	1	BUESING, JESSICA K MD	5/13/2021	207R00000X	NA	Other	026	PHYSICIANS	165547	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158694	Fee-for-Service	1194949180	1194949180	1	1	BEHROOZAN, BENJAMIN MD INC	4/8/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5255 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5716	19	06037	34.09815646	-118.304595	Los Angeles County
158702	Fee-for-Service	1750617387	1750617387	1	1	BERGER, BRIAN T MD	9/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114319	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
158724	Fee-for-Service	1750950499	1750950499	1	2	BARTON MEDICAL FOUNDATION	5/22/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
158741	Fee-for-Service	1497712780	1497712780	1	1	BOYD, LINDA R MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
158744	Fee-for-Service	1871537324	1871537324	1	1	BEHMAND, MICHELE A MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79460	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
158768	Fee-for-Service	1306611371	1306611371	1	1	BROST, SIGRID A NP	1/23/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158773	Fee-for-Service	1417419730	1417419730	1	1	BARRY, ROSE MD	4/23/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180226	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
158774	Fee-for-Service	1073871950	1073871950	1	1	BAHK, BRENDA S MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118661	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
158786	Fee-for-Service	1306011382	1306011382	2	1	BAPTIST - MCGEHEE, WENDI M L	5/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15437 ANACAPA ROAD	SUITE 30	VICTORVILLE	CA	92392	2424	36	06071	34.50557513	-117.3250277	San Bernardino County
158824	Fee-for-Service	1639771868	1639771868	1	1	B7 HEALTH	3/15/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2675 E SLAUSON AVE	SUITE A	HUNTINGTON PARK	CA	90255	2926	19	06037	33.9892055	-118.2228885	Los Angeles County
158853	Fee-for-Service	1760744395	1760744395	1	1	BEG, TASNIM M MD	3/31/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156688	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158854	Fee-for-Service	1053407544	1053407544	1	1	BERGQUIST, DWIGHT A MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	38711	36	Psychiatry	0	In state provider	None	5230 CLARK AVE	STE 10	LAKEWOOD	CA	90712	2649	19	06037	33.853032	-118.1337615	Los Angeles County
158866	Fee-for-Service	1467494179	1467494179	1	1	BUONO, COLLEEN J MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76799	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158873	Fee-for-Service	1144209693	1144209693	1	1	BERKOWITZ, CAROL MD	10/31/1986	207PP0204X	NA	Other	026	PHYSICIANS	26068	01	General Practice	0	In state provider	None	1124 W CARSON ST	# BLA1	TORRANCE	CA	90502	2006	19	06037	33.83154152	-118.2954105	Los Angeles County
158920	Fee-for-Service	1336150200	1336150200	1	2	BAKERSFIELD CENTER FOR	4/19/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	WOMENS HLTH MED GRP	2525 EYE STREET	SUITE 110	BAKERSFIELD	CA	93301	2064	15	06029	35.38245357	-119.0200102	Kern County
158926	Fee-for-Service	1346289824	1346289824	1	1	BOSSERMAN, LINDA D MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49004	02	General Surgery	0	In state provider	None	50 BELLEFONTAINE ST	STE 304	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
158972	Fee-for-Service	1407970213	1407970213	1	1	BALLESTEROS, MARY ANN O	2/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2610 AUGUSTINE DRIVE	None	SANTA CLARA	CA	95054	2900	43	06085	37.38233149	-121.9735799	Santa Clara County
158974	Fee-for-Service	1275885113	1275885113	1	1	BETTIS, MICHAEL W LMFT	8/3/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5005 LAMART DR	100B3	RIVERSIDE	CA	92507	8902	33	06065	33.959493	-117.3322255	Riverside County
158982	Fee-for-Service	1255169629	1255169629	1	1	BAILEY, DARRELL B NP	8/16/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
158989	Fee-for-Service	1114556909	1114556909	1	1	BASALI, FARIBA H MD	10/3/2023	207R00000X	NA	Other	026	PHYSICIANS	182752	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
159001	Fee-for-Service	1952663643	1952663643	1	1	BUI, LINH N MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129338	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
159011	Fee-for-Service	1750950499	1750950499	1	2	BARTON MEDICAL FOUNDATION	10/1/2024	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
159069	Fee-for-Service	1609898345	1609898345	1	1	BREWER, JEANNIE A MD	4/30/1990	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	65325	None	None	0	In state provider	None	2250 ALCAZAR ST	STE 126	LOS ANGELES	CA	90089	0274	19	06037	34.06313563	-118.1997071	Los Angeles County
159072	Fee-for-Service	1477585925	1477585925	1	1	BIRLEW, NICHOLAS R DO	6/16/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	4979	01	General Practice	0	In state provider	STOCKTON URGENT CARE MED	1148 W HAMMER LN	None	STOCKTON	CA	95209	3011	39	06077	38.0208837	-121.3261283	San Joaquin County
159128	Fee-for-Service	1619055357	1619055357	1	1	BROWNE, DAVID L MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67826	40	Pediatrics	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
159132	Fee-for-Service	1932255411	1932255411	1	1	BENNETT, LISETTE J MD	8/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91483	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
159142	Fee-for-Service	1336216340	1336216340	1	1	BERDY, ALEXANDER G MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74405	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
159147	Fee-for-Service	1386754216	1386754216	1	1	BEARIE, BRIAN J MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73011	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
159177	Fee-for-Service	1770100240	1770100240	1	1	BANARIA, DALISAY RCP	7/10/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
159183	Fee-for-Service	1013262302	1013262302	1	1	BOEHME, LAN PT	8/21/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
159201	Fee-for-Service	1740444777	1740444777	1	1	BHANSALI, RAKESH K MD	10/1/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	119352	-	NOT APPLICABLE	0	In state provider	None	2695 S 4TH STREET	2ND FLOOR	EL CENTRO	CA	92243	6012	13	06025	32.76973509	-115.5520629	Imperial County
159219	Fee-for-Service	1093049918	1093049918	2	1	BURGOS, YVONNE B PSYD	3/28/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	S	16425 EL REVINO DR	None	FONTANA	CA	92336	5843	36	06071	34.13844956	-117.4465056	San Bernardino County
159225	Fee-for-Service	1497845077	1497845077	1	1	BOSSART, PHILIP J MD	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF UTHA ER	50 N MEDICAL DR	None	SALT LAKE CTY	UT	84132	0001	00	None	40.77197161	-111.8352608	Salt Lake County
159235	Fee-for-Service	1619102738	1619102738	1	2	BOTROS, MAGED W MD	9/8/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	106640	-	NOT APPLICABLE	0	In state provider	None	11600 ELDRIDGE AVENUE	None	LAKE VIEW TERRACE	CA	91342	6506	19	06037	34.28038404	-118.3838708	Los Angeles County
159251	Fee-for-Service	1457941445	1457941445	1	1	BARNES, RAEESHA M	11/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
159266	Fee-for-Service	1497863146	1497863146	1	1	BACON, OLIVER M MD	11/19/2008	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	73008	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159267	Fee-for-Service	1528493418	1528493418	1	1	BULOS, NELIA B NP	7/7/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
159295	Fee-for-Service	1902905755	1902905755	1	1	BRUBAKER, DANIEL B D0	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	5307	01	General Practice	0	In state provider	MUSCULAR SKELETAL MED	3726 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
159301	Fee-for-Service	1750950499	1750950499	1	2	BARTON MEDICAL FOUNDATION	5/22/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
159311	Fee-for-Service	1316997505	1316997505	1	18	BALBOA NEPHROLOGY MEDICAL GR	3/5/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	752 MEDICAL CENTER CT	SUITE 302	CHULA VISTA	CA	91911	6661	37	06073	32.61800405	-117.0232585	San Diego County
159330	Fee-for-Service	1548399249	1548399249	1	1	BROWNING, SABRINA MD	5/1/2024	2085N0700X	NA	MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
159339	Fee-for-Service	1386063089	1386063089	1	1	BORENSTEIN, YEHONATAN MD	4/13/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143174	36	Psychiatry	0	In state provider	None	5016 CHESEBRO RD	STE 200	AGOURA HILLS	CA	91301	2277	19	06037	34.14134802	-118.7392827	Los Angeles County
159359	Fee-for-Service	1649451071	1649451071	1	1	BENEDICTO M ESTOESTA MD	7/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49318	08	Family Practice	0	In state provider	INC A PROF CORP	55 S HIGHWAY 26	STE 1	VALLEY SPRINGS	CA	95252	8422	05	06009	38.19099952	-120.8281672	Calaveras County
159360	Fee-for-Service	1477585925	1477585925	1	1	BIRLEW, NICHOLAS R DO	6/16/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	4979	08	Family Practice	0	In state provider	STOCKTON URGENT CARE MED	1148 W HAMMER LN	None	STOCKTON	CA	95209	3011	39	06077	38.0208837	-121.3261283	San Joaquin County
159383	Fee-for-Service	1821653262	1821653262	1	1	BREWSTER, AMBER MD	1/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190634	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
159394	Fee-for-Service	1538579024	1538579024	1	1	BRAINARD, JOHN W MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148405	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
159432	Fee-for-Service	1417179623	1417179623	1	1	BARTSCH, STEPHEN B MD	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100862	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
159463	Fee-for-Service	1649503319	1649503319	1	8	BEAVER MEDICAL GROUP LP	12/1/2004	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
159514	Fee-for-Service	1497845077	1497845077	1	1	BOSSART, PHILIP J MD	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF UTHA ER	50 N MEDICAL DR	None	SALT LAKE CTY	UT	84132	0001	00	None	40.77197161	-111.8352608	Salt Lake County
159521	Fee-for-Service	1407395114	1407395114	1	1	BISSET, REBEKAH A PT	10/19/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
159582	Fee-for-Service	1396881546	1396881546	1	1	BLACKMAN, CAROLYN MD	3/19/2024	207R00000X	NA	Other	026	PHYSICIANS	186835	None	None	0	In state provider	None	1800 ADOBE ST	None	CONCORD	CA	94520	2313	07	06013	37.97700068	-122.0381159	Contra Costa County
159583	Fee-for-Service	1902905755	1902905755	1	1	BRUBAKER, DANIEL B D0	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	5307	22	Pathology (M.D. only)	0	In state provider	MUSCULAR SKELETAL MED	3726 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
159603	Fee-for-Service	1316997505	1316997505	1	18	BALBOA NEPHROLOGY MEDICAL GR	3/5/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC	752 MEDICAL CENTER CT	SUITE 302	CHULA VISTA	CA	91911	6661	37	06073	32.61800405	-117.0232585	San Diego County
159647	Fee-for-Service	1649451071	1649451071	1	1	BENEDICTO M ESTOESTA MD	7/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49318	66	Emergency Medicine (Urgent Care)	0	In state provider	INC A PROF CORP	55 S HIGHWAY 26	STE 1	VALLEY SPRINGS	CA	95252	8422	05	06009	38.19099952	-120.8281672	Calaveras County
159653	Fee-for-Service	1023155090	1023155090	1	1	BROWN, PATRICIA T CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	513 PETALUMA BLVD S	None	PETALUMA	CA	94952	5128	49	06097	38.23077046	-122.6323996	Sonoma County
159666	Fee-for-Service	1528422847	1528422847	1	1	BARBER, GRANT E MD	4/25/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	151462	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159682	Fee-for-Service	1346349065	1346349065	1	1	BRICE, BRIAN L MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54371	25	Physical Medicine and Rehabilitation	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
159708	Fee-for-Service	1780620138	1780620138	1	1	BARDENHEIER, JEAN W MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	26965	08	Family Practice	0	In state provider	None	914 E GLADSTONE ST	None	AZUSA	CA	91702	4747	19	06037	34.11408612	-117.8893715	Los Angeles County
159717	Fee-for-Service	1508823451	1508823451	1	1	BURDEN, LINDA J MD	4/15/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35454	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
159731	Fee-for-Service	1093887747	1093887747	1	1	BEGLEY, JASON S MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70931	None	None	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
159794	Fee-for-Service	1417413709	1417413709	1	1	BIGGS UNIFIED SCHOOL	1/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	300 B STREET	None	BIGGS	CA	95917	9732	04	06007	39.41500435	-121.7030739	Butte County
159812	Fee-for-Service	1467005413	1467005413	1	1	BAST, SIDNEY A OT	3/27/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 DIAMOND DR.,	101	LAKE ELSINORE	CA	92530	0000	33	06065	33.65802263	-117.3002985	Riverside County
159814	Fee-for-Service	1316409576	1316409576	1	1	BAAL, JOE DARRYL MD	6/25/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182294	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
159824	Fee-for-Service	1508199431	1508199431	1	1	BISUNA, BLANCA B MD	5/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125110	01	General Practice	0	In state provider	None	1555 HIGUERA ST	None	SAN LUIS OBISPO	CA	93401	2917	40	06079	35.28600339	-120.6530238	San Luis Obispo County
159827	Fee-for-Service	1962443465	1962443465	1	1	BATISTA, OSCAR A MD	6/1/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	168922	None	None	0	In state provider	None	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
159852	Fee-for-Service	1043983505	1043983505	1	1	BEVERLY HILLS REHABILITATION	9/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTRE LLC	580 S SAN VICENTE BLVD	None	LOS ANGELES	CA	90048	4621	19	06037	34.06647955	-118.3732887	Los Angeles County
159868	Fee-for-Service	1902905755	1902905755	1	1	BRUBAKER, DANIEL B D0	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	5307	68	Hematology	0	In state provider	MUSCULAR SKELETAL MED	3726 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
159883	Fee-for-Service	1093936486	1093936486	1	1	BAZ, BRONWYN MD	7/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96638	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
159911	Fee-for-Service	1699866004	1699866004	1	1	BATCH, LOUIS S MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	25522	01	General Practice	0	In state provider	None	1149 W 190TH ST	None	TORRANCE	CA	90248	4321	19	06037	33.85834052	-118.2958065	Los Angeles County
159930	Fee-for-Service	1801182621	1801182621	1	1	BEDAYAT, ARASH MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142404	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159951	Fee-for-Service	1184687782	1184687782	1	2	BHANGOO, SARUPINDER S MD	10/5/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	40294	-	NOT APPLICABLE	0	In state provider	None	1010 1/2 S UNION AVE	None	BAKERSFIELD	CA	93307	3642	15	06029	35.34390262	-119.0029241	Kern County
159955	Fee-for-Service	1598042608	1598042608	1	1	BRIDGE 2 LIFE-ADDISON LLC	2/20/2013	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1331 ADDISON WAY	None	PERRIS	CA	92571	3878	33	06065	33.80281111	-117.1966561	Riverside County
159956	Fee-for-Service	1942294822	1942294822	1	2	BENHACENE, ASSIA MD	11/25/2024	207L00000X	NA	Other	026	PHYSICIANS	92875	05	Anesthesiology	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
160002	Fee-for-Service	1831415280	1831415280	1	1	BALDERAMA, GLADYS P MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120666	41	Internal Medicine	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
160082	Fee-for-Service	1841292406	1841292406	2	1	BRISTOL DRUG CO INC	2/22/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	160 E ARTESIA STREET	SUITE 135	POMONA	CA	91767	2900	19	06037	34.07556833	-117.7507835	Los Angeles County
160127	Fee-for-Service	1770224099	1770224099	1	1	BERRY, ABIGAIL MD	4/29/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	189885	08	Family Practice	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
160144	Fee-for-Service	1972839561	1972839561	1	1	BABARIA, PALAV A MD	3/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
160165	Fee-for-Service	1578737441	1578737441	1	1	BRAGONIER, BRUCE R MD	4/28/2006	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	75427	20	Orthopedic Surgery	0	In state provider	A PROF CORP	555 PETALUMA AVE	STE B	SEBASTOPOL	CA	95472	4225	49	06097	38.39744712	-122.8206197	Sonoma County
160169	Fee-for-Service	1043360282	1043360282	1	1	BARRUETO, GRACE C LMFT	11/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
160221	Fee-for-Service	1801476833	1801476833	1	1	BARMINOVA, INC	4/19/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
160226	Fee-for-Service	1619252418	1619252418	1	1	BRODERICK, RYAN C MD	7/30/2018	208600000X	NA	General Surgery	026	PHYSICIANS	124721	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
160270	Fee-for-Service	1346426509	1346426509	1	1	BOYLE, SIMON PT	3/2/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
160306	Fee-for-Service	1508970195	1508970195	1	1	BLOCH, MICHAEL J MD	5/19/2021	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
160327	Fee-for-Service	1194802512	1194802512	1	1	BROCK-UTNE, ALICE C MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89825	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
160343	Fee-for-Service	1043716947	1043716947	1	1	BALACHANDRAN, BANUJAN MD	9/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164139	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
160377	Fee-for-Service	1851358261	1851358261	1	1	BARBARA LYNN HOFFMAN	4/23/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
160384	Fee-for-Service	1316066624	1316066624	1	1	BRIGGS, LENORA LMFT	4/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	190 SIERRA CT	B111	PALMDALE	CA	93550	7605	19	06037	34.64013337	-118.1280539	Los Angeles County
160395	Fee-for-Service	1649296476	1649296476	1	1	BERNARDINO, DEANNA NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
160410	Fee-for-Service	1346856697	1346856697	1	1	BARRETT, NIKKI LCSW	12/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10251 VISTA SORRENTO PAR	SUITE 280	SAN DIEGO	CA	92121	3776	37	06073	32.89524013	-117.2142063	San Diego County
160444	Fee-for-Service	1588651582	1588651582	1	1	BURNS, CHARLES H MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	46294	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
160470	Fee-for-Service	1689740292	1689740292	1	1	BESHANY, SHIRLEY E MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	60050	30	Radiology	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
160480	Fee-for-Service	1013448471	1013448471	1	1	BLAISDELL, ADAM C MD	6/15/2023	163WG0100X	NA	Other	026	PHYSICIANS	158452	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160483	Fee-for-Service	1215326376	1215326376	1	1	BOLEN, STEPHEN DO	9/1/2019	207P00000X	NA	Other	026	PHYSICIANS	17382	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
160495	Fee-for-Service	1033522032	1033522032	1	1	BECKER, STACI S MD	12/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141836	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
160514	Fee-for-Service	1568948057	1568948057	1	1	BURTON, NAOMI C	2/8/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
160524	Fee-for-Service	1427099571	1427099571	1	1	BRANDECKER,GARY MD	8/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	BOISE	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
160561	Fee-for-Service	1669772331	1669772331	1	1	BLUETT, BRENT R DO	9/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13423	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
160586	Fee-for-Service	1780794404	1780794404	1	1	BARRERA, RICHARD D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
160622	Fee-for-Service	1437205416	1437205416	1	1	BUNGART, JEAN MARIE LVN	11/1/2006	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	425 COLUMBIA AVE	None	MERCED	CA	95340	0914	24	06047	37.32383114	-120.4651597	Merced County
160626	Fee-for-Service	1285814509	1285814509	1	1	BOPPANA, SWAPNA MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127873	41	Internal Medicine	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
160635	Fee-for-Service	1437145505	1437145505	1	1	BALISTRERI, NICOLE A MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62657	08	Family Practice	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
160655	Fee-for-Service	1558477273	1558477273	2	1	BAY AREA EARS, NOSE AND THRO	7/31/2020	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	AT MEDICAL GROUP	13847 E 14TH STREET	SUITE 200	SAN LEANDRO	CA	94578	2626	01	06001	37.71457844	-122.1418551	Alameda County
160666	Fee-for-Service	1417996018	1417996018	1	1	BALLEHR, LISA O DO	6/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9111	30	Radiology	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
160676	Fee-for-Service	1780658450	1780658450	1	1	BEAR, HOWARD M MD	3/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53263	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
160697	Fee-for-Service	1861562498	1861562498	1	1	BERNARD, KAREN M CRNA	5/30/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	624 E ELDER ST	None	FALLBROOK	CA	92028	3004	37	06073	33.38020455	-117.2446307	San Diego County
160698	Fee-for-Service	1487816567	1487816567	1	1	BUI, THAI BINH	7/21/2009	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2222 W BURBANK BLVD	#101	BURBANK	CA	91506	1280	19	06037	34.1795859	-118.3353987	Los Angeles County
160703	Fee-for-Service	1306096698	1306096698	1	1	BHARGAVA, AMIT MD	2/14/2025	207RE0101X	NA	Endocrinology	026	PHYSICIANS	159320	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
160738	Fee-for-Service	1316034465	1316034465	1	1	BENSON, LAUREL J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE UNIV OF CO HOSPITAL	4200 E 9TH AVE	None	DENVER	CO	80218	0000	00	None	39.73096549	-104.9380785	Denver County
160768	Fee-for-Service	1689005431	1689005431	1	1	BAUTISTA, ALONSO D LMFT	9/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
160799	Fee-for-Service	1013007848	1013007848	1	1	BIRNBAUM, JUSTIN A MD	4/30/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	77734	36	Psychiatry	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
160832	Fee-for-Service	1275709883	1275709883	1	1	BATTH, NITASHA K MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146379	30	Radiology	0	In state provider	None	1867 E FIR AVE	STE 101	FRESNO	CA	93720	3841	10	06019	36.8391095	-119.7486135	Fresno County
160861	Fee-for-Service	1275912321	1275912321	1	1	BOATENG, ADJOA A MD	7/28/2020	207L00000X	NA	Other	026	PHYSICIANS	162030	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
160914	Fee-for-Service	1588935100	1588935100	1	1	BENTSON, NORMAN R PHD	2/17/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
160917	Fee-for-Service	1285814509	1285814509	1	1	BOPPANA, SWAPNA MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127873	78	Neoplastic Diseases/Oncology	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
160938	Fee-for-Service	1134985310	1134985310	1	1	BOARD, ANAIYA L DOULA	2/28/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
160944	Fee-for-Service	1558477273	1558477273	2	1	BAY AREA EARS, NOSE AND THRO	7/31/2020	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	AT MEDICAL GROUP	13847 E 14TH STREET	SUITE 200	SAN LEANDRO	CA	94578	2626	01	06001	37.71457844	-122.1418551	Alameda County
160951	Fee-for-Service	1437142882	1437142882	1	1	BIRNBAUM, NEAL S MD	2/2/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	36561	None	None	0	In state provider	None	2300 CALIFORNIA ST	# 3	SAN FRANCISCO	CA	94115	2753	38	06075	37.78910083	-122.4323944	San Francisco County
160978	Fee-for-Service	1841488715	1841488715	1	1	BACLENE, JULIE PT	8/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	81 CERNON ST.	None	VACAVILLE	CA	95688	2803	48	06095	38.36102104	-121.9906107	Solano County
160987	Fee-for-Service	1255493540	1255493540	1	1	BENHAM, ANNE LELAND MD	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35998	26	Psychiatry (child)	0	In state provider	None	725 WELCH ROAD MC 5500	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
160990	Fee-for-Service	1114005980	1114005980	1	2	BAKAL, ARTHUR E MD	10/11/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49908	-	NOT APPLICABLE	0	In state provider	None	1820 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87536985	-122.2622489	Alameda County
161018	Fee-for-Service	1144582719	1144582719	1	1	BELZER, CASSIE L CNM	9/6/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	14500 ROSCOE BLVD	FLOOR 4 OFFICE 58	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
161021	Fee-for-Service	1003885302	1003885302	1	1	BUTLER, LISA C.	6/6/1996	207R00000X	NA	Other	026	PHYSICIANS	77400	41	Internal Medicine	0	In state provider	None	1330 W COVINA BLVD	STE 205	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
161054	Fee-for-Service	1437286952	1437286952	1	1	BEN - OZER, SNUNIT MD	6/10/2019	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79191	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
161079	Fee-for-Service	1528027323	1528027323	1	1	BEDRICK,ALAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL	None	TUCSON	AZ	85724	0000	00	None	32.240493	-110.9460825	Pima County
161106	Fee-for-Service	1912293796	1912293796	1	1	BROWN, CHE'RON	8/4/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4735 W. AVENUE J3	None	LANCASTER	CA	93536	2305	19	06037	34.686855	-118.215891	Los Angeles County
161120	Fee-for-Service	1275709883	1275709883	1	1	BATTH, NITASHA K MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146379	13	Neurology (M.D. only)	0	In state provider	None	1867 E FIR AVE	STE 101	FRESNO	CA	93720	3841	10	06019	36.8391095	-119.7486135	Fresno County
161132	Fee-for-Service	1043290042	1043290042	1	1	BAILEY, ROBERT B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1920 E CAMBRIDGE AVE	STE 302	PHOENIX	AZ	85006	1464	00	None	33.4775733	-112.040141	Maricopa County
161143	Fee-for-Service	1558805028	1558805028	1	1	BABINS, NEIL LMFT	5/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
161146	Fee-for-Service	1720083447	1720083447	1	1	BOORMAN, ANITA L DO	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7268	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
161152	Fee-for-Service	1871074849	1871074849	1	1	BALLINGER, SHARON NP	2/12/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
161181	Fee-for-Service	1013938745	1013938745	1	1	BINIWALE, MANOJ A MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53244	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
161182	Fee-for-Service	1144780941	1144780941	1	1	BALCEREK, JOANNA MD	7/3/2023	207ZP0105X	NA	Other	026	PHYSICIANS	180012	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
161184	Fee-for-Service	1285692756	1285692756	1	1	BIANES, BEVERLY P	6/2/1991	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	916 E 8TH ST	STE 8	NATIONAL CITY	CA	91950	2566	37	06073	32.67844844	-117.0974319	San Diego County
161190	Fee-for-Service	1780181446	1780181446	1	1	BLACUTT, MIGUEL A MD	8/4/2022	207L00000X	NA	Other	026	PHYSICIANS	163600	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
161195	Fee-for-Service	1942627864	1942627864	1	1	BARTRET, ADAM L MD	5/28/2019	2085R0001X	NA	Other	026	PHYSICIANS	138185	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161203	Fee-for-Service	1982750451	1982750451	1	1	BARTA, GINA E MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	68375	01	General Practice	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
161205	Fee-for-Service	1285814509	1285814509	1	1	BOPPANA, SWAPNA MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127873	68	Hematology	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
161209	Fee-for-Service	1295178325	1295178325	1	1	BADALIAN, SILVA LCSW	4/17/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
161233	Fee-for-Service	1043257082	1043257082	1	1	BORIGINI, MARK JAMES MD	3/31/1989	207RR0500X	NA	Other	026	PHYSICIANS	67619	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
161242	Fee-for-Service	1750363248	1750363248	1	1	BAY ARE CARDIOLOGY MED	8/15/1988	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	GROUP	2222 EAST ST	STE 260	CONCORD	CA	94520	2074	07	06013	37.98125538	-122.0329375	Contra Costa County
161249	Fee-for-Service	1003868894	1003868894	1	1	BHAGAT, VISHAL J MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55786	30	Radiology	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
161256	Fee-for-Service	1609897529	1609897529	1	1	BI-VALLEY MEDICAL CLINIC	7/15/1981	261QM2800X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	INC.	2100 CAPITOL AVE	None	SACRAMENTO	CA	95816	5721	34	06067	38.572722	-121.479849	Sacramento County
161272	Fee-for-Service	1255493540	1255493540	1	1	BENHAM, ANNE LELAND MD	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35998	36	Psychiatry	0	In state provider	None	725 WELCH ROAD MC 5500	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
161284	Fee-for-Service	1740848373	1740848373	1	1	BERNAL, OLIVIA A MD	10/28/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	180219	38	Geriatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
161290	Fee-for-Service	1275629107	1275629107	1	1	BENNETT, GARY D MD	2/8/2015	207LP2900X	NA	Other	026	PHYSICIANS	40059	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
161300	Fee-for-Service	1902175441	1902175441	1	1	BABAIE, CAMELLIA MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	119462	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
161322	Fee-for-Service	1588167498	1588167498	1	1	BARSAMIAN, JEANNE B	11/19/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 S 13TH STREET	SUITE 209	GROVER BEACH	CA	93433	2263	40	06079	35.11998633	-120.6154278	San Luis Obispo County
161343	Fee-for-Service	1497930275	1497930275	1	1	BEN-ROOHI, MOSHE MD	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108444	25	Physical Medicine and Rehabilitation	0	In state provider	None	41670 IVY STREET	STE B	MURRIETA	CA	92562	9433	33	06065	33.55420371	-117.207013	Riverside County
161373	Fee-for-Service	1013912641	1013912641	1	2	BAKERSFIELD FAMILY MED	5/6/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GRP INC	10420 MAIN ST	None	LAMONT	CA	93421	1727	15	06029	35.2602534	-118.9145592	Kern County
161379	Fee-for-Service	1205144862	1205144862	1	1	BRAVO, OSCAR P MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130205	66	Emergency Medicine (Urgent Care)	0	In state provider	None	520 WEST I ST	None	LOS BANOS	CA	95616	6201	24	06047	37.06346603	-120.8593647	Merced County
161383	Fee-for-Service	1891249926	1891249926	1	2	BALBI, MIRANDA J	2/24/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	111807	-	NOT APPLICABLE	0	In state provider	None	113 E F ST	None	TEHACHAPI	CA	93561	1710	15	06029	35.13095398	-118.4470847	Kern County
161384	Fee-for-Service	1538235411	1538235411	1	1	BEYER, SARAH P PHD	9/26/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
161393	Fee-for-Service	1912293796	1912293796	1	1	BROWN, CHE'RON	8/4/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4735 W. AVENUE J3	None	LANCASTER	CA	93536	2305	19	06037	34.686855	-118.215891	Los Angeles County
161433	Fee-for-Service	1003862376	1003862376	1	1	BROWN, PAUL J MD	6/4/2008	207R00000X	NA	Other	026	PHYSICIANS	73322	41	Internal Medicine	0	In state provider	None	3333 SKYPARK DR	STE 160	TORRANCE	CA	90505	5042	19	06037	33.81036565	-118.3466218	Los Angeles County
161438	Fee-for-Service	1477631182	1477631182	1	1	BUI, JAMES MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61800	01	General Practice	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
161445	Fee-for-Service	1912065111	1912065111	1	1	BULLOCK, ROBERT A MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	12026	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5101 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.771997	-117.0059635	San Diego County
161488	Fee-for-Service	1902812878	1902812878	1	1	BARR, NANCY MD	2/1/1993	207ZP0102X	NA	Other	026	PHYSICIANS	52555	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
161495	Fee-for-Service	1609201664	1609201664	1	1	BOLSA EXPRESS PHARMACY INC	2/25/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9262 BOLSA AVE	STE A	WESTMINSTER	CA	92683	8905	30	06059	33.74473951	-117.9676755	Orange County
161497	Fee-for-Service	1730376518	1730376518	1	1	BRIAN HYUN PARK MD	5/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	747 BROADWAY	None	SEATTLE	WA	98122	4379	00	None	47.608326	-122.3207985	King County
161504	Fee-for-Service	1649462821	1649462821	1	1	BHATIA, RICHA MD	6/26/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	117359	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161524	Fee-for-Service	1962475566	1962475566	1	1	BERNARD, AARON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1945 CORLIES AVE	None	NEPTUNE	NJ	08753	0000	00	None	40.20750349	-74.0406949	Monmouth County
161530	Fee-for-Service	1427584374	1427584374	1	1	BESSER, ALEXANDRA	6/15/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165976	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161532	Fee-for-Service	1801097118	1801097118	1	1	BITTAR, NATALIE K MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100100	08	Family Practice	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
161542	Fee-for-Service	1649503319	1649503319	1	5	BEAVER MEDICAL GROUP LP	2/17/1993	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
161556	Fee-for-Service	1164691572	1164691572	1	1	BURROWS, FREDERICK C LMFT	7/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
161570	Fee-for-Service	1881086502	1881086502	1	1	BIGGS, KATHERINE MD	4/1/2022	207P00000X	NA	Other	026	PHYSICIANS	19110	None	None	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
161591	Fee-for-Service	1932154135	1932154135	1	1	BUCHANAN, SCOTT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	818 CONGRESS ST	None	PORTLAND	ME	04102	3112	00	None	43.654338	-70.2736065	Cumberland County
161602	Fee-for-Service	1235320722	1235320722	1	1	BIRDWELL, ERIC MD	1/31/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55660	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
161667	Fee-for-Service	1013912641	1013912641	1	2	BAKERSFIELD FAMILY MED	5/6/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GRP INC	10420 MAIN ST	None	LAMONT	CA	93421	1727	15	06029	35.2602534	-118.9145592	Kern County
161690	Fee-for-Service	1821459033	1821459033	1	1	BECKETT, JOSHUA LMFT	11/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2525 W WASHINGTON BL	104	LOS ANGELES	CA	90018	1247	19	06037	34.03992146	-118.3185405	Los Angeles County
161694	Fee-for-Service	1508138538	1508138538	1	1	BRINING, LUCY P MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121956	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
161711	Fee-for-Service	1659317667	1659317667	1	1	BRAND, MICHAEL R MD	11/30/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54989	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
161712	Fee-for-Service	1891782009	1891782009	1	1	BASI, UPINDER K MD	6/1/1998	207R00000X	NA	Other	026	PHYSICIANS	65829	41	Internal Medicine	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
161723	Fee-for-Service	1932121654	1932121654	1	1	BERMAN, MARK H MD	1/1/1996	207L00000X	NA	Other	026	PHYSICIANS	55944	05	Anesthesiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
161726	Fee-for-Service	1033521190	1033521190	1	1	BERMAN, ZACHARY T MD	7/10/2020	2085R0204X	NA	Other	026	PHYSICIANS	141051	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
161730	Fee-for-Service	1912065111	1912065111	1	1	BULLOCK, ROBERT A MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	12026	05	Anesthesiology	0	In state provider	None	5101 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.771997	-117.0059635	San Diego County
161755	Fee-for-Service	1669856217	1669856217	1	1	BANAJJAR REVANASIDDAPPA, VAN	5/22/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162179	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ITHA MD	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
161761	Fee-for-Service	1629145552	1629145552	1	1	BARROW, IVAN L MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61170	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
161790	Fee-for-Service	1871545012	1871545012	1	1	BYUN, TIMOTHY E MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70195	67	Endocrinology	0	In state provider	None	1140 W LAVETA	STE 610	ORANGE	CA	92780	0000	30	06059	33.7802984	-117.8651669	Orange County
161824	Fee-for-Service	1891221073	1891221073	1	1	BRAR, RAMANPREET K MD	7/1/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164941	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
161843	Fee-for-Service	1972088581	1972088581	1	1	BAY AREA PL SERVICES	3/27/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	841 SAN BRUNO AVE W	STE 100	SAN BRUNO	CA	94066	3443	41	06081	37.62821976	-122.4179614	San Mateo County
161877	Fee-for-Service	1750797908	1750797908	1	1	BROWN, SHENAE N LMFT	10/22/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	114977	-	NOT APPLICABLE	0	In state provider	None	2550 W. CLINTON AVE.	R, S, Y, D, P	FRESNO	CA	93705	4201	10	06019	36.77202022	-119.8415276	Fresno County
161894	Fee-for-Service	1336963503	1336963503	1	1	BANUELOS, DANIEL PT	12/11/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1916 N MAIN ST.	None	SALINAS	CA	93906	2034	27	06053	36.71995522	-121.655807	Monterey County
161896	Fee-for-Service	1245595016	1245595016	1	1	BAQUING, MARY A T M MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126927	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
161898	Fee-for-Service	1679262265	1679262265	1	1	BEATON-BARRETT, CARA A NP	6/15/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161908	Fee-for-Service	1265884498	1265884498	1	1	BALOUCH, EAMAN MD	11/15/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	167007	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
161928	Fee-for-Service	1134288897	1134288897	1	1	BLOOM, EDWARD E MD	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	20554	84	Surgery-Head and Neck	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
161934	Fee-for-Service	1215908512	1215908512	1	1	BRASS, ERIC P MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78003	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
161950	Fee-for-Service	1013371194	1013371194	1	1	BURKHOLDER, DAVID MD	10/28/2019	207P00000X	NA	Other	026	PHYSICIANS	160400	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
161954	Fee-for-Service	1366439473	1366439473	1	1	BENSON, CHRISTOPHER J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSP & CLNS	200 HAWKINS DR	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
161955	Fee-for-Service	1669534327	1669534327	1	1	BUMGARDNER, MELODY PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
161967	Fee-for-Service	1831103381	1831103381	1	1	BENGS, CHRISTOPHER J MD	8/31/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53107	01	General Practice	0	In state provider	None	2910 JEFFERSON ST	STE 100	CARLSBAD	CA	92008	2357	37	06073	33.16226261	-117.3463592	San Diego County
161970	Fee-for-Service	1346869567	1346869567	1	1	BAJWA, SAHIBA MD	12/1/2023	207R00000X	NA	Other	026	PHYSICIANS	191215	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
161975	Fee-for-Service	1720468341	1720468341	1	1	BAUTISTA VALLDERUTEN, CAROLI	11/3/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173277	None	None	0	In state provider	NA MD	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
162003	Fee-for-Service	1831374883	1831374883	1	1	BABU, JOOBY MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100099	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	LOS ANGELES	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles
162017	Fee-for-Service	1912065111	1912065111	1	1	BULLOCK, ROBERT A MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	12026	01	General Practice	0	In state provider	None	5101 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.771997	-117.0059635	San Diego County
162034	Fee-for-Service	1790944783	1790944783	1	1	BOLAND, BRENDAN MD	10/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87312	02	General Surgery	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
162041	Fee-for-Service	1124558267	1124558267	1	1	BELCHENKO, DMITRY D DO	11/11/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	19737	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
162050	Fee-for-Service	1932270907	1932270907	1	1	BRONSTEIN, MICHAEL A MD	10/1/1995	207RC0200X	NA	Other	026	PHYSICIANS	68645	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
162051	Fee-for-Service	1629145552	1629145552	1	1	BARROW, IVAN L MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61170	01	General Practice	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
162070	Fee-for-Service	1609916733	1609916733	1	1	BILCHIK, ANTON J	8/31/1990	2086X0206X	NA	General Surgery	026	PHYSICIANS	49766	78	Neoplastic Diseases/Oncology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
162072	Fee-for-Service	1396829396	1396829396	1	1	BELANI, JAY S MD	9/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91036	34	Urology and Urological Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
162078	Fee-for-Service	1871545012	1871545012	1	1	BYUN, TIMOTHY E MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70195	78	Neoplastic Diseases/Oncology	0	In state provider	None	1140 W LAVETA	STE 610	ORANGE	CA	92780	0000	30	06059	33.7802984	-117.8651669	Orange County
162079	Fee-for-Service	1184160517	1184160517	1	1	BANKS, JAMINELLI DPM	7/8/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 100	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
162100	Fee-for-Service	1356609663	1356609663	1	1	BERGER, CHRISTOPHER ALLEN MD	3/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129759	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94409	4364	41	06081	37.53039072	-122.2987772	San Mateo County
162120	Fee-for-Service	1518535921	1518535921	1	1	BERNARD, LINDSEY T AU	10/28/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
162146	Fee-for-Service	1881216885	1881216885	1	1	BRIGHTSTAR HOSPICE INC	9/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18711 SHERMAN WAY	SUITE 107	RESEDA	CA	91335	4095	19	06037	34.20120092	-118.5408066	Los Angeles County
162160	Fee-for-Service	1710340203	1710340203	1	1	BLACK, JOHN MD	7/25/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
162189	Fee-for-Service	1417278615	1417278615	1	1	BENNETT, SHARMA F LMFT	10/16/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
162191	Fee-for-Service	1770576142	1770576142	1	1	BROWN, ANTHONY J MD	8/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82833	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
162199	Fee-for-Service	1952383929	1952383929	1	1	BULLOCK, DANIEL W MD	12/31/2012	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	30957	20	Orthopedic Surgery	0	In state provider	None	444 BRUCE STREET	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
162212	Fee-for-Service	1114411709	1114411709	1	1	BUNGGAY, JOYCE HYACINTH F NP	2/8/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	550 W RANCH VIEW DR	2005	ROCKLIN	CA	95765	5396	31	06061	38.83760761	-121.2972372	Placer County
162216	Fee-for-Service	1134288897	1134288897	1	1	BLOOM, EDWARD E MD	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	20554	04	Otology, Laryngology, Rhinology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
162221	Fee-for-Service	1215908512	1215908512	1	1	BRASS, ERIC P MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78003	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
162235	Fee-for-Service	1942623657	1942623657	1	2	BORREGO COMMUNITY HEALTH	8/12/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	58581 US HIGHWAY 371	SUITE F, G, H	ANZA	CA	92539	9331	33	06065	33.5569201	-116.6397862	Riverside County
162256	Fee-for-Service	1831103381	1831103381	1	1	BENGS, CHRISTOPHER J MD	8/31/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53107	08	Family Practice	0	In state provider	None	2910 JEFFERSON ST	STE 100	CARLSBAD	CA	92008	2357	37	06073	33.16226261	-117.3463592	San Diego County
162271	Fee-for-Service	1639270614	1639270614	1	1	BURGER, SHAWN G	5/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
162288	Fee-for-Service	1619647898	1619647898	1	1	BETTER LIFE HOME HEALTH AGEN	4/11/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 502A	NORTH HOLLYWOOD	CA	91606	3183	19	06037	34.18663951	-118.4043555	Los Angeles County
162291	Fee-for-Service	1831374883	1831374883	1	1	BABU, JOOBY MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100099	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	LOS ANGELES	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles
162336	Fee-for-Service	1932270907	1932270907	1	1	BRONSTEIN, MICHAEL A MD	10/1/1995	207RC0200X	NA	Other	026	PHYSICIANS	68645	41	Internal Medicine	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
162339	Fee-for-Service	1932247939	1932247939	1	1	BANDA, PARVATHI D MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64080	41	Internal Medicine	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
162353	Fee-for-Service	1316997505	1316997505	1	30	BALBOA NEPHROLOGY MEDICAL GR	11/27/2024	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	855 THIRD AVE	SUITE 2210	CHULA VISTA	CA	91911	1350	37	06073	32.62197574	-117.0723222	San Diego County
162358	Fee-for-Service	1609916733	1609916733	1	1	BILCHIK, ANTON J	8/31/1990	2086X0206X	NA	General Surgery	026	PHYSICIANS	49766	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
162365	Fee-for-Service	1487327201	1487327201	1	1	B&B MEDICAL GROUP INC	4/27/2022	2085R0204X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	CH	16506 LAKEWOOD BLVD	STE 200	BELLFLOWER	CA	90706	5165	19	06037	33.88470916	-118.1424401	Los Angeles County
162409	Fee-for-Service	1336258037	1336258037	1	1	BANSUAN, RAINER G MD	9/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	51021	None	None	0	In state provider	BANSUAN MEDICAL CLINIC	10305 GARVEY AVE	None	EL MONTE	CA	91733	2135	19	06037	34.0627893	-118.0464002	Los Angeles County
162413	Fee-for-Service	1770517690	1770517690	1	1	BIRKHOLMS ORTHO SVC INC	3/1/2005	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	510 E CHAPEL ST	None	SANTA MARIA	CA	93454	4520	42	06083	34.95426852	-120.4293825	Santa Barbara County
162417	Fee-for-Service	1982058673	1982058673	1	1	BOYD, BRITTNI A MD	6/12/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153950	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
162421	Fee-for-Service	1235769100	1235769100	1	1	BARNES, MIRANDA	8/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 N BRAND BLVD	202	GLENDALE	CA	91203	2644	19	06037	34.147521	-118.2549325	Los Angeles County
162434	Fee-for-Service	1881216885	1881216885	1	1	BRIGHTSTAR HOSPICE INC	9/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18711 SHERMAN WAY	SUITE 107	RESEDA	CA	91335	4095	19	06037	34.20120092	-118.5408066	Los Angeles County
162448	Fee-for-Service	1265180681	1265180681	1	1	BURNEY, HEIDI PSYD	4/4/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
162477	Fee-for-Service	1710097001	1710097001	1	1	BLOOD, DAVID C MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68900	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
162506	Fee-for-Service	1740866847	1740866847	1	1	BENNION, OWEN	7/19/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
162521	Fee-for-Service	1760702468	1760702468	1	1	BARISCIANO, TRACI PHD	5/26/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
162523	Fee-for-Service	1942623657	1942623657	1	2	BORREGO COMMUNITY HEALTH	8/12/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	58581 US HIGHWAY 371	SUITE F, G, H	ANZA	CA	92539	9331	33	06065	33.5569201	-116.6397862	Riverside County
162524	Fee-for-Service	1588017628	1588017628	1	1	BALTZ, GEORGE J LCSW	5/26/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
162538	Fee-for-Service	1487120630	1487120630	1	1	BLYTHE, MOOREA PSYD	5/25/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1074 EAST AVE	STE J #3	CHICO	CA	95926	1052	04	06007	39.76099443	-121.8353929	Butte County
162539	Fee-for-Service	1417123308	1417123308	1	1	BAINS, SUNDEEP S MD	11/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103580	08	Family Practice	0	In state provider	None	2020 SUTTER PLACE	None	DAVIS	CA	95616	6213	57	06113	38.56287659	-121.7715536	Yolo County
162562	Fee-for-Service	1740322429	1740322429	1	1	BROOKS, JILLIAN M RHT	10/1/2002	261QR0200X	NA	Mammography/MRI Provider	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	CORNING X-RAY	155 SOLANO ST	None	CORNING	CA	96021	3511	52	06103	39.92779745	-122.1687508	Tehama County
162579	Fee-for-Service	1831374883	1831374883	1	1	BABU, JOOBY MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100099	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	LOS ANGELES	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles
162600	Fee-for-Service	1023053592	1023053592	1	1	BASINGER, BRADLEY B	1/31/1990	208600000X	NA	General Surgery	026	PHYSICIANS	68890	02	General Surgery	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
162613	Fee-for-Service	1366590523	1366590523	1	1	BOL, EVA K PHD	11/1/1996	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	14610 ADDISON ST	None	SHERMAN OAKS	CA	91403	1709	19	06037	34.16119807	-118.45142	Los Angeles County
162616	Fee-for-Service	1023632528	1023632528	1	1	BURDICK, BETHANY L MD	7/14/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187196	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
162621	Fee-for-Service	1841610482	1841610482	1	1	BAIK, ALAN H CA	6/21/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	139577	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162643	Fee-for-Service	1104093277	1104093277	1	1	BERNER, NAIRI A MD	10/14/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	120980	67	Endocrinology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
162652	Fee-for-Service	1215382841	1215382841	1	1	BERNADETT, ALEX MD	8/14/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163325	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
162657	Fee-for-Service	1831103878	1831103878	1	1	BARON, ROBINSON V MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	32332	02	General Surgery	0	In state provider	None	274 W BADILLO ST	None	COVINA	CA	91723	1906	19	06037	34.08623971	-117.8942892	Los Angeles County
162664	Fee-for-Service	1801121751	1801121751	1	1	BERONA, KRISTIN M MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113837	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
162739	Fee-for-Service	1255470829	1255470829	1	1	BISSANTI, NICHOLAS A PT	3/5/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
162740	Fee-for-Service	1780365809	1780365809	1	1	BALAJADIA, MARLONINO V CRNA	12/26/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
162770	Fee-for-Service	1467695452	1467695452	1	1	BAHIA, RAJWINDER S MD	3/19/2016	207R00000X	NA	Other	026	PHYSICIANS	106330	41	Internal Medicine	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
162841	Fee-for-Service	1982017364	1982017364	1	1	BOSLEY, AMANDA M CRNA	11/14/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
162853	Fee-for-Service	1790413920	1790413920	1	1	BASCO, DAVID M NP	7/1/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
162931	Fee-for-Service	1689653651	1689653651	1	1	BARKER, MATTHEW D MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131787	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
162939	Fee-for-Service	1639177488	1639177488	1	1	BLASCHKA, SHARON L NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162965	Fee-for-Service	1932376209	1932376209	1	1	BRECEK, CALLIE H NP	9/9/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
162967	Fee-for-Service	1851457980	1851457980	1	1	BERKENKOTTER, EREN G PHD	2/24/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162968	Fee-for-Service	1568893162	1568893162	1	1	BOOTH, CHRISTOPHER R PSYD	1/31/2019	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
162978	Fee-for-Service	1114955036	1114955036	2	1	BRAIN AND SPINE SURGEONS	9/6/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	OF ORANGE COUNTY AMC	3900 WEST COAST HIGHWAY	SUITE 300	NEWPORT BEACH	CA	92663	4093	30	06059	33.62164982	-117.9325147	Orange County
163005	Fee-for-Service	1144857186	1144857186	1	1	BITAR, JOYCE M MD	8/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	184993	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
163035	Fee-for-Service	1902297864	1902297864	1	1	BAKER, ALEXIS B MFT	4/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	85363	-	NOT APPLICABLE	0	In state provider	None	306 SPRUCE AVE	None	S SAN FRANCISCO	CA	94080	2741	41	06081	37.65669155	-122.4159146	San Mateo County
163041	Fee-for-Service	1437607041	1437607041	1	1	BEHMARDIAN, ANAHITA S CNP	10/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4950 BARRANCA PKWY	STE 104	IRVINE	CA	92604	8644	30	06059	33.67620851	-117.7948348	Orange County
163042	Fee-for-Service	1427687797	1427687797	1	1	BABAIAN, NINA MD	9/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184181	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
163055	Fee-for-Service	1376164210	1376164210	1	1	BOTELLO, EDGAR A CNP	12/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5530 AVENUE DE LOS ROBLE	None	VISALIA	CA	93291	5174	54	06107	36.328365	-119.3525775	Tulare County
163075	Fee-for-Service	1568449916	1568449916	1	1	BLAZES, CHRISTOPHER K MD	11/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140172	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
163080	Fee-for-Service	1790853760	1790853760	1	1	BASRAI, KARANJIT S MD	1/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73010	25	Physical Medicine and Rehabilitation	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
163096	Fee-for-Service	1861539868	1861539868	1	1	BYNUM, SUSAN OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVIEW HWY	None	PETALUMA	CA	94954	5698	49	06097	38.32168809	-122.6254468	Sonoma County
163155	Fee-for-Service	1952581563	1952581563	1	1	BULGARELLI, TIMOTHY CPO	8/25/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	PACIFIC PROSTHETICS & OR	44439 N 17TH ST WEST	#101	LANCASTER	CA	93534	2831	19	06037	34.69070437	-118.161312	Los Angeles County
163178	Fee-for-Service	1710929393	1710929393	1	1	BRODEY, PHILIP A MD	7/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	31828	30	Radiology	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
163246	Fee-for-Service	1396761342	1396761342	1	1	BASTA, HANY L MD	8/2/1995	207L00000X	NA	Other	026	PHYSICIANS	54439	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
163256	Fee-for-Service	1851035869	1851035869	1	1	BABCHANIK, SVYATOSLAV I PT	12/16/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
163262	Fee-for-Service	1679583579	1679583579	1	1	BASU, ANJULI MD	5/30/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77943	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
163268	Fee-for-Service	1396773636	1396773636	1	1	BERMAN, ALAN S MD	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	26936	08	Family Practice	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
163273	Fee-for-Service	1619984234	1619984234	1	1	BLUMENKRANTZ, MICHAEL MD	9/30/1989	207RN0300X	NA	Nephrology	026	PHYSICIANS	17734	01	General Practice	0	In state provider	None	2080 CENTURY PARK E	STE 707	LOS ANGELES	CA	90067	2010	19	06037	34.05887194	-118.4122914	Los Angeles County
163281	Fee-for-Service	1598748402	1598748402	1	1	BHANU, ARCHANA MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	48082	08	Family Practice	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
163284	Fee-for-Service	1063982874	1063982874	1	1	BROWN, JULIANE C LMFT	1/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	921 THE ALAMEDA	STE 227	BERKELEY	CA	94707	2311	01	06001	37.89086106	-122.2769457	Alameda County
163381	Fee-for-Service	1588735468	1588735468	1	1	BELLMAN, GARY C MD	5/10/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51907	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
163405	Fee-for-Service	1518915008	1518915008	1	1	BERNSTEIN, BENJAMIN MD	8/11/2020	208800000X	NA	Other	026	PHYSICIANS	168759	34	Urology and Urological Surgery	0	In state provider	None	2576 RENFREW ST	None	EUREKA	CA	95501	3345	12	06023	40.78539559	-124.1387085	Humboldt County
163414	Fee-for-Service	1326673914	1326673914	1	1	BLU ALLIANCE COUNSELING CENT	4/26/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ER	1109 W SAN BERNARDINO RD	150	COVINA	CA	91722	4163	19	06037	34.0887369	-117.9124702	Los Angeles County
163421	Fee-for-Service	1285867887	1285867887	1	1	BEVERLY RADIOLOGY MEDICAL	1/29/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	222 E MAIN ST	#214	BARSTOW	CA	92311	2361	36	06071	34.89870403	-117.025149	San Bernardino County
163426	Fee-for-Service	1861744799	1861744799	1	1	BURTON, DIANA L	7/11/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95815	7097	34	06067	38.56554	-121.4664615	Sacramento County
163432	Fee-for-Service	1346791852	1346791852	1	1	BERMUDEZ, CARLOS H CNP	7/28/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95040241	-	NOT APPLICABLE	0	In state provider	None	730 POLK STREET	4TH FLOOR	SAN FRANCISCO	CA	94109	7813	38	06075	37.78379532	-122.4192766	San Francisco County
163452	Fee-for-Service	1619644879	1619644879	1	1	BOOK A RIDE	5/24/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13601 WHITTIER BLVD	201	WHITTIER	CA	90605	1954	19	06037	33.96101144	-118.0289736	Los Angeles County
163460	Fee-for-Service	1972838829	1972838829	1	2	BROOKS, DIONNE P LCSW	3/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	811 W. 7TH ST.	12TH FLOOR	LOS ANGELES	CA	90017	3403	19	06037	34.0489635	-118.2591312	Los Angeles County
163462	Fee-for-Service	1053563262	1053563262	1	1	BENAVIDES, REBECCA S PT	8/25/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
163483	Fee-for-Service	1306149174	1306149174	1	1	BAKER, BURTON H MD AMC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	22979	02	General Surgery	0	In state provider	None	2425 EAST STREET	SUITE 18	CONCORD	CA	94520	1926	07	06013	37.98269056	-122.0340837	Contra Costa County
163509	Fee-for-Service	1255410312	1255410312	1	1	BURNS, DARRYL E DPM	10/31/1985	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	951 BLANCO CIR	STE E	SALINAS	CA	93901	4451	27	06053	36.65589725	-121.6366313	Monterey County
163518	Fee-for-Service	1336646751	1336646751	1	1	BERGH, JUSTIN DO	1/1/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22196	None	None	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
163530	Fee-for-Service	1346309309	1346309309	1	1	BHURIA, HIMANSHU MD	9/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	87684	41	Internal Medicine	0	In state provider	None	1595 SOQUEL AVE	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98156752	-122.0042426	Santa Cruz County
163535	Fee-for-Service	1396761342	1396761342	1	1	BASTA, HANY L MD	8/2/1995	207L00000X	NA	Other	026	PHYSICIANS	54439	01	General Practice	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
163599	Fee-for-Service	1578050795	1578050795	1	1	BADII, MELODY MD	9/1/2023	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	177067	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
163620	Fee-for-Service	1891346508	1891346508	1	1	BENFIELD, SHELLY B CNP	1/16/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2510 EL CAMINO REAL	None	CARLSBAD	CA	92008	1273	37	06073	33.17942276	-117.3266425	San Diego County
163644	Fee-for-Service	1881663714	1881663714	1	1	BEADLES, KEVIN A MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75050	18	Ophthalmology	0	In state provider	None	1313 SOLANO AVE	None	ALBANY	CA	94706	1825	01	06001	37.8906857	-122.2920823	Alameda County
163671	Fee-for-Service	1831622927	1831622927	1	1	BONNICK, KRISTINE MD	9/21/2023	208600000X	NA	General Surgery	026	PHYSICIANS	157751	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
163686	Fee-for-Service	1477655066	1477655066	1	1	BLEHA, JULIET L MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68780	40	Pediatrics	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
163690	Fee-for-Service	1114005741	1114005741	1	1	BOWER, KIMBERLY A MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83280	08	Family Practice	0	In state provider	None	4311 THIRD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
163727	Fee-for-Service	1669488391	1669488391	1	1	BULLARD-BERENT, JEFFREY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
163747	Fee-for-Service	1215005558	1215005558	1	1	BAKER,ALAN F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
163801	Fee-for-Service	1467612622	1467612622	1	1	BRUNER, HEATHER C MD	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55860	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
163806	Fee-for-Service	1437134582	1437134582	1	1	BATCHTOLD, JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	557 W WASHINGTON ST	None	BURNS	OR	97720	1441	00	None	43.58870813	-119.060725	Harney County
163807	Fee-for-Service	1316997505	1316997505	1	13	BALBOA NEPHROLOGY MEDICAL GR	9/20/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC	655 SO EUCLID AVE	SUITE 303	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
163811	Fee-for-Service	1235139791	1235139791	1	1	BURMAN, ERIK J MD	6/1/1998	207ZP0102X	NA	Other	026	PHYSICIANS	64607	22	Pathology (M.D. only)	0	In state provider	None	2425 HARRISON AVE	None	EUREKA	CA	95501	3218	12	06023	40.78525339	-124.1395667	Humboldt County
163818	Fee-for-Service	1609117704	1609117704	1	1	BOUTELLE, AMY L NP	9/24/2019	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
163858	Fee-for-Service	1033341326	1033341326	1	1	BARRIGA, HELIBET F LCSW	1/9/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
163881	Fee-for-Service	1639553688	1639553688	1	1	BIG SUR HEALTH CENTER	12/22/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	46896 HIGHWAY 1	None	BIG SUR	CA	93920	9693	27	06053	36.26867238	-121.8064797	Monterey County
163920	Fee-for-Service	1225297021	1225297021	1	1	BABIKIAN, SARKIS MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109747	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
163945	Fee-for-Service	1639286792	1639286792	1	1	BIARDI, LAURA J CNM	10/18/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
163954	Fee-for-Service	1053337998	1053337998	1	1	BAE, HO S MD INC	1/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	83132	10	Gastroenterology (M.D. only)	0	In state provider	None	201 S ALVARADO ST	STE 711	LOS ANGELES	CA	90057	2390	19	06037	34.06417777	-118.2719543	Los Angeles County
163966	Fee-for-Service	1033360052	1033360052	1	1	B MANALU, CRYSTAL	2/12/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	04	06007	0	0	None
163986	Fee-for-Service	1174704951	1174704951	1	1	BHASKER-RAO, BOBBY S MD APC	6/12/2006	208600000X	NA	General Surgery	026	PHYSICIANS	76846	02	General Surgery	0	In state provider	None	35900 BOB HOPE DR	STE 205	RANCHO MIRAGE	CA	92270	1764	33	06065	33.790311	-116.405864	Riverside County
163994	Fee-for-Service	1124106729	1124106729	1	1	BLOOM, HOWARD R MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65007	18	Ophthalmology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
164010	Fee-for-Service	1528329190	1528329190	1	1	BANALES, ISABEL R	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
164018	Fee-for-Service	1457425233	1457425233	1	1	BROWN, RHONDA L LMFT	10/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5701 W SLAUSON AVE	116	CULVER CITY	CA	90230	6523	19	06037	33.98900269	-118.3811279	Los Angeles County
164027	Fee-for-Service	1508420464	1508420464	1	1	BLOCH, AARON S MD	9/5/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	28078 BAXTER RD	450	MURRIETA	CA	92563	1402	33	06065	33.615	-117.1670265	Riverside County
164028	Fee-for-Service	1558479691	1558479691	1	1	BIELEN, ROBERT J MD INC	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	35222	20	Orthopedic Surgery	0	In state provider	None	280 S MAIN ST	STE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
164053	Fee-for-Service	1396087136	1396087136	1	1	BRADY, RYAN P MD	7/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140347	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
164084	Fee-for-Service	1316315955	1316315955	1	1	BIO-MEDICAL APPLICATIONS OF	10/1/2015	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1809 W CHAPMAN AVE	None	ORANGE	CA	92868	2605	30	06059	33.78793852	-117.8720775	Orange County
164095	Fee-for-Service	1316997505	1316997505	1	13	BALBOA NEPHROLOGY MEDICAL GR	9/20/2013	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	655 SO EUCLID AVE	SUITE 303	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
164112	Fee-for-Service	1841341377	1841341377	1	1	BAIN, MICHAEL A MD INC	4/7/2015	208200000X	NA	General Surgery	026	PHYSICIANS	88162	24	Plastic Surgery	0	In state provider	None	1441 AVOCADO AVE	STE 706	NEWPORT BEACH	CA	92660	7708	30	06059	33.61338536	-117.8693961	Orange County
164155	Fee-for-Service	1033134770	1033134770	1	1	BANZUELA, CRESENCIA D MD	8/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53873	None	None	0	In state provider	INC	260 E ONTARIO AVE	STE 204	CORONA	CA	92879	3507	33	06065	33.8560157	-117.5678999	Riverside County
164167	Fee-for-Service	1639553688	1639553688	1	1	BIG SUR HEALTH CENTER	12/22/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	46896 HIGHWAY 1	None	BIG SUR	CA	93920	9693	27	06053	36.26867238	-121.8064797	Monterey County
164179	Fee-for-Service	1780918276	1780918276	1	1	BLANCO, ERNESTO I MD	5/12/2020	2085P0229X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
164235	Fee-for-Service	1750758595	1750758595	1	1	BANGEN, KATHERINE J PHD	7/5/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
164268	Fee-for-Service	1972777217	1972777217	1	1	BARAZI, HASSAN MD	2/2/2020	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
164273	Fee-for-Service	1871052787	1871052787	1	1	BIRO, JULIANA B MD	12/9/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179862	None	None	0	In state provider	None	2801 ATLANTIC AVE	3RD FL	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
164275	Fee-for-Service	1174704951	1174704951	1	1	BHASKER-RAO, BOBBY S MD APC	6/12/2006	208600000X	NA	General Surgery	026	PHYSICIANS	76846	10	Gastroenterology (M.D. only)	0	In state provider	None	35900 BOB HOPE DR	STE 205	RANCHO MIRAGE	CA	92270	1764	33	06065	33.790311	-116.405864	Riverside County
164290	Fee-for-Service	1770767923	1770767923	1	1	BOWDISH, MATTHEW S MD	4/4/2018	207K00000X	NA	Other	026	PHYSICIANS	92192	03	Allergy	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
164311	Fee-for-Service	1134745821	1134745821	1	1	BHAT, SUDARSHAN	11/2/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191247	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
164344	Fee-for-Service	1396092227	1396092227	1	1	BUI, VIET L MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128401	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLZ	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
164349	Fee-for-Service	1902098304	1902098304	1	1	BAKER, GARY L MD APC	1/3/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	5750 DOWNEY AVE	STE 306	LAKEWOOD	CA	90712	1480	19	06037	33.859611	-118.1511435	Los Angeles County
164364	Fee-for-Service	1801260120	1801260120	1	1	BLATT, ALISA G LMFT	4/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22231 MULHOLLAND HWY	#212	CALABASAS	CA	91302	5123	19	06037	34.14821793	-118.6123368	Los Angeles County
164377	Fee-for-Service	1861758476	1861758476	1	1	BACA, QUENTIN J MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126544	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
164383	Fee-for-Service	1619102191	1619102191	1	1	BERKOVIC, YURO J MD	10/28/2019	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	161452	04	Otology, Laryngology, Rhinology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
164402	Fee-for-Service	1801858048	1801858048	1	1	BRENIS, MARK I DPM	9/30/1992	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1850 41ST AVE	STE 103	CAPITOLA	CA	95010	2569	44	06087	36.9765	-121.9648415	Santa Cruz County
164447	Fee-for-Service	1831327253	1831327253	1	2	BLUE RIBBON HOME HEALTH INC	2/8/2015	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4854 VAN NUYS BLVD	SUITE 250	SHERMAN OAKS	CA	91403	2112	19	06037	34.159122	-118.4486945	Los Angeles County
164458	Fee-for-Service	1639553688	1639553688	1	1	BIG SUR HEALTH CENTER	12/22/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	46896 HIGHWAY 1	None	BIG SUR	CA	93920	9693	27	06053	36.26867238	-121.8064797	Monterey County
164461	Fee-for-Service	1336497502	1336497502	1	1	BYRD, JOSEPH M	4/4/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3951 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	3620	33	06065	33.92276786	-117.4483793	Riverside County
164470	Fee-for-Service	1245967025	1245967025	1	1	BOSCO THERAPY LCSW PC	1/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	777 E TAHQUITZ CANYON WA	None	PALM SPRINGS	CA	92262	6784	33	06065	33.82304055	-116.540676	Riverside County
164501	Fee-for-Service	1982887006	1982887006	1	1	BROOKES, KYLIE L MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145300	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
164536	Fee-for-Service	1083651657	1083651657	1	1	BRAVO, JAN S MD	9/30/1987	207P00000X	NA	Other	026	PHYSICIANS	43844	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
164541	Fee-for-Service	1841914520	1841914520	1	1	BELONGIA, MACY M	3/4/2025	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	4056 ALTA MESA DR	None	REDDING	CA	96002	3732	45	06089	40.54821409	-122.3303114	Shasta County
164544	Fee-for-Service	1295380517	1295380517	1	1	BADRZADEH, HOUMAN MD	1/22/2025	207R00000X	NA	Other	026	PHYSICIANS	20306	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
164608	Fee-for-Service	1104002914	1104002914	1	1	BEACH AREA FAM HLTH CTR	8/16/1991	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	3705 MISSION BLVD	None	SAN DIEGO	CA	92109	7104	37	06073	32.78273202	-117.2524549	San Diego County
164619	Fee-for-Service	1285014498	1285014498	1	1	BETTY, MARYANN R MD	8/15/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158573	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
164631	Fee-for-Service	1396092227	1396092227	1	1	BUI, VIET L MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128401	83	Rheumatology	0	In state provider	None	200 MEDICAL PLZ	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
164651	Fee-for-Service	1437784469	1437784469	1	1	BAZAN, JOSE L NP	1/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
164654	Fee-for-Service	1013239037	1013239037	1	1	BARTLETT'S HEARING AID CENTE	6/9/2010	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	2201 PILLSBURY ROAD	#194	CHICO	CA	95926	1373	04	06007	39.75797923	-121.8485781	Butte County
164672	Fee-for-Service	1952445454	1952445454	2	1	BURTIS, LISA LARIMER LMFT	3/29/2021	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	327 E. REDWOOD AVENUE	B	FORT BRAGG	CA	95437	3263	23	06045	39.4442763	-123.80293	Mendocino County
164690	Fee-for-Service	1669014866	1669014866	1	1	BUNTHUNG, CHANNE NP	12/20/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	390 N PACIFIC COAST HWY	STE 1000	EL SEGUNDO	CA	90245	4475	19	06037	33.92077214	-118.3960953	Los Angeles County
164720	Fee-for-Service	1104355643	1104355643	1	1	BARONI, ERIN MD	9/28/2021	207R00000X	NA	Other	026	PHYSICIANS	173100	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
164726	Fee-for-Service	1255754263	1255754263	1	1	BEUCK, JULES E LCSW	7/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	33	06065	33.79748917	-116.3786855	Riverside County
164727	Fee-for-Service	1013433424	1013433424	1	1	BENNETT, FRANCES L LMFT	9/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
164746	Fee-for-Service	1639553688	1639553688	1	1	BIG SUR HEALTH CENTER	12/22/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	46896 HIGHWAY 1	None	BIG SUR	CA	93920	9693	27	06053	36.26867238	-121.8064797	Monterey County
164750	Fee-for-Service	1336114545	1336114545	1	2	BELL, IRA MD	7/1/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	47339	None	None	0	In state provider	None	23832 ROCKFIELD BLVD	SUITE 210	LAKE FOREST	CA	92630	2876	30	06059	33.6263651	-117.7142932	Orange County
164787	Fee-for-Service	1366911232	1366911232	1	1	BUTTARS, ALEXANDRA PT	4/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6759 SIERRA CT	SUITE A	DUBLIN	CA	94568	2670	01	06001	37.70825702	-121.9144925	Alameda County
164797	Fee-for-Service	1275587586	1275587586	1	1	BLEDSOE, SCOTT C MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8187	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
164806	Fee-for-Service	1679817019	1679817019	1	1	BANJ HEALTH CENTER INC	11/20/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3624 MLK JR BLVD	None	LYNWOOD	CA	90262	2607	19	06037	33.93146164	-118.2031117	Los Angeles County
164811	Fee-for-Service	1154468429	1154468429	1	1	BAKER, CHRISTOPHER D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTIVEW BLVD	None	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
164827	Fee-for-Service	1528578382	1528578382	1	1	BESBRIS, ELENA LCSW	3/18/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107113	-	NOT APPLICABLE	0	In state provider	None	2330 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2220	19	06037	34.0681396	-118.2738016	Los Angeles County
164829	Fee-for-Service	1083677561	1083677561	1	1	BRADFORD, JOHN E PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8253 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10363411	-117.5643979	San Bernardino County
164843	Fee-for-Service	1932225208	1932225208	1	1	BADYMOGHADDAM, YAGHOUB	9/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52570	01	General Practice	0	In state provider	None	5726 E OLYMPIC BLVD	None	LOS ANGELES	CA	90022	5120	19	06037	34.01390045	-118.1473735	Los Angeles County
164845	Fee-for-Service	1457982522	1457982522	1	1	BRUCE, THALIA L	5/21/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5743 1/2 CASE AVE	None	NORTH HOLLYWOOD	CA	91601	5723	19	06037	34.175124	-118.371979	Los Angeles County
164858	Fee-for-Service	1437484516	1437484516	1	1	BILOTTI, CAITLIN P MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110562	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
164875	Fee-for-Service	1255664124	1255664124	1	1	BOO, THOMAS J MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80249	08	Family Practice	0	In state provider	None	153 PIONEER LN	STE B	BISHOP	CA	93514	2517	14	06027	37.3624356	-118.4073711	Inyo County
164907	Fee-for-Service	1023321460	1023321460	1	1	BHADARE, DILRANI PSYD	6/5/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
164921	Fee-for-Service	1871223115	1871223115	1	1	BOKHARI, SHARMEEN	7/14/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	179 GUNNISON AVE	None	SACRAMENTO	CA	95838	2101	34	06067	38.650959	-121.4640765	Sacramento County
164922	Fee-for-Service	1063732428	1063732428	1	1	BACON, LOUISE N MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135799	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
164940	Fee-for-Service	1336686369	1336686369	1	1	BRIDGES TO SELF EMPOWERMENT	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	406 CHINN ST	None	SANTA ROSA	CA	95404	4339	49	06097	38.444787	-122.707098	Sonoma County
164966	Fee-for-Service	1295094845	1295094845	1	1	BRAM-MOSTYN, AVRAM A DO	7/20/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	16910	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
164977	Fee-for-Service	1790006187	1790006187	1	1	BROGAN, SAPNA S MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138496	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
164992	Fee-for-Service	1295078608	1295078608	1	1	BLAKE, BRIAN W MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132770	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
164993	Fee-for-Service	1225340961	1225340961	1	1	BYUN, CHARLTON K MD	12/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54035	30	Radiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3917	19	06037	34.062852	-117.9446658	Los Angeles County
165029	Fee-for-Service	1548450489	1548450489	1	1	BAHL, PANKAJ MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97988	68	Hematology	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
165031	Fee-for-Service	1699918367	1699918367	1	1	BOUFENNARA, CARLA D LMFT	9/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	863 FRANCISCO BLVD E	SUITE A	SAN RAFAEL	CA	94901	4782	21	06041	37.96169984	-122.5077494	Marin County
165041	Fee-for-Service	1184292229	1184292229	1	1	BJORK, MATTHEW	4/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2300 N. IMPERIAL AVE	STE H	CALEXICO	CA	92231	3209	13	06025	32.691258	-115.4988845	Imperial County
165047	Fee-for-Service	1851582050	1851582050	1	1	BRANNIGAN, DANIEL S DC	8/10/2016	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
165055	Fee-for-Service	1659498004	1659498004	1	4	BOYLE HEIGHTS CARDIOVASCULAR	3/9/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP. INC	1700 E CESAR E CHAVEZ AV	1200	LOS ANGELES	CA	90033	2467	19	06037	34.05101259	-118.217259	Los Angeles County
165085	Fee-for-Service	1275587586	1275587586	1	1	BLEDSOE, SCOTT C MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8187	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
165090	Fee-for-Service	1477566099	1477566099	1	1	BOURCIER, CAROLINE	11/13/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	465 MILLER AVE	None	MILL VALLEY	CA	94941	2941	21	06041	37.89532639	-122.5342048	Marin County
165096	Fee-for-Service	1851637235	1851637235	1	1	BERGER, ANDRE K MD	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123661	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
165106	Fee-for-Service	1225220684	1225220684	1	1	BOWMAN, WILLIAM E JR MD INC	1/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	34592	20	Orthopedic Surgery	0	In state provider	None	7910 FROST ST	STE 200	SAN DIEGO	CA	92123	2776	37	06073	32.80027449	-117.153846	San Diego County
165112	Fee-for-Service	1962937532	1962937532	1	1	BEST, ANJALI	8/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22532	08	Family Practice	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
165129	Fee-for-Service	1578853438	1578853438	1	1	BRIAN B GRIFFITH DO	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
165152	Fee-for-Service	1457982522	1457982522	1	1	BRUCE, THALIA L	5/21/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5743 1/2 CASE AVE	None	NORTH HOLLYWOOD	CA	91601	5723	19	06037	34.175124	-118.371979	Los Angeles County
165159	Fee-for-Service	1194766451	1194766451	1	1	BROWN, CHRISTOPHER CRNA	2/8/2015	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	34521 VIA CATALINA	None	CAPISTRANO BEACH	CA	92624	1215	30	06059	33.46142637	-117.6729018	Orange County
165166	Fee-for-Service	1437739133	1437739133	1	1	BAHBAK ADRANGI MD	11/29/2021	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
165207	Fee-for-Service	1871223115	1871223115	1	1	BOKHARI, SHARMEEN	7/14/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	179 GUNNISON AVE	None	SACRAMENTO	CA	95838	2101	34	06067	38.650959	-121.4640765	Sacramento County
165223	Fee-for-Service	1982854980	1982854980	1	1	BALLARD, PATRICK E DO	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
165248	Fee-for-Service	1144993429	1144993429	1	1	BEDROSIAN, ANIA CRNA	5/3/2023	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
165278	Fee-for-Service	1063802106	1063802106	1	1	BLESSED HOPE HOSPICE INC	9/26/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2619 S WATERMAN AVE	STE D	SAN BERNARDINO	CA	92408	3724	36	06071	34.053786	-117.278703	San Bernardino County
165280	Fee-for-Service	1982607669	1982607669	1	1	BRUNER,C JACK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KAMIAH CLINIC	518 OAK	None	KAMIAH	ID	83536	0000	00	None	46.226556	-116.0254175	Lewis County
165285	Fee-for-Service	1245392364	1245392364	1	1	BONECHI, LINDA J	4/28/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
165297	Fee-for-Service	1689860470	1689860470	1	1	BRADSHAW, VESTER L LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4900 CALIFORNIA AVE	STE 200	BAKERSFIELD	CA	93309	7024	15	06029	35.36440586	-119.0562732	Kern County
165329	Fee-for-Service	1609850635	1609850635	1	1	BASSI, SOHANJEET A MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48656	77	Infectious Disease	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
165351	Fee-for-Service	1891249926	1891249926	1	1	BALBI, MIRANDA J LMFT	2/24/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	111807	-	NOT APPLICABLE	0	In state provider	None	930 F ST	None	WASCO	CA	93280	2040	15	06029	35.590986	-119.3337445	Kern County
165369	Fee-for-Service	1619345352	1619345352	1	1	BERTHA RIOJAS CUELLAR	5/10/2016	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	30086 MISSION BLVD	None	HAYWARD	CA	94544	7233	01	06001	37.62668651	-122.0433367	Alameda County
165380	Fee-for-Service	1003342155	1003342155	1	1	BONILLA, BRENDA	7/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
165470	Fee-for-Service	1053324582	1053324582	1	1	BORDEN, JOSEPH I DPM INC	1/1/1979	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	19231 VICTORY BLVD	STE 204 S	RESEDA	CA	91335	6308	19	06037	34.18659852	-118.552221	Los Angeles County
165531	Fee-for-Service	1669653861	1669653861	1	1	BACKER, MATTHEW W MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125819	30	Radiology	0	In state provider	None	2320 BATH STREET	208	SANTA BARBARA	CA	93105	5322	42	06083	34.43082689	-119.7223032	Santa Barbara County
165549	Fee-for-Service	1497945471	1497945471	1	1	BOUBLIK, JAN MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139846	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
165553	Fee-for-Service	1174057384	1174057384	1	1	BINHIMAID, GINA MARIE	5/2/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9447 VISAYA DR	None	RIVERSIDE	CA	92508	8029	33	06065	33.87889968	-117.3471958	Riverside County
165562	Fee-for-Service	1063802106	1063802106	1	1	BLESSED HOPE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2619 S WATERMAN AVE	STE D	SAN BERNARDINO	CA	92408	3724	36	06071	34.053786	-117.278703	San Bernardino County
165578	Fee-for-Service	1861870875	1861870875	1	1	BEALL, BRYAN D DO	6/11/2019	390200000X	NA	Other	026	PHYSICIANS	16731	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
165583	Fee-for-Service	1700230745	1700230745	1	1	BOYLE, PENNY A DO	10/6/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19003	None	None	0	In state provider	None	THREE MEDICAL PLAZA	STE 120	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
165593	Fee-for-Service	1326240235	1326240235	1	1	BIXLER, JAMES R MD	9/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100101	08	Family Practice	0	In state provider	None	3133 PROFESSIONAL DRIVE	STE 20	AUBURN	CA	95603	2463	31	06061	38.9412	-121.100888	Placer County
165600	Fee-for-Service	1306890215	1306890215	1	1	BEI, ROBERT A MD	10/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83562	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
165621	Fee-for-Service	1245253897	1245253897	1	1	BENNION, ROBERT S MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43157	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
165625	Fee-for-Service	1467847608	1467847608	1	1	BASCOMBE, QUINCY K MD	9/9/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	167350	39	Preventive (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
165697	Fee-for-Service	1902871601	1902871601	1	1	BUSSEY, DARLA G CRNA	6/17/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
165703	Fee-for-Service	1205325750	1205325750	1	1	BENCITO, CARISSA CNP	4/25/2022	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	22840 SOLEDAD CANYON RD	None	SAUGUS	CA	93510	2630	19	06037	34.4217426	-118.5364625	Los Angeles County
165726	Fee-for-Service	1013152842	1013152842	1	1	BENATAR, MARTINE R LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	39564	-	NOT APPLICABLE	0	In state provider	None	370 SOUTH CRENSHAW BLVD	SUITE E-100	TORRANCE	CA	90503	1727	19	06037	33.84549	-118.3287415	Los Angeles County
165743	Fee-for-Service	1427814938	1427814938	1	1	BRITS, VANESSA NP	9/9/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6789 N BLACKSTONE AVE	None	FRESNO	CA	93710	3530	10	06019	36.83695148	-119.7904013	Fresno County
165751	Fee-for-Service	1316789522	1316789522	1	1	BAKER, ALLISON LCSW	10/7/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
165758	Fee-for-Service	1518480698	1518480698	1	1	BARNES, AMANDA F MD	3/10/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151710	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
165762	Fee-for-Service	1104453513	1104453513	1	1	BARNES, ADAM F	2/14/2023	2279E0002X	NA	Other	026	PHYSICIANS	181367	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
165763	Fee-for-Service	1720692098	1720692098	1	1	BELL, SARAH C LMFT	10/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28991 OLD TOWN FRONT ST	102	TEMECULA	CA	92590	2660	33	06065	33.48435441	-117.1437755	Riverside County
165770	Fee-for-Service	1053439083	1053439083	1	1	BUCHANAN, SONYA W MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136405	01	General Practice	0	In state provider	None	15751 ROCKFIELD BLVD	None	IRVINE	CA	92618	2832	30	06059	33.63421195	-117.7205486	Orange County
165771	Fee-for-Service	1235242165	1235242165	1	1	BLATT, JOSEPH A MD	4/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114521	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
165796	Fee-for-Service	1205999190	1205999190	1	1	BONALES, VERONICA MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99114	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
165831	Fee-for-Service	1043396559	1043396559	1	1	BANTHIA, VISHAL MD	8/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86814	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
165840	Fee-for-Service	1174057384	1174057384	1	1	BINHIMAID, GINA MARIE	5/2/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9447 VISAYA DR	None	RIVERSIDE	CA	92508	8029	33	06065	33.87889968	-117.3471958	Riverside County
165843	Fee-for-Service	1962812800	1962812800	1	1	BERKELEY ENDOCRINE CLINIC	5/3/2016	207RE0101X	NA	Endocrinology	026	PHYSICIANS	115859	None	None	0	In state provider	INC	3000 COLBY ST	STE 203B	BERKELEY	CA	94705	2058	01	06001	37.85473248	-122.2575793	Alameda County
165859	Fee-for-Service	1386414829	1386414829	1	1	BARAWKAR, KSHITIJA D PT	2/24/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	291 EAST MAIN ST.	D, E	LOS GATOS	CA	95030	6137	43	06085	37.22109751	-121.9747502	Santa Clara County
165865	Fee-for-Service	1306216726	1306216726	1	1	BARNARD, ZACHARY R MD	7/16/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	137359	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
165872	Fee-for-Service	1184628000	1184628000	1	1	BRICCA, GREGORY M MD	4/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	70396	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
165877	Fee-for-Service	1508164682	1508164682	1	1	BAY, LORINE E LMFT	11/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
165882	Fee-for-Service	1194985242	1194985242	1	1	BROWN, DANIEL J MD	5/20/2010	208200000X	NA	General Surgery	026	PHYSICIANS	103653	24	Plastic Surgery	0	In state provider	None	317 ROSECRANS AVE	None	MANHATTAN BEACH	CA	90266	3241	19	06037	33.90124824	-118.4173142	Los Angeles County
165898	Fee-for-Service	1356585665	1356585665	1	1	BAUMANN, CHRISTOPHER J MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2900 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	7101	00	None	42.2526295	-121.788099	Klamath County
165941	Fee-for-Service	1740504927	1740504927	1	1	BRADSHAW, DAVID C MD APC	12/24/2009	193400000X	NA	Other	026	PHYSICIANS	38599	25	Physical Medicine and Rehabilitation	0	In state provider	None	19830 LAKE CHABOT RD	STE C	CASTRO VALLEY	CA	94546	5305	01	06001	37.70011045	-122.0877799	Alameda County
165957	Fee-for-Service	1609858141	1609858141	1	1	BRADY, GAIL C MD	7/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51588	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
165988	Fee-for-Service	1407498975	1407498975	1	1	BERNSTEIN, CAROL R LCSW	11/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
166004	Fee-for-Service	1659678068	1659678068	1	1	BAHADOR, ALBORZ	7/31/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
166030	Fee-for-Service	1528014032	1528014032	1	1	BLOMBERG, LARS E MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
166041	Fee-for-Service	1033780556	1033780556	1	1	BAKERSFIELD REHABILITATION	4/8/2022	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL LLC	4400 KIRKCALDY DR	None	BAKERSFIELD	CA	93306	5542	15	06029	35.39416835	-118.9186826	Kern County
166050	Fee-for-Service	1942503073	1942503073	1	1	BAISDEN, CHRISTINA A LCSW	8/14/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	490 S FARRELL DR	STE C208	PALM SPRINGS	CA	92262	7944	33	06065	33.81651	-116.5180015	Riverside County
166055	Fee-for-Service	1184651713	1184651713	1	1	BARRS, MARNI M CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
166067	Fee-for-Service	1538392659	1538392659	1	1	BINOD WAGLE MD	2/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2640	00	None	39.08455286	-94.57578107	Jackson County
166076	Fee-for-Service	1598128225	1598128225	1	1	BAINS, SUKHKARN S MD	9/24/2021	207R00000X	NA	Other	026	PHYSICIANS	151756	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
166081	Fee-for-Service	1083069629	1083069629	1	1	BACH, DIANNE MD	10/23/2019	207L00000X	NA	Other	026	PHYSICIANS	144943	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
166124	Fee-for-Service	1700817988	1700817988	1	1	BROWNE, DONN R.	7/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40247	40	Pediatrics	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
166142	Fee-for-Service	1760457162	1760457162	1	1	BINNINGS, CLEMENT B JR MD	11/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155535	01	General Practice	0	In state provider	None	46900 OCEAN DR	None	GUALALA	CA	95445	8353	23	06045	38.80460137	-123.5780677	Mendocino County
166175	Fee-for-Service	1639127376	1639127376	1	1	BUYS, WILLIAM E MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8118	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
166187	Fee-for-Service	1356585665	1356585665	1	1	BAUMANN, CHRISTOPHER J MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2900 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	7101	00	None	42.2526295	-121.788099	Klamath County
166192	Fee-for-Service	1700951217	1700951217	2	1	BLADH, DR TAYLOR OD INC	5/3/2012	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	718 N DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4122	19	06037	34.03167081	-117.8089198	Los Angeles County
166203	Fee-for-Service	1447299201	1447299201	1	1	BURKE, VINCENT D MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	33964	30	Radiology	0	In state provider	None	3004 BROADWAY	# &	REDWOOD CITY	CA	94062	1512	41	06081	37.48597455	-122.2397976	San Mateo County
166206	Fee-for-Service	1811093669	1811093669	1	1	BRACEY, JEFFERSON D DO	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
166216	Fee-for-Service	1205160660	1205160660	1	1	BURKE, CYNTHIA M NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166281	Fee-for-Service	1083258198	1083258198	1	1	BUZZANGA, TANYA R CCC-SP	9/15/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
166282	Fee-for-Service	1164031886	1164031886	1	1	BEAVER, SARAH L LMFT	12/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	560 N ARROWHEAD AVE	2B	SAN BERNARDINO	CA	92404	4234	36	06071	34.109496	-117.289667	San Bernardino County
166300	Fee-for-Service	1538393244	1538393244	1	1	BURKE, JOCELYN F MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149257	02	General Surgery	0	In state provider	None	1450 SAN PABLO ST	STE 6200	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
166329	Fee-for-Service	1033780556	1033780556	1	1	BAKERSFIELD REHABILITATION	4/8/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL LLC	4400 KIRKCALDY DR	None	BAKERSFIELD	CA	93306	5542	15	06029	35.39416835	-118.9186826	Kern County
166397	Fee-for-Service	1255524609	1255524609	1	1	BARBU, ANCA M MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141413	04	Otology, Laryngology, Rhinology	0	In state provider	None	8635 W 3RD STREET	1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
166399	Fee-for-Service	1750732376	1750732376	1	1	BOWMAN, SEAN MD	11/7/2019	390200000X	NA	Other	026	PHYSICIANS	151840	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
166407	Fee-for-Service	1508337650	1508337650	1	1	BERRYESSAWIDENER, LEE A RCP	9/10/2020	2279C0205X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
166421	Fee-for-Service	1700897295	1700897295	1	1	BODYSTORE, INC	2/15/2005	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ES	3000 N HOLLYWOOD WAY	SUITE 103	BURBANK	CA	91505	1026	19	06037	34.203258	-118.3487525	Los Angeles County
166430	Fee-for-Service	1053632034	1053632034	1	1	BUTLER, IAN B MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137716	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
166465	Fee-for-Service	1205458148	1205458148	1	1	BRIDGE HOSPICE SOLANO LLC	9/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	STE 250	FAIRFIELD	CA	94533	4825	48	06095	38.25812361	-122.0495417	Solano County
166470	Fee-for-Service	1710985569	1710985569	1	1	BAKR, SABRY E MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53098	40	Pediatrics	0	In state provider	None	36320 INLAND VALLEY DR	STE 207	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
166474	Fee-for-Service	1952416695	1952416695	1	1	BARBADILLO, TERESITA MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	38742	40	Pediatrics	0	In state provider	None	655 EUCLID AVE	STE 201	NATIONAL CITY	CA	91950	2966	37	06073	32.68353398	-117.082625	San Diego County
166478	Fee-for-Service	1245588581	1245588581	1	1	BLOSSOM RIDGE HOME HEALTH	5/1/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	AGENCY, LLC	520 9TH STREET	SUITE 240	SACRAMENTO	CA	95814	1327	34	06067	38.585466	-121.4929395	Sacramento County
166480	Fee-for-Service	1740395672	1740395672	1	1	BURN, C TERRIGAL MD	11/2/1981	207R00000X	NA	Other	026	PHYSICIANS	41846	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
166483	Fee-for-Service	1447439583	1447439583	1	1	BAY EYE MEDICAL GROUP INC	4/5/2004	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	150 CARNATION DR	STE 2	FREEDOM	CA	95019	3132	44	06087	36.93711696	-121.7705737	Santa Cruz County
166497	Fee-for-Service	1912419607	1912419607	1	1	BROOKSHIRE, CAROLE L	8/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	115869	-	NOT APPLICABLE	0	In state provider	None	660 E LOS ANGELES AVE	B2	SIMI VALLEY	CA	93065	1873	56	06111	34.27162154	-118.7846685	Ventura County
166505	Fee-for-Service	1285657049	1285657049	1	1	BEACHEY, JENNIFER L MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65938	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
166512	Fee-for-Service	1841619244	1841619244	1	1	BOYAJIAN, MARK A MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117511	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
166518	Fee-for-Service	1386157667	1386157667	1	1	BROWNLEE, CYNTHIA L LMFT	5/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
166521	Fee-for-Service	1720579980	1720579980	1	1	BHALARU, SUNEET K NP	7/11/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
166576	Fee-for-Service	1467766121	1467766121	1	1	BUSS, MELISSA A	11/29/2010	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
166618	Fee-for-Service	1871677856	1871677856	1	1	BANKS, EDWARD W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39199	02	General Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
166624	Fee-for-Service	1649321191	1649321191	1	1	BUSH, KELLY PHD	2/14/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
166636	Fee-for-Service	1992966238	1992966238	1	1	BROOKS, KYLE L MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115511	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
166670	Fee-for-Service	1558315390	1558315390	1	2	BORER, MICHAEL MD	10/14/2024	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	12569	-	NOT APPLICABLE	0	In state provider	None	4660 EL CAJON BLVD	STE 105	SAN DIEGO	CA	92105	4639	37	06073	32.75587585	-117.093663	San Diego County
166694	Fee-for-Service	1841719226	1841719226	1	1	BOX ACUPUNCTURE AND TRADITIO	6/21/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CHINESE MEDICINE	2505 SAMARITAN DRIVE	305	SAN JOSE	CA	95124	4006	43	06085	37.25111447	-121.9483395	Santa Clara County
166723	Fee-for-Service	1790842763	1790842763	1	1	BULLOCK, KIM DAWN A MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56037	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
166727	Fee-for-Service	1972512382	1972512382	1	1	BRAGANZA, RABINDRA A MD	6/30/1993	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	64032	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	317 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4355	42	06083	34.42967671	-119.7228362	Santa Barbara County
166732	Fee-for-Service	1578077715	1578077715	1	1	BIXLER, NICOLE M LCSW	12/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
166757	Fee-for-Service	1205458148	1205458148	1	1	BRIDGE HOSPICE SOLANO LLC	9/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	STE 250	FAIRFIELD	CA	94533	4825	48	06095	38.25812361	-122.0495417	Solano County
166762	Fee-for-Service	1952416695	1952416695	1	1	BARBADILLO, TERESITA MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	38742	08	Family Practice	0	In state provider	None	655 EUCLID AVE	STE 201	NATIONAL CITY	CA	91950	2966	37	06073	32.68353398	-117.082625	San Diego County
166764	Fee-for-Service	1245588581	1245588581	1	1	BLOSSOM RIDGE HOME HEALTH	7/1/2013	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	AGENCY, LLC	520 9TH STREET	SUITE 240	SACRAMENTO	CA	95814	1327	34	06067	38.585466	-121.4929395	Sacramento County
166816	Fee-for-Service	1538404579	1538404579	1	1	BALDERAS MARTINEZ, FABIOLA	10/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
166827	Fee-for-Service	1275064966	1275064966	1	1	BARGER, BRITTANY L	6/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
166835	Fee-for-Service	1396026274	1396026274	1	1	BURT, JOHN LMFT	10/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
166846	Fee-for-Service	1770897357	1770897357	1	1	BELTAGUI, AMR MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145859	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
166855	Fee-for-Service	1114958154	1114958154	1	1	BARENSTEIN, VERONICA R PSYD	5/27/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
166866	Fee-for-Service	1750773768	1750773768	1	1	BRYANT, CHRISTIE PT	1/30/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3140 APRON AVE	None	ATWATER	CA	95301	5103	24	06047	37.36532552	-120.5674796	Merced County
166889	Fee-for-Service	1235102872	1235102872	1	1	BRANDENBURG, ELIZABETH J MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53595	41	Internal Medicine	0	In state provider	None	1000 GREENLY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
166905	Fee-for-Service	1053428011	1053428011	1	1	BYSTRITSKY, ALEXANDER MD	6/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	41302	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
166909	Fee-for-Service	1629675038	1629675038	1	1	BRIGHT UNIVERSE HOSPICE INC	11/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20149 DEVONSHIRE ST	STE 210B	CHATSWORTH	CA	91311	2375	19	06037	34.2572921	-118.5725888	Los Angeles County
166912	Fee-for-Service	1235382235	1235382235	1	1	BRADLEY, THOMAS P MD PHD INC	1/22/2014	193400000X	NA	Other	026	PHYSICIANS	75220	78	Neoplastic Diseases/Oncology	0	In state provider	None	24571 SILVER CLOUD COURT	SUITE 201	MONTEREY	CA	93940	6544	27	06053	36.57293465	-121.8043702	Monterey County
166944	Fee-for-Service	1134461486	1134461486	1	1	BABIN, IVAN	2/18/2021	2085R0204X	NA	Other	026	PHYSICIANS	144561	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
166953	Fee-for-Service	1114129723	1114129723	1	1	BEAUMONT UNIFIED SCHOOL	12/5/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	500 GRACE AVE	None	BEAUMONT	CA	92223	2156	33	06065	33.92838037	-116.9823054	Riverside County
166976	Fee-for-Service	1700888047	1700888047	2	1	BULLOCK, TODD CPO	4/12/2024	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	138 JOERSCHKE DR.	None	GRASS VALLEY	CA	95945	5248	29	06057	39.23343046	-121.0409894	Nevada County
166984	Fee-for-Service	1194136275	1194136275	1	1	BANUELOS, SUSAN P MD	2/18/2019	207P00000X	NA	Other	026	PHYSICIANS	155931	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
167026	Fee-for-Service	1972576759	1972576759	1	1	BECK, RACHEL R M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79977	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65817286	-121.6460674	Monterey County
167047	Fee-for-Service	1407171036	1407171036	1	1	BRAR, NIKHRAJ S MD	12/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121052	25	Physical Medicine and Rehabilitation	0	In state provider	None	1611 FEATHER RIVER BLVD	STE 9	OROVILLE	CA	95965	4548	04	06007	39.50613596	-121.5700804	Butte County
167054	Fee-for-Service	1245588581	1245588581	1	1	BLOSSOM RIDGE HOME HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	AGENCY, LLC	520 9TH STREET	SUITE 240	SACRAMENTO	CA	95814	1327	34	06067	38.585466	-121.4929395	Sacramento County
167069	Fee-for-Service	1942313200	1942313200	1	1	BROWN, EDWARD D MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64475	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
167082	Fee-for-Service	1750796652	1750796652	1	1	BRYMAN, AMY C LCSW	2/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
167101	Fee-for-Service	1811504749	1811504749	1	1	BURTCH, MAGGIE M CNM	9/9/2022	363LX0001X	NA	Nurse Practitioner	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
167107	Fee-for-Service	1043374333	1043374333	1	1	BOCCANFUSO, VICTORIA E PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2180 W GRANT LINE ROAD	STE 219	TRACY	CA	95377	7309	39	06077	37.75399789	-121.4571561	San Joaquin County
167108	Fee-for-Service	1750398509	1750398509	2	1	BARCOHANA, DAVID MD	10/17/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	38962	01	General Practice	0	In state provider	None	9400 BRIGHTON WAY	STE 305	BEVERLY HILLS	CA	90210	4710	19	06037	34.07043476	-118.4011952	Los Angeles County
167137	Fee-for-Service	1851928063	1851928063	1	1	BRYAN J MIRONE OPTOMETRIC IN	11/12/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4000 TYLER ST	None	RIVERSIDE	CA	92503	3458	33	06065	33.91564903	-117.464488	Riverside County
167147	Fee-for-Service	1508281403	1508281403	1	1	BUI, KIET T OD	8/31/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1931 N CAMPUS AVE	None	UPLAND	CA	91784	1667	36	06071	34.133643	-117.640674	San Bernardino County
167170	Fee-for-Service	1518055490	1518055490	1	1	BLANK, NEAL S DO	6/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12218	08	Family Practice	0	In state provider	None	43839 15TH STREET WEST	None	LANCASTER	CA	92354	4756	19	06037	34.678791	-118.156867	Los Angeles County
167198	Fee-for-Service	1629675038	1629675038	1	1	BRIGHT UNIVERSE HOSPICE INC	11/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20149 DEVONSHIRE ST	STE 210B	CHATSWORTH	CA	91311	2375	19	06037	34.2572921	-118.5725888	Los Angeles County
167199	Fee-for-Service	1235382235	1235382235	1	1	BRADLEY, THOMAS P MD PHD INC	1/22/2014	193400000X	NA	Other	026	PHYSICIANS	75220	68	Hematology	0	In state provider	None	24571 SILVER CLOUD COURT	SUITE 201	MONTEREY	CA	93940	6544	27	06053	36.57293465	-121.8043702	Monterey County
167222	Fee-for-Service	1619107638	1619107638	1	1	BURNETT, MOLLY M MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116155	13	Neurology (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
167242	Fee-for-Service	1720166200	1720166200	1	1	BRADY, JANE R MD	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86922	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
167259	Fee-for-Service	1750592580	1750592580	1	1	BAKER, JUSTIN N MD	3/25/2024	2080H0002X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
167268	Fee-for-Service	1275304578	1275304578	1	1	BARKAI, RUCHAMA CRNA	9/4/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
167270	Fee-for-Service	1710965462	1710965462	1	1	BROWDER, TIMOTHY D MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96189	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
167277	Fee-for-Service	1952366304	1952366304	1	1	BORDADOR, PRINCESS GLADYS M	2/13/2024	207R00000X	NA	Other	026	PHYSICIANS	74348	None	None	0	In state provider	D	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
167300	Fee-for-Service	1578662342	1578662342	1	1	BIGELOW, TRACY L DO	5/29/2018	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	11567	20	Orthopedic Surgery	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
167306	Fee-for-Service	1972653178	1972653178	1	1	BERKSHIRE MANOR, INC	12/16/2004	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ROUNDTREE HOME	4868 ROUNDTREE DR	None	CAMPBELL	CA	95008	5747	43	06085	37.26875481	-121.9873857	Santa Clara County
167321	Fee-for-Service	1689724494	1689724494	1	1	BOX-NORIEGA, BRANDY A MD	10/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72883	78	Neoplastic Diseases/Oncology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
167333	Fee-for-Service	1326020447	1326020447	1	1	BERGER HOSPITAL	4/24/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 N PICKAWAY ST	None	CIRCLEVILLE	OH	43113	1499	00	None	39.61061748	-82.93755504	Pickaway County
167334	Fee-for-Service	1649787268	1649787268	1	1	BANCROFT HEALTH GROUP INC	6/17/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1475 BANCROFT AVE	None	SAN LEANDRO	CA	94577	5105	01	06001	37.72568915	-122.1472559	Alameda County
167340	Fee-for-Service	1245588581	1245588581	1	1	BLOSSOM RIDGE HOME HEALTH	3/27/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY, LLC	520 9TH STREET	SUITE 240	SACRAMENTO	CA	95814	1327	34	06067	38.585466	-121.4929395	Sacramento County
167353	Fee-for-Service	1649629932	1649629932	1	1	BRANDON GIGLIO	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
167358	Fee-for-Service	1942313200	1942313200	1	1	BROWN, EDWARD D MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64475	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
167392	Fee-for-Service	1710100045	1710100045	1	1	BODE, KENNETH S MD	1/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122470	20	Orthopedic Surgery	0	In state provider	None	2 BON AIR ROAD	SUITE 120	LARKSPUR	CA	94939	1142	21	06041	37.94364568	-122.5396483	Marin County
167395	Fee-for-Service	1780895003	1780895003	1	1	BUDDE, ARUN P MD	5/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99583	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
167479	Fee-for-Service	1487684155	1487684155	1	1	BLANCHARD, DANIEL	7/1/1987	207R00000X	NA	Other	026	PHYSICIANS	59868	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
167488	Fee-for-Service	1235382235	1235382235	1	1	BRADLEY, THOMAS P MD PHD INC	1/22/2014	193400000X	NA	Other	026	PHYSICIANS	75220	41	Internal Medicine	0	In state provider	None	24571 SILVER CLOUD COURT	SUITE 201	MONTEREY	CA	93940	6544	27	06053	36.57293465	-121.8043702	Monterey County
167491	Fee-for-Service	1568987261	1568987261	1	1	BENNETT, JANNA A NP	11/16/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
167511	Fee-for-Service	1851042857	1851042857	1	1	BLACKBURN, CRYSTAL CRNA	5/29/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
167540	Fee-for-Service	1467544478	1467544478	2	1	BARR PHARMACY INC	8/1/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1825 ACADEMY AVE	None	SANGER	CA	93657	3705	10	06019	36.69100389	-119.5544688	Fresno County
167544	Fee-for-Service	1801246111	1801246111	1	1	BAUTISTA, JEMIANNE T MD	6/3/2019	207R00000X	NA	Other	026	PHYSICIANS	150437	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
167585	Fee-for-Service	1154350882	1154350882	1	1	BENDER, LEON I MD	11/27/1985	208800000X	NA	Other	026	PHYSICIANS	15668	01	General Practice	0	In state provider	None	664 E REGENT ST	None	INGLEWOOD	CA	90301	1415	19	06037	33.96448452	-118.344195	Los Angeles County
167587	Fee-for-Service	1275873812	1275873812	1	1	BHELA, SERENA MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150813	None	None	0	In state provider	None	3230 BEARD RD	STE 1	NAPA	CA	94558	3659	28	06055	38.3216968	-122.2953847	Napa County
167588	Fee-for-Service	1578662342	1578662342	1	1	BIGELOW, TRACY L DO	5/29/2018	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	11567	46	Hand Surgery	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
167591	Fee-for-Service	1225529928	1225529928	1	1	BATRA-SHARMA, HEMALI C MD	9/4/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	167126	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
167595	Fee-for-Service	1700913118	1700913118	5	1	BIOLOGICAL LABORATORY, INC.	5/17/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	620 W COVINA BLVD	None	SAN DIMAS	CA	91773	2956	19	06037	34.09932052	-117.8174925	Los Angeles County
167601	Fee-for-Service	1700958451	1700958451	1	1	BUDAYR, AMER MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	41703	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
167607	Fee-for-Service	1689724494	1689724494	1	1	BOX-NORIEGA, BRANDY A MD	10/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72883	68	Hematology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
167608	Fee-for-Service	1730611625	1730611625	1	1	BRYAN, DANIEL M MD	8/2/2021	390200000X	NA	Other	026	PHYSICIANS	171899	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
167612	Fee-for-Service	1003058991	1003058991	1	1	BUTLER, BRIAN R MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115294	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
167615	Fee-for-Service	1831116441	1831116441	1	1	BRONSON METHODIST HOSP	7/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 JOHN ST	None	KALAMAZOO	MI	49007	5341	00	None	42.28505881	-85.58080075	Kalamazoo County
167621	Fee-for-Service	1871832956	1871832956	1	1	BRUNOCUNDIFF, SABRINA LCSW	3/30/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
167627	Fee-for-Service	1861464711	1861464711	1	1	BERGEY, DARREN L MD	12/12/2019	174400000X	NA	Other	026	PHYSICIANS	72267	20	Orthopedic Surgery	0	In state provider	None	900 E WASHINGTON ST	SUITE 300	COLTON	CA	92324	8182	36	06071	34.04820662	-117.3128102	San Bernardino County
167630	Fee-for-Service	1427865187	1427865187	1	1	BAHIA, NAVNEET K NP	1/28/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
167642	Fee-for-Service	1629311477	1629311477	1	1	BAILEY, KELLY MD	3/10/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
167649	Fee-for-Service	1154594976	1154594976	1	1	BOOTH, CASSIE L MD	7/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111252	22	Pathology (M.D. only)	0	In state provider	None	11234 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
167723	Fee-for-Service	1649258005	1649258005	1	1	BAUSBACK, KURT N MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	57335	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
167727	Fee-for-Service	1710342654	1710342654	1	1	BROWN, ELISE S MD APC	12/13/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	85861	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6719 ALVARADO RD	STE 302	SAN DIEGO	CA	92120	5263	37	06073	32.77684978	-117.055137	San Diego County
167730	Fee-for-Service	1720079619	1720079619	1	1	BOZEMAN DEACONESS HSP	12/3/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
167746	Fee-for-Service	1376609149	1376609149	1	2	BEGEL, DANIEL MD	7/17/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	85110	-	NOT APPLICABLE	0	In state provider	None	11027 BURBANK BLVD	None	NORTH HOLLYWOOD	CA	91601	2431	19	06037	34.17218853	-118.371609	Los Angeles County
167758	Fee-for-Service	1245992635	1245992635	1	1	BEDFORD, LERONICA	1/21/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
167776	Fee-for-Service	1558446476	1558446476	1	1	BUCHBINDER, MICHAEL C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47834	18	Ophthalmology	0	In state provider	None	11546 DOWNEY AVE	None	DOWNEY	CA	90241	4955	19	06037	33.93652675	-118.135345	Los Angeles County
167780	Fee-for-Service	1831739457	1831739457	1	1	BELL, BRITTANY PSYD	12/28/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3517 CAMINO DEL RIO S	302	SAN DIEGO	CA	92108	4029	37	06073	32.77777042	-117.1179225	San Diego County
167784	Fee-for-Service	1174581573	1174581573	1	1	BRETZ, STEPHEN W MD	1/1/1998	207P00000X	NA	Other	026	PHYSICIANS	61172	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
167788	Fee-for-Service	1710259908	1710259908	1	1	BUNDY, MICHAEL J MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129933	04	Otology, Laryngology, Rhinology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
167791	Fee-for-Service	1386792109	1386792109	1	1	BONDAD, CLEOTILDE G MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37405	40	Pediatrics	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
167835	Fee-for-Service	1891024808	1891024808	1	1	BANSAL, MANVI MD	9/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109611	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
167858	Fee-for-Service	1497941421	1497941421	1	1	BEVERLY RADIOLOGY MED GR	2/13/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IMAGING	12276 HESPERIA RD	STE 6	VICTORVILLE	CA	92395	5838	36	06071	34.47424926	-117.2915621	San Bernardino County
167864	Fee-for-Service	1336120310	1336120310	1	1	BAKER, BRUCE H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 WATERS RIDGE DR	STE A	LEWISVILLE	TX	75057	6039	00	None	33.02353532	-96.97500301	Denton County
167871	Fee-for-Service	1154350882	1154350882	1	1	BENDER, LEON I MD	11/27/1985	208800000X	NA	Other	026	PHYSICIANS	15668	34	Urology and Urological Surgery	0	In state provider	None	664 E REGENT ST	None	INGLEWOOD	CA	90301	1415	19	06037	33.96448452	-118.344195	Los Angeles County
167887	Fee-for-Service	1700958451	1700958451	1	1	BUDAYR, AMER MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	41703	67	Endocrinology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
167893	Fee-for-Service	1053892976	1053892976	1	1	BAVISHI, PAYAL S OD	11/13/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1575 B STREET	None	HAYWARD	CA	94541	3017	01	06001	37.67905755	-122.072805	Alameda County
167901	Fee-for-Service	1831116441	1831116441	1	1	BRONSON METHODIST HOSP	7/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 JOHN ST	None	KALAMAZOO	MI	49007	5341	00	None	42.28505881	-85.58080075	Kalamazoo County
167914	Fee-for-Service	1801117866	1801117866	1	1	BHULLAR, RAJROOP MD	11/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154640	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
167956	Fee-for-Service	1568844066	1568844066	1	1	BABARAN, WESLEY MD	3/3/2021	207R00000X	NA	Other	026	PHYSICIANS	157663	None	None	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
167963	Fee-for-Service	1396803201	1396803201	1	1	BENSON, JEOFFREY MD	3/13/1991	207LP2900X	NA	Other	026	PHYSICIANS	58983	05	Anesthesiology	0	In state provider	None	504 W PUEBLO ST	SUITE 301	SANTA BARBARA	CA	93105	6211	42	06083	34.42829882	-119.7243868	Santa Barbara County
167964	Fee-for-Service	1336604537	1336604537	1	1	BOUDREAUX, DANIELLE LMFT	2/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
167974	Fee-for-Service	1700345535	1700345535	1	1	BALDWIN JEFFERSON, AVIONNA	2/25/2025	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	179028	20	Orthopedic Surgery	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
167999	Fee-for-Service	1275949638	1275949638	1	1	BACKMAN, MARTIN J MD MEDICAL	10/28/2015	2084N0400X	NA	Neurology	026	PHYSICIANS	44638	13	Neurology (M.D. only)	0	In state provider	CORPORATION	2414 S FAIRVIEW ST	STE 110	SANTA ANA	CA	92704	5318	30	06059	33.71437705	-117.9079237	Orange County
168012	Fee-for-Service	1417149220	1417149220	1	1	BROWN, KRISTIN M MD	8/8/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	124831	40	Pediatrics	0	In state provider	None	8170 LAGUNA BLVD	STE 210	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
168017	Fee-for-Service	1720079619	1720079619	1	1	BOZEMAN DEACONESS HSP	10/2/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
168042	Fee-for-Service	1417396615	1417396615	1	1	BIRKHOFF, CALEB P LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
168043	Fee-for-Service	1275246647	1275246647	1	1	BURUGU, RACHEL NYAMBURA	10/13/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3845 EAST HARTER COURT	None	VISALIA	CA	93292	1308	54	06107	36.311859	-119.249352	Tulare County
168044	Fee-for-Service	1659380178	1659380178	1	1	BELKIN, RICHARD A MD	6/19/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	65997	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2403 CASTILLO STREET	STE 206	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
168047	Fee-for-Service	1518512524	1518512524	1	1	BHATIA, SRAVYA MD	8/29/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	185986	None	None	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
168050	Fee-for-Service	1487664207	1487664207	2	1	BEJJANI, BASSAM K MD	11/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33388	34	Urology and Urological Surgery	0	In state provider	None	14860 ROSCOE BLVD	STE 308	PANORAMA CITY	CA	91402	4698	19	06037	34.2214515	-118.4573205	Los Angeles County
168098	Fee-for-Service	1144475013	1144475013	1	1	BOURNE, KANITA LCSW	1/7/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10601 CIVIC CENTER DR	#100 A-D	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
168120	Fee-for-Service	1114254398	1114254398	1	1	BERG, AMOREENA LMFT	3/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
168141	Fee-for-Service	1245318336	1245318336	1	1	BAR-DIN, RONA MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77079	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
168186	Fee-for-Service	1821280058	1821280058	1	1	BOO, DOROTHY MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137043	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
168188	Fee-for-Service	1578803318	1578803318	1	1	BRUCIA, KELSIE C	12/12/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6670 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
168209	Fee-for-Service	1114061504	1114061504	1	1	BEUERLE, JOHN R MD	5/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97723	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
168210	Fee-for-Service	1821093972	1821093972	1	1	BURTLE, SALLY A MD	3/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94836	07	Dermatology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
168285	Fee-for-Service	1023357977	1023357977	1	1	BILLIG, ERIC LMFT	3/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
168297	Fee-for-Service	1366557266	1366557266	1	1	BRUCE, BEVERLY F	12/1/2005	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
168331	Fee-for-Service	1275246647	1275246647	1	1	BURUGU, RACHEL NYAMBURA	10/13/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3845 EAST HARTER COURT	None	VISALIA	CA	93292	1308	54	06107	36.311859	-119.249352	Tulare County
168333	Fee-for-Service	1992819247	1992819247	1	1	BECHARD, JONATHAN G MD	2/1/2020	207R00000X	NA	Other	026	PHYSICIANS	147138	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
168386	Fee-for-Service	1760629307	1760629307	1	1	BADAL, SHAMIRAM B MD	12/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113428	08	Family Practice	0	In state provider	None	2121 COLORADO AVE	STE C	TURLOCK	CA	95382	2012	50	06099	37.5117454	-120.8353096	Stanislaus County
168394	Fee-for-Service	1932589736	1932589736	1	1	BUCHANAN, ASHLEY MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161690	40	Pediatrics	0	In state provider	None	1400 E CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
168405	Fee-for-Service	1114157484	1114157484	1	1	BASRA, MANREET MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137215	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1801 E MARCH LANE	SUITE D400	STOCKTON	CA	95210	6675	39	06077	38.00315652	-121.2868715	San Joaquin County
168424	Fee-for-Service	1265952477	1265952477	1	1	BROWN, AUSTIN M MD	10/6/2023	171000000X	NA	Other	026	PHYSICIANS	158451	None	None	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
168434	Fee-for-Service	1497280036	1497280036	1	1	BRAR, POOJA P MD	10/25/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	102 E 6TH ST	STE 200	CORONA	CA	92879	1450	33	06065	33.87540602	-117.5666997	Riverside County
168441	Fee-for-Service	1720254584	1720254584	1	1	BACON, ALLISON	3/19/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	109867	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
168456	Fee-for-Service	1801820857	1801820857	1	4	BHARATHI S VAYUVEGULA MD PHD	12/4/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1624 S GRAND AVE	None	GLENDORA	CA	91740	5433	19	06037	34.109424	-117.8724915	Los Angeles County
168471	Fee-for-Service	1821280058	1821280058	1	1	BOO, DOROTHY MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137043	78	Neoplastic Diseases/Oncology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
168472	Fee-for-Service	1578129813	1578129813	1	1	BRUCE-WASHINGTON, ASHLEY LM	10/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
168487	Fee-for-Service	1013970276	1013970276	1	1	BARRIATUA,ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 SE STRATUS AVE	None	MCMINNVILLE	OR	97128	0000	00	None	45.20010494	-123.1656951	Yamhill County
168495	Fee-for-Service	1225233182	1225233182	1	1	BANCELLS, MARC JC	9/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 CRAVEN ROAD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
168512	Fee-for-Service	1871532960	1871532960	1	1	BURTON, PAUL D DO	8/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8514	None	None	0	In state provider	None	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
168513	Fee-for-Service	1316997505	1316997505	1	19	BALBOA NEPHROLOGY MEDICAL GR	3/30/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	OUP, INC.	6402 EL CAJON BLVD	SUITE 102	SAN DIEGO	CA	92115	2645	37	06073	32.76516432	-117.0605937	San Diego County
168543	Fee-for-Service	1689091035	1689091035	1	1	BURQUET, GISELA V LMFT	3/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	450 BRAND	638	GLENDALE	CA	91203	2347	19	06037	34.152633	-118.254971	Los Angeles County
168544	Fee-for-Service	1437311560	1437311560	1	1	BAE, TRACY E MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106393	77	Infectious Disease	0	In state provider	None	3801 HOWE STREET	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
168552	Fee-for-Service	1487886859	1487886859	1	1	BLANKENSHIP, SALLY A	8/19/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 PARK MARINA DRIVE	None	REDDING	CA	96001	2111	45	06089	40.58138366	-122.3714737	Shasta County
168593	Fee-for-Service	1942595111	1942595111	1	1	BUTT, OLIVIA MEDICAL CORP	6/20/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	106483	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 SOUTH SHORE CENTRE	STE D	ALAMEDA	CA	94501	5752	01	06001	37.75884896	-122.2528366	Alameda County
168617	Fee-for-Service	1013960202	1013960202	1	1	BARAD, MARK G MD	12/1/1999	2084P0800X	NA	Psychiatry	026	PHYSICIANS	85383	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
168648	Fee-for-Service	1811931124	1811931124	1	1	BETTS, JAMES M MD	7/24/2000	2086S0120X	NA	General Surgery	026	PHYSICIANS	41126	85	Surgery-Pediatric	0	In state provider	None	744 52ND ST	STE 4100	OAKLAND	CA	94609	1810	01	06001	37.83734299	-122.2677613	Alameda County
168651	Fee-for-Service	1275190258	1275190258	1	1	BRANDER, REVE CRNA	10/1/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
168674	Fee-for-Service	1245729086	1245729086	1	1	BARRERAS-RIVEST, ELIZABETH M	10/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164815	None	None	0	In state provider	MD	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
168677	Fee-for-Service	1114695038	1114695038	1	1	BURDICK, FELICITY C LCSW	10/26/2021	2279P3800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
168702	Fee-for-Service	1861891483	1861891483	1	1	BARACHETTI, MAURO	8/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	31071	-	NOT APPLICABLE	0	In state provider	None	1450 N LAKE AVENUE	150	PASADENA	CA	91104	2387	19	06037	34.17087521	-118.132138	Los Angeles County
168716	Fee-for-Service	1073928586	1073928586	1	1	BAULE, MICHAEL DO	2/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20460	None	None	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
168744	Fee-for-Service	1245839042	1245839042	1	1	BIO-MEDICAL APPLICATIONS OF	7/1/2022	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, INC	160 COUNTRY CLUB DR	None	S SAN FRANCISCO	CA	94080	4347	41	06081	37.64537793	-122.4288364	San Mateo County
168753	Fee-for-Service	1972210284	1972210284	1	1	BOPARAI, NAVNEET NP	4/2/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	900 CHURCH ST	None	LODI	CA	95240	1282	39	06077	38.12242332	-121.2757115	San Joaquin County
168802	Fee-for-Service	1316997505	1316997505	1	19	BALBOA NEPHROLOGY MEDICAL GR	3/30/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP, INC.	6402 EL CAJON BLVD	SUITE 102	SAN DIEGO	CA	92115	2645	37	06073	32.76516432	-117.0605937	San Diego County
168807	Fee-for-Service	1225007974	1225007974	1	1	BENCH, GARY R MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35873	02	General Surgery	0	In state provider	None	7910 FROST ST	STE 104	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
168844	Fee-for-Service	1437193737	1437193737	1	1	BARUCH-OREN, TAMAR MD	5/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70968	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
168881	Fee-for-Service	1225255201	1225255201	1	1	BLINCHIK, MIKHAIL MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96997	41	Internal Medicine	0	In state provider	None	222 W EULALIA ST	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
168896	Fee-for-Service	1548243421	1548243421	1	1	BOGGAN, JAMES E MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	35112	14	Neurological Surgery	0	In state provider	U C MEDICAL CENTER	505 PARNASSUS AVE	RM 786M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
168933	Fee-for-Service	1811931124	1811931124	1	1	BETTS, JAMES M MD	7/24/2000	2086S0120X	NA	General Surgery	026	PHYSICIANS	41126	34	Urology and Urological Surgery	0	In state provider	None	744 52ND ST	STE 4100	OAKLAND	CA	94609	1810	01	06001	37.83734299	-122.2677613	Alameda County
168982	Fee-for-Service	1700050408	1700050408	1	1	BRADLEY, DEBORAH C LMFT	12/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 S WESTMORELAND AVE	None	LOS ANGELES	CA	90005	3999	19	06037	34.06348495	-118.28845	Los Angeles County
169016	Fee-for-Service	1417936568	1417936568	1	1	BRUNELLI, BRIAN T MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88363	13	Neurology (M.D. only)	0	In state provider	None	1661 SOQUEL DR	STE D	SANTA CRUZ	CA	95065	1816	44	06087	36.98895429	-121.9821088	Santa Cruz County
169036	Fee-for-Service	1417624859	1417624859	1	1	BUCKELEW, LACEY LCSW	1/30/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
169037	Fee-for-Service	1790859007	1790859007	1	1	BERNSTEIN, MARK L MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	35233	20	Orthopedic Surgery	0	In state provider	#400	7230 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
169039	Fee-for-Service	1154585891	1154585891	1	1	BAVA, LAURA PSYD	4/18/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
169075	Fee-for-Service	1780688515	1780688515	1	1	BLOCK, STEVEN L MD	8/1/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23058	06	Cardiovascular Disease (M.D. only)	0	In state provider	LODI HEART CENTER	777 S HAM LN	STE G	LODI	CA	95242	3593	39	06077	38.125224	-121.2882885	San Joaquin County
169077	Fee-for-Service	1750728663	1750728663	1	1	BALDWIN PARK MEDICAL CLINIC	4/29/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62452	08	Family Practice	0	In state provider	INC	14051 RAMONA PKWY	None	BALDWIN PARK	CA	91706	4114	19	06037	34.08521541	-117.9674931	Los Angeles County
169089	Fee-for-Service	1295924033	1295924033	1	1	BARRAGREE, MATTHEW W CRNA	3/1/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
169094	Fee-for-Service	1144373168	1144373168	1	1	BUTANI, ANJALI K MDO	1/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100583	07	Dermatology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
169112	Fee-for-Service	1952539272	1952539272	1	1	BRUCE, DAVID A LMFT	10/9/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
169118	Fee-for-Service	1346299716	1346299716	1	1	BALL, DERICK A DPM	2/8/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13624 HAWTHORNE BLVD	STE 206	HAWTHORNE	CA	90250	5818	19	06037	33.9083784	-118.3523983	Los Angeles County
169140	Fee-for-Service	1821521774	1821521774	1	1	BERRY, RANI MD	8/21/2023	163WG0100X	NA	Other	026	PHYSICIANS	161171	None	None	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
169196	Fee-for-Service	1417941642	1417941642	1	1	BOLLINGER, MICHAEL T MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	65404	20	Orthopedic Surgery	0	In state provider	None	555 PETALUMA AVE	STE B	SEBASTOPOL	CA	95472	4225	49	06097	38.39744712	-122.8206197	Sonoma County
169206	Fee-for-Service	1770894826	1770894826	1	1	BATTLE, NATALIE C MD	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150798	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
169227	Fee-for-Service	1053391185	1053391185	1	1	BARSOUM, NOHA R MD	6/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64657	45	Nephrology (Renal-Kidney)	0	In state provider	None	15211 VANOWEN ST	STE 300	VAN NUYS	CA	91405	3617	19	06037	34.19395411	-118.4642527	Los Angeles County
169268	Fee-for-Service	1205010360	1205010360	1	1	BHANDARKAR, NAVEEN D MD	7/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112946	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
169290	Fee-for-Service	1770527269	1770527269	1	1	BALLESTEROS, JOSE V MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52195	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 DOYLE PARK DR	STE 205	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
169300	Fee-for-Service	1811512981	1811512981	1	1	BRUCE, SARAH PSYD	5/31/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
169302	Fee-for-Service	1437205416	1437205416	1	2	BUNGART, JEAN MARIE LVN	9/26/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	425 COLUMBIA AVE	None	MERCED	CA	95340	0914	24	06047	37.32383114	-120.4651597	Merced County
169319	Fee-for-Service	1851871164	1851871164	1	1	BLACKWELL, SANDRA L RCP	9/18/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
169328	Fee-for-Service	1740463322	1740463322	1	1	BAGHERI, MICHAEL MD	8/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117008	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1180 N INDIAN CANYON DR	#E319	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
169347	Fee-for-Service	1902884117	1902884117	1	1	BRETZMAN,ALAN PETER MDD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON	None	ST PAUL	MN	55101	2370	00	None	44.94428014	-93.10733608	Ramsey County
169353	Fee-for-Service	1255837837	1255837837	1	1	BOVE, NICHOLAS MD	2/16/2021	207P00000X	NA	Other	026	PHYSICIANS	164223	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
169362	Fee-for-Service	1528784899	1528784899	1	1	BERTRAND, HAIYUN CRNA	11/18/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
169365	Fee-for-Service	1750728663	1750728663	1	1	BALDWIN PARK MEDICAL CLINIC	4/29/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62452	01	General Practice	0	In state provider	INC	14051 RAMONA PKWY	None	BALDWIN PARK	CA	91706	4114	19	06037	34.08521541	-117.9674931	Los Angeles County
169384	Fee-for-Service	1609954700	1609954700	1	1	BOULRIS, CRAIG	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	83083	20	Orthopedic Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
169428	Fee-for-Service	1013912641	1013912641	1	1	BAKERSFIELD FAMILY MED	11/15/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GRP	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	7013	15	06029	35.36605632	-119.0531502	Kern County
169429	Fee-for-Service	1255429528	1255429528	1	1	BARACCO, MARY J CNM	1/24/2025	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	P, PHN	443 EAST SPRING ST	None	NAPA	CA	94559	1536	28	06055	38.30589633	-122.2698507	Napa County
169440	Fee-for-Service	1811279763	1811279763	1	3	BARTZ ALTADONNA COMMUNITY	4/20/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9300 N LOOP DR	SUITE C	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13321511	-117.9623345	Kern County
169441	Fee-for-Service	1639141716	1639141716	1	2	BLUM, BARRY MD	6/25/2019	207R00000X	NA	Other	086	MEDICAL DIRECTORS	34386	-	NOT APPLICABLE	0	In state provider	None	744 E WALNUT ST	None	PASADENA	CA	91101	1638	19	06037	34.14954596	-118.1351901	Los Angeles County
169461	Fee-for-Service	1003995093	1003995093	1	1	BREKHUS, SHARYN D MD	3/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56126	14	Neurological Surgery	0	In state provider	None	160 E ARTESIA STREET	# 360	POMONA	CA	91767	2921	19	06037	34.07556833	-117.7507835	Los Angeles County
169469	Fee-for-Service	1306327325	1306327325	1	1	BOZICK, ALEXANDRA LMFT	2/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25283 CABOT RD	STE 107	LAGUNA HILLS	CA	92653	5509	30	06059	33.59495207	-117.6757167	Orange County
169483	Fee-for-Service	1417941642	1417941642	1	1	BOLLINGER, MICHAEL T MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	65404	46	Hand Surgery	0	In state provider	None	555 PETALUMA AVE	STE B	SEBASTOPOL	CA	95472	4225	49	06097	38.39744712	-122.8206197	Sonoma County
169500	Fee-for-Service	1841295003	1841295003	1	1	BELLAKEN HEALTH GROUP	5/3/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	,INC	2780 26TH AVE	None	OAKLAND	CA	94601	1911	01	06001	37.79339436	-122.2213635	Alameda County
169508	Fee-for-Service	1326301383	1326301383	1	1	BATOULI, ALI MD	6/23/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184218	None	None	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
169518	Fee-for-Service	1760556567	1760556567	1	1	BROWN, KATHLEEN S LMFT	2/1/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44011	-	NOT APPLICABLE	0	In state provider	None	39155 LIBERTY ST	STE 500	FREMONT	CA	94537	5006	01	06001	37.55123907	-121.9828956	Alameda County
169532	Fee-for-Service	1265782676	1265782676	1	1	BHOOT SURGICAL INC	4/22/2013	208600000X	NA	General Surgery	026	PHYSICIANS	94735	02	General Surgery	0	In state provider	None	2520 HONOLULU AVE	STE 160	MONTROSE	CA	91020	1853	19	06037	34.20751518	-118.2337088	Los Angeles County
169559	Fee-for-Service	1689695082	1689695082	1	1	BANEZ, MARIENELLE MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62285	40	Pediatrics	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
169563	Fee-for-Service	1033192844	1033192844	1	1	BOTNICK, MARC I MD	8/24/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72882	30	Radiology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
169574	Fee-for-Service	1205294915	1205294915	1	1	BARNETT, VIRGINIA LMFT	8/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
169590	Fee-for-Service	1255445557	1255445557	1	1	BAILIE, DARYL E MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	44981	01	General Practice	0	In state provider	None	1810 N OLIVE AVE	STE 7	TURLOCK	CA	95382	2500	50	06099	37.509336	-120.839862	Stanislaus County
169591	Fee-for-Service	1649296021	1649296021	1	1	BARSOUMIAN, KRIKOR MD	3/24/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35033	18	Ophthalmology	0	In state provider	A PROFESSIONAL CORP	2440 SAMARITAN DR	STE 3	SAN JOSE	CA	95124	3911	43	06085	37.25105247	-121.9471875	Santa Clara County
169621	Fee-for-Service	1508361452	1508361452	1	1	BARRUGA DUONG, CARLY P MD	7/8/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166382	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
169635	Fee-for-Service	1588059521	1588059521	1	1	BARRETT, KODY MD	11/6/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	152958	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
169655	Fee-for-Service	1528488350	1528488350	1	1	BRAVO, ARLENE B MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142116	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
169660	Fee-for-Service	1225226558	1225226558	1	1	BOCK, BONNIE V MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	35572	41	Internal Medicine	0	In state provider	None	1501 SUPERIOR AVE	STE 300	NEWPORT BEACH	CA	92663	3641	30	06059	33.62918676	-117.9305675	Orange County
169712	Fee-for-Service	1760724850	1760724850	1	1	BOGSETH, MICHAEL MD	2/21/2020	207P00000X	NA	Other	026	PHYSICIANS	165682	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
169729	Fee-for-Service	1811279763	1811279763	1	3	BARTZ ALTADONNA COMMUNITY	4/20/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9300 N LOOP DR	SUITE C	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13321511	-117.9623345	Kern County
169742	Fee-for-Service	1316997505	1316997505	1	17	BALBOA NEPHROLOGY MEDICAL GR	2/2/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	6402 EL CAJON BLVD	SUITE 100	SAN DIEGO	CA	92115	2645	37	06073	32.76516432	-117.0605937	San Diego County
169760	Fee-for-Service	1760698237	1760698237	1	1	BRADFIELD, JASON S MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86969	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	# 365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
169788	Fee-for-Service	1841295003	1841295003	1	1	BELLAKEN HEALTH GROUP	1/18/2001	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	,INC	2780 26TH AVE	None	OAKLAND	CA	94601	1911	01	06001	37.79339436	-122.2213635	Alameda County
169812	Fee-for-Service	1770641805	1770641805	1	1	BONGALE, RAJSHREE N MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55702	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
169822	Fee-for-Service	1558820811	1558820811	1	1	BUI, ANH D MD	6/8/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	181838	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169838	Fee-for-Service	1013076751	1013076751	1	1	BRAR, SOMJOT S MD	10/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81204	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
169844	Fee-for-Service	1689695082	1689695082	1	1	BANEZ, MARIENELLE MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62285	01	General Practice	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
169852	Fee-for-Service	1033192844	1033192844	1	1	BOTNICK, MARC I MD	8/24/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72882	78	Neoplastic Diseases/Oncology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
169853	Fee-for-Service	1053480418	1053480418	1	1	BROADWAY MANOR CARE CTR	1/1/2001	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	605 W BROADWAY	None	GLENDALE	CA	91204	1007	19	06037	34.14683148	-118.2670022	Los Angeles County
169882	Fee-for-Service	1295051266	1295051266	1	1	BAUTISTA, LINDSAY N MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118577	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
169889	Fee-for-Service	1396819603	1396819603	1	1	BAINS, SHASHI K MD	6/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89419	77	Infectious Disease	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
169891	Fee-for-Service	1104993021	1104993021	1	1	BATRA, BINESH MD	8/31/1990	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	49308	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
169906	Fee-for-Service	1649247602	1649247602	1	1	BALZER, BONNIE L MD	2/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78681	22	Pathology (M.D. only)	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
169913	Fee-for-Service	1326038217	1326038217	1	1	BERNARDO, ANGELA M OD	9/13/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
169920	Fee-for-Service	1790495810	1790495810	1	1	BARDAVID, KAREN LMFT	1/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
169926	Fee-for-Service	1871642272	1871642272	1	1	BROWN, MELANDEE D MD	12/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	146149	14	Neurological Surgery	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
169931	Fee-for-Service	1851577662	1851577662	1	1	BEACH AREA FAMILY HEALTH	1/2/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	3705 MISSION BLVD	None	SAN DIEGO	CA	92109	7104	37	06073	32.78273202	-117.2524549	San Diego County
169937	Fee-for-Service	1528142502	1528142502	1	1	BARLOW, CHARLES R MD	5/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	49377	None	None	0	In state provider	None	411 30TH ST	STE 208	OAKLAND	CA	94609	3303	01	06001	37.81903474	-122.2649444	Alameda County
169943	Fee-for-Service	1376775536	1376775536	1	1	BOOKATZ, ALLEN G MD	11/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122570	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
169944	Fee-for-Service	1356542245	1356542245	1	1	BARRE, ABDUSELAM H MD	6/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72745	08	Family Practice	0	In state provider	None	2279 E PALMDALE	#A	PLAMDALE	CA	93550	4909	19	06037	34.58020552	-118.087164	Los Angeles County
169957	Fee-for-Service	1659843738	1659843738	1	1	BESSER, ELI S DO	10/14/2022	207P00000X	NA	Other	026	PHYSICIANS	19679	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
169971	Fee-for-Service	1205027158	1205027158	1	1	BLOUNT, DEAN A	5/4/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	205 CLAYDELLE AVE	STE 105	EL CAJON	CA	92020	4555	37	06073	32.79381683	-116.9587603	San Diego County
169979	Fee-for-Service	1699864256	1699864256	1	1	BLAIR, NANETTE W MD INC	10/1/1998	207P00000X	NA	Other	026	PHYSICIANS	54986	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
169995	Fee-for-Service	1952507998	1952507998	1	1	BAER, ALINE LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
170001	Fee-for-Service	1538237557	1538237557	1	1	BEVERLY HILLS INTEGRATIVE	11/14/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	MEDICINE GROUP INC	7414 BEVERLY BLVD	None	LOS ANGELES	CA	90036	2725	19	06037	34.07611851	-118.351728	Los Angeles County
170017	Fee-for-Service	1811279763	1811279763	1	3	BARTZ ALTADONNA COMMUNITY	11/16/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9300 N LOOP DR	SUITE C	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13321511	-117.9623345	Kern County
170025	Fee-for-Service	1689673626	1689673626	1	1	BUENA, NARDO B MD	1/17/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	141682	01	General Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
170026	Fee-for-Service	1619054541	1619054541	1	1	BARSKY, CAROL L MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65745	40	Pediatrics	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
170031	Fee-for-Service	1316997505	1316997505	1	17	BALBOA NEPHROLOGY MEDICAL GR	2/2/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC	6402 EL CAJON BLVD	SUITE 100	SAN DIEGO	CA	92115	2645	37	06073	32.76516432	-117.0605937	San Diego County
170038	Fee-for-Service	1760698237	1760698237	1	1	BRADFIELD, JASON S MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86969	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	# 365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
170128	Fee-for-Service	1952695777	1952695777	1	1	BRIGGS, BENJAMIN J MD	8/1/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	148562	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
170157	Fee-for-Service	1366743858	1366743858	1	1	BAUMAN, MARTIN MD	12/12/1981	207R00000X	NA	Other	026	PHYSICIANS	22160	83	Rheumatology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
170185	Fee-for-Service	1699432997	1699432997	1	1	BOSSETT, SHERISEE J LCSW	12/27/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
170191	Fee-for-Service	1457400558	1457400558	1	1	BALES, PETER MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63997	20	Orthopedic Surgery	0	In state provider	None	1613 EUREKA RD	STE 100	ROSEVILLE	CA	95661	3067	31	06061	38.74772701	-121.2472635	Placer County
170194	Fee-for-Service	1437330008	1437330008	1	1	BECKER, BRENT A MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111991	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
170218	Fee-for-Service	1487219390	1487219390	1	1	BOSS, DEREK C PT	10/2/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8501 BRIMHALL RD	SUITE 201	BAKERSFIELD	CA	93312	2252	15	06029	35.36876784	-119.0971029	Kern County
170257	Fee-for-Service	1023247004	1023247004	1	1	BILLENS-IVORY, SUSAN C P	12/31/1983	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5363 BALBOA BLVD	STE 337	ENCINO	CA	91316	2805	19	06037	34.169058	-118.5011265	Los Angeles County
170297	Fee-for-Service	1194351189	1194351189	1	1	BAYSINGER, AMBER N MD	5/7/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179833	36	Psychiatry	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
170319	Fee-for-Service	1417128208	1417128208	1	1	BRETT R BELOUD, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2050 W SOUTHERN AVE	None	APACHE JUNCTION	AZ	85120	7305	00	None	33.39423	-111.56679	Pinal County
170320	Fee-for-Service	1346219557	1346219557	1	1	BULLER, JUANCARLOS MD	4/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66601	41	Internal Medicine	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
170321	Fee-for-Service	1629258215	1629258215	1	1	BUTTERFIELD, RAECHEL M LCSW	7/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
170324	Fee-for-Service	1720199227	1720199227	1	1	BUSTAMANTE, ANDRES F MD	11/30/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70351	41	Internal Medicine	0	In state provider	None	227 CHURCH AVE	None	CHULA VISTA	CA	91910	2702	37	06073	32.64410747	-117.0798279	San Diego County
170328	Fee-for-Service	1891131702	1891131702	1	1	BAGGA, SUMIT S MD	5/18/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161444	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
170329	Fee-for-Service	1922073436	1922073436	1	1	BUSBY, LESLIE J OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 KENNEDY PL	STE 6	DAVIS	CA	95616	1266	57	06113	38.55948846	-121.7376601	Yolo County
170330	Fee-for-Service	1760698237	1760698237	1	1	BRADFIELD, JASON S MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86969	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	# 365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
170342	Fee-for-Service	1952644247	1952644247	1	1	BEKAREV, KEHVON	6/13/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153485	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
170350	Fee-for-Service	1851559298	1851559298	1	1	BATES, DINA M MD	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120934	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
170375	Fee-for-Service	1831868314	1831868314	1	1	BAYLEY, CARLY N PT	1/5/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	210 W PINE ST	None	LODI	CA	95240	2020	39	06077	38.13427214	-121.2755342	San Joaquin County
170416	Fee-for-Service	1952695777	1952695777	1	1	BRIGGS, BENJAMIN J MD	8/1/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	148562	68	Hematology	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
170439	Fee-for-Service	1083638977	1083638977	1	1	BROOKS, KARIN A MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90158	07	Dermatology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
170462	Fee-for-Service	1043373970	1043373970	1	1	BRENNAN, GAVIA C PSYD	9/26/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
170484	Fee-for-Service	1437412046	1437412046	1	1	BEAIRD, OMER E MD	4/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141517	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
170491	Fee-for-Service	1316135155	1316135155	1	2	BAUM, STEVE E	12/1/2001	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 S ELLSWORTH AVE	STE 203	SAN MATEO	CA	94401	3932	41	06081	37.56665635	-122.3247743	San Mateo County
170499	Fee-for-Service	1083801708	1083801708	1	1	BEDELL, KIMBERLY MD INC	9/16/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
170519	Fee-for-Service	1508912387	1508912387	1	1	BENYEHUDA, ORI MD	7/31/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51936	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
170528	Fee-for-Service	1154810034	1154810034	1	1	BLOCK, ELLIOTT S DO	1/18/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18018	None	None	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
170537	Fee-for-Service	1457420077	1457420077	1	1	BALLOU, NICOLETTE L MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	53313	40	Pediatrics	0	In state provider	None	8920 WILSHIRE BLVD	STE 604	BEVERLY HILLS	CA	90211	2006	19	06037	34.06703599	-118.3863456	Los Angeles County
170552	Fee-for-Service	1326158080	1326158080	1	1	BEL AIR PHARMACY #518	2/18/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2341 SUNSET BLVD	None	ROCKLIN	CA	95765	4337	31	06061	38.79721599	-121.2660156	Placer County
170560	Fee-for-Service	1427163898	1427163898	1	1	BRAGANZA, SUSHILA L MD	11/1/1997	207R00000X	NA	Other	026	PHYSICIANS	51010	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
170568	Fee-for-Service	1780791038	1780791038	1	1	BAKR, ALIYA A MD	12/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	79908	36	Psychiatry	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
170585	Fee-for-Service	1790863520	1790863520	1	1	BERRONES, MARIA I MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63364	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
170588	Fee-for-Service	1073731204	1073731204	1	1	BAE, KIM Y CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	14435 SHERMAN WAY	STE 101	VAN NUYS	CA	91405	6221	19	06037	34.20123151	-118.4475285	Los Angeles County
170611	Fee-for-Service	1346219557	1346219557	1	1	BULLER, JUANCARLOS MD	4/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66601	08	Family Practice	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
170616	Fee-for-Service	1720199227	1720199227	1	1	BUSTAMANTE, ANDRES F MD	11/30/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70351	66	Emergency Medicine (Urgent Care)	0	In state provider	None	227 CHURCH AVE	None	CHULA VISTA	CA	91910	2702	37	06073	32.64410747	-117.0798279	San Diego County
170634	Fee-for-Service	1174938062	1174938062	1	1	BAKHTIARY, PEJMAN MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142900	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
170696	Fee-for-Service	1316997505	1316997505	1	22	BALBOA NEPHROLOGY MEDICAL GR	11/16/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	320 SANTA FE DRIVE	SUITE 212	ENCINITAS	CA	92024	5139	37	06073	33.038847	-117.285579	San Diego County
170720	Fee-for-Service	1649503319	1649503319	1	7	BEAVER MEDICAL GROUP LP	2/17/1993	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
170732	Fee-for-Service	1174549372	1174549372	1	1	BELL, DOUGLAS S MD	6/1/1995	207R00000X	NA	Other	026	PHYSICIANS	79822	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
170805	Fee-for-Service	1508912387	1508912387	1	1	BENYEHUDA, ORI MD	7/31/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51936	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
170843	Fee-for-Service	1174646590	1174646590	1	2	BAILEY-WALTON, PAULA MD	6/3/2021	207R00000X	NA	Other	086	MEDICAL DIRECTORS	70461	-	NOT APPLICABLE	0	In state provider	None	1331 WEST AVE J	SUITE 103 AND SUITE 206	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
170849	Fee-for-Service	1063947596	1063947596	1	1	BAZAN, LESLIE LMFT	2/24/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
170854	Fee-for-Service	1598710162	1598710162	1	1	BROWN, GORDON D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UTAH VALLEY RADIOLOGY	1034 N 500 W	None	PROVO	UT	84603	0000	00	None	40.248072	-111.6673905	Utah County
170863	Fee-for-Service	1184081150	1184081150	1	1	BAILEY, LYDIA A CRNA	3/15/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
170871	Fee-for-Service	1649493750	1649493750	1	1	BUI, HAO D MD	11/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74562	02	General Surgery	0	In state provider	None	4901 CENTENIAL PLAZA WY	None	BAKERSFIELD	CA	93312	2011	15	06029	35.40400955	-119.0934945	Kern County
170886	Fee-for-Service	1356453500	1356453500	1	1	BOBROVE, ARTHUR M MD	8/5/1976	207RR0500X	NA	Other	026	PHYSICIANS	19533	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
170929	Fee-for-Service	1033167119	1033167119	1	1	BRAMSON, WALTER D MD	5/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	40647	08	Family Practice	0	In state provider	None	580 FOREST SHADE BOX L-C	None	CRESTLINE	CA	92325	0000	36	06071	34.24265206	-117.2780226	San Bernardino County
170953	Fee-for-Service	1376519561	1376519561	1	1	BROOKS, ANDREW T MD	8/12/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	60076	20	Orthopedic Surgery	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
170986	Fee-for-Service	1316997505	1316997505	1	22	BALBOA NEPHROLOGY MEDICAL GR	11/16/2015	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC	320 SANTA FE DRIVE	SUITE 212	ENCINITAS	CA	92024	5139	37	06073	33.038847	-117.285579	San Diego County
170988	Fee-for-Service	1518129964	1518129964	1	1	BERT, BENJAMIN B MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120092	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	ROOM 1340	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
171005	Fee-for-Service	1962481929	1962481929	1	1	BLAKE, GERARD F MD	8/19/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53165	08	Family Practice	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
171040	Fee-for-Service	1457463259	1457463259	1	1	BIO-MEDICAL APPS OF CA	12/9/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN GABRIEL DIALYSIS CTR	1801 W VALLEY BLVD	STE 102	ALHAMBRA	CA	91803	2300	19	06037	34.07741913	-118.1432981	Los Angeles County
171056	Fee-for-Service	1043202146	1043202146	4	1	BEVERLY PLAZA RX INC	2/7/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 E BEVERLY BLVD	STE 101	MONTEBELLO	CA	90640	4314	19	06037	34.01556395	-118.0983878	Los Angeles County
171074	Fee-for-Service	1073685897	1073685897	1	1	BARTELS, HILARY H MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64258	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
171095	Fee-for-Service	1508912387	1508912387	1	1	BENYEHUDA, ORI MD	7/31/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51936	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
171097	Fee-for-Service	1508176876	1508176876	1	1	BATES, SHARITA R LMFT	3/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
171134	Fee-for-Service	1982741633	1982741633	1	2	BAART BEHAVIORAL HEALTH SERV	3/4/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1301 & 1313 CUTTING BLVD	None	RICHMOND	CA	94804	2554	07	06013	37.92523852	-122.3565435	Contra Costa County
171135	Fee-for-Service	1679750574	1679750574	2	1	BANDARI, ARMIN MD	11/9/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	105051	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1941 JOHNSON AVE	STE 101	SAN LUIS OBISPO	CA	93401	4154	40	06079	35.27804785	-120.649711	San Luis Obispo County
171137	Fee-for-Service	1972532679	1972532679	1	1	BADESHA, PRITAM S MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51470	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
171145	Fee-for-Service	1669401386	1669401386	1	1	BOPARAI, KULVINDER S MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	50051	41	Internal Medicine	0	In state provider	None	3234 MARYSVILLE BLVD	None	SACRAMENTO	CA	95815	1411	34	06067	38.626371	-121.4322615	Sacramento County
171148	Fee-for-Service	1205313871	1205313871	1	1	BARRIGA, ILEANA MSW LCSW	10/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
171175	Fee-for-Service	1225108228	1225108228	1	1	BANKS, RONALD W PSYD	4/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
171205	Fee-for-Service	1134425754	1134425754	1	1	BANSAL, RUCHI MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136724	41	Internal Medicine	0	In state provider	None	8305 BRIMHALL RD	STE 1601	BAKERSFIELD	CA	93312	2174	15	06029	35.36876049	-119.0948805	Kern County
171240	Fee-for-Service	1780023770	1780023770	1	1	BARRA, MOHSIN S MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141532	41	Internal Medicine	0	In state provider	None	4053 LONE TREE WAY	STE 101	ANTIOCH	CA	94531	6200	07	06013	37.97569499	-121.800733	Contra Costa County
171244	Fee-for-Service	1104060144	1104060144	1	1	BUTLER, CAROLINE C MD	6/17/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	175398	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
171282	Fee-for-Service	1285646877	1285646877	1	1	BARTH, ANDREAS M	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
171310	Fee-for-Service	1679718225	1679718225	1	1	BRUNO DIALYSIS, LLC	12/1/2008	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	146 S MAIN ST	None	ORANGE	CA	92868	2861	30	06059	33.786891	-117.867329	Orange County
171317	Fee-for-Service	1295748259	1295748259	1	1	BICK, ARON B MD	3/4/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	39149	78	Neoplastic Diseases/Oncology	0	In state provider	None	2080 CENTURY PARK E	STE 1208	CENTURY CITY	CA	90067	2015	19	06037	34.05887194	-118.4122914	Los Angeles County
171323	Fee-for-Service	1700383288	1700383288	1	1	BARACCHINI, CINDY M LMFT	11/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	201 W 4TH ST	SUITE 200	CLAREMONT	CA	91711	4707	19	06037	34.09762851	-117.7166655	Los Angeles County
171360	Fee-for-Service	1932640794	1932640794	1	1	BOHARA, LINDA E	8/22/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
171387	Fee-for-Service	1568589737	1568589737	1	1	BASTEDO PSYCHOLOGICAL INC	11/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5199 E PACIFIC COAST HWY	SUITE 504	LONG BEACH	CA	90804	3371	19	06037	33.78293818	-118.1329326	Los Angeles County
171394	Fee-for-Service	1386148419	1386148419	1	1	BUI, THIEN DAN MD	1/3/2022	390200000X	NA	Other	026	PHYSICIANS	174276	None	None	0	In state provider	None	43112 N 15TH ST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
171395	Fee-for-Service	1477800043	1477800043	1	1	BURKE, HILLARY S PSY	10/2/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
171408	Fee-for-Service	1164445615	1164445615	1	1	BIRDSALL, DAVID A MD	11/1/1998	207P00000X	NA	Other	026	PHYSICIANS	54542	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
171411	Fee-for-Service	1437154143	1437154143	1	1	BOISKIN, MARK M MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52055	45	Nephrology (Renal-Kidney)	0	In state provider	None	15708 POMERADO ROAD	SUITE N 205	POWAY	CA	92064	2419	37	06073	32.99948815	-117.0580342	San Diego County
171434	Fee-for-Service	1376807354	1376807354	1	1	BUTLER, IAN B DO	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1200 W MOHAVE STREET	None	PARKER	AZ	85344	6349	00	None	34.13580083	-114.2842352	La Paz County
171449	Fee-for-Service	1497980288	1497980288	1	1	BERRIE, MONTEA A LCSW	1/19/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22365 BARTON RD	STE 302	GRAND TERRACE	CA	92313	5078	36	06071	34.03387854	-117.316818	San Bernardino County
171465	Fee-for-Service	1952379836	1952379836	1	1	BRANDON, JODEE R MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143257	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
171489	Fee-for-Service	1134425754	1134425754	1	1	BANSAL, RUCHI MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136724	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8305 BRIMHALL RD	STE 1601	BAKERSFIELD	CA	93312	2174	15	06029	35.36876049	-119.0948805	Kern County
171526	Fee-for-Service	1992327357	1992327357	1	1	BENNING, KIMBERLY S LMFT	1/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1849 SAWTELLE BLVD.	610	LOS ANGELES	CA	90049	0000	19	06037	34.04266851	-118.4451527	Los Angeles County
171533	Fee-for-Service	1467080341	1467080341	1	1	BUI, AN Q	9/10/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
171538	Fee-for-Service	1285659482	1285659482	1	1	BELPERIO, JOHN MD	7/24/2000	207RP1001X	NA	Pulmonology	026	PHYSICIANS	72669	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
171584	Fee-for-Service	1659498004	1659498004	1	1	BOYLE HEIGHTS CARDIOVASCULAR	7/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69594	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10362 GARVEY AVE	None	EL MONTE	CA	91733	2186	19	06037	34.0626747	-118.0450487	Los Angeles County
171593	Fee-for-Service	1649503319	1649503319	1	6	BEAVER MEDICAL GROUP LP	2/17/1993	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	259 TERRACINA BLVD	None	REDLANDS	CA	92373	4847	36	06071	34.03768081	-117.2052723	San Bernardino County
171604	Fee-for-Service	1295748259	1295748259	1	1	BICK, ARON B MD	3/4/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	39149	68	Hematology	0	In state provider	None	2080 CENTURY PARK E	STE 1208	CENTURY CITY	CA	90067	2015	19	06037	34.05887194	-118.4122914	Los Angeles County
171626	Fee-for-Service	1275589608	1275589608	1	1	BERNARD, GABRIELLE D MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85928	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
171644	Fee-for-Service	1588653083	1588653083	1	1	BANERJEE, AMITABHA MD	6/20/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	49318	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
171647	Fee-for-Service	1588789218	1588789218	1	1	BELL, HERMAN BENJAMIN DO	3/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5193	None	None	0	In state provider	None	12134 VICTORY BLVD	SUITE C	NORTH HOLLYWOOD	CA	91606	3205	19	06037	34.18664618	-118.3978356	Los Angeles County
171650	Fee-for-Service	1952437204	1952437204	1	1	BROWN, HAROLD F PHD	12/4/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7200 PARKWAY DR	#113	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
171667	Fee-for-Service	1225560188	1225560188	1	1	BE HEALTHY HOME HEALTH INC	11/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18401 BURBANK BLVD	SUITE 110	TARZANA	CA	91356	2878	19	06037	34.17187827	-118.5339035	Los Angeles County
171687	Fee-for-Service	1316014269	1316014269	1	1	BRISINGER, MIKAEL N MD	2/28/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50865	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
171694	Fee-for-Service	1164445615	1164445615	1	1	BIRDSALL, DAVID A MD	11/1/1998	207P00000X	NA	Other	026	PHYSICIANS	54542	01	General Practice	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
171701	Fee-for-Service	1437154143	1437154143	1	1	BOISKIN, MARK M MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52055	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15708 POMERADO ROAD	SUITE N 205	POWAY	CA	92064	2419	37	06073	32.99948815	-117.0580342	San Diego County
171707	Fee-for-Service	1407898455	1407898455	1	1	BROOKS, GEORGE F MD	7/30/1981	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	33063	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
171709	Fee-for-Service	1750770087	1750770087	1	1	BAGWELL, LAUREN N LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
171713	Fee-for-Service	1992257083	1992257083	1	1	BRYANT, STACIE LCSW	5/18/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
171730	Fee-for-Service	1629148218	1629148218	1	1	BULL, HANNAH-LEIGH LMFT	7/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1035 CEDAR STREET	None	FORT BRAGG	CA	95437	3840	23	06045	39.44360292	-123.7921961	Mendocino County
171736	Fee-for-Service	1508879750	1508879750	1	1	BAYO INC	6/26/2006	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	244 N JACKSON AVE	STE 110	SAN JOSE	CA	95116	1604	43	06085	37.36405837	-121.8488656	Santa Clara County
171769	Fee-for-Service	1033136916	1033136916	1	1	BOCK, JENNIFER F MD	8/31/1990	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	71603	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
171776	Fee-for-Service	1447995618	1447995618	1	1	BIENESTAR THERAPY & WELLNESS	7/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27851 BRADLEY RD	SUITE 102	MENIFEE	CA	92586	2213	33	06065	33.71630969	-117.1904696	Riverside County
171816	Fee-for-Service	1376597989	1376597989	1	1	BUTZLAFF, ALICE L NP	7/28/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	07	06013	37.88758326	-122.1181419	Contra Costa County
171843	Fee-for-Service	1659300093	1659300093	1	1	BUTLER, HOWARD G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST MARYS HOSPITAL	901 45TH ST	None	WEST PALM BCH	FL	33407	2413	00	None	26.756073	-80.0626545	Palm Beach County
171855	Fee-for-Service	1073819181	1073819181	1	1	BEACHSIDE ANESTHESIA A PROFE	4/7/2020	193400000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	SSIONAL CORPORATION	4081 OLYMPIC	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
171882	Fee-for-Service	1144220492	1144220492	1	2	BDO CORPORATION	3/6/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 N FAIRFAX AVE	#110	LOS ANGELES	CA	90046	5363	19	06037	34.091127	-118.361506	Los Angeles County
171894	Fee-for-Service	1295748259	1295748259	1	1	BICK, ARON B MD	3/4/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	39149	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	STE 1208	CENTURY CITY	CA	90067	2015	19	06037	34.05887194	-118.4122914	Los Angeles County
171899	Fee-for-Service	1295937183	1295937183	1	1	BARANANO, ANNE E MD	4/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107674	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO STREET	SUITE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
171902	Fee-for-Service	1508864711	1508864711	1	1	BAKER, BRUCE C MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	72025	None	None	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
171919	Fee-for-Service	1467667824	1467667824	1	1	BORLIK, MARCY F MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99995	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
171931	Fee-for-Service	1851360168	1851360168	1	1	BURNHAM, JOHN MD	2/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	26120	30	Radiology	0	In state provider	None	W 5TH & ESPLANADE	None	CHICO	CA	95926	0000	04	06007	39.741948	-121.848921	Butte County
171980	Fee-for-Service	1093120172	1093120172	1	1	BETZ-MUNCY, DIANA LMFT	9/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1816 FIRST STREET	None	SUSANVILLE	CA	96130	0000	18	06035	40.41577601	-120.6464795	Lassen County
171986	Fee-for-Service	1437154143	1437154143	1	1	BOISKIN, MARK M MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52055	41	Internal Medicine	0	In state provider	None	15708 POMERADO ROAD	SUITE N 205	POWAY	CA	92064	2419	37	06073	32.99948815	-117.0580342	San Diego County
171987	Fee-for-Service	1740372366	1740372366	1	1	BLANCO, DEBRA A PA	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	14845	-	NOT APPLICABLE	0	In state provider	None	15229 EAST AMAR ROAD	None	LA PUENTE	CA	91744	2066	19	06037	34.03785444	-117.9526169	Los Angeles County
171995	Fee-for-Service	1407898455	1407898455	1	1	BROOKS, GEORGE F MD	7/30/1981	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	33063	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
171998	Fee-for-Service	1528001617	1528001617	1	1	BOWEN, LARRY W MD	8/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52020	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	87 SCRIPPS DR	STE 310	SACRAMENTO	CA	95825	6318	34	06067	38.572092	-121.410261	Sacramento County
172001	Fee-for-Service	1326054255	1326054255	1	1	BLAKE, DAVID A MD	4/25/2023	207L00000X	NA	Other	026	PHYSICIANS	77088	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
172034	Fee-for-Service	1386938397	1386938397	1	1	BOUSTANI, ANDRE J MD	5/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135379	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
172054	Fee-for-Service	1174694053	1174694053	1	1	BAKER, JAMES E MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	74599	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
172057	Fee-for-Service	1033136916	1033136916	1	1	BOCK, JENNIFER F MD	8/31/1990	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	71603	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
172078	Fee-for-Service	1336118637	1336118637	1	1	BROWN, STANLEY K MD	11/19/2013	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 S HWY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
172088	Fee-for-Service	1790956290	1790956290	1	1	BURDOIN-ROGERS, ERICA M	4/3/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	1742	01	06001	37.54866156	-121.9750739	Alameda County
172119	Fee-for-Service	1205100526	1205100526	1	2	BROWN, KIMBERLY M MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	123420	-	NOT APPLICABLE	0	In state provider	None	8739 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4507	19	06037	34.08687562	-118.3813577	Los Angeles County
172125	Fee-for-Service	1447319066	1447319066	1	1	BHATT, PREETI N MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82134	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
172161	Fee-for-Service	1720508476	1720508476	1	1	BRADSHAW, CAITLIN J DO	10/3/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16970	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
172178	Fee-for-Service	1285052704	1285052704	1	1	BINYAMIN, TAMAR R MD	8/4/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	129258	None	None	0	In state provider	None	20055 LAKE CHABOT ROAD	SUITE 110	CASTRO VALLEY	CA	94546	5331	01	06001	37.69836512	-122.0873587	Alameda County
172202	Fee-for-Service	1295793024	1295793024	1	1	BLUESTEIN, HARRY G MD	2/8/2015	207RR0500X	NA	Other	026	PHYSICIANS	20053	01	General Practice	0	In state provider	DEPT OF MEDICINE	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
172282	Fee-for-Service	1407898455	1407898455	1	1	BROOKS, GEORGE F MD	7/30/1981	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	33063	77	Infectious Disease	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
172303	Fee-for-Service	1295724326	1295724326	1	1	BRION, PAUL H MD	8/1/1996	207RR0500X	NA	Other	026	PHYSICIANS	55328	None	None	0	In state provider	None	845 N LARK ELLEN AVE	None	WEST COVINA	CA	91791	1069	19	06037	34.0869951	-117.9166283	Los Angeles County
172319	Fee-for-Service	1871612341	1871612341	1	1	BRUMLEY, KATHLEEN NP	6/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
172361	Fee-for-Service	1881002939	1881002939	1	1	BAVEJA, SWATI MD	9/21/2020	207R00000X	NA	Other	026	PHYSICIANS	168368	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
172379	Fee-for-Service	1023183811	1023183811	1	1	BELLAVIA, JOHN MD	11/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
172386	Fee-for-Service	1114971314	1114971314	1	1	BIO-BEHAVIORAL MED CLIN	5/9/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1060 W SIERRA AVE	STE 105	FRESNO	CA	93711	2063	10	06019	36.83009575	-119.8099386	Fresno County
172455	Fee-for-Service	1770087389	1770087389	1	1	BUI, NGOC T MD	9/28/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166169	None	None	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
172472	Fee-for-Service	1396700936	1396700936	1	1	BORGESON, MICHELE D MD	6/28/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76947	40	Pediatrics	0	In state provider	None	11 PROFESSIONAL PKWY	# P	SAN RAFAEL	CA	94903	2702	21	06041	38.00987589	-122.5401279	Marin County
172511	Fee-for-Service	1053497180	1053497180	1	1	BROWN, MICHELLE R PHD	9/10/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172524	Fee-for-Service	1396150736	1396150736	1	1	BHANDARI, RUSHA MD	6/2/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	148298	40	Pediatrics	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
172560	Fee-for-Service	1093431769	1093431769	1	1	BORREGO COMMUNITY HEALTH FOU	1/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	NDATION PHARMACY	49869 CALHOUN STREET	None	COACHELLA	CA	92236	9120	33	06065	33.68683253	-116.2077712	Riverside County
172562	Fee-for-Service	1316903271	1316903271	1	1	BOGETZ, MARTIN S MD	7/31/1989	207L00000X	NA	Other	026	PHYSICIANS	40185	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
172569	Fee-for-Service	1619992997	1619992997	1	1	BEYER, RICHARD A	1/31/1987	2084N0400X	NA	Neurology	026	PHYSICIANS	45428	13	Neurology (M.D. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
172573	Fee-for-Service	1104893692	1104893692	1	1	BIGHAM, WILLIAM J MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54117	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
172639	Fee-for-Service	1740405992	1740405992	1	1	BARCAL, NANCY K	2/15/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2530 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3989	31	06061	38.7441318	-121.2403457	Placer County
172641	Fee-for-Service	1982890901	1982890901	1	1	BENOUNI, SARALEEN MD	4/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101331	03	Allergy	0	In state provider	None	11500 W OLYMPIC BLVD	STE 630	LOS ANGELES	CA	90064	1538	19	06037	34.03617514	-118.4445122	Los Angeles County
172644	Fee-for-Service	1619102738	1619102738	1	1	BOTROS, MAGED W MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106640	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
172645	Fee-for-Service	1881002939	1881002939	1	1	BAVEJA, SWATI MD	9/21/2020	207R00000X	NA	Other	026	PHYSICIANS	168368	41	Internal Medicine	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
172658	Fee-for-Service	1447590401	1447590401	1	1	BAGLEY, TYLER J CRNA	3/11/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
172696	Fee-for-Service	1285658625	1285658625	1	1	BOWERS, ANN P. MD	1/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G STREET	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
172698	Fee-for-Service	1750844601	1750844601	1	1	BURGESS, JONATHAN D MD	6/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172704	Fee-for-Service	1558826461	1558826461	1	1	BADGETT, AMANDA J CRNA	6/10/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
172743	Fee-for-Service	1285645226	1285645226	1	1	BERGLUND, ROY V	1/1/1994	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	CRESTVIEW CLINICAL LAB	1471 S RIVERSIDE AVE	None	RIALTO	CA	92376	7703	36	06071	34.07459705	-117.3702576	San Bernardino County
172760	Fee-for-Service	1396700936	1396700936	1	1	BORGESON, MICHELE D MD	6/28/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76947	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11 PROFESSIONAL PKWY	# P	SAN RAFAEL	CA	94903	2702	21	06041	38.00987589	-122.5401279	Marin County
172811	Fee-for-Service	1598169666	1598169666	1	1	BELMAR VILLA LLC	9/1/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2020 N WEBER AVE	None	FRESNO	CA	93705	4313	10	06019	36.76954961	-119.8332794	Fresno County
172823	Fee-for-Service	1679871875	1679871875	1	1	BAI, BRIAN CLINIC INC	7/11/2011	193400000X	NA	Other	026	PHYSICIANS	101489	08	Family Practice	0	In state provider	None	1200 N VENTURA RD	STE A	OXNARD	CA	93030	3827	56	06111	34.21435634	-119.1943831	Ventura County
172828	Fee-for-Service	1700165784	1700165784	1	1	BERNAL, IRENE LMFT	4/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
172836	Fee-for-Service	1508894122	1508894122	1	1	BRODSKY, JAY B MD	11/27/1985	207L00000X	NA	Other	026	PHYSICIANS	33501	05	Anesthesiology	0	In state provider	None	STANFORD UNIV MED CTR	None	STANFORD	CA	94305	0000	43	06085	37.41407916	-122.1574664	Santa Clara County
172858	Fee-for-Service	1134203656	1134203656	1	1	BLOCK, MICHAEL R MD	6/28/2010	207R00000X	NA	Other	026	PHYSICIANS	24174	45	Nephrology (Renal-Kidney)	0	In state provider	None	970 MONUMENT ST	STE 210	PACIFIC PALISADES	CA	90272	3891	19	06037	34.0463954	-118.5240711	Los Angeles County
172869	Fee-for-Service	1619354370	1619354370	1	1	BOGLER, YAEL MD	8/26/2020	282N00000X	NA	Hospitals	026	PHYSICIANS	153096	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
172881	Fee-for-Service	1447325758	1447325758	1	1	BAIK, SANDRA I MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	7861	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
172910	Fee-for-Service	1396893376	1396893376	1	1	BAKHRU, ASHA J MD	11/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48108	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
172927	Fee-for-Service	1982890901	1982890901	1	1	BENOUNI, SARALEEN MD	4/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101331	41	Internal Medicine	0	In state provider	None	11500 W OLYMPIC BLVD	STE 630	LOS ANGELES	CA	90064	1538	19	06037	34.03617514	-118.4445122	Los Angeles County
172939	Fee-for-Service	1043357262	1043357262	1	1	BALLARD, CHARLES H DO	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10039	08	Family Practice	0	In state provider	None	1600 E CITRUS AVENUE	STE A	REDLANDS	CA	92374	4270	36	06071	34.05557272	-117.1468659	San Bernardino County
172942	Fee-for-Service	1942503073	1942503073	1	2	BAISDEN, CHRISTINA A LCSW	1/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27309 IDA IANE	None	HEMET	CA	92544	8242	33	06065	33.72512651	-116.9395996	Riverside County
172969	Fee-for-Service	1649229816	1649229816	1	1	BLUM, MICHAEL R MD	11/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61247	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
172973	Fee-for-Service	1881035145	1881035145	1	1	BAEK, JOSEPH W MD	10/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132845	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
173002	Fee-for-Service	1285247601	1285247601	1	1	BONSU, ABENA	2/23/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5362 FAIRVIEW BLVD	None	LOS ANGELES	CA	90056	3086	19	06037	33.97973321	-118.3736756	Los Angeles County
173049	Fee-for-Service	1871508325	1871508325	1	1	BANKHURST, ARTHUR D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
173050	Fee-for-Service	1861922940	1861922940	1	1	BERMAN, DANIEL MD	12/18/2022	207P00000X	NA	Other	026	PHYSICIANS	169762	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
173076	Fee-for-Service	1922119445	1922119445	1	1	BEDOYA, LUIS A MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	51105	None	None	0	In state provider	None	227 CHURCH AVE	None	CHULA VISTA	CA	91910	2702	37	06073	32.64410747	-117.0798279	San Diego County
173077	Fee-for-Service	1144924432	1144924432	1	1	BEHAVIOR ANALYST SUPERVISOR,	4/12/2024	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC.	809 MCCLOUD AVE	None	MOUNT SHASTA	CA	96067	9603	47	06093	41.31222185	-122.3009402	Siskiyou County
173094	Fee-for-Service	1417082751	1417082751	1	1	BINDRA, ROGER J MD	4/28/1999	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	55101	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
173097	Fee-for-Service	1003983925	1003983925	1	1	BRADBURNE, RICHARD M MD	6/30/1989	207RC0200X	NA	Other	026	PHYSICIANS	48285	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
173128	Fee-for-Service	1750516100	1750516100	1	1	BOYD, DEVON G CRNA	10/10/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
173131	Fee-for-Service	1912018953	1912018953	1	1	BERNAT, SUSZANNE I MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95165	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
173143	Fee-for-Service	1437199841	1437199841	1	1	BARKER, REBECCA C MD	6/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76436	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
173160	Fee-for-Service	1619354370	1619354370	1	1	BOGLER, YAEL MD	8/26/2020	282N00000X	NA	Hospitals	026	PHYSICIANS	153096	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
173164	Fee-for-Service	1376595314	1376595314	1	1	BAHADI, KEYVAN MD	10/1/1996	208600000X	NA	General Surgery	026	PHYSICIANS	31245	02	General Surgery	0	In state provider	None	2505 SAMARITAN DR	STE 103	SAN JOSE	CA	95124	4007	43	06085	37.25111447	-121.9483395	Santa Clara County
173182	Fee-for-Service	1124022850	1124022850	1	1	BAKER, JOHN DEAN MD	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65259	41	Internal Medicine	0	In state provider	None	3150 BRISTOL ST	STE 150	COSTA MESA	CA	92626	7300	30	06059	33.68601312	-117.8854624	Orange County
173219	Fee-for-Service	1942408638	1942408638	1	1	BALDWIN, EMILY MD	2/1/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	92910	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
173242	Fee-for-Service	1386055465	1386055465	1	1	BRADLEY, CEDRICK S MD	2/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150728	08	Family Practice	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
173245	Fee-for-Service	1235453648	1235453648	1	1	BARBIC, DAWN E PHD	11/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
173250	Fee-for-Service	1447457353	1447457353	1	1	BURRUS, TAMIKA M MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110775	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
173259	Fee-for-Service	1548292113	1548292113	1	1	BANERJEE, ABHIJAN MD	10/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94631	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
173268	Fee-for-Service	1851705719	1851705719	1	1	BOKARIUS, ANDREW V MD	9/14/2020	207P00000X	NA	Other	026	PHYSICIANS	169445	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
173280	Fee-for-Service	1306034467	1306034467	1	1	BRADLEY, SCOTT M MD	6/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105948	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
173290	Fee-for-Service	1285247601	1285247601	1	1	BONSU, ABENA	2/23/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5362 FAIRVIEW BLVD	None	LOS ANGELES	CA	90056	3086	19	06037	33.97973321	-118.3736756	Los Angeles County
173305	Fee-for-Service	1649503319	1649503319	1	12	BEAVER MEDICAL GROUP LP	7/29/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	245 TERRACINA BLVD	SUITE 102	REDLANDS	CA	92373	4865	36	06071	34.03858912	-117.2066515	San Bernardino County
173336	Fee-for-Service	1033272810	1033272810	1	1	BURNS, BRUCE E MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	49064	36	Psychiatry	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
173354	Fee-for-Service	1871749754	1871749754	1	1	BAY IMAGING CONSULTANTS	3/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
173374	Fee-for-Service	1558534131	1558534131	1	1	BARAKAT, MOHAMAD N MD	7/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113836	41	Internal Medicine	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
173406	Fee-for-Service	1336520360	1336520360	1	1	BRIGHT FUTURE RECOVERY INC.	12/21/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 FAIRVIEW RD	None	HOLLISTER	CA	95023	9644	35	06069	36.83036035	-121.3636084	San Benito County
173453	Fee-for-Service	1295007748	1295007748	1	1	BATES, CHRISTOPHER W LCSW	11/28/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
173469	Fee-for-Service	1124022850	1124022850	1	1	BAKER, JOHN DEAN MD	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65259	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3150 BRISTOL ST	STE 150	COSTA MESA	CA	92626	7300	30	06059	33.68601312	-117.8854624	Orange County
173475	Fee-for-Service	1992529804	1992529804	1	1	BEIDOUN, SABRINA PT	2/4/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
173484	Fee-for-Service	1295183002	1295183002	1	1	BOER, CARA E CO	8/15/2016	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	7863 LA MESA BOULEVARD	SUITE 100	LA MESA	CA	91942	0657	37	06073	32.76738848	-117.0283515	San Diego County
173530	Fee-for-Service	1467548008	1467548008	1	1	BOLANOS, ALBERTO MD	6/1/1998	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	84190	20	Orthopedic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
173540	Fee-for-Service	1023082393	1023082393	1	1	BOSETTI, JOHN B MD	7/31/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	63507	None	None	0	In state provider	None	3260 BEARD RD	None	NAPA	CA	94558	3423	28	06055	38.32237321	-122.2955875	Napa County
173547	Fee-for-Service	1780486704	1780486704	1	1	BLOOM TOGETHER, LLC	4/1/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
173598	Fee-for-Service	1437559770	1437559770	1	1	BARTLETT, JOSEPH J	11/18/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	331 ELM STREET	None	RED BLUFF	CA	96080	0301	52	06103	40.17542475	-122.2340147	Tehama County
173599	Fee-for-Service	1194769745	1194769745	1	1	BERNSTEIN, WILLIAM MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38094	30	Radiology	0	In state provider	None	16453 COLORADO AVE	None	PARAMOUNT	CA	90723	5011	19	06037	33.8848803	-118.1614216	Los Angeles County
173651	Fee-for-Service	1639212400	1639212400	1	1	BALANI, EKTA Y DPM	12/16/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
173683	Fee-for-Service	1487648135	1487648135	1	1	BETHANY HOME SOCIETY OF	3/1/1966	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SAN JOAQUIN	930 W MAIN ST	None	RIPON	CA	95366	2325	39	06077	37.73944159	-121.1345994	San Joaquin County
173703	Fee-for-Service	1790924165	1790924165	1	1	BARBOUR, JULIE A MFT	3/7/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41212	-	NOT APPLICABLE	0	In state provider	None	315 N STATE COLLEGE BLVD	None	ANAHEIM	CA	92806	2915	30	06059	33.84378	-117.889316	Orange County
173720	Fee-for-Service	1770206559	1770206559	1	1	BONITA SPRINGS TRANSIT LLC	12/14/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RANSPORTATION	8545 MONTEREY ST	#C	GILROY	CA	95020	4273	43	06085	37.02054622	-121.5754058	Santa Clara County
173745	Fee-for-Service	1205129731	1205129731	1	1	BANKA, GAURAV MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123190	41	Internal Medicine	0	In state provider	None	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
173746	Fee-for-Service	1760470207	1760470207	1	1	BELL, LAUREL L MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
173783	Fee-for-Service	1548202641	1548202641	1	1	BETH ISRAEL DEACONESS	7/2/1998	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER INC	330 BROOKLINE AVE	None	BOSTON	MA	02215	5400	00	None	42.34094064	-71.105021	Suffolk County
173793	Fee-for-Service	1447578927	1447578927	1	1	BALAKRISHNAN, PREETHI MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121827	01	General Practice	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
173857	Fee-for-Service	1659582534	1659582534	1	1	BIGLOW, KRYSTEL T PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CONSULTING COLLECTIVE	5777 W CENTURY BLVD	STE 910	LOS ANGELES	CA	90045	5600	19	06037	33.94561146	-118.382661	Los Angeles County
173862	Fee-for-Service	1588866164	1588866164	1	1	BEERS, SARA LYNN MD	11/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
173890	Fee-for-Service	1902860950	1902860950	1	1	BECHTEL, TIMOTHY MD	6/16/2006	208600000X	NA	General Surgery	026	PHYSICIANS	94734	02	General Surgery	0	In state provider	None	1805 N CALIFORNIA ST	SUITE 201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
173894	Fee-for-Service	1013118843	1013118843	1	1	BUTLER, SUSAN T MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111303	07	Dermatology	0	In state provider	None	301 INDUSTRIAL RD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
173895	Fee-for-Service	1609055979	1609055979	1	1	BAYAT, NEDA MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7340	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
173898	Fee-for-Service	1124446067	1124446067	1	1	BAJWA, RANJEET S OD INC	7/31/2017	261QP2300X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1889 KNOLL DRIVE	None	VENTURA	CA	93003	7348	56	06111	34.2558747	-119.2202641	Ventura County
173912	Fee-for-Service	1437537107	1437537107	1	1	BRAND SURGERY CENTER LLC	2/1/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1146 N BRAND BLVD	None	GLENDALE	CA	91202	2504	19	06037	34.163109	-118.255031	Los Angeles County
173928	Fee-for-Service	1932307030	1932307030	1	1	BENABIO, JEFFREY ALLEN V	12/26/2007	207N00000X	NA	Dermatology	026	PHYSICIANS	89678	07	Dermatology	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
173942	Fee-for-Service	1205151024	1205151024	1	1	BOTT, KRISTIE L LCSW	2/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
173955	Fee-for-Service	1922180595	1922180595	1	1	BILLAKANTI, GNANESWER MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
173974	Fee-for-Service	1508845983	1508845983	1	1	BOSCH, PHILIP C	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	46782	34	Urology and Urological Surgery	0	In state provider	None	651 E PENNSYLVANIA AVE	STE 201	ESCONDIDO	CA	92025	3053	37	06073	33.12669989	-117.0741135	San Diego County
173975	Fee-for-Service	1205557550	1205557550	1	1	BALLESTEROS, LEIA OD	11/17/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 E STOWELL RD	None	SANTA MARIA	CA	93454	7001	42	06083	34.93834649	-120.422502	Santa Barbara County
173989	Fee-for-Service	1962403667	1962403667	2	1	BHATNAGAR, GUNJAN MD	5/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77891	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	33 CREEK RD	STE 270	IRVINE	CA	92604	7707	30	06059	33.67506955	-117.796973	Orange County
173994	Fee-for-Service	1508903154	1508903154	1	1	BEACHELL, ERIC M CRNA	7/2/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
174014	Fee-for-Service	1437544251	1437544251	1	1	BURNETT, LINDSEY A MD	6/12/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145791	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
174039	Fee-for-Service	1861680795	1861680795	1	1	BRAATON, PAUL J MD INC	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84066	20	Orthopedic Surgery	0	In state provider	None	1335 COFFEE RD	STE 100	MODESTO	CA	95355	3192	50	06099	37.66291854	-120.9756994	Stanislaus County
174042	Fee-for-Service	1205836954	1205836954	1	1	BUKACHEVSKY, ROMAN P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71259	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	295 POSADA LN	STE B	TEMPLETON	CA	93465	4055	40	06079	35.55315971	-120.7214435	San Luis Obispo County
174044	Fee-for-Service	1942068473	1942068473	1	1	BEHESHT, MOHAMMAD S	3/29/2024	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2605 PITCHSTONE WAY	None	ANTIOCH	CA	94531	9331	07	06013	37.97960664	-121.7819012	Contra Costa County
174057	Fee-for-Service	1588255053	1588255053	1	1	BUNAG, KATHLEEN A NP	6/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27141 HIDAWAY AVE	204	SANTA CLARITA	CA	91351	4147	19	06037	34.41483	-118.469039	Los Angeles County
174068	Fee-for-Service	1548202641	1548202641	1	1	BETH ISRAEL DEACONESS	3/1/1992	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER INC	330 BROOKLINE AVE	None	BOSTON	MA	02215	5400	00	None	42.34094064	-71.105021	Suffolk County
174070	Fee-for-Service	1043267651	1043267651	1	1	BALDWIN MD INC BENNER MD	1/1/1979	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	INC & VERLENDEN MD INC	2 UPPER RAGSDALE	STE B230	MONTEREY	CA	93940	7836	27	06053	36.57940327	-121.8142876	Monterey County
174081	Fee-for-Service	1326227992	1326227992	1	1	BRINK, JAN MD	2/28/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	72078	-	NOT APPLICABLE	0	In state provider	None	11776 MARIPOSA ROAD	101, 103, & 104	HESPERIA	CA	92345	1622	36	06071	34.46463128	-117.3491141	San Bernardino County
174085	Fee-for-Service	1316280977	1316280977	1	1	BUTALA, NIRAJ P MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147264	07	Dermatology	0	In state provider	None	200 MED PLAZA	#365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
174086	Fee-for-Service	1396093464	1396093464	1	1	BELCHER, LUCI LCSW	11/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
174088	Fee-for-Service	1093998122	1093998122	1	1	BEVERLY RADIOLOGY MED GR	2/22/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3715 E SOUTH ST	None	LONG BEACH	CA	90805	4521	19	06037	33.86026343	-118.1478013	Los Angeles County
174138	Fee-for-Service	1841266418	1841266418	1	1	BUSCHMAN, DENNIS MD	7/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	174874	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
174182	Fee-for-Service	1811351687	1811351687	1	1	BOWES, RYAN DO	6/25/2020	390200000X	NA	Other	026	PHYSICIANS	16377	13	Neurology (M.D. only)	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
174190	Fee-for-Service	1699091702	1699091702	1	1	BENJAMIN, JACQUELINE A MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	77777	22	Pathology (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
174193	Fee-for-Service	1932856200	1932856200	1	1	BRIDGEWOOD POST ACUTE LLC	3/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5901 LEMON HILL AVENUE	None	SACRAMENTO	CA	95824	3231	34	06067	38.516274	-121.4365905	Sacramento County
174194	Fee-for-Service	1639176308	1639176308	1	1	BURKHART, CHRIS S MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30153	41	Internal Medicine	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
174197	Fee-for-Service	1730332255	1730332255	1	1	BENDER, MARK G PHD	1/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
174199	Fee-for-Service	1538131693	1538131693	1	1	BHATIA, SATINDER J S MD	3/1/1984	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	50016	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
174216	Fee-for-Service	1972670735	1972670735	1	1	BUTCHER, HEIDI L NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9449 IMPERIAL HWY	STE ABCD	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
174235	Fee-for-Service	1356077754	1356077754	1	1	BLISS PSYCHOTHERAPY BY DR. V	3/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AKILI INC.	5000 BIRCH ST	310	NEWPORT BEACH	CA	92660	2127	30	06059	33.66605605	-117.8586733	Orange County
174243	Fee-for-Service	1831160282	1831160282	1	1	BASS, STUART K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE,	STE 500	PHOENIX	AZ	85067	3219	00	None	33.480666	-112.0729905	Maricopa County
174262	Fee-for-Service	1922023449	1922023449	1	1	BORDELON, YVETTE M MD	11/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	89162	None	None	0	In state provider	None	300 MEDICAL PLAZA B200	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
174309	Fee-for-Service	1346297322	1346297322	1	1	BALOIAN, LISA B OD	11/19/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	628 CALIFORNIA BLVD	STE B	SAN LUIS OBISPO	CA	93401	2554	40	06079	35.28917428	-120.6578269	San Luis Obispo County
174317	Fee-for-Service	1467527028	1467527028	1	1	BLADH, TAYLOR W OD	4/30/1991	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1255 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4122	19	06037	33.99914104	-117.8123495	Los Angeles County
174349	Fee-for-Service	1952622300	1952622300	1	1	BARAJAS, RAMON F MD	10/18/2019	2085N0700X	NA	MRI Provider	026	PHYSICIANS	114318	30	Radiology	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
174350	Fee-for-Service	1518248640	1518248640	1	1	BROADNAX, EDWIN C LCSW	4/5/2022	1041S0200X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	308 W STATE ST	STE 3D	REDLANDS	CA	92373	4653	36	06071	34.05649746	-117.18603	San Bernardino County
174356	Fee-for-Service	1326198524	1326198524	1	1	BENNETT VALLEY ICF/DD-H	2/1/2002	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	2416 CACTUS AVE	None	SANTA ROSA	CA	95405	8355	49	06097	38.425302	-122.6722635	Sonoma County
174396	Fee-for-Service	1366205387	1366205387	1	1	BANDONG, KIRSTIANA	11/22/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
174424	Fee-for-Service	1316026800	1316026800	2	1	BERJIS, AMIR MD	1/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75137	02	General Surgery	0	In state provider	None	1700 MOUNT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
174460	Fee-for-Service	1083687594	1083687594	1	1	BALOUGH, BEN J MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	71198	01	General Practice	0	In state provider	None	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
174478	Fee-for-Service	1174681191	1174681191	1	1	BANG, MICHAEL D	8/5/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
174488	Fee-for-Service	1538131693	1538131693	1	1	BHATIA, SATINDER J S MD	3/1/1984	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	50016	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
174505	Fee-for-Service	1831682608	1831682608	1	1	BONNER, STEPHANIE CRNA	5/13/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6601 WHITE FEATHER	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
174512	Fee-for-Service	1659853539	1659853539	1	1	BRUNELL, CHRISTOPHER J PHD	9/23/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	9024 SNIKTAW LN	None	FORT JONES	CA	96032	9408	47	06093	41.59983924	-122.9748122	Siskiyou County
174583	Fee-for-Service	1104958156	1104958156	1	2	BOSSHARDT, THOMAS L MD	10/5/2020	208600000X	NA	General Surgery	026	PHYSICIANS	78405	None	None	0	In state provider	None	1325 CHURCH	STE 202	SANTA MARIA	CA	93454	5909	42	06083	34.95209265	-120.4147348	Santa Barbara County
174589	Fee-for-Service	1508253758	1508253758	1	1	BISHOP, BETHANY LMFT	7/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106521	-	NOT APPLICABLE	0	In state provider	None	2640 BRESLAUER WAY	WING 2 WEST	REDDING	CA	96001	4246	45	06089	40.5496754	-122.3791396	Shasta County
174613	Fee-for-Service	1285093021	1285093021	1	1	BARAHONA, JUAN DO	8/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15671	08	Family Practice	0	In state provider	None	3612 DALE RD	None	MODESTO	CA	95356	0500	50	06099	37.69097901	-121.0498748	Stanislaus County
174638	Fee-for-Service	1245442839	1245442839	1	1	BAKER, KATHLEEN L MD DO	8/1/2018	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1650 CREEKSIDE DRIVE	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
174644	Fee-for-Service	1164588471	1164588471	1	1	BATRA, PRIYA PSYD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
174646	Fee-for-Service	1326196338	1326196338	1	1	BAHRAMFARSI, MARYAM MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89824	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
174659	Fee-for-Service	1154583466	1154583466	1	1	BURNETT, JOHN F MD INC	10/11/2010	208200000X	NA	General Surgery	026	PHYSICIANS	45980	24	Plastic Surgery	0	In state provider	None	460 GREENFIELD AVENUE	SUITE 5	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
174709	Fee-for-Service	1316026800	1316026800	2	1	BERJIS, AMIR MD	1/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75137	33	Thoracic Surgery	0	In state provider	None	1700 MOUNT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
174748	Fee-for-Service	1083687594	1083687594	1	1	BALOUGH, BEN J MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	71198	04	Otology, Laryngology, Rhinology	0	In state provider	None	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
174788	Fee-for-Service	1720395171	1720395171	1	1	BANOTH, PRAMEELA	4/27/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	184795	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
174797	Fee-for-Service	1255855367	1255855367	1	1	BERGH, WESTON L PT	11/12/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
174814	Fee-for-Service	1467527382	1467527382	1	2	BLEAKLEY, DENNIS W MD	1/22/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	24509	-	NOT APPLICABLE	0	In state provider	None	303 EAST 52ND STREET	None	LOS ANGELES	CA	90011	4513	19	06037	33.99526806	-118.2699516	Los Angeles County
174829	Fee-for-Service	1285152736	1285152736	1	1	BAIOCCO, DOMINIC C PT	5/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1916 MAIN ST	None	SALINAS	CA	93906	2034	27	06053	36.71995522	-121.655807	Monterey County
174832	Fee-for-Service	1699967075	1699967075	1	1	BENEDICT, JENNIFER L MD	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95721	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
174839	Fee-for-Service	1518979442	1518979442	1	1	BROWN, DENISE S MD	11/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66335	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
174841	Fee-for-Service	1801159736	1801159736	1	1	BEVERLY RADIOLOGY MEDICAL	10/2/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	1901 W LUGONIA AVE	#110	REDLANDS	CA	92374	9704	36	06071	34.07027851	-117.218421	San Bernardino County
174842	Fee-for-Service	1386664514	1386664514	1	1	BAUER, EWA MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	82070	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
174843	Fee-for-Service	1275030066	1275030066	1	1	BENTON, KIMBERLY A MD	2/1/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166427	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
174871	Fee-for-Service	1326243940	1326243940	1	1	BARRIS, RANIA E MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89708	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
174879	Fee-for-Service	1497074579	1497074579	1	1	BUI, THANH-TUYEN C MD	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117767	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
174882	Fee-for-Service	1083683619	1083683619	1	1	BHOJWANI, DEEPA MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135644	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
174908	Fee-for-Service	1033245972	1033245972	1	2	BENFIELD, NERYS C MD	7/13/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	98810	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
174979	Fee-for-Service	1356769079	1356769079	1	2	BLAKE, SARAH F DO	5/6/2022	207R00000X	NA	Other	026	PHYSICIANS	18312	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
175010	Fee-for-Service	1417185224	1417185224	1	1	BACKUS, YOLANDA A MD	6/30/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117428	None	None	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
175014	Fee-for-Service	1467524520	1467524520	1	1	BHASKAR, ROHIT MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50842	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J ST	STE 500	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
175044	Fee-for-Service	1366806333	1366806333	1	1	BELLINO, ANDREW M MD	9/1/2021	207P00000X	NA	Other	026	PHYSICIANS	151215	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
175067	Fee-for-Service	1528292380	1528292380	1	1	BISCOCHO, WEDNESDAY A MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119322	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175087	Fee-for-Service	1588731459	1588731459	1	1	BURKE, JEAN MARIE MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64866	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
175100	Fee-for-Service	1487203832	1487203832	1	1	BRIGHTLANE HEALTHCARE INC	10/27/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5050 PALO VERDE ST	STE 212	MONTCLAIR	CA	91763	2333	36	06071	34.08145549	-117.69516	San Bernardino County
175101	Fee-for-Service	1174754857	1174754857	1	1	BECK, JOSHUA R MD	3/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113943	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
175142	Fee-for-Service	1922334846	1922334846	1	1	BANNER LASSEN MEDICAL CT	7/11/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BANNER LASSEN MEDICAL CT	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
175147	Fee-for-Service	1043746316	1043746316	1	1	BAHAREH FAZILAT MD INC	8/15/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	90071	None	None	0	In state provider	None	4940 VAN NUYS BLVD.	SUITE 302	SHERMAN OAKS	CA	91403	1743	19	06037	34.160589	-118.4486715	Los Angeles County
175161	Fee-for-Service	1417926874	1417926874	1	1	BERGER, ROBERT A. MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	77 W FOREST AVE	STE 201	FLAGSTAFF	AZ	86001	1483	00	None	35.210619	-111.6436275	Coconino County
175170	Fee-for-Service	1083683619	1083683619	1	1	BHOJWANI, DEEPA MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135644	68	Hematology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
175172	Fee-for-Service	1043492358	1043492358	1	1	BUTLER VALLEY INC	9/14/1983	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	380 12TH ST	None	ARCATA	CA	95521	5914	12	06023	40.87047967	-124.0815146	Humboldt County
175174	Fee-for-Service	1184791055	1184791055	1	1	BLACK, JENNIFER A MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68013	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
175185	Fee-for-Service	1427150952	1427150952	1	1	BALIAN, HARRY MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66799	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
175242	Fee-for-Service	1700865367	1700865367	1	1	BRAUN, RONALD J MD	5/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55197	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
175284	Fee-for-Service	1821061060	1821061060	2	1	BROWN, MARK A MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
175287	Fee-for-Service	1932661659	1932661659	1	1	BELL-RUSHAKOFF, SAMANTHA W M	6/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178708	None	None	0	In state provider	D	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
175301	Fee-for-Service	1467524520	1467524520	1	1	BHASKAR, ROHIT MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50842	41	Internal Medicine	0	In state provider	None	3941 J ST	STE 500	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
175334	Fee-for-Service	1891759502	1891759502	1	1	BARTON MEMORIAL HOSPITAL	4/4/1997	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2170 SOUTH AVE	None	S LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
175337	Fee-for-Service	1073148896	1073148896	1	1	BIO-MEDICAL APPLICATIONS OF	1/20/2023	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, INC	41549 KALMIA ST	None	MURRIETA	CA	92562	9597	33	06065	33.560353	-117.2119592	Riverside County
175351	Fee-for-Service	1548518525	1548518525	1	1	BAR, SHELLY MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121723	01	General Practice	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
175356	Fee-for-Service	1528292380	1528292380	1	1	BISCOCHO, WEDNESDAY A MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119322	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175418	Fee-for-Service	1215956438	1215956438	1	1	BILLINGSLEY, ANNE MD	10/11/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	COGENT HEALTHCARE OF CA	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
175421	Fee-for-Service	1508062993	1508062993	1	1	BRIDENSTINE,MARK P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	PO BOX 111719	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
175434	Fee-for-Service	1679695761	1679695761	1	1	BLEAZARD, SCOTT L MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55792	30	Radiology	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	1380	47	06093	41.31798759	-122.3218165	Siskiyou County
175454	Fee-for-Service	1487912812	1487912812	1	1	BUSZKA, JENNIFER M	5/11/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9850 GENESEE AVE	SUITE 440	SAN DIEGO	CA	92037	1212	37	06073	32.882913	-117.226341	San Diego County
175481	Fee-for-Service	1568272912	1568272912	1	1	BARAJAS LOZA, KARINA NP	3/3/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	421 N BROOKHURST ST	STE 119	ANAHEIM	CA	92801	5618	30	06059	33.83743497	-117.9590498	Orange County
175488	Fee-for-Service	1245513167	1245513167	1	1	BASUTA, KIRIN K LCSW	10/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
175508	Fee-for-Service	1700827482	1700827482	1	1	BEYDOUN, SAID R MD	10/31/1984	2084N0400X	NA	Neurology	026	PHYSICIANS	40914	13	Neurology (M.D. only)	0	In state provider	None	2025 ZONAL AVE	BLDG GNH5641	LOS ANGELES	CA	90089	0264	19	06037	34.05998665	-118.2058023	Los Angeles County
175515	Fee-for-Service	1023239118	1023239118	1	1	BENADERET, TOVA S MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103270	08	Family Practice	0	In state provider	None	1595 SOQUEL DRIVE	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
175528	Fee-for-Service	1003844051	1003844051	1	1	BLECHMAN, DAN MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31545	05	Anesthesiology	0	In state provider	None	15151 JANINE DR	None	WHITTIER	CA	90605	1803	19	06037	33.94969305	-118.0035917	Los Angeles County
175531	Fee-for-Service	1699837328	1699837328	1	1	BERNHARDY, DIANA M LCSW	12/5/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
175535	Fee-for-Service	1417285107	1417285107	1	1	BURKHARDT, GLASER F IV LMFT	8/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7177 BROCKTON AVE	STE 109	RIVERSIDE	CA	92506	2632	33	06065	33.94289496	-117.3943941	Riverside County
175553	Fee-for-Service	1699205740	1699205740	1	1	BARRACK, FRANK A MD	10/12/2023	207L00000X	NA	Other	026	PHYSICIANS	191422	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
175571	Fee-for-Service	1821061060	1821061060	2	1	BROWN, MARK A MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
175583	Fee-for-Service	1891120697	1891120697	1	1	BRANCH, CANDICE M MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127587	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
175584	Fee-for-Service	1275108458	1275108458	1	1	BALANKARI, VISHIDHA MD	12/23/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
175593	Fee-for-Service	1669407680	1669407680	1	1	BERGER, DANIEL N MD	5/31/1995	207RE0101X	NA	Endocrinology	026	PHYSICIANS	79192	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
175602	Fee-for-Service	1124284633	1124284633	1	1	BOPARAI, DAVE S MD	8/29/2024	208M00000X	NA	Other	026	PHYSICIANS	170643	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
175631	Fee-for-Service	1760903397	1760903397	1	1	BERNEDO, SANDRA A PT	2/27/2018	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
175633	Fee-for-Service	1265775092	1265775092	1	1	BAHAR, RUNALIA MD	7/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133805	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
175636	Fee-for-Service	1366701831	1366701831	1	1	BELL, PETER B MD	7/26/2020	207L00000X	NA	Other	026	PHYSICIANS	145751	05	Anesthesiology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3522	48	06095	38.26109552	-122.0470245	Solano County
175637	Fee-for-Service	1033297882	1033297882	1	1	BRONDFIELD, ERIC S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	21028	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
175639	Fee-for-Service	1548518525	1548518525	1	1	BAR, SHELLY MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121723	41	Internal Medicine	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
175665	Fee-for-Service	1487201091	1487201091	1	1	BURNAM, HOLLY A NP	12/9/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
175713	Fee-for-Service	1508027681	1508027681	1	1	BRINKLEY, PAULA MD	9/16/2009	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	51506	40	Pediatrics	0	In state provider	None	11875 DUBLIN BLVD	STE C140	DUBLIN	CA	94568	2811	01	06001	37.70140147	-121.9380576	Alameda County
175736	Fee-for-Service	1356563753	1356563753	1	1	BETTER LIFE ADHC INC	12/19/2002	261Q00000X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	13550 SHERMAN WAY	None	VAN NUYS	CA	91405	2830	19	06037	34.20116249	-118.4284935	Los Angeles County
175748	Fee-for-Service	1992796791	1992796791	1	1	BEAGHLER, MARC A MD	10/10/2007	208800000X	NA	Other	026	PHYSICIANS	73931	34	Urology and Urological Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
175764	Fee-for-Service	1609860980	1609860980	1	1	BYUNG YUL KIM, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
175826	Fee-for-Service	1891915401	1891915401	1	1	BONIFACIO, SONIA L MD	5/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91240	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
175836	Fee-for-Service	1831138676	1831138676	1	1	BHISITKUL, ROBERT B MD	9/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	84511	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
175861	Fee-for-Service	1073054490	1073054490	1	1	BENVEGNU, NEILEN A MD	6/30/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	158103	20	Orthopedic Surgery	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
175872	Fee-for-Service	1730237694	1730237694	1	1	BERBERICH, WALTER F MD	7/1/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18819	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
175970	Fee-for-Service	1457428724	1457428724	1	1	BARRISFORD, GLEN W MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130117	34	Urology and Urological Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
175979	Fee-for-Service	1275513665	1275513665	1	1	BERKMAN, SCOTT A MD	2/17/2017	2088P0231X	NA	Other	026	PHYSICIANS	147490	34	Urology and Urological Surgery	0	In state provider	None	1524 MCHENRY AVE	STE 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
175992	Fee-for-Service	1548273196	1548273196	1	1	BARRIGA, AURORA V OD	7/11/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	715 JACKSON ST	STE A	RED BLUFF	CA	96080	3757	52	06103	40.17524703	-122.2405638	Tehama County
176018	Fee-for-Service	1679351274	1679351274	1	1	BRENNER, EINAT	2/19/2025	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
176019	Fee-for-Service	1518344993	1518344993	1	2	BLOSSOM CARE HOSPICE, INC	4/20/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	STE 210	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
176024	Fee-for-Service	1770029175	1770029175	1	1	BLITCH, DANIEL LPCC	4/9/2025	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
176035	Fee-for-Service	1992796791	1992796791	1	1	BEAGHLER, MARC A MD	10/10/2007	208800000X	NA	Other	026	PHYSICIANS	73931	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
176039	Fee-for-Service	1588823538	1588823538	1	1	BRICKMAN GONZALEZ, CRISTINA	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128152	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
176103	Fee-for-Service	1407850381	1407850381	1	1	BIRD,JULIO J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1910 SOUTH AVE	None	LA'CROSSE	WI	54601	0000	00	None	43.79473653	-91.24623835	La Crosse
176111	Fee-for-Service	1649477258	1649477258	1	1	BEERS, EMILY H MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147756	24	Plastic Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
176115	Fee-for-Service	1376791269	1376791269	1	1	BORCHARDT, SHAVONNE S DO	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13414	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
176121	Fee-for-Service	1427473495	1427473495	1	1	BRITTNER, STACY A LMFT	3/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
176154	Fee-for-Service	1316259179	1316259179	1	1	BANTA, DARYL P M D INC	1/14/2011	207RC0200X	NA	Other	026	PHYSICIANS	88722	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	39 CONGRESS ST	SUITE 201A	PASADENA	CA	91105	3021	19	06037	34.13407645	-118.151226	Los Angeles County
176161	Fee-for-Service	1841277944	1841277944	1	1	BRUNO, DIETER MD	4/1/2021	208800000X	NA	Other	026	PHYSICIANS	96007	None	None	0	In state provider	None	2900 WHIPPLE	STE 132	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
176189	Fee-for-Service	1174941710	1174941710	1	1	BALL, TALI M PHD	6/21/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
176193	Fee-for-Service	1811279763	1811279763	1	5	BARTZ ALTADONNA COMMUNITY	9/11/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	12560 BORON AVE	None	BORON	CA	93516	1647	15	06029	35.00735021	-117.6497254	Kern County
176232	Fee-for-Service	1437306537	1437306537	1	1	BRAGAS, MARK RYAN D	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
176243	Fee-for-Service	1427593821	1427593821	1	1	BURGETT, KATE LMFT	6/6/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	139586	-	NOT APPLICABLE	0	In state provider	None	44443 N 10TH STREET WEST	SUITE A	LANCASTER	CA	93534	3346	19	06037	34.69074211	-118.1480945	Los Angeles County
176249	Fee-for-Service	1730114794	1730114794	1	1	BERNSTEIN, ADAM M MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90438	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
176255	Fee-for-Service	1750533881	1750533881	1	1	BOURKE, MICHELLE N MD	1/7/2009	207R00000X	NA	Other	026	PHYSICIANS	73725	41	Internal Medicine	0	In state provider	None	250 BON AIR ROAD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
176260	Fee-for-Service	1659968303	1659968303	1	1	BAKSHI, ARJUN DO	9/17/2024	207P00000X	NA	Other	026	PHYSICIANS	21805	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
176309	Fee-for-Service	1518344993	1518344993	1	2	BLOSSOM CARE HOSPICE, INC	4/20/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	STE 210	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
176360	Fee-for-Service	1316475270	1316475270	1	1	BARRY, ADRIENNE MD	5/12/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	159987	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
176364	Fee-for-Service	1487620829	1487620829	1	1	BANCIU-ODELL, CORNELIA G MD	11/3/2009	207R00000X	NA	Other	026	PHYSICIANS	76154	41	Internal Medicine	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
176369	Fee-for-Service	1578576880	1578576880	1	1	BRIGHT MEDICAL ASSOC INC	1/6/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
176372	Fee-for-Service	1245366046	1245366046	1	1	BYRNE, MICHAEL L OD INC	10/19/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	LA MIRADA OPTOMETRY INC	12819 VALLEY VIEW AVE	None	LA MIRADA	CA	90638	1945	19	06037	33.91521727	-118.0293935	Los Angeles County
176421	Fee-for-Service	1134144165	1134144165	1	7	BORREGO COMMUNITY HEALTH	10/8/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	590 PALM CANYON DR	STE 212	BORREGO SPRINGS	CA	92004	0000	37	06073	33.25655753	-116.380188	San Diego County
176422	Fee-for-Service	1699968305	1699968305	1	1	BROWNE, ADRIANNA MD	12/28/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	116404	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
176464	Fee-for-Service	1073874830	1073874830	1	1	BUSHAN, ARTHI PT	3/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
176467	Fee-for-Service	1588031322	1588031322	1	1	BARNNY JEPP LLC	3/23/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1145 W 6TH ST	SUITE 100	LOS ANGELES	CA	90017	1828	19	06037	34.05462682	-118.2634078	Los Angeles County
176477	Fee-for-Service	1164188587	1164188587	1	1	BENSON-KELSEY, MARLENA NP	7/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	36	06071	34.06914052	-117.2695442	San Bernardino County
176482	Fee-for-Service	1811279763	1811279763	1	5	BARTZ ALTADONNA COMMUNITY	9/11/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	12560 BORON AVE	None	BORON	CA	93516	1647	15	06029	35.00735021	-117.6497254	Kern County
176491	Fee-for-Service	1326075565	1326075565	1	1	BRANDES, DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MED HAWAII, INC	221 MAHALANI ST	None	WAILUKU	HI	96793	2526	00	None	20.88554026	-156.4902142	Maui County
176496	Fee-for-Service	1164454930	1164454930	1	1	BOWES, LARRY D MD INC	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	22459	18	Ophthalmology	0	In state provider	None	2544 E WASHINGTON BLVD	STE C	PASADENA	CA	91107	1465	19	06037	34.16911248	-118.097577	Los Angeles County
176500	Fee-for-Service	1427109073	1427109073	1	1	BRAWLEY UNION HSD	3/14/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	480 N IMPERIAL AVE	None	BRAWLEY	CA	92227	1625	13	06025	32.98283859	-115.5349117	Imperial County
176510	Fee-for-Service	1154825479	1154825479	1	1	BAKER, MATTHEW S MD	6/8/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165375	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
176526	Fee-for-Service	1386336501	1386336501	1	1	BANYAN PSYCHOLOGY INC.	8/27/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 S ELLSWORTH AVE	STE 802	SAN MATEO	CA	94401	3926	41	06081	37.56665635	-122.3247743	San Mateo County
176531	Fee-for-Service	1821422312	1821422312	1	1	BVA HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	315 ARDEN AVE	SUITE 25	GLENDALE	CA	91203	1101	19	06037	34.15852735	-118.2587759	Los Angeles County
176535	Fee-for-Service	1407334063	1407334063	1	1	BOQUIREN, LAWRENCE F RCP	9/3/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
176564	Fee-for-Service	1003172529	1003172529	1	1	BAE, SANGMEE MD	11/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132195	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,120,420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
176575	Fee-for-Service	1811289317	1811289317	1	1	BOXIDARA INC	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87090	None	None	0	In state provider	C/O LANCASTER WOUND CARE	43845 10TH ST W #2A	None	LANCASTER	CA	93534	4800	19	06037	34.68012017	-118.1479449	Los Angeles County
176596	Fee-for-Service	1164460978	1164460978	1	1	BULLOCK, SHAWN F MD	8/1/1999	207L00000X	NA	Other	026	PHYSICIANS	62757	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
176616	Fee-for-Service	1083377634	1083377634	1	1	BLUE FIN NON EMERGENCY MEDIC	10/15/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AL TRANSPORTATION INC	7448 ELDER CREEK RD	None	SACRAMENTO	CA	95824	4311	34	06067	38.510217	-121.4165025	Sacramento County
176630	Fee-for-Service	1043471022	1043471022	1	1	BHAVSAR, RAJESH A MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151868	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
176639	Fee-for-Service	1033369947	1033369947	1	1	BULIBEK, BATYRJAN K MD	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148198	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
176641	Fee-for-Service	1962180265	1962180265	1	1	BELLEFONTAINE HEALTH CENTER	4/1/2024	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE	120 BELLEFONTAINE ST	None	PASADENA	CA	91105	3102	19	06037	34.1315505	-118.1531025	Los Angeles County
176649	Fee-for-Service	1396739678	1396739678	1	1	BUI, MINH MD	5/31/1992	174400000X	NA	Other	026	PHYSICIANS	51266	None	None	0	In state provider	None	1505 W 17TH ST	None	SAN BERNARDINO	CA	92411	1202	36	06071	34.13045153	-117.31869	San Bernardino County
176662	Fee-for-Service	1316032972	1316032972	1	1	BALL, ERIC H MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83928	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
176694	Fee-for-Service	1447749031	1447749031	1	1	BAE, EDWARD MD	9/26/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	185353	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
176709	Fee-for-Service	1134144165	1134144165	1	7	BORREGO COMMUNITY HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	590 PALM CANYON DR	STE 212	BORREGO SPRINGS	CA	92004	0000	37	06073	33.25655753	-116.380188	San Diego County
176740	Fee-for-Service	1619365699	1619365699	1	1	BEST IN CARE PARTNERS INC	10/7/2015	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	5601 WEST SLAUSON AVE	SUITE 272	CULVER CITY	CA	90230	6672	19	06037	33.98900447	-118.37979	Los Angeles County
176771	Fee-for-Service	1144293119	1144293119	1	1	BARNES, GEORGE MD	6/30/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	84187	None	None	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	4878	19	06037	34.39696803	-118.5525278	Los Angeles County
176820	Fee-for-Service	1124199047	1124199047	1	1	BARTZ, STEPHEN H.	10/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	68967	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
176821	Fee-for-Service	1821422312	1821422312	1	1	BVA HOSPICE CARE INC	6/18/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	315 ARDEN AVE	SUITE 25	GLENDALE	CA	91203	1101	19	06037	34.15852735	-118.2587759	Los Angeles County
176822	Fee-for-Service	1235459140	1235459140	1	1	BIANCONI, SIMONA E MD	12/2/2019	207SG0201X	NA	Other	026	PHYSICIANS	162693	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
176834	Fee-for-Service	1558853234	1558853234	1	1	BROADWAY LASER SURGICAL INST	9/4/2020	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ITUTE, INC.	1100 E BROADWAY	#200	GLENDALE	CA	91205	1380	19	06037	34.14622171	-118.2415193	Los Angeles County
176867	Fee-for-Service	1750444766	1750444766	1	1	BLAZE, ALLISON E MD	8/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82136	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
176868	Fee-for-Service	1356803753	1356803753	1	1	BAKER, JORDAN J DO	6/14/2022	207P00000X	NA	Other	026	PHYSICIANS	19373	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
176893	Fee-for-Service	1619029840	1619029840	1	1	BARKER, CHRISTOPHER L MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	32194	08	Family Practice	0	In state provider	None	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
176897	Fee-for-Service	1720064629	1720064629	1	1	BARRY, KIM BAKER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7700 S BROADWAY	None	LITTLETON	CO	80122	2602	00	None	39.576573	-104.9859	Arapahoe County
176908	Fee-for-Service	1154347565	1154347565	1	1	BURT, VIVIEN K MD	5/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55895	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
176909	Fee-for-Service	1760557706	1760557706	1	1	BARZO, MELISSA K	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
176915	Fee-for-Service	1699848580	1699848580	1	1	BALCH, CHRISTA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85922	08	Family Practice	0	In state provider	None	130 E ROMIE LN	STE D	SALINAS	CA	93901	3160	27	06053	36.66175331	-121.6541075	Monterey County
176919	Fee-for-Service	1801058938	1801058938	1	1	BADAKHSHAN, BITA MD	1/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116789	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3025	30	06059	33.85429563	-117.8166478	Orange County
176929	Fee-for-Service	1396727319	1396727319	1	1	BHARATIYA, SAROJ MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94149	41	Internal Medicine	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
176962	Fee-for-Service	1710307186	1710307186	1	1	BUCHER HEMATOLOGY-ONCOLOGY	7/15/2014	193400000X	NA	Other	026	PHYSICIANS	91791	78	Neoplastic Diseases/Oncology	0	In state provider	INC	1180 N INDIAN CANYON DR	SUITE E-218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
177017	Fee-for-Service	1275890287	1275890287	1	1	BENARD, SHAWNA W MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141367	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
177040	Fee-for-Service	1861413700	1861413700	1	1	BUTCHER, BRENT A MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67738	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
177058	Fee-for-Service	1104111442	1104111442	1	1	BRUNO, CHRISTOPHER M MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141763	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177085	Fee-for-Service	1194746057	1194746057	1	4	BERKELEY CARDIOVASCULAR	8/11/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL	3300 WEBSTER ST	SUITE 702	OAKLAND	CA	94609	3122	01	06001	37.82132826	-122.2621843	Alameda County
177115	Fee-for-Service	1972598506	1972598506	1	1	BASS,CLAYTON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
177116	Fee-for-Service	1194746057	1194746057	1	1	BERKELEY CARDIOVASCULAR	8/5/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
177118	Fee-for-Service	1184752610	1184752610	1	1	BIXBY, CHRISTINA E MD	4/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81484	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
177131	Fee-for-Service	1679747760	1679747760	1	1	BATH, HARNEET	3/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103419	41	Internal Medicine	0	In state provider	None	2107 LIVINGSTON ST	STE A	OAKLAND	CA	94606	5218	01	06001	37.78079097	-122.2404748	Alameda County
177179	Fee-for-Service	1407353170	1407353170	1	1	BAEK, JANET J MD	6/15/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	163790	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
177196	Fee-for-Service	1144370966	1144370966	1	1	BANGI, EDWIN T MD	3/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	86633	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
177220	Fee-for-Service	1013128610	1013128610	1	1	BARTOLOME, RHETT M DO	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9865	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
177239	Fee-for-Service	1174103840	1174103840	1	1	BAKKE, BRIAN M MD	9/9/2024	207R00000X	NA	Other	026	PHYSICIANS	191885	41	Internal Medicine	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
177248	Fee-for-Service	1710307186	1710307186	1	1	BUCHER HEMATOLOGY-ONCOLOGY	7/15/2014	193400000X	NA	Other	026	PHYSICIANS	91791	68	Hematology	0	In state provider	INC	1180 N INDIAN CANYON DR	SUITE E-218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
177254	Fee-for-Service	1467729806	1467729806	1	1	BOSSI, ERIC	3/17/2020	2084F0202X	NA	Psychiatry	026	PHYSICIANS	132983	36	Psychiatry	0	In state provider	None	5016 CHESEBRO RD	STE 200	AGOURA HILLS	CA	91301	2277	19	06037	34.14134802	-118.7392827	Los Angeles County
177292	Fee-for-Service	1194763326	1194763326	1	1	BLACK, JENNIFER M MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84075	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177293	Fee-for-Service	1225179138	1225179138	1	1	BHANDARKAR, VIDYA N MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105877	40	Pediatrics	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.4876781	-122.2249265	San Mateo County
177307	Fee-for-Service	1609882471	1609882471	1	1	BRUDER, NANCY L MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85308	05	Anesthesiology	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
177350	Fee-for-Service	1558449249	1558449249	1	1	BARBOUR, SANDRA I MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79742	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
177370	Fee-for-Service	1538501002	1538501002	1	1	BRANSON, PAIGE E	5/23/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
177387	Fee-for-Service	1023064243	1023064243	1	1	BERNAL, DAVID MD	8/31/1988	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	43703	41	Internal Medicine	0	In state provider	None	8731 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2670	19	06037	34.00247122	-118.0861643	Los Angeles County
177395	Fee-for-Service	1063660033	1063660033	1	1	BAILEY, LORI A OD	5/22/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2125 E THOUSAND OAKS BLV	SUITE A	THOUSAND OAKS	CA	91362	2945	56	06111	34.17525064	-118.8467186	Ventura County
177405	Fee-for-Service	1194746057	1194746057	1	5	BERKELEY CARDIOVASCULAR	8/1/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP	345 9TH STREET	SUITE 205	OAKLAND	CA	94607	4206	01	06001	37.79975865	-122.2705956	Alameda County
177423	Fee-for-Service	1366763906	1366763906	1	1	BAJWA, RAHULJIT S MD	10/11/2019	208M00000X	NA	Other	026	PHYSICIANS	152179	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
177430	Fee-for-Service	1386934404	1386934404	1	1	BRANDON, MICHAEL S JR MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13872	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
177522	Fee-for-Service	1801539226	1801539226	1	1	BARRAMEDA, DONITA F MD	3/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188978	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
177527	Fee-for-Service	1174103840	1174103840	1	1	BAKKE, BRIAN M MD	9/9/2024	207R00000X	NA	Other	026	PHYSICIANS	191885	70	Clinic (mixed specialty)	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
177535	Fee-for-Service	1013111087	1013111087	1	1	BHATT, PRITI J PT	10/18/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
177553	Fee-for-Service	1689224255	1689224255	1	1	BARAJAS EMESTICA, EKATERINA	2/3/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
177556	Fee-for-Service	1861458598	1861458598	1	1	BRETT, CLAIRE M MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36606	05	Anesthesiology	0	In state provider	None	513 PARNASSUS AVE	# 436	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
177567	Fee-for-Service	1063545317	1063545317	1	2	BYRNES, MATTHEW C MD	3/9/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	138017	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
177580	Fee-for-Service	1194763326	1194763326	1	1	BLACK, JENNIFER M MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84075	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177585	Fee-for-Service	1255890836	1255890836	1	1	BEYER, KERRIE NP	7/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3300 WEBSTER STREET	SUITE 900	OAKLAND	CA	94609	3156	01	06001	37.82132826	-122.2621843	Alameda County
177638	Fee-for-Service	1053935775	1053935775	1	1	BARADEI, ALEXANDER MD	3/31/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	1805 N CALIFORNIA ST	201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
177659	Fee-for-Service	1295989861	1295989861	1	1	BARDASIAN, BRENDA L	1/11/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
177662	Fee-for-Service	1396857199	1396857199	1	1	BIO MEDICAL APPLICATIONS	8/1/1991	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	715 SOUTHPOINT BLVD	STE A	PETALUMA	CA	94954	6836	49	06097	38.25753127	-122.6461294	Sonoma County
177680	Fee-for-Service	1669550885	1669550885	1	1	BEATON, ROBERTO A MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	45244	41	Internal Medicine	0	In state provider	None	4314 W VICTORY BLVD	None	BURBANK	CA	91505	1334	19	06037	34.18483654	-118.3581315	Los Angeles County
177682	Fee-for-Service	1902291479	1902291479	1	1	BUEN, FLOYD M MD	8/13/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	147361	None	None	0	In state provider	None	26726 CROWN VALLEY PKWY	#200	MISSION VIEJO	CA	92691	8003	30	06059	33.56385623	-117.6639538	Orange County
177711	Fee-for-Service	1366763906	1366763906	1	1	BAJWA, RAHULJIT S MD	10/11/2019	208M00000X	NA	Other	026	PHYSICIANS	152179	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
177773	Fee-for-Service	1003925363	1003925363	2	1	BLOK, BARBARA K MD	4/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
177867	Fee-for-Service	1114419355	1114419355	1	1	BENNION, DOUGLAS M MD	6/1/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	186423	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177879	Fee-for-Service	1871883397	1871883397	1	1	BARDEN, MATTHIAS MD	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122125	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	2804	36	06071	34.047153	-117.2611485	San Bernardino County
177880	Fee-for-Service	1558927947	1558927947	1	1	BAKER, HAILEY MD	10/3/2024	207RR0500X	NA	Other	026	PHYSICIANS	192235	41	Internal Medicine	0	In state provider	None	1955 CITRACADO PKWY	STE 200	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
177939	Fee-for-Service	1184632523	1184632523	1	1	BEMILLER, LYNN S MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	45335	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177980	Fee-for-Service	1114005980	1114005980	1	1	BAKAL, ARTHUR E MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	49908	41	Internal Medicine	0	In state provider	None	6500 FAIRMOUNT AVE	STE 7	EL CERRITO	CA	94530	3623	07	06013	37.90115255	-122.3007746	Contra Costa County
178050	Fee-for-Service	1932929718	1932929718	1	1	BMJC MEDICAL GROUP INC	3/4/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UP	23365 HAWTHORNE BLVD	STE 104	TORRANCE	CA	90505	3736	19	06037	33.814098	-118.3512385	Los Angeles County
178080	Fee-for-Service	1720288327	1720288327	1	1	BANSKOTA, NIRMAL K MD INC	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44429	41	Internal Medicine	0	In state provider	None	1015 N FIRST AVENUE	SUITE B	ARCADIA	CA	91006	7401	19	06037	34.15065339	-118.0285869	Los Angeles County
178085	Fee-for-Service	1619902152	1619902152	1	1	BRUGLER, BETSY A LCSW	6/13/1999	104100000X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5905 SOQUEL DR	STE 650	SOQUEL	CA	95073	2862	44	06087	36.98881452	-121.9364193	Santa Cruz County
178092	Fee-for-Service	1437392263	1437392263	1	1	BYMASTER, ANGELA J MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101603	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
178095	Fee-for-Service	1275605008	1275605008	1	1	BRAHAN, DENISE M MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91486	40	Pediatrics	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
178103	Fee-for-Service	1871655084	1871655084	1	1	BLANKFELD, DEBORAH F PHD	4/17/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
178106	Fee-for-Service	1336497270	1336497270	1	1	BONAVITA, ANTHONY P PHD	10/25/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1227 DE LA VINA ST	None	SANTA BARBARA	CA	93101	3129	42	06083	34.42190785	-119.7076889	Santa Barbara County
178134	Fee-for-Service	1497190763	1497190763	1	1	BREEN, VANESSA L NP	5/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
178143	Fee-for-Service	1952562209	1952562209	1	1	BAHL, GAUTAM MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110559	30	Radiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92193	2410	37	06073	32.7537975	-117.1658298	San Diego County
178152	Fee-for-Service	1295317709	1295317709	1	1	BUTLER, REGINA M NP	3/6/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
178164	Fee-for-Service	1841250750	1841250750	1	1	BUCKELEW, SARA M MD	9/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71789	40	Pediatrics	0	In state provider	None	652 W 11TH ST	STE 129	TRACY	CA	95376	3821	39	06077	37.73965047	-121.435452	San Joaquin County
178204	Fee-for-Service	1427315548	1427315548	1	1	BLOCKMAN, BRITTANY N MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128373	40	Pediatrics	0	In state provider	None	2200 O'FARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
178226	Fee-for-Service	1184632523	1184632523	1	1	BEMILLER, LYNN S MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	45335	68	Hematology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
178258	Fee-for-Service	1801261920	1801261920	1	1	BAUTISTA, MARIA C NP	7/6/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	SAN MATEO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo
178262	Fee-for-Service	1700102787	1700102787	1	1	BALAZS, ANDY LMFT	10/25/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1826 S ELENA AVE	STE D	REDONDO BEACH	CA	90277	5718	19	06037	33.81706829	-118.3862424	Los Angeles County
178273	Fee-for-Service	1689102535	1689102535	1	1	BILKHU, GURTEJBIR S DO	8/7/2020	207P00000X	NA	Other	026	PHYSICIANS	18161	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
178287	Fee-for-Service	1487842878	1487842878	1	1	BHUPATHY, VELLORE R MD APC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26441	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	14350 WHITTIER BLVD	SUITE 205	WHITTIER	CA	90605	2142	19	06037	33.95501294	-118.0185665	Los Angeles County
178301	Fee-for-Service	1942236542	1942236542	1	1	BOONE, WILLIE B MD	1/1/1979	207W00000X	NA	Ophthalmology	026	PHYSICIANS	13745	18	Ophthalmology	0	In state provider	None	301 N PRAIRIE AVE	STE 601	INGLEWOOD	CA	90301	4513	19	06037	33.965712	-118.3439965	Los Angeles County
178302	Fee-for-Service	1730151366	1730151366	1	1	BAILEY, GEORGE M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 13TH ST	None	HOOD RIVER	OR	97031	1210	00	None	45.70448869	-121.5251705	Hood River County
178320	Fee-for-Service	1265525075	1265525075	1	1	BIREN, HELEN M MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	66742	36	Psychiatry	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
178337	Fee-for-Service	1922199785	1922199785	1	1	BARTH, RICHARD A MD	11/30/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33056	30	Radiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
178338	Fee-for-Service	1932929718	1932929718	1	1	BMJC MEDICAL GROUP INC	3/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	UP	23365 HAWTHORNE BLVD	STE 104	TORRANCE	CA	90505	3736	19	06037	33.814098	-118.3512385	Los Angeles County
178370	Fee-for-Service	1720288327	1720288327	1	1	BANSKOTA, NIRMAL K MD INC	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44429	67	Endocrinology	0	In state provider	None	1015 N FIRST AVENUE	SUITE B	ARCADIA	CA	91006	7401	19	06037	34.15065339	-118.0285869	Los Angeles County
178384	Fee-for-Service	1053526285	1053526285	1	1	BARRETO, WILLIAM M MD	3/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	91430	None	None	0	In state provider	None	3620 ATLANTIC AVE	None	LONG BEACH	CA	90807	3718	19	06037	33.822846	-118.185003	Los Angeles County
178390	Fee-for-Service	1134744733	1134744733	1	1	BAKER, JUSTIN	6/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
178429	Fee-for-Service	1871555425	1871555425	1	1	BAKER, PHILIP A MD	11/3/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87468	None	None	0	In state provider	None	2020 COURT ST	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
178460	Fee-for-Service	1215260591	1215260591	1	1	BLANK, JEREMY A PSYD	1/11/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27403 YNEZ RD.	205	TEMECULA	CA	92591	4616	33	06065	33.5066395	-117.15022	Riverside County
178471	Fee-for-Service	1649686791	1649686791	1	1	BABAKHANIAN, ZAREE MD INC	11/24/2014	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	109953	41	Internal Medicine	0	In state provider	None	50 BELLEFONTAINE ST	STE 409	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
178473	Fee-for-Service	1720460074	1720460074	1	1	BLEE, ELIZABETH A LMFT	9/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
178476	Fee-for-Service	1689729527	1689729527	2	1	BHUPATHY, VELLORE R MD	3/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	26441	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	14350 WHITTIER BLVD	SUITE 205	WHITTIER	CA	90605	2142	19	06037	33.95501294	-118.0185665	Los Angeles County
178513	Fee-for-Service	1184632523	1184632523	1	1	BEMILLER, LYNN S MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	45335	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
178538	Fee-for-Service	1801908371	1801908371	1	1	BHINDER, JAGMOHAN S MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61992	40	Pediatrics	0	In state provider	None	1860 COLORADO AVE	None	TURLOCK	CA	95382	2717	50	06099	37.509975	-120.835262	Stanislaus County
178546	Fee-for-Service	1558594309	1558594309	1	1	BEDDAWI, YAZEN MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141961	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	411 30TH ST	3RD FLOOR	OAKLAND	CA	94609	3312	01	06001	37.81903474	-122.2649444	Alameda County
178565	Fee-for-Service	1255799599	1255799599	1	1	BURBANK HOSPICE CARE	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	16909 PARTHENIA ST	SUITE 103	NORTH HILLS	CA	91343	4557	19	06037	34.22852346	-118.500687	Los Angeles County
178570	Fee-for-Service	1639784457	1639784457	1	1	BANH, JEFFREY PT	9/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 N MAIN ST	STE 340	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
178597	Fee-for-Service	1972063378	1972063378	1	1	BARKER, SIMONE M MD	7/1/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	1561 CREEKSIDE DRIVE	180	FOLSOM	CA	95630	3492	34	06067	38.668032	-121.150188	Sacramento County
178598	Fee-for-Service	1447490958	1447490958	1	1	BAGOURDI, ELENI PHD	11/19/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 S BARRINGTON AVE	SUITE 314	LOS ANGELES	CA	90025	5379	19	06037	34.03672191	-118.4500156	Los Angeles County
178607	Fee-for-Service	1326198144	1326198144	1	1	BATRA, AMIT A MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74555	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
178626	Fee-for-Service	1932929718	1932929718	1	1	BMJC MEDICAL GROUP INC	3/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	UP	23365 HAWTHORNE BLVD	STE 104	TORRANCE	CA	90505	3736	19	06037	33.814098	-118.3512385	Los Angeles County
178629	Fee-for-Service	1407993694	1407993694	1	1	BASSETT, ELIZABETH L MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89483	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
178638	Fee-for-Service	1881199578	1881199578	1	1	BRANT, AMANDA MD	8/14/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	15	Obstetrics (D.O. only)	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
178640	Fee-for-Service	1225324049	1225324049	1	1	BUTTERFIELD, JANICE E	1/24/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
178693	Fee-for-Service	1215221635	1215221635	1	1	BARROW, ALISON B MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132252	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 FOURTH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
178738	Fee-for-Service	1295883114	1295883114	1	1	BIRNBAUM, JACOB S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34559	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
178751	Fee-for-Service	1083142236	1083142236	1	1	BOWMAN, SHELBY DDS	8/19/2024	122300000X	NA	Dental Provider	026	PHYSICIANS	None	47	Miscellaneous	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
178759	Fee-for-Service	1649686791	1649686791	1	1	BABAKHANIAN, ZAREE MD INC	11/24/2014	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	109953	10	Gastroenterology (M.D. only)	0	In state provider	None	50 BELLEFONTAINE ST	STE 409	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
178768	Fee-for-Service	1689708695	1689708695	1	1	BADKOOBEHI, HEDIEH MD	5/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81155	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
178790	Fee-for-Service	1598772196	1598772196	1	1	BOONE, JAMES D MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85924	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
178828	Fee-for-Service	1558594309	1558594309	1	1	BEDDAWI, YAZEN MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	411 30TH ST	3RD FLOOR	OAKLAND	CA	94609	3312	01	06001	37.81903474	-122.2649444	Alameda County
178846	Fee-for-Service	1346504883	1346504883	1	1	BARWANI, JHARNA MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133357	41	Internal Medicine	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
178850	Fee-for-Service	1255799599	1255799599	1	1	BURBANK HOSPICE CARE	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	16909 PARTHENIA ST	SUITE 103	NORTH HILLS	CA	91343	4557	19	06037	34.22852346	-118.500687	Los Angeles County
178856	Fee-for-Service	1992739643	1992739643	1	1	BERKMAN,MATTHEW R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
178857	Fee-for-Service	1730150392	1730150392	1	1	BOSWELL, GILBERT E MD	11/30/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	65288	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
178899	Fee-for-Service	1801908850	1801908850	1	1	BROWN, ROGER S MD INC	2/28/1993	207L00000X	NA	Other	026	PHYSICIANS	20744	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
178914	Fee-for-Service	1932929718	1932929718	1	1	BMJC MEDICAL GROUP INC	3/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	UP	23365 HAWTHORNE BLVD	STE 104	TORRANCE	CA	90505	3736	19	06037	33.814098	-118.3512385	Los Angeles County
178928	Fee-for-Service	1881199578	1881199578	1	1	BRANT, AMANDA MD	8/14/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	09	Gynecology (D.O. only)	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
178930	Fee-for-Service	1891322640	1891322640	1	1	BAILEY, KATHERINE MD	8/28/2023	390200000X	NA	Other	026	PHYSICIANS	184692	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
178932	Fee-for-Service	1215546197	1215546197	1	1	BOLTON, ALEXIS R CNP	11/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16773 BERNARDO CENTER DR	None	SAN DIEGO	CA	92128	2525	37	06073	33.01874412	-117.0752752	San Diego County
178939	Fee-for-Service	1598742710	1598742710	1	1	BERRY, JASON C DO	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	7047	None	None	0	In state provider	None	500 S ANAHEIM HILLS RD	STE 242	ANAHEIM	CA	92807	4760	30	06059	33.8427954	-117.7772895	Orange County
178947	Fee-for-Service	1902008592	1902008592	1	1	BISHT, GEETA MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	106332	41	Internal Medicine	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
178983	Fee-for-Service	1992925564	1992925564	1	1	BOUNOUA, FARIDA MD	12/24/2015	208600000X	NA	General Surgery	026	PHYSICIANS	89619	02	General Surgery	0	In state provider	None	2323 DE LA VINA	STE 207	SANTA BARBARA	CA	93105	3880	42	06083	34.43202913	-119.7212339	Santa Barbara County
179000	Fee-for-Service	1649341686	1649341686	1	1	BROOME, DIANE L MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	23474	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
179029	Fee-for-Service	1841267234	1841267234	1	1	BOB, BRUCE	2/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	24577	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
179045	Fee-for-Service	1750338729	1750338729	1	1	BYERS, ROBERT H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41030	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1341 S ELISEO DR	STE 200	GREENBRAE	CA	94904	2000	21	06041	37.9449045	-122.537105	Marin County
179078	Fee-for-Service	1598772196	1598772196	1	1	BOONE, JAMES D MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85924	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
179079	Fee-for-Service	1619943024	1619943024	1	1	BAUTISTA-AZORES, RICHELLE P	2/6/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54691	40	Pediatrics	0	In state provider	MD	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
179137	Fee-for-Service	1396038931	1396038931	1	1	BHANVADIA, SUMEET K MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116945	34	Urology and Urological Surgery	0	In state provider	None	863 N DOUGLAS STREET	#100	EL SEGUNDO	CA	92045	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
179153	Fee-for-Service	1760801716	1760801716	1	1	BRIONES, LORENZO A MD INC	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	39376	None	None	0	In state provider	None	4643 BEVERLY BLVD	SUITE 103	LOS ANGELES	CA	90004	3101	19	06037	34.07626384	-118.3106685	Los Angeles County
179164	Fee-for-Service	1134157316	1134157316	1	1	BENDER, GREGORY N MD	1/24/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	47599	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
179167	Fee-for-Service	1891866877	1891866877	1	1	BRUNNGRABER, EDWARD H MD	7/31/1992	2085R0001X	NA	Other	026	PHYSICIANS	66792	30	Radiology	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
179169	Fee-for-Service	1134446610	1134446610	1	1	BOYD, RHEA W MD	8/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119754	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	4121	43	06085	37.43920432	-122.162109	Santa Clara County
179183	Fee-for-Service	1881126209	1881126209	1	1	BAER, SHOSHAUNA G	8/31/2022	208M00000X	NA	Other	026	PHYSICIANS	170364	None	None	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
179201	Fee-for-Service	1740269752	1740269752	1	1	BIRNBAUM, PETER L MD	11/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52432	33	Thoracic Surgery	0	In state provider	None	30 RIVER PARK PL W	STE 260	FRESNO	CA	93720	1547	10	06019	36.85863998	-119.7892053	Fresno County
179215	Fee-for-Service	1265403117	1265403117	1	1	BRAATZ, STEVEN E	9/18/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87968	None	None	0	In state provider	None	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43814074	-120.6259249	Lassen County
179217	Fee-for-Service	1932235553	1932235553	1	1	BALASUBRAMANIAN, VIJAYALAKSH	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	36974	05	Anesthesiology	0	In state provider	None	1600 WEST AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
179219	Fee-for-Service	1649503319	1649503319	1	9	BEAVER MEDICAL GROUP LP	7/10/2008	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
179224	Fee-for-Service	1699184259	1699184259	1	1	BAKER, TANYA E NP	2/3/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
179225	Fee-for-Service	1487721247	1487721247	1	1	BELL, MARIA R OD	9/10/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 CALIFORNIA STREET	None	REDLANDS	CA	92374	2910	36	06071	34.07159807	-117.2263378	San Bernardino County
179230	Fee-for-Service	1932140639	1932140639	1	1	BUKATA, SUSAN V MD	3/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55109	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
179236	Fee-for-Service	1215208673	1215208673	1	1	BHANU, SHIV B MD	5/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133806	30	Radiology	0	In state provider	None	1516 COTNER AVE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
179244	Fee-for-Service	1548411259	1548411259	1	1	BENDER, ROSEMARY C MD	4/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112207	22	Pathology (M.D. only)	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
179246	Fee-for-Service	1053356089	1053356089	1	1	BRAUNSTEIN, SHEILA M MD	7/31/1990	207N00000X	NA	Dermatology	026	PHYSICIANS	48550	07	Dermatology	0	In state provider	None	87 SCRIPPS DR	STE 104	SACRAMENTO	CA	95825	6379	34	06067	38.572092	-121.410261	Sacramento County
179259	Fee-for-Service	1902965387	1902965387	1	1	BENNETT, MARK	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
179293	Fee-for-Service	1154492072	1154492072	1	1	BOWLUS, THOMAS L MD	2/28/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39810	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
179295	Fee-for-Service	1881697183	1881697183	1	1	BUFFORD D MOORE, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2802 GARTH RD	SUITE 301	BAYTOWN	TX	77521	3925	00	None	29.75231384	-94.97718676	Harris County
179306	Fee-for-Service	1821148941	1821148941	1	1	BHUVA, RAJIV H MD	9/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73890	41	Internal Medicine	0	In state provider	None	655 S MAIN ST	None	LOS ANGELES	CA	90014	2003	19	06037	34.0441643	-118.2511469	Los Angeles County
179308	Fee-for-Service	1467558734	1467558734	1	1	BARKODAR, JOHN MD INC	4/30/1987	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	44541	None	None	0	In state provider	VICTORIA MEDICAL GROUP	3314 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	2938	19	06037	33.95457876	-118.2106077	Los Angeles County
179315	Fee-for-Service	1922383579	1922383579	1	1	BRANDT, JASON J	10/9/2014	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	39615 WASHINGTON ST	SUITE C	PALM DESERT	CA	92211	4157	33	06065	33.76215174	-116.3007949	Riverside County
179371	Fee-for-Service	1780230995	1780230995	1	1	BULLOCK, DINA D LCSW	7/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
179391	Fee-for-Service	1205948007	1205948007	1	1	BIO MEDICAL APPLICATIONS	8/1/1991	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA	1020 2ND ST	None	SANTA ROSA	CA	95404	6607	49	06097	38.442321	-122.7053475	Sonoma County
179415	Fee-for-Service	1063698199	1063698199	1	1	BEYOND PROSTHETICS INC	4/10/2009	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	BEYOND PROSTHETICS INC	15899 LOS GATOS ALMADEN	#7	LOS GATOS	CA	95032	3739	43	06085	37.24342542	-121.9487944	Santa Clara County
179428	Fee-for-Service	1225010648	1225010648	1	1	BINDER, ROBERT P	9/1/1983	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9535 RESEDA BLVD	STE 109	NORTHRIDGE	CA	91324	6022	19	06037	34.243128	-118.5361055	Los Angeles County
179461	Fee-for-Service	1588742241	1588742241	1	1	BICOCCA, MICHAEL J MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80709	05	Anesthesiology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
179485	Fee-for-Service	1851431746	1851431746	1	1	BORROWDALE, ANITA H MD	5/31/1988	207P00000X	NA	Other	026	PHYSICIANS	58160	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
179502	Fee-for-Service	1255750196	1255750196	1	1	BRANDAL, DELARA B MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140514	30	Radiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
179505	Fee-for-Service	1932235553	1932235553	1	1	BALASUBRAMANIAN, VIJAYALAKSH	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	36974	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 WEST AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
179508	Fee-for-Service	1649503319	1649503319	1	9	BEAVER MEDICAL GROUP LP	11/20/2019	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
179588	Fee-for-Service	1306874755	1306874755	1	1	BLACKFORD, AMBER R DC	2/1/2001	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	701 HIGHLAND SPRINGS AVE	STE 8	BEAUMONT	CA	92223	2551	33	06065	33.93142778	-116.946913	Riverside County
179608	Fee-for-Service	1881689347	1881689347	1	1	BARON, DICRAN MD	9/30/1986	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40050	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	705 W LA VETA AVE	STE 112	ORANGE	CA	92868	4475	30	06059	33.78062272	-117.8600738	Orange County
179613	Fee-for-Service	1821141961	1821141961	1	1	BRUNDAGE, SUSAN R	11/5/2003	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5930 ADOBE RD	None	TWENTYNINE PALMS	CA	92277	2356	36	06071	34.145901	-116.0542365	San Bernardino County
179618	Fee-for-Service	1194740415	1194740415	1	1	BURKE,DENNIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	BRONSON METHODIST HOSP	601 JOHN STREET	None	KALAMAZOO	MI	49007	0000	00	None	42.28505881	-85.58080075	Kalamazoo County
179629	Fee-for-Service	1255549093	1255549093	1	1	BATH, ERAKA P MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52881	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
179651	Fee-for-Service	1295746386	1295746386	1	1	BARCELOUX, DONALD MD	9/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	29616	41	Internal Medicine	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
179657	Fee-for-Service	1396910246	1396910246	1	1	BOVE, LISA A LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
179661	Fee-for-Service	1720326952	1720326952	1	1	BIANCO, ANDREA D NP	5/26/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
179666	Fee-for-Service	1366425019	1366425019	1	1	BECKETT, WILLIAM W MD	8/23/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	174369	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
179673	Fee-for-Service	1124709233	1124709233	1	1	BAILEY, ASHLEY CRNA	2/22/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
179685	Fee-for-Service	1104801547	1104801547	1	1	BARTON COUNTY MEMORIAL HOSP	3/9/2010	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	29 NW 1ST LANE	None	LAMAR	MO	64759	8105	00	None	37.50550865	-94.29944631	Barton County
179691	Fee-for-Service	1033228838	1033228838	1	1	BERGER, SHAUN S MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60943	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12-311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
179699	Fee-for-Service	1659756559	1659756559	1	1	BASSA, RONIT DO	11/20/2020	208600000X	NA	General Surgery	026	PHYSICIANS	18322	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
179719	Fee-for-Service	1861471591	1861471591	1	1	BARON, JOHN P MD	6/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10040	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
179753	Fee-for-Service	1487141081	1487141081	1	1	BERQUIST, SEAN W MD	7/26/2024	208800000X	NA	Other	026	PHYSICIANS	163805	34	Urology and Urological Surgery	0	In state provider	None	2900 WHIPPLE	STE 132	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
179795	Fee-for-Service	1649503319	1649503319	1	9	BEAVER MEDICAL GROUP LP	12/28/2018	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
179815	Fee-for-Service	1255348660	1255348660	1	1	BELLINOFF, ROBERT D MD	7/1/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	50353	18	Ophthalmology	0	In state provider	None	1617 SAINT MARKS PLZ	STE D	STOCKTON	CA	95207	6423	39	06077	37.98864819	-121.3268062	San Joaquin County
179818	Fee-for-Service	1740333954	1740333954	1	1	BLAKE, CHRISTINE C PSYD	9/26/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
179823	Fee-for-Service	1235389826	1235389826	1	1	BRENNAN, LAURA A NP	8/13/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
179863	Fee-for-Service	1215049119	1215049119	1	1	BIO MEDICAL APPS OF FRESNO	1/23/1989	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	3636 N 1ST ST	STE 144	FRESNO	CA	93726	6818	10	06019	36.78322578	-119.7724022	Fresno County
179878	Fee-for-Service	1104168293	1104168293	1	1	BAILEY, JAMES A MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
179919	Fee-for-Service	1588626980	1588626980	1	1	BECHTOLD, BERYL C OD	2/21/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2620 HURLEY WAY	#A	SACRAMENTO	CA	95864	3789	34	06067	38.58822	-121.400838	Sacramento County
179923	Fee-for-Service	1437467891	1437467891	1	1	BARAD, STEVEN J MD INC	3/14/2016	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	43713	20	Orthopedic Surgery	0	In state provider	None	8120 TIMBERLAKE WAY	STE 112	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
179929	Fee-for-Service	1841641099	1841641099	1	1	BEARD, JENNIFER A CNM	5/19/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
179939	Fee-for-Service	1295746386	1295746386	1	1	BARCELOUX, DONALD MD	9/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	29616	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
179942	Fee-for-Service	1801820436	1801820436	1	1	BAUDENDISTEL, THOMAS MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62853	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
179969	Fee-for-Service	1104801547	1104801547	1	1	BARTON COUNTY MEMORIAL HOSP	3/9/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	29 NW 1ST LANE	None	LAMAR	MO	64759	8105	00	None	37.50550865	-94.29944631	Barton County
179977	Fee-for-Service	1245273119	1245273119	1	1	BAILEY, CHARLES C JR MD	7/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38854	77	Infectious Disease	0	In state provider	None	320 SUPERIOR AVE	STE 290	NEWPORT BEACH	CA	92663	6140	30	06059	33.62657138	-117.9330754	Orange County
179978	Fee-for-Service	1053876466	1053876466	1	1	BEST RESULT HOME HEALTH CARE	4/24/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4854 VAN NUYS BLVD	SUITE 230	SHERMAN OAKS	CA	91403	2112	19	06037	34.159122	-118.4486945	Los Angeles County
180012	Fee-for-Service	1831573963	1831573963	1	1	B P L P A PHARMACY	7/28/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	12730 HEACOCK STREET	STE 1	MORENO VALLEY	CA	92553	3070	33	06065	33.935697	-117.243761	Riverside County
180084	Fee-for-Service	1407517659	1407517659	1	1	BILBAO, MARYANNE E CRNA	2/6/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
180104	Fee-for-Service	1255348660	1255348660	1	1	BELLINOFF, ROBERT D MD	7/1/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	50353	08	Family Practice	0	In state provider	None	1617 SAINT MARKS PLZ	STE D	STOCKTON	CA	95207	6423	39	06077	37.98864819	-121.3268062	San Joaquin County
180196	Fee-for-Service	1669648838	1669648838	1	1	BLACKETT, ASHLEY A LMFT	3/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
180223	Fee-for-Service	1932594959	1932594959	1	1	BARNETT, GREGORY J MD	7/13/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	162522	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
180243	Fee-for-Service	1407476534	1407476534	1	1	BRABENDER, DANIELLE MD	11/14/2023	208600000X	NA	General Surgery	026	PHYSICIANS	190963	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
180259	Fee-for-Service	1417901679	1417901679	1	1	BARRY, TYLENE A C PHD	6/27/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
180300	Fee-for-Service	1851770846	1851770846	1	1	BRIGHT HEALTH PHYSICIANS OF	10/1/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PIH	15725 W WHITTIER BLVD	STE 200, 250	WHITTIER	CA	90603	2338	19	06037	33.94435533	-117.9931159	Los Angeles County
180317	Fee-for-Service	1396904835	1396904835	1	1	BROOKS, DARISSA L	8/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 E GARVEY AVE N	B2	WEST COVINA	CA	91791	1544	19	06037	34.07280989	-117.8995249	Los Angeles County
180321	Fee-for-Service	1336562347	1336562347	1	1	BOURGEA, MARLA LMFT	12/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
180357	Fee-for-Service	1487627634	1487627634	1	1	BUNDSCHUH, MICHAEL J DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV PHYS HOSP AT KINO	2800 E AJO WAY	None	TUCSON	AZ	85713	0000	00	None	32.175801	-110.9306925	Pima County
180366	Fee-for-Service	1437375094	1437375094	1	1	BISHOP, CHRISTIANNE MD	11/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	73675	38	Geriatrics	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
180372	Fee-for-Service	1104850403	1104850403	1	1	BROOK ROBERT HM	1/1/1995	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	26868	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	BLDG 32	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
180421	Fee-for-Service	1336118322	1336118322	1	1	BENSON HOSPITAL	4/29/1995	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	450 S OCOTILLO AVE	None	BENSON	AZ	85602	6403	00	None	31.9641892	-110.3072175	Cochise County
180431	Fee-for-Service	1487764833	1487764833	2	1	BLACKETER, BETHANY MD	7/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	69805	08	Family Practice	0	In state provider	None	1140 MAIN STREET	None	LIVINGSTON	CA	95334	1257	24	06047	37.37992056	-120.7234222	Merced County
180438	Fee-for-Service	1043296676	1043296676	1	1	BAAY, PETER L MD	5/26/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	152548	None	None	0	In state provider	None	400 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
180464	Fee-for-Service	1194848150	1194848150	1	1	BREYER, DONALD A MD	10/17/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	23907	30	Radiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
180507	Fee-for-Service	1043361132	1043361132	1	1	BUSCH, JULIANN L	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
180534	Fee-for-Service	1710302906	1710302906	1	1	BIRNER, JENNIFER D LMFT	5/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901A N PACIFIC COAST HWY	STE 200	REDONDO BEACH	CA	90277	7702	19	06037	33.85446844	-118.3902643	Los Angeles County
180538	Fee-for-Service	1043701006	1043701006	1	1	BRUCETA, MELANIO MD	1/17/2024	207L00000X	NA	Other	026	PHYSICIANS	192532	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
180546	Fee-for-Service	1144519000	1144519000	1	1	BROOKS, DANIEL C MD	3/21/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	183435	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
180553	Fee-for-Service	1578028189	1578028189	1	1	BROKA, ANDREA MD	8/28/2024	207R00000X	NA	Other	026	PHYSICIANS	177792	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
180565	Fee-for-Service	1306341698	1306341698	1	1	BAKER, TRAVIS L DO	9/12/2023	207L00000X	NA	Other	026	PHYSICIANS	20999	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
180567	Fee-for-Service	1306972880	1306972880	1	1	BROOKS, DOROTHY A RN	8/5/2005	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	FNP INC	3330 CHURN CREEK RD	STE B3	REDDING	CA	96002	2532	45	06089	40.55890497	-122.3530646	Shasta County
180570	Fee-for-Service	1518698257	1518698257	1	1	BATES, MATILDA SIENNAE	3/2/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11111 IRIS CT	None	CORONA	CA	92883	3112	33	06065	33.75320801	-117.4665059	Riverside County
180610	Fee-for-Service	1275622052	1275622052	1	1	BHULLER, AMARDIP S MD	2/16/2023	208200000X	NA	General Surgery	026	PHYSICIANS	55208	None	None	0	In state provider	None	25805 BARTON RD	A-101,A102,A103	LOMA LINDA	CA	92354	3814	36	06071	34.04825223	-117.2408371	San Bernardino County
180643	Fee-for-Service	1255367348	1255367348	1	1	BURT, TODD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 HOSPITAL DRIVE	None	KETCHUM	ID	83340	0100	00	None	43.6482607	-114.3490716	Blaine County
180653	Fee-for-Service	1912968447	1912968447	1	1	BUTLIG, RICHARD M MD	2/4/2010	207R00000X	NA	Other	026	PHYSICIANS	77702	None	None	0	In state provider	None	940 E DOMINGUEZ ST	STE D	CARSON	CA	90746	7205	19	06037	33.84040849	-118.2582045	Los Angeles County
180683	Fee-for-Service	1699720235	1699720235	1	1	BARRETT, MICHAEL T CRNA	9/29/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
180691	Fee-for-Service	1699072546	1699072546	1	1	BEHNAM PARTOVI PSYCHOLOGIST	9/15/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	12304 SANTA MONICA BLVD	SUITE 315	LOS ANGELES	CA	90025	1007	19	06037	34.03948285	-118.4656304	Los Angeles County
180694	Fee-for-Service	1497951974	1497951974	1	1	BHULLAR, PARDEEP S MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61537	41	Internal Medicine	0	In state provider	INC	6327 N FRESNO ST	STE 104	FRESNO	CA	93710	5236	10	06019	36.82875536	-119.781417	Fresno County
180713	Fee-for-Service	1336118322	1336118322	1	1	BENSON HOSPITAL	6/20/2009	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	450 S OCOTILLO AVE	None	BENSON	AZ	85602	6403	00	None	31.9641892	-110.3072175	Cochise County
180717	Fee-for-Service	1487764833	1487764833	2	1	BLACKETER, BETHANY MD	7/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	69805	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1140 MAIN STREET	None	LIVINGSTON	CA	95334	1257	24	06047	37.37992056	-120.7234222	Merced County
180720	Fee-for-Service	1497039192	1497039192	1	1	BONZON, TEODULO C LCSW	3/1/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4525 EAGLE ROCK	None	EAGLE ROCK	CA	90041	3214	19	06037	34.12685986	-118.2185809	Los Angeles County
180728	Fee-for-Service	1275759896	1275759896	1	1	BERNHOFT, JENNIFER LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3333 SKYPARK DR	STE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
180767	Fee-for-Service	1194941641	1194941641	1	1	BALLECER, RONALDO A MD	11/1/2005	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	34864	04	Otology, Laryngology, Rhinology	0	In state provider	None	1383 E HERNDON AVE	STE 105	FRESNO	CA	93720	3302	10	06019	36.83690167	-119.7635813	Fresno County
180796	Fee-for-Service	1639143530	1639143530	1	1	BUHAY, CARINA DE LEON MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49063	41	Internal Medicine	0	In state provider	None	1710 BARTON RD	None	REDLANDS	CA	92373	5304	36	06071	34.0483569	-117.2140061	San Bernardino County
180813	Fee-for-Service	1194746057	1194746057	1	2	BERKELEY CARDIOVASCULAR	2/4/2005	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	15 ALTARINDA RD	SUITE 112	ORINDA	CA	94563	2607	07	06013	37.88328547	-122.1835825	Contra Costa County
180820	Fee-for-Service	1174512685	1174512685	1	1	BISLA, HARINDER K MD	5/2/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60071	41	Internal Medicine	0	In state provider	None	16870 W BERNARDO DR	None	SAN DIEGO	CA	92127	1677	37	06073	33.01956754	-117.0809122	San Diego County
180822	Fee-for-Service	1235507815	1235507815	1	1	BISHOP, BARBARA J MFT	6/17/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	38391	-	NOT APPLICABLE	0	In state provider	None	205 W 9TH ST	None	SAN PEDRO	CA	90731	3711	19	06037	33.7359805	-118.281609	Los Angeles County
180837	Fee-for-Service	1376128124	1376128124	1	1	BOB CHIANG MD INC	6/6/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	2101 WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
180855	Fee-for-Service	1871817312	1871817312	1	1	BLAKE, PATRICK W MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130951	07	Dermatology	0	In state provider	None	15725 POMERADO RD	SUITE 102	POWAY	CA	92064	2057	37	06073	33.00037882	-117.0580735	San Diego County
180858	Fee-for-Service	1518698257	1518698257	1	1	BATES, MATILDA SIENNAE	3/2/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11111 IRIS CT	None	CORONA	CA	92883	3112	33	06065	33.75320801	-117.4665059	Riverside County
180870	Fee-for-Service	1013972298	1013972298	1	1	BLANC, PAUL D MD	10/31/1988	207R00000X	NA	Other	026	PHYSICIANS	54987	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
180878	Fee-for-Service	1538368014	1538368014	1	1	BAHMANPOUR, KAVEH MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109450	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
180973	Fee-for-Service	1861714487	1861714487	1	1	BLACKSHER, DEYANA M LMFT	11/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9800 S LA CIENEGA BLVD	STE 200	INGLEWOOD	CA	90301	4408	19	06037	33.947001	-118.370043	Los Angeles County
181004	Fee-for-Service	1790769016	1790769016	1	1	BASTUBA, MARTIN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76872	34	Urology and Urological Surgery	0	In state provider	MALE FERT & SEXUAL MED	6699 ALVARADO RD	STE 2207	SAN DIEGO	CA	92120	5240	37	06073	32.77665383	-117.0540279	San Diego County
181031	Fee-for-Service	1740213875	1740213875	1	1	BROCK, REBECCA J MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64149	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1510 FLORIDA AVE	None	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
181036	Fee-for-Service	1518047349	1518047349	1	1	BAXTER, THERESA P MSW LCSW	5/26/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	133 D ST	SUITE J	DAVIS	CA	95616	4695	57	06113	38.54276879	-121.742095	Yolo County
181045	Fee-for-Service	1720048168	1720048168	2	1	BURKET, BRENT A MD	12/30/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	84835	08	Family Practice	0	In state provider	None	7800 NILES ST	None	BAKERSFIELD	CA	93306	4922	15	06029	35.37628052	-118.9179	Kern County
181054	Fee-for-Service	1528355872	1528355872	1	1	BAKRIWALA, KETAN J OD	4/28/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	342 F ST	None	CHULA VISTA	CA	91910	2625	37	06073	32.64073026	-117.0815293	San Diego County
181055	Fee-for-Service	1144251067	1144251067	1	1	BOLIVAR, SAMUEL A MD	7/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	41590	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3410 LA SIERRA AVE	# F369	RIVERSIDE	CA	92503	5270	33	06065	33.89746312	-117.4714117	Riverside County
181080	Fee-for-Service	1356309504	1356309504	1	1	BAKIR, SHATHA A MD	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49522	41	Internal Medicine	0	In state provider	None	19333 BEAR VALLEY RD	SUITE 106	APPLE VALLEY	CA	92308	5149	36	06071	34.47104148	-117.2413863	San Bernardino County
181109	Fee-for-Service	1326459256	1326459256	1	1	BASILIOS, MAGED MD INC	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	61990	08	Family Practice	0	In state provider	None	4505 E SLAUSON AVE	STE E	MAYWOOD	CA	90270	4955	19	06037	33.98719828	-118.1849335	Los Angeles County
181139	Fee-for-Service	1184237372	1184237372	1	1	BUTH, NICOLLETTE S NP	12/5/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3828 SCHAUFELE AVENUE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
181152	Fee-for-Service	1740468263	1740468263	1	1	BEKENDAM, PETER D MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	95411	18	Ophthalmology	0	In state provider	None	555 N THIRTEENTH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
181153	Fee-for-Service	1518259837	1518259837	1	1	BELFOUR, CHRISTOPHER A MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123740	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
181220	Fee-for-Service	1992123962	1992123962	1	1	BECKERMAN JOHNSON, JESSICA	9/11/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	141692	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
181248	Fee-for-Service	1942623657	1942623657	1	3	BORREGO COMMUNITY HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	29490 LAKEVIEW AVE	None	NUEVO	CA	92567	9705	33	06065	33.81758755	-117.1322999	Riverside County
181270	Fee-for-Service	1174283428	1174283428	1	1	BRAZEL, MARCUS NP	3/7/2023	363LC0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
181285	Fee-for-Service	1730408964	1730408964	1	1	BENJAMIN GOOD	1/9/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 N 3RD AVE	None	SANDPOINT	ID	83864	1507	00	None	48.27786153	-116.5503511	Bonner County
181293	Fee-for-Service	1790769016	1790769016	1	1	BASTUBA, MARTIN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76872	66	Emergency Medicine (Urgent Care)	0	In state provider	MALE FERT & SEXUAL MED	6699 ALVARADO RD	STE 2207	SAN DIEGO	CA	92120	5240	37	06073	32.77665383	-117.0540279	San Diego County
181299	Fee-for-Service	1659498004	1659498004	1	2	BOYLE HEIGHTS CARDIOVASCULAR	7/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69594	41	Internal Medicine	0	In state provider	None	1700 E CESAR E CHAVEZ AV	STE 1200	LOS ANGELES	CA	90033	2467	19	06037	34.05101259	-118.217259	Los Angeles County
181342	Fee-for-Service	1144251067	1144251067	1	1	BOLIVAR, SAMUEL A MD	7/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	41590	41	Internal Medicine	0	In state provider	None	3410 LA SIERRA AVE	# F369	RIVERSIDE	CA	92503	5270	33	06065	33.89746312	-117.4714117	Riverside County
181402	Fee-for-Service	1649503319	1649503319	1	10	BEAVER MEDICAL GROUP LP	9/1/2001	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7223 CHURCH ST	STE C	HIGHLAND	CA	92346	5816	36	06071	34.122888	-117.1737945	San Bernardino County
181415	Fee-for-Service	1376257865	1376257865	1	1	BACALLAN, ARLYN O PT	10/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 5TH AVE.	SUITE 100	SAN DIEGO	CA	92103	3108	37	06073	32.749335	-117.160413	San Diego County
181418	Fee-for-Service	1972262814	1972262814	1	1	BURGER, MOLLY CRNA	10/12/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
181423	Fee-for-Service	1205457587	1205457587	1	1	BERNAL, DIANA I CRNA	12/16/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
181434	Fee-for-Service	1821593211	1821593211	1	1	BEHNIWAL, SIMRAN DO	1/25/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19429	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
181437	Fee-for-Service	1255302576	1255302576	1	1	BOZANICH,ALEXANDER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7550 HOHMAN AVE	STE 600	MUNSTER	IN	46321	0000	00	None	41.575518	-87.522732	Lake County
181446	Fee-for-Service	1952176091	1952176091	1	1	BROWN, WHITNEY NP	1/11/2024	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
181449	Fee-for-Service	1770996589	1770996589	1	1	BULUMULLE, ANUSHI MD	10/28/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	5 HARRIS CT	BLDG T 2ND FL	MONTEREY	CA	93940	5750	27	06053	36.58051622	-121.8198331	Monterey County
181454	Fee-for-Service	1841435047	1841435047	1	1	BOSE, BRENT J MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	842 E MAIN STREET	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
181464	Fee-for-Service	1063901163	1063901163	1	1	BRADLEY, GRECIA CRNA	8/26/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
181507	Fee-for-Service	1194074336	1194074336	1	1	BARTE, FELISE MAY G MD INC	5/8/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	121145	18	Ophthalmology	0	In state provider	None	23928 LYONS AVE	STE 106	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
181522	Fee-for-Service	1508805193	1508805193	1	1	BOE, STEPHEN L MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	BEND ANESTHESIOLOGY GR	2500 NE NEFF ROAD	None	BEND	OR	97701	6015	00	None	44.067735	-121.268187	Deschutes County
181537	Fee-for-Service	1942623657	1942623657	1	3	BORREGO COMMUNITY HEALTH	7/1/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	29490 LAKEVIEW AVE	None	NUEVO	CA	92567	9705	33	06065	33.81758755	-117.1322999	Riverside County
181539	Fee-for-Service	1649503319	1649503319	1	3	BEAVER MEDICAL GROUP LP	2/13/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1300 E COLLEY DR	None	COLTON	CA	92324	3905	36	06071	34.0544745	-117.306315	San Bernardino County
181554	Fee-for-Service	1710191267	1710191267	1	1	BROWN, JANET A. OTR	1/1/1981	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1891 GOODYEAR AVE	STE 605	VENTURA	CA	93003	8003	56	06111	34.25564179	-119.2324784	Ventura County
181567	Fee-for-Service	1679553671	1679553671	1	1	BRIGGS, LAWRENCE J MD	11/30/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	142127	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
181585	Fee-for-Service	1376041400	1376041400	1	1	BRAGGINS, ELISA MARIE S	10/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	16453 BEAR VALLEY RD	None	HESPERIA	CA	92345	1752	36	06071	34.47081596	-117.3043788	San Bernardino County
181609	Fee-for-Service	1063552735	1063552735	1	1	BHAGIA, SUDHA U	3/7/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	19520 NORDHOFF ST	STE 5	NORTHRIDGE	CA	91324	2451	19	06037	34.23392022	-118.557451	Los Angeles County
181655	Fee-for-Service	1548209612	1548209612	1	1	BOSWELL, WILLIAM D JR MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26673	30	Radiology	0	In state provider	None	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
181676	Fee-for-Service	1710358395	1710358395	1	1	BOGGS, PHILLIP NP	10/15/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
181682	Fee-for-Service	1346426921	1346426921	1	1	BRUCE, PATRICIA R LCSW	8/17/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2844 SUMMIT ST	STE 211	OAKLAND	CA	94609	1809	01	06001	37.81754276	-122.2646445	Alameda County
181694	Fee-for-Service	1881685394	1881685394	1	1	BERKEY, AARON J MD	4/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	74163	30	Radiology	0	In state provider	None	1700 S COURT STREET	SUITE F	VISALIA	CA	93277	4931	54	06107	36.315108	-119.2916925	Tulare County
181697	Fee-for-Service	1295059749	1295059749	1	1	BUHR, RUSSELL G MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MED PLAZA BLVD	STE 365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
181738	Fee-for-Service	1770996589	1770996589	1	1	BULUMULLE, ANUSHI MD	10/28/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	5 HARRIS CT	BLDG T 2ND FL	MONTEREY	CA	93940	5750	27	06053	36.58051622	-121.8198331	Monterey County
181776	Fee-for-Service	1154583466	1154583466	1	2	BURNETT, JOHN F MD INC	10/3/2011	208200000X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	1105 E SPRUCE AVE	SUITE 203	FRESNO	CA	93720	3313	10	06019	36.839466	-119.762685	Fresno County
181778	Fee-for-Service	1992869176	1992869176	1	1	BRADLEY, WILLIAM A CNP	5/7/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
181790	Fee-for-Service	1942304084	1942304084	1	1	BURKE, MARY G MD	3/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	68366	36	Psychiatry	0	In state provider	None	1350 S ELISIO DRIVE	STE 220	GREENBRAE	CA	94904	2133	21	06041	37.94490653	-122.537021	Marin County
181812	Fee-for-Service	1093101297	1093101297	1	1	BANGARU, SAROJA D MD	11/22/2023	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	162424	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
181814	Fee-for-Service	1851329270	1851329270	1	1	BENN, ANDREW J MD	5/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73528	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	365 HAWTHORNE AVE	STE 201	OAKLAND	CA	94609	3114	01	06001	37.82079728	-122.2633226	Alameda County
181826	Fee-for-Service	1649503319	1649503319	1	3	BEAVER MEDICAL GROUP LP	5/18/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 E COLLEY DR	None	COLTON	CA	92324	3905	36	06071	34.0544745	-117.306315	San Bernardino County
181846	Fee-for-Service	1578844783	1578844783	2	1	BHARDWAJ, ABHISHEK MD	6/8/2023	207RC0200X	NA	Other	026	PHYSICIANS	177600	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
181854	Fee-for-Service	1417914169	1417914169	1	1	BURKHOLZ, KIMBERLY J MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82906	None	None	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
181859	Fee-for-Service	1164520326	1164520326	1	1	BLANCO-ECCLESTON, MARTIN	9/20/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	42392	08	Family Practice	0	In state provider	MD	500 S ANAHEIM HILLS RD	STE 230	ANAHEIM	CA	92807	4760	30	06059	33.8427954	-117.7772895	Orange County
181877	Fee-for-Service	1619216546	1619216546	1	1	BOVEE, VANESSA O LMFT	3/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
181885	Fee-for-Service	1538748801	1538748801	1	1	BRIGHT HORIZON HOME HEALTH	3/14/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4711 OAKWOOD AVE	STE 202D	LOS ANGELES	CA	90004	2471	19	06037	34.07729413	-118.3096899	Los Angeles County
181905	Fee-for-Service	1588668917	1588668917	1	1	BONAKDAR, M ALEXANDER OD	4/27/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 N TUSTIN AVE	STE 404	SANTA ANA	CA	92705	3608	30	06059	33.752286	-117.8341735	Orange County
181920	Fee-for-Service	1295285823	1295285823	1	1	BOTTAZZO, ERICA PT	3/12/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
181927	Fee-for-Service	1902190721	1902190721	1	1	BRADY, BRIAN M MD	3/28/2018	246ZN0300X	NA	Other	026	PHYSICIANS	136657	45	Nephrology (Renal-Kidney)	0	In state provider	None	1300 S ELISEO DRIVE	SUITE 104	GREENBRAE	CA	94904	2014	21	06041	37.94447529	-122.53657	Marin County
181945	Fee-for-Service	1902551815	1902551815	1	1	BAQUIR, DANNMILLE P AU	1/9/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
181967	Fee-for-Service	1063066546	1063066546	1	1	BROWN, YASHEIKA P	8/27/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5051 W AVENUE M4	None	QUARTZ HILLS	CA	93536	3030	19	06037	34.64157575	-118.220284	Los Angeles County
181979	Fee-for-Service	1457446684	1457446684	1	1	BERMAN, BRETT J MD	6/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	78854	None	None	0	In state provider	None	9834 GENESEE AVE	STE 125	LA JOLLA	CA	92037	1230	37	06073	32.884074	-117.225855	San Diego County
181984	Fee-for-Service	1972797959	1972797959	1	1	BHARDWAJ, VRINDA MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112822	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
181985	Fee-for-Service	1295059749	1295059749	1	1	BUHR, RUSSELL G MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129932	41	Internal Medicine	0	In state provider	None	200 MED PLAZA BLVD	STE 365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
181997	Fee-for-Service	1093974651	1093974651	1	1	BESONG, ALICE E MD	5/31/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162037	08	Family Practice	0	In state provider	None	8520 ARCHIBALD AVENUE	BLDG 20, SUITE B	RANCHO CUCAMONGA	CA	91730	4648	36	06071	34.099002	-117.5935065	San Bernardino County
182017	Fee-for-Service	1306386719	1306386719	1	1	BRAID, BRIAN LMFT	8/28/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
182025	Fee-for-Service	1932543428	1932543428	1	1	BANNER GOLDFIELD MEDICAL	2/7/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	2050 W SOUTHERN AVE	None	APACHE JUNCTION	AZ	85120	7305	00	None	33.39423	-111.56679	Pinal County
182033	Fee-for-Service	1639272560	1639272560	1	1	BLUM, FREDERICK C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 STADIUM DR	None	MORGANTOWN	WV	26506	7911	00	None	39.65345878	-79.95562791	Monongalia County
182047	Fee-for-Service	1558419481	1558419481	1	1	BLITZ, IRA A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24255	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
182051	Fee-for-Service	1205195146	1205195146	1	1	BEN ABDA, RAFIK DO	3/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
182064	Fee-for-Service	1326622812	1326622812	1	1	BENDER, MARGARET H LCSW	10/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
182068	Fee-for-Service	1316904717	1316904717	1	1	BRADLEY C STROUT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
182070	Fee-for-Service	1306007232	1306007232	1	1	BHAT, DEEPTI MD	12/30/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
182075	Fee-for-Service	1942304084	1942304084	1	1	BURKE, MARY G MD	3/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	68366	26	Psychiatry (child)	0	In state provider	None	1350 S ELISIO DRIVE	STE 220	GREENBRAE	CA	94904	2133	21	06041	37.94490653	-122.537021	Marin County
182089	Fee-for-Service	1417956236	1417956236	1	1	BAUMAN, JOHN M. MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
182093	Fee-for-Service	1366412157	1366412157	1	1	BROWN III, WILLIAM M DO	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14174	01	General Practice	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
182099	Fee-for-Service	1770650335	1770650335	1	1	BIRING, MANMOHAN S MD	5/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54442	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
182110	Fee-for-Service	1043387046	1043387046	1	1	BALLENTINE, RENEE H DO	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8509	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
182111	Fee-for-Service	1821106329	1821106329	1	1	BULUSU, NARAYANA V MD	9/20/2007	208800000X	NA	Other	026	PHYSICIANS	30679	34	Urology and Urological Surgery	0	In state provider	ASSOCIATED UROLOGY MEDIC	20055 LAKE CHABOT RD	STE 310	CASTRO VALLEY	CA	94546	5334	01	06001	37.69836512	-122.0873587	Alameda County
182116	Fee-for-Service	1871734509	1871734509	1	1	BUCHBINDER, DAVID K MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90272	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
182130	Fee-for-Service	1982057360	1982057360	1	1	BARON, VANESSA E LMFT	10/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
182139	Fee-for-Service	1811040942	1811040942	1	1	BIREN DESAI MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 JOHNSON FERRY RD	None	ATLANTA	GA	30342	1606	00	None	33.90791732	-84.3540509	Fulton County
182152	Fee-for-Service	1962469841	1962469841	1	1	BOBER, ROBERT M MD	9/19/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
182161	Fee-for-Service	1982625257	1982625257	1	1	BHULLAR, HARMEET K MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98115	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
182163	Fee-for-Service	1609188903	1609188903	1	1	BROUSSARD, ASHLEY E MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117196	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
182209	Fee-for-Service	1851422141	1851422141	1	1	BORGES, JACQUELINE M LMFT	1/2/2018	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1724 EDGEWOOD DRIVE	None	TURLOCK	CA	95382	9250	50	06099	37.5194142	-120.8291714	Stanislaus County
182221	Fee-for-Service	1003126327	1003126327	1	1	BAKHTARY, SARA MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113463	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
182226	Fee-for-Service	1619345527	1619345527	1	1	BOTIKA INC	11/3/2015	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1939 MONTEREY HWY	STE 2	SAN JOSE	CA	95112	6149	43	06085	37.30561944	-121.8680802	Santa Clara County
182252	Fee-for-Service	1508890021	1508890021	1	1	BERGER, FRED K. MD	1/1/1979	2084P0800X	NA	Psychiatry	026	PHYSICIANS	33996	36	Psychiatry	0	In state provider	None	9896 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.88557933	-117.2231317	San Diego County
182257	Fee-for-Service	1063066546	1063066546	1	1	BROWN, YASHEIKA P	8/27/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5051 W AVENUE M4	None	QUARTZ HILLS	CA	93536	3030	19	06037	34.64157575	-118.220284	Los Angeles County
182266	Fee-for-Service	1922079847	1922079847	1	1	BEDI, HARVINDER MD	3/4/2025	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	171760	40	Pediatrics	0	In state provider	None	30 MARK WEST SPRINGS	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
182297	Fee-for-Service	1871569020	1871569020	1	1	BERNARD EDWARD YANKE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2150 NE DIVISION ST	STE 202	GRESHAM	OR	97030	5859	00	None	45.50480649	-122.410818	Multnomah County
182315	Fee-for-Service	1932543428	1932543428	1	1	BANNER GOLDFIELD MEDICAL	2/7/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	2050 W SOUTHERN AVE	None	APACHE JUNCTION	AZ	85120	7305	00	None	33.39423	-111.56679	Pinal County
182322	Fee-for-Service	1659450708	1659450708	1	1	BOLDEN, NAOMI M MD	5/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79194	40	Pediatrics	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
182338	Fee-for-Service	1457884116	1457884116	1	1	BONANO, JOHN MD	9/26/2023	163WX0800X	NA	Other	026	PHYSICIANS	158320	None	None	0	In state provider	None	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	27	06053	36.66192801	-121.6413283	Monterey County
182346	Fee-for-Service	1285877605	1285877605	1	1	BLANKENSHIP, ALAN L MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124991	07	Dermatology	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
182386	Fee-for-Service	1770650335	1770650335	1	1	BIRING, MANMOHAN S MD	5/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54442	01	General Practice	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
182415	Fee-for-Service	1669422705	1669422705	1	1	BRIZGYS, ROMUALDAS V MD	5/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	43948	05	Anesthesiology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
182416	Fee-for-Service	1669763702	1669763702	1	1	BORS, JACQUELINE M MD	9/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125544	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
182425	Fee-for-Service	1215332184	1215332184	1	1	BEHREND, JESSICA E NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
182471	Fee-for-Service	1699708966	1699708966	1	1	BENVENUTI, THOMAS G MD	2/8/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52876	66	Emergency Medicine (Urgent Care)	0	In state provider	None	355 PLACENTIA AVE	STE 100	NEWPORT BEACH	CA	92663	3301	30	06059	33.62672719	-117.9312941	Orange County
182496	Fee-for-Service	1881753200	1881753200	1	1	BOLEN, DEWEY L	11/14/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2469 OLD EUREKA WAY	None	REDDING	CA	96001	0336	45	06089	40.58589079	-122.4073788	Shasta County
182500	Fee-for-Service	1700440427	1700440427	1	1	BHUKHEN, ARTI MD	9/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184224	08	Family Practice	0	In state provider	None	2050 BLUE OAKS BLVD	None	ROSEVILLE	CA	94747	6506	31	06061	38.79182804	-121.3591888	Placer County
182508	Fee-for-Service	1194800052	1194800052	1	1	BAILEY, TIMOTHY S MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60763	67	Endocrinology	0	In state provider	None	700 W EL NORTE PKWY	SUITE 201	ESCONDIDO	CA	92026	3923	37	06073	33.14611822	-117.1023285	San Diego County
182547	Fee-for-Service	1821167925	1821167925	1	1	BACHOURA, LEON MD INC	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	36186	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	931 BUENA VISTA ST	STE 301	DUARTE	CA	91010	1714	19	06037	34.141635	-117.9775755	Los Angeles County
182576	Fee-for-Service	1417376435	1417376435	1	1	BETTI, FRANCESCA MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138018	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
182579	Fee-for-Service	1851787584	1851787584	1	1	BRENNAN, COURTNEY E MD	5/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129135	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
182587	Fee-for-Service	1578882759	1578882759	1	2	BAUGH, JONATHAN DO	11/13/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	13545	66	Emergency Medicine (Urgent Care)	0	In state provider	None	151 N SUNRISE	SUITE 1203	ROSEVILLE	CA	95661	2932	31	06061	38.74746043	-121.2655348	Placer County
182611	Fee-for-Service	1659450708	1659450708	1	1	BOLDEN, NAOMI M MD	5/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79194	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
182662	Fee-for-Service	1386605087	1386605087	1	1	BARTHEL, ROBERT V MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55858	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
182668	Fee-for-Service	1578730420	1578730420	1	1	BACHHUBER, MELISSA R MD	7/21/2009	207R00000X	NA	Other	026	PHYSICIANS	103529	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
182761	Fee-for-Service	1699708966	1699708966	1	1	BENVENUTI, THOMAS G MD	2/8/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52876	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	355 PLACENTIA AVE	STE 100	NEWPORT BEACH	CA	92663	3301	30	06059	33.62672719	-117.9312941	Orange County
182779	Fee-for-Service	1336298702	1336298702	1	1	BATTERSON, SHERRY PHD	7/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
182804	Fee-for-Service	1104143197	1104143197	1	1	BANERJEE, POONAM N PHD	4/25/2013	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2441 W ORANGETHORPE AVE	None	FULLERTON	CA	92833	4201	30	06059	33.85916571	-117.9710549	Orange County
182822	Fee-for-Service	1396716759	1396716759	1	1	BALASUBRAMANIAN, G R MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	39680	05	Anesthesiology	0	In state provider	None	1709 20TH ST	None	BAKERSFIELD	CA	93301	3903	15	06029	35.37717292	-119.02184	Kern County
182824	Fee-for-Service	1366548620	1366548620	1	1	BESHARAT, FARID MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49504	01	General Practice	0	In state provider	None	321 N LARCHMONT BLVD	STE 909	LOS ANGELES	CA	90004	6409	19	06037	34.0769016	-118.323663	Los Angeles County
182831	Fee-for-Service	1609822477	1609822477	1	1	BERTRANDO, ROBERT B MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
182837	Fee-for-Service	1043692494	1043692494	1	1	BELLE, JOSHUA MD	7/7/2020	208800000X	NA	Other	026	PHYSICIANS	168520	34	Urology and Urological Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2050	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
182843	Fee-for-Service	1609014141	1609014141	1	1	BAGALSO, MARY GRACE Q CRNA	12/12/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
182858	Fee-for-Service	1962411264	1962411264	1	1	BRYNE, MARK G MD	9/17/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	30 BRENNAN ST	None	WATSONVILLE	CA	95076	4303	44	06087	36.91346025	-121.7577455	Santa Cruz County
182862	Fee-for-Service	1285764233	1285764233	1	1	BERTOLINI, TAMARA L LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	158 N GLENDORA AVE	STE H	GLENDORA	CA	91741	3346	19	06037	34.13763478	-117.8654456	Los Angeles County
182895	Fee-for-Service	1326133067	1326133067	1	1	BRYNIARSKI, ELIZABETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6567 E CARONDELET DR	None	TUCSON	AZ	85710	6152	00	None	32.226876	-110.8535445	Pima County
182929	Fee-for-Service	1568009561	1568009561	1	1	BAIRD, JONATHON D PSYD	12/7/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2491 ALLUVIAL AVE	400	CLOVIS	CA	93611	9587	10	06019	36.84477477	-119.6688867	Fresno County
182943	Fee-for-Service	1366454241	1366454241	1	1	BROWN, KENNETH S MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70912	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
182977	Fee-for-Service	1417074881	1417074881	1	1	BARASH JOHNATHAN LOUIS	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77819	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
183086	Fee-for-Service	1184080053	1184080053	1	1	BAGUMYAN, LILIT CCC-SLP	2/20/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
183111	Fee-for-Service	1366548620	1366548620	1	1	BESHARAT, FARID MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49504	40	Pediatrics	0	In state provider	None	321 N LARCHMONT BLVD	STE 909	LOS ANGELES	CA	90004	6409	19	06037	34.0769016	-118.323663	Los Angeles County
183131	Fee-for-Service	1154586337	1154586337	1	1	BRIONES, MAYLENE C DO	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10480	41	Internal Medicine	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
183159	Fee-for-Service	1235559386	1235559386	1	1	BRAL, MATTHEW P DO	7/10/2018	207L00000X	NA	Other	026	PHYSICIANS	16262	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
183191	Fee-for-Service	1366641821	1366641821	1	1	BROOKS, MARILYN J CNP	1/19/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 S BALDWIN AVE	None	ARCADIA	CA	91007	7922	19	06037	34.12357479	-118.0551359	Los Angeles County
183205	Fee-for-Service	1134704661	1134704661	1	1	BARRETO, ALISSA LMFT	2/20/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	440 E HUNTINGTON DR	STE 361	ARCADIA	CA	91006	3775	19	06037	34.14014147	-118.0220265	Los Angeles County
183206	Fee-for-Service	1770586448	1770586448	1	1	BLUM, MITCHELL E MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	25010	None	None	0	In state provider	None	6633 COYLE AVE	STE 1	CARMICHAEL	CA	95608	6332	34	06067	38.668275	-121.3097265	Sacramento County
183223	Fee-for-Service	1225053101	1225053101	1	1	BORNSTEIN, ISAAC M MD	12/23/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	56580	30	Radiology	0	In state provider	None	1213 COFFEE RD	STE B	MODESTO	CA	95355	4229	50	06099	37.660401	-120.975669	Stanislaus County
183225	Fee-for-Service	1760559645	1760559645	1	1	BLAKE, OSBOURNE A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62083	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
183228	Fee-for-Service	1366454241	1366454241	1	1	BROWN, KENNETH S MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70912	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
183230	Fee-for-Service	1861926982	1861926982	1	1	BAE, CHAY DO	9/6/2022	207RR0500X	NA	Other	026	PHYSICIANS	18562	None	None	0	In state provider	None	26538 MOULTON PARKWAY	SUITE 38E	LAGUNA HILLS	CA	92653	8232	30	06059	33.57744684	-117.702553	Orange County
183233	Fee-for-Service	1619263712	1619263712	1	1	BRENNAN MEDICAL CORPORATION	9/25/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	30 BRENNAN STREET	None	WATSONVILLE	CA	95076	4303	44	06087	36.91346025	-121.7577455	Santa Cruz County
183258	Fee-for-Service	1003832254	1003832254	1	1	BRETT WAIBEL	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
183274	Fee-for-Service	1922043413	1922043413	1	1	BOJMAN, LUDMILA MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61793	30	Radiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
183296	Fee-for-Service	1023495033	1023495033	1	1	BENVENUTO, JUDITH C LMFT	7/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	540 N GOLDEN CIR DR	112	SANTA ANA	CA	92705	3926	30	06059	33.74924495	-117.8386722	Orange County
183314	Fee-for-Service	1750192555	1750192555	1	1	BIRTHPOWER DOULA LLC	2/3/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
183324	Fee-for-Service	1609119486	1609119486	1	1	BANERJEE, SOMALEE MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132848	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
183335	Fee-for-Service	1255574943	1255574943	1	1	BABB, AMY M MD	2/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144250	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
183342	Fee-for-Service	1669480984	1669480984	1	1	BAIRD, ROBERT A MD	3/24/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	23472	20	Orthopedic Surgery	0	In state provider	None	16300 SAND CANYON AVE	STE 511	IRVINE	CA	92618	3705	30	06059	33.66115075	-117.7742405	Orange County
183355	Fee-for-Service	1114519733	1114519733	1	1	BOOST HOME HEALTH INC	8/23/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	STE 210	RESEDA	CA	91335	4000	19	06037	34.2011975	-118.5419835	Los Angeles County
183368	Fee-for-Service	1619036217	1619036217	1	1	BITEW, SOLOMON F MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72125	45	Nephrology (Renal-Kidney)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
183381	Fee-for-Service	1205396751	1205396751	1	1	BAHRI, FARAIEN S MD	3/22/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177368	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
183386	Fee-for-Service	1245470749	1245470749	1	1	BATISH, SANGITA DO	12/7/2010	207R00000X	NA	Other	026	PHYSICIANS	10375	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
183388	Fee-for-Service	1265696116	1265696116	1	1	BROWN, JASON H MD	6/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	1319 PUNAHOU STREET	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
183389	Fee-for-Service	1518937754	1518937754	1	2	BHOLA, RAKESH MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39683	None	None	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
183409	Fee-for-Service	1487728242	1487728242	1	1	BALBON, BRIAN W DC	12/25/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	BAY VISTA CHIROPRACTIC	2424 MISSION ST	None	SAN FRANCISCO	CA	94110	2415	38	06075	37.75816928	-122.4190376	San Francisco County
183426	Fee-for-Service	1043282379	1043282379	1	1	BALASSANIAN, RONALD MD	11/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	66054	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
183435	Fee-for-Service	1164606646	1164606646	1	1	BHATT, AJAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
183454	Fee-for-Service	1164726378	1164726378	1	1	BELLO, OSAGIE MD	7/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115182	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
183456	Fee-for-Service	1073922415	1073922415	1	1	BAUER, MICHAEL G LMFT	1/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5619 N FIGUEROA ST	223	LOS ANGELES	CA	90042	4977	19	06037	34.10918419	-118.1936708	Los Angeles County
183465	Fee-for-Service	1386849511	1386849511	1	1	BUCKLAND, ROBERT L LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
183479	Fee-for-Service	1740445857	1740445857	1	1	BADAWI, AMR A MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121136	41	Internal Medicine	0	In state provider	None	271 TURN PIKE DRIVE	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
183492	Fee-for-Service	1629605456	1629605456	1	1	BASSI, NAVNEET MD	1/24/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	20787	45	Nephrology (Renal-Kidney)	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
183495	Fee-for-Service	1174943872	1174943872	1	1	BHAT, SWETHA R MD	8/28/2017	207R00000X	NA	Other	026	PHYSICIANS	138029	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
183508	Fee-for-Service	1609064880	1609064880	1	1	BROUKHIM, MICHAEL S MD	6/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101434	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1762 WESTWOOD BLVD	STE 300	LOS ANGELES	CA	90024	5641	19	06037	34.05057734	-118.4376712	Los Angeles County
183513	Fee-for-Service	1881914653	1881914653	1	1	BORENSTEIN, TODD R MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139526	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
183518	Fee-for-Service	1619263712	1619263712	1	1	BRENNAN MEDICAL CORPORATION	9/25/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	30 BRENNAN STREET	None	WATSONVILLE	CA	95076	4303	44	06087	36.91346025	-121.7577455	Santa Cruz County
183522	Fee-for-Service	1508457797	1508457797	1	1	BEST OF HOME HEALTH INC	11/26/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7120 HAYVENHURST AVE	STE 119	VAN NUYS	CA	91406	3813	19	06037	34.200018	-118.492384	Los Angeles County
183581	Fee-for-Service	1396056487	1396056487	1	1	BROCATTO-KECK, MIREYA	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
183597	Fee-for-Service	1023196896	1023196896	1	1	BERGSTROM, STEVEN K MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	58591	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
183610	Fee-for-Service	1154433951	1154433951	1	1	BIO-MEDICAL APPLICATIONS OF	2/1/2001	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1540 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.07034573	-117.9402713	Los Angeles County
183625	Fee-for-Service	1255574943	1255574943	1	1	BABB, AMY M MD	2/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144250	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
183666	Fee-for-Service	1093998122	1093998122	1	3	BEVERLY RADIOLOGY MED GR	12/15/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	8311 FLORENCE AVE	None	DOWNEY	CA	90240	3928	19	06037	33.95103918	-118.1247373	Los Angeles County
183679	Fee-for-Service	1538201405	1538201405	1	1	BERUBE, CAROLINE MD	11/2/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86293	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
183683	Fee-for-Service	1356725329	1356725329	1	2	BEDROSIAN, ARMEN H MD	10/18/2018	208M00000X	NA	Other	026	PHYSICIANS	145237	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
183692	Fee-for-Service	1568100022	1568100022	1	1	BROWN, PAYTON A	10/4/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
183707	Fee-for-Service	1316353022	1316353022	1	1	BALDRIAS, APRIL	6/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 UNIVERSITY AVE.	#140	SACRAMENTO	CA	95825	6535	34	06067	38.570976	-121.416651	Sacramento County
183718	Fee-for-Service	1023749173	1023749173	1	1	BARANES, SARAH MD	2/29/2024	390200000X	NA	Other	026	PHYSICIANS	190633	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
183727	Fee-for-Service	1194287862	1194287862	1	1	BOOTH, BROCK E DO	8/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19467	None	None	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	9999	30	06059	33.85429451	-117.8446551	Orange County
183746	Fee-for-Service	1770961575	1770961575	1	1	BAWEJA, ABINAV MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154829	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
183751	Fee-for-Service	1558673632	1558673632	1	1	BRYDEN, KARA D N MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120063	40	Pediatrics	0	In state provider	None	1235 OSOS ST	SUITE 100	SAN LUIS OBISPO	CA	93401	3619	40	06079	35.27979518	-120.6596361	San Luis Obispo County
183770	Fee-for-Service	1811034648	1811034648	1	3	BAART BEHAVIORAL HEALTH SERV	8/7/2015	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	433 TURK ST	None	SAN FRANCISCO	CA	94102	3329	38	06075	37.78247225	-122.4163506	San Francisco County
183782	Fee-for-Service	1528323177	1528323177	1	1	BRAR, GAGANDEEP MD	11/18/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	132193	None	None	0	In state provider	None	15031 RINALDI ST	150	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
183801	Fee-for-Service	1205333051	1205333051	1	1	BHARDWAJ, SUPRIYA MD	8/6/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1325 N LITCHFIELD RD	110	GOODYEAR	AZ	85395	1228	00	None	33.461118	-112.355739	Maricopa County
183806	Fee-for-Service	1619263712	1619263712	1	1	BRENNAN MEDICAL CORPORATION	9/25/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	30 BRENNAN STREET	None	WATSONVILLE	CA	95076	4303	44	06087	36.91346025	-121.7577455	Santa Cruz County
183839	Fee-for-Service	1649807546	1649807546	1	1	BARTON, SHAWN M MD	3/25/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
183851	Fee-for-Service	1871583682	1871583682	1	1	BROOKS, DARRELL MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81805	24	Plastic Surgery	0	In state provider	None	280 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
183856	Fee-for-Service	1730422767	1730422767	1	1	BERNSTEIN, MARTINE S NP	2/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	900 VETERANS BLVD	None	REDWOOD CITY	CA	94063	1715	41	06081	37.49009082	-122.2276816	San Mateo County
183862	Fee-for-Service	1790262269	1790262269	1	1	BYRNE, BONNIE Z PT	5/18/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
183884	Fee-for-Service	1023196896	1023196896	1	1	BERGSTROM, STEVEN K MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	58591	68	Hematology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
183885	Fee-for-Service	1578655262	1578655262	1	1	BARTON, LORAYNE H MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13691	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	92106	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
183910	Fee-for-Service	1467435172	1467435172	1	1	BAKES, PETER F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
183937	Fee-for-Service	1881636496	1881636496	1	1	BIRNDORF, LORI B	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	6178	None	None	0	In state provider	None	12139 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91607	3832	19	06037	34.15763747	-118.3980195	Los Angeles County
183940	Fee-for-Service	1346213394	1346213394	1	1	BROCKWAY, STEPHEN K MD	5/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81223	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
183962	Fee-for-Service	1649544933	1649544933	1	1	BASTIEN, JOHANNE C CRNA	3/19/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
183966	Fee-for-Service	1538201405	1538201405	1	1	BERUBE, CAROLINE MD	11/2/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86293	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
183987	Fee-for-Service	1336764521	1336764521	1	1	BLACK MOUNTAIN HEALTHCARE	6/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	3750 CONVOY ST.	SUITE 220B	SAN DIEGO	CA	92111	3741	37	06073	32.81201122	-117.1531108	San Diego County
183997	Fee-for-Service	1851669030	1851669030	1	1	BURKE, MICHELLE C	8/9/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
184021	Fee-for-Service	1013239037	1013239037	1	2	BARTLETT'S HEARING AID CENTE	6/9/2010	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	2450 ORODAM BLVD	SUITE C	OROVILLE	CA	95966	6052	04	06007	39.50570174	-121.5470597	Butte County
184026	Fee-for-Service	1376863621	1376863621	1	1	BRADY, MATTHEW T MD	7/10/2018	208600000X	NA	General Surgery	026	PHYSICIANS	148963	02	General Surgery	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
184082	Fee-for-Service	1134955784	1134955784	1	1	BHATIA, ROMIO NP	12/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
184088	Fee-for-Service	1174815021	1174815021	1	1	BERRY, GRANT W MD	5/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	214 E 23RD STREET	None	CHEYENNE	WY	82001	3748	00	None	41.1402124	-104.8159812	Laramie County
184113	Fee-for-Service	1154654069	1154654069	1	1	BALES, DAVID R LMFT	10/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
184139	Fee-for-Service	1871583682	1871583682	1	1	BROOKS, DARRELL MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81805	46	Hand Surgery	0	In state provider	None	280 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
184150	Fee-for-Service	1316061518	1316061518	1	1	BERNER, MARK D MD	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
184171	Fee-for-Service	1023196896	1023196896	1	1	BERGSTROM, STEVEN K MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	58591	78	Neoplastic Diseases/Oncology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
184173	Fee-for-Service	1578655262	1578655262	1	1	BARTON, LORAYNE H MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13691	40	Pediatrics	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	92106	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
184189	Fee-for-Service	1962657544	1962657544	1	1	BADAR, FRANCISCO L III	12/26/2008	193400000X	NA	Other	026	PHYSICIANS	103012	08	Family Practice	0	In state provider	MD INC	3650 E SOUTH ST	STE 404	LAKEWOOD	CA	90712	1508	19	06037	33.8601747	-118.1494013	Los Angeles County
184212	Fee-for-Service	1023053345	1023053345	1	1	BELLWOOD MEDICAL CENTER	4/27/2004	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY CORP	10230 ARTESIA BLVD	STE 101	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
184248	Fee-for-Service	1407888126	1407888126	1	1	BISHOP, JOHN MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	62213	22	Pathology (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
184261	Fee-for-Service	1356518013	1356518013	1	1	BHALLA, SARBPAUL S MD AMC	4/30/1986	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	36251	20	Orthopedic Surgery	0	In state provider	None	3610 LONG BEACH BLVD	STE 202	LONG BEACH	CA	90807	4091	19	06037	33.822396	-118.1893225	Los Angeles County
184274	Fee-for-Service	1336764521	1336764521	1	1	BLACK MOUNTAIN HEALTHCARE	6/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	3750 CONVOY ST.	SUITE 220B	SAN DIEGO	CA	92111	3741	37	06073	32.81201122	-117.1531108	San Diego County
184321	Fee-for-Service	1982808010	1982808010	1	1	BOUDAKIAN, SUSAN MD	9/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	6939	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
184351	Fee-for-Service	1952584401	1952584401	1	1	BEATO, ANGEL LCSW	11/28/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
184359	Fee-for-Service	1366024838	1366024838	1	1	BATRA, SAMTA DPM	10/3/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
184363	Fee-for-Service	1295985356	1295985356	1	1	BAILEY, ANNA M PSYD	3/18/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
184368	Fee-for-Service	1508895962	1508895962	1	1	BLOCK, STEVEN M MD	4/27/1999	207L00000X	NA	Other	026	PHYSICIANS	34275	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
184369	Fee-for-Service	1457430399	1457430399	1	1	BOUZAGLOU, ARMAND MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	26098	None	None	0	In state provider	None	201 S ALVARADO	STE A	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
184371	Fee-for-Service	1386731768	1386731768	1	1	BLAIR, FREDERICK C	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67736	None	None	0	In state provider	None	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.25037548	-122.049045	Solano County
184386	Fee-for-Service	1750865358	1750865358	1	1	BINGTAO LIN, MD, PC	9/23/2022	163WP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1600 CREEKSIDE DR	STE 2400	FOLSOM	CA	95630	3485	34	06067	38.669994	-121.147488	Sacramento County
184393	Fee-for-Service	1194892570	1194892570	1	1	BAY PHYSICAL THERAPY AND SPO	10/23/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NESS CENTER	500 LIGHTHOUSE AVE.	SUITE B	MONTEREY	CA	93940	1423	27	06053	36.61269281	-121.9009435	Monterey County
184408	Fee-for-Service	1700893765	1700893765	1	1	BRUCE V MATHIS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
184431	Fee-for-Service	1265465926	1265465926	2	1	BESHAI, YOUSSEF N	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72742	None	None	0	In state provider	None	650 META ST	None	OXNARD	CA	93030	7182	56	06111	34.195239	-119.1759535	Ventura County
184457	Fee-for-Service	1316995889	1316995889	1	1	BERROL, RONN MD	2/4/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70707	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
184483	Fee-for-Service	1174159412	1174159412	1	1	BARRETO ABRAMS, JESUS O PHD	2/9/2023	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
184492	Fee-for-Service	1306234372	1306234372	1	1	BRUUN, AIDA T K NP	11/2/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184495	Fee-for-Service	1316249378	1316249378	1	1	BELCHER, ANNA C P CRNA	8/1/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
184497	Fee-for-Service	1891748372	1891748372	1	1	BAINTON, BRUCE G MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	49882	05	Anesthesiology	0	In state provider	STE D	100 S. SAN MATEO DR.	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
184499	Fee-for-Service	1356346365	1356346365	1	1	BEHNIWAL, KULDIP J B MD	8/15/2008	208800000X	NA	Other	026	PHYSICIANS	39586	34	Urology and Urological Surgery	0	In state provider	None	7014 N WHITNEY AVE	None	FRESNO	CA	93720	0155	10	06019	36.83834474	-119.7423213	Fresno County
184504	Fee-for-Service	1801206354	1801206354	1	1	BELLINGHAUSEN STEWART, AMY L	9/23/2019	207R00000X	NA	Other	026	PHYSICIANS	143164	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
184511	Fee-for-Service	1124079181	1124079181	1	1	BERGER, TIMOTHY G MD	2/28/1989	207N00000X	NA	Dermatology	026	PHYSICIANS	32599	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184512	Fee-for-Service	1790245116	1790245116	1	1	BOURBEAU-MEDINILLA, KATHERIN	8/8/2022	207R00000X	NA	Other	026	PHYSICIANS	178058	None	None	0	In state provider	E E MD	400 PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
184527	Fee-for-Service	1336337385	1336337385	1	1	BARBALA, PATRICIA J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72220	41	Internal Medicine	0	In state provider	None	801 W YOSEMITE AVE	None	MADERA	CA	93637	4552	20	06039	36.95623697	-120.0681754	Madera County
184548	Fee-for-Service	1235229311	1235229311	1	1	BHARNE, ABHINANDAN A MD	11/24/2008	207RP1001X	NA	Pulmonology	026	PHYSICIANS	80880	None	None	0	In state provider	None	1801 W ROMNEYA DR	STE 409	ANAHEIM	CA	92801	1830	30	06059	33.8506615	-117.946413	Orange County
184554	Fee-for-Service	1902499882	1902499882	1	1	BAIRD, RANDALL F LMFT	11/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1900 TAHQUITZ CANYON WAY	STE C4	PALM SPRINGS	CA	92262	7024	33	06065	33.8232242	-116.5255435	Riverside County
184560	Fee-for-Service	1447575360	1447575360	1	1	BAO, JEAN J MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135080	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
184562	Fee-for-Service	1053331173	1053331173	1	1	BARTON, LEON MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	35547	13	Neurology (M.D. only)	0	In state provider	None	201 S ALVARADO ST	STE 215	LOS ANGELES	CA	90057	2388	19	06037	34.06417777	-118.2719543	Los Angeles County
184566	Fee-for-Service	1962140145	1962140145	1	1	BAO, DANLIN PT	5/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
184576	Fee-for-Service	1326509878	1326509878	1	1	BOULOS, NANCY M MD	8/23/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
184587	Fee-for-Service	1811120868	1811120868	1	1	BRADLEY, ASHLEY	5/17/2023	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
184616	Fee-for-Service	1073546404	1073546404	1	2	BONDS, CURLEY L II MD	10/12/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	78535	-	NOT APPLICABLE	0	In state provider	None	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	19	06037	34.1427285	-118.230039	Los Angeles County
184633	Fee-for-Service	1154416493	1154416493	2	1	BUI, KHANH D OD	1/12/1994	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	68 S PARK VICTORIA DR	None	MILPITAS	CA	95035	5723	43	06085	37.4344846	-121.8838689	Santa Clara County
184648	Fee-for-Service	1619923810	1619923810	1	1	BLANKENSHIP, BRADLEY S MD	1/15/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75672	None	None	0	In state provider	None	1444 FLORIDA AVE	STE 103	MODESTO	CA	95350	4400	50	06099	37.66487562	-120.9961927	Stanislaus County
184676	Fee-for-Service	1942323399	1942323399	1	1	BRUSKY, JOHN P MD	2/25/2008	208800000X	NA	Other	026	PHYSICIANS	82835	34	Urology and Urological Surgery	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
184677	Fee-for-Service	1750865358	1750865358	1	1	BINGTAO LIN, MD, PC	9/23/2022	163WP0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1600 CREEKSIDE DR	STE 2400	FOLSOM	CA	95630	3485	34	06067	38.669994	-121.147488	Sacramento County
184724	Fee-for-Service	1255105219	1255105219	1	1	BATES, KAYLEIGH A PT	1/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2260 TAPO ST	B117	SIMI VALLEY	CA	93063	3022	56	06111	34.27695447	-118.7089305	Ventura County
184730	Fee-for-Service	1023166980	1023166980	1	1	BAYAN, RUBY P MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	36859	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
184732	Fee-for-Service	1235760091	1235760091	1	1	BALDWIN, JASMINE CRNA	2/19/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
184764	Fee-for-Service	1144232760	1144232760	1	1	BECKETT, JAMES B MD	8/9/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60701	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
184800	Fee-for-Service	1346870771	1346870771	1	1	BUCHANAN, BRIGGITTE LPCC	12/23/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
184810	Fee-for-Service	1730165911	1730165911	1	1	BLATT, ELLEN R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDRENS HOSPITAL	0401 CASTLE CREEK RD	None	ASPEN	CO	81611	1159	00	None	39.190482	-106.839324	Pitkin County
184813	Fee-for-Service	1073101143	1073101143	1	1	BELIEVE HOSPICE, INC	4/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	STE 225	RESEDA	CA	91335	4000	19	06037	34.2011975	-118.5419835	Los Angeles County
184825	Fee-for-Service	1679638662	1679638662	1	1	BARICHIEVICH, CAROLINE	2/6/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	220 CONCOURSE BLVD	None	SANTA ROSA	CA	95403	8210	49	06097	38.51395202	-122.7888221	Sonoma County
184849	Fee-for-Service	1053331173	1053331173	1	1	BARTON, LEON MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	35547	01	General Practice	0	In state provider	None	201 S ALVARADO ST	STE 215	LOS ANGELES	CA	90057	2388	19	06037	34.06417777	-118.2719543	Los Angeles County
184865	Fee-for-Service	1932132511	1932132511	1	1	BRADLEY STETZER, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	1998	00	None	41.46242416	-81.69888235	Cuyahoga County
184874	Fee-for-Service	1356874192	1356874192	1	1	BELLACOSE, CARMEL S MD	10/1/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	174102	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
184915	Fee-for-Service	1033696315	1033696315	1	1	BRENTON, THEODORE W C NP	8/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
184959	Fee-for-Service	1407392012	1407392012	1	1	BRIDGES, DUSTIN B PHD	3/12/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
184973	Fee-for-Service	1568153682	1568153682	1	1	BUNYE, CHLOIE NP	9/25/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95025060	-	NOT APPLICABLE	0	In state provider	None	6022 VARIEL AVENUE	None	WOODLAND HILLS	CA	91367	3719	19	06037	34.180029	-118.592771	Los Angeles County
184975	Fee-for-Service	1841513660	1841513660	1	1	BEAL, PATRICIA A LMFT	8/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
184988	Fee-for-Service	1528789856	1528789856	1	1	BOEHMER, ALEXANDRA	4/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
184999	Fee-for-Service	1508885278	1508885278	1	1	BENSON, STEPHEN A DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	28240 AGOURA ROAD	STE 101	AGOURA HILLS	CA	91301	2485	19	06037	34.14086266	-118.7423339	Los Angeles County
185021	Fee-for-Service	1114435583	1114435583	1	1	BURT'S PHARMACY, INC.	6/28/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2900 TOWNSGATE RD.	STE. 105	WESTLAKE VILLAGE	CA	91361	3001	56	06111	34.15215119	-118.8228094	Ventura County
185027	Fee-for-Service	1053069450	1053069450	1	1	BYRON COLLIER DPM INC	10/30/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	911 OAK PARK BLVD	STE 106	PISMO BEACH	CA	93449	3406	40	06079	35.13435006	-120.6051746	San Luis Obispo County
185030	Fee-for-Service	1528192184	1528192184	1	1	BARRON, JENNIFER L PHD	11/1/1986	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1758 BIG DALTON AVE	None	BALDWIN PARK	CA	91706	5910	19	06037	34.06902724	-117.9674883	Los Angeles County
185077	Fee-for-Service	1811188303	1811188303	1	1	BABAYANS, KATHERINE LMFT	2/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	212 LANE STREET	None	YREKA	CA	96097	2915	47	06093	41.73040672	-122.6368507	Siskiyou County
185090	Fee-for-Service	1346378163	1346378163	1	1	BECKER, LESLIE L LMFT	9/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
185099	Fee-for-Service	1073101143	1073101143	1	1	BELIEVE HOSPICE, INC	4/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	STE 225	RESEDA	CA	91335	4000	19	06037	34.2011975	-118.5419835	Los Angeles County
185104	Fee-for-Service	1982619763	1982619763	1	1	BHAIKA, HARPAL S MD	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39802	10	Gastroenterology (M.D. only)	0	In state provider	None	5959 TRUXTUN AVE	STE 200	BAKERSFIELD	CA	93309	0437	15	06029	35.36306164	-119.0711264	Kern County
185123	Fee-for-Service	1205582905	1205582905	1	1	BROADVIEW HOME HEALTH INC	7/25/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	517 E WILSON AVE	STE 103B	GLENDALE	CA	91206	4376	19	06037	34.14818643	-118.2491864	Los Angeles County
185138	Fee-for-Service	1245467448	1245467448	1	1	BARLOW, BRIAN T MD	9/27/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	158151	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
185139	Fee-for-Service	1417533761	1417533761	1	1	BELINGHERI, ELIZABETH M LCSW	12/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
185159	Fee-for-Service	1285925693	1285925693	1	1	BUEHLER, PHYLLIS K	5/4/2018	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	1816 HOWARD AVE	None	SAN DIEGO	CA	92013	2507	37	06073	32.75405945	-117.146007	San Diego County
185177	Fee-for-Service	1013139328	1013139328	1	1	BERGIN, AINE LMFT	1/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 INDIANA AVE	SUITE 130	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
185253	Fee-for-Service	1780172775	1780172775	1	1	BHUPATHI, VIVEK R MD	7/26/2021	207R00000X	NA	Other	026	PHYSICIANS	173671	None	None	0	In state provider	None	2333 MOWRY AVE	STE 300	FREMONT	CA	94538	1602	01	06001	37.55614438	-121.9822469	Alameda County
185266	Fee-for-Service	1366578924	1366578924	1	1	BENJAMIN GREGORY WILLIAMS	12/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 E NICOLLET BLVD	None	BURNSVILLE	MN	55337	5714	00	None	44.749107	-93.2733135	Dakota County
185271	Fee-for-Service	1154940682	1154940682	1	1	BOUZ, HANIA A MD	8/17/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185731	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
185274	Fee-for-Service	1487018610	1487018610	1	1	BELLO, MICHAEL C LCSW	12/9/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON STREET	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
185296	Fee-for-Service	1891412656	1891412656	1	1	BENNETT, MYKEL D NP	12/27/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185302	Fee-for-Service	1861570509	1861570509	1	1	BULLEN, MARYLOU D MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60549	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
185340	Fee-for-Service	1285762443	1285762443	1	1	BUTTE COUNTY DEPARTMENT OF P	5/2/2024	251K00000X	NA	Other	109	LOCAL HEALTH JURISDICTIONS	-	-	NOT APPLICABLE	0	In state provider	LTH DEPARTMENT	25 COUNTY CENTER DR	213	OROVILLE	CA	95965	3316	04	06007	39.52773321	-121.5716548	Butte County
185341	Fee-for-Service	1518342609	1518342609	1	1	BENNETT, CHRISTINE NP	3/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
185343	Fee-for-Service	1144657537	1144657537	1	2	BARNETT, CHALON A LCSW	5/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2810 E DEL MAR BLVD	12	PASADENA	CA	91107	6709	19	06037	34.14212984	-118.092328	Los Angeles County
185349	Fee-for-Service	1639587868	1639587868	1	1	BIRDI, MAHEEP S MD	9/24/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	134352	13	Neurology (M.D. only)	0	In state provider	None	2901 SILLECT AVE	100	BAKERSFIELD	CA	93308	6371	15	06029	35.38611256	-119.0393796	Kern County
185360	Fee-for-Service	1326042078	1326042078	1	1	BARRETT HOSPITAL	9/26/2006	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	90 HIGHWAY 91 SOUTH	None	DILLON	MT	59725	0000	00	None	45.207027	-112.641705	Beaverhead County
185362	Fee-for-Service	1396938155	1396938155	1	1	BANNING UNIFIED SCH DIST	7/1/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	161 W WILLIAMS ST	None	BANNING	CA	92220	4798	33	06065	33.9272313	-116.878477	Riverside County
185364	Fee-for-Service	1548345143	1548345143	1	1	BARRUGA, MARVIN J CRNA	2/1/2003	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2120 FOOTHILL BLVD	STE 213	LA VERNE	CA	91750	2950	19	06037	34.1128457	-117.7639454	Los Angeles County
185367	Fee-for-Service	1245968676	1245968676	1	1	BAYONA, FRANCIS A CNP	2/26/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	19	06037	34.18659936	-118.5552114	Los Angeles County
185377	Fee-for-Service	1528093085	1528093085	1	1	BARSTIS, JOHN L MD	1/1/1982	207RH0003X	NA	Oncology	026	PHYSICIANS	39366	01	General Practice	0	In state provider	None	301 N PRAIRIE AVE	STE 311	INGLEWOOD	CA	90301	4510	19	06037	33.965712	-118.3439965	Los Angeles County
185423	Fee-for-Service	1316163454	1316163454	1	1	BIEBESHEIMER, JESSE B MD	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92276	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06489065	-118.4443287	Los Angeles County
185446	Fee-for-Service	1437210754	1437210754	1	1	BORDE, MADHUSUDAN MD INC	3/5/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35179	41	Internal Medicine	0	In state provider	None	1460 N CAMINO ALTO	SUITE 111	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
185480	Fee-for-Service	1720307564	1720307564	1	1	BHATT, NIKUNJ A MD	5/1/2021	171000000X	NA	Other	026	PHYSICIANS	171295	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
185484	Fee-for-Service	1821198755	1821198755	1	1	BLOOMSBURG HOSPITAL	3/17/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	549 FAIR ST	None	BLOOMSBURG	PA	17815	1419	00	None	41.009292	-76.4525655	Columbia County
185496	Fee-for-Service	1770510760	1770510760	1	1	BECKER, ANTHONY D MD	6/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	63205	None	None	0	In state provider	None	16506 LAKEWOOD BLVD	None	BELLFLOWER	CA	90706	5123	19	06037	33.88470916	-118.1424401	Los Angeles County
185511	Fee-for-Service	1043899099	1043899099	1	1	BOOTH, LEESA S CNP	6/22/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
185547	Fee-for-Service	1700376951	1700376951	1	1	BRIDGE HOSPICE EAST BAY LLC	7/31/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3021 CITRUS CIRCLE	SUITE 230	WALNUT CREEK	CA	94598	2675	07	06013	37.92845517	-122.0144911	Contra Costa County
185555	Fee-for-Service	1134153331	1134153331	1	1	BUZAD, PAUL MD	8/31/1986	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43412	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10660 WHITE OAK AVE	None	GRANADA HILLS	CA	91344	5943	19	06037	34.263918	-118.5197545	Los Angeles County
185575	Fee-for-Service	1841545142	1841545142	1	1	BUTLER, PAUL M MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142810	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
185589	Fee-for-Service	1750419230	1750419230	1	2	BHARDWAJ, PRITI MD	5/3/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	94479	36	Psychiatry	0	In state provider	None	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
185608	Fee-for-Service	1467665703	1467665703	1	1	BREUER, TUVIA DO	10/27/2021	2084P0015X	NA	Psychiatry	026	PHYSICIANS	14921	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
185617	Fee-for-Service	1902949985	1902949985	1	1	BENCAL HEARING GROUP	1/19/2007	193400000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	BENCAL HEARING GROUP	7391 N PALM AVE	STE 104	FRESNO	CA	93711	5512	10	06019	36.8441681	-119.8087217	Fresno County
185632	Fee-for-Service	1164627725	1164627725	1	1	BROWN, COLIN N MD	7/15/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160458	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
185633	Fee-for-Service	1093729436	1093729436	1	1	BAMBHANIA, RAMESCHANDRA	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45672	41	Internal Medicine	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
185646	Fee-for-Service	1326042078	1326042078	1	1	BARRETT HOSPITAL	9/26/2006	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	90 HIGHWAY 91 SOUTH	None	DILLON	MT	59725	0000	00	None	45.207027	-112.641705	Beaverhead County
185665	Fee-for-Service	1528093085	1528093085	1	1	BARSTIS, JOHN L MD	1/1/1982	207RH0003X	NA	Oncology	026	PHYSICIANS	39366	41	Internal Medicine	0	In state provider	None	301 N PRAIRIE AVE	STE 311	INGLEWOOD	CA	90301	4510	19	06037	33.965712	-118.3439965	Los Angeles County
185704	Fee-for-Service	1821098336	1821098336	1	1	BROPHY III, DONALD R DC	3/21/2006	111NI0900X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3731 SUNSET LN	STE 102	ANTIOCH	CA	94509	6127	07	06013	37.98376866	-121.8041894	Contra Costa County
185706	Fee-for-Service	1659882876	1659882876	1	1	BOHNERT, NICOLETTE K CRNA	8/27/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
185729	Fee-for-Service	1750419230	1750419230	1	1	BHARDWAJ, PRITI MD	7/31/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	94479	-	NOT APPLICABLE	0	In state provider	None	5715 SOUTH BROADWAY AVE	None	LOS ANGELES	CA	90037	4131	19	06037	33.990273	-118.2783255	Los Angeles County
185735	Fee-for-Service	1437210754	1437210754	1	1	BORDE, MADHUSUDAN MD INC	3/5/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35179	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1460 N CAMINO ALTO	SUITE 111	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
185745	Fee-for-Service	1134818537	1134818537	1	1	BONNELL, RUTH NP	3/12/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
185759	Fee-for-Service	1285800391	1285800391	1	1	BEATO, DAVID K MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82090	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
185773	Fee-for-Service	1821198755	1821198755	1	1	BLOOMSBURG HOSPITAL	5/11/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	549 FAIR ST	None	BLOOMSBURG	PA	17815	1419	00	None	41.009292	-76.4525655	Columbia County
185779	Fee-for-Service	1942705637	1942705637	1	1	BAGINGITO, AUSTIN G MD	9/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163977	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
185793	Fee-for-Service	1356597637	1356597637	1	1	BAY IMAGING CONSULTANTS	5/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
185806	Fee-for-Service	1689414674	1689414674	1	1	BELL-LAM, CHAU L	6/11/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
185808	Fee-for-Service	1790966877	1790966877	1	1	BAROUNIS, TIMOTHY J MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105853	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9000	37	06073	32.7537975	-117.1658298	San Diego County
185834	Fee-for-Service	1700376951	1700376951	1	1	BRIDGE HOSPICE EAST BAY LLC	7/31/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3021 CITRUS CIRCLE	SUITE 230	WALNUT CREEK	CA	94598	2675	07	06013	37.92845517	-122.0144911	Contra Costa County
185837	Fee-for-Service	1710220454	1710220454	1	1	BASRA, HARSIMRAN S MD	9/4/2018	207R00000X	NA	Other	026	PHYSICIANS	151896	41	Internal Medicine	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
185847	Fee-for-Service	1356378566	1356378566	1	1	BURKS, JAMES A MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54736	02	General Surgery	0	In state provider	None	1082 GLENDON AVENUE	None	LOS ANGELES	CA	90024	2908	19	06037	34.06109265	-118.4443071	Los Angeles County
185858	Fee-for-Service	1205945284	1205945284	1	1	BOQUERA, ROSA T MD	9/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54261	03	Allergy	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
185897	Fee-for-Service	1225336423	1225336423	1	1	BLUEBELL HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	107 CATHERINE LANE	None	GRASS VALLEY	CA	95945	5705	29	06057	39.22975754	-121.0475958	Nevada County
185929	Fee-for-Service	1689767626	1689767626	1	1	BASKETT, JOHN S OD	9/1/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1689 ARDEN WAY	STE 1091	SACRAMENTO	CA	95815	4096	34	06067	38.601549	-121.4274825	Sacramento County
185939	Fee-for-Service	1851820088	1851820088	1	1	BARRERA, MARIA E CA	6/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	24541 PACIFIC PARK	STE 205	ALISO VIEJO	CA	92656	3050	30	06059	33.57211592	-117.7018027	Orange County
185944	Fee-for-Service	1558328468	1558328468	1	1	BROWN, JAMES W	4/17/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13071 BROOKHURST ST	SUITE 110	GARDEN GROVE	CA	92843	1091	30	06059	33.77319252	-117.9551609	Orange County
186058	Fee-for-Service	1508150947	1508150947	1	1	BATAL, OBAIDA MD	7/31/2018	208600000X	NA	General Surgery	026	PHYSICIANS	140060	02	General Surgery	0	In state provider	None	1041 E YORBA LINDA BLVD	209	PLACENTIA	CA	92870	3728	30	06059	33.88848865	-117.8451029	Orange County
186070	Fee-for-Service	1316280662	1316280662	1	1	BURGES, MOLLY P MD	12/8/2021	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	134147	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
186076	Fee-for-Service	1629683354	1629683354	1	1	BOWEN, LYNDSAY C CCC-SLP	10/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
186090	Fee-for-Service	1073716940	1073716940	1	1	BAGIAS, CHELSEA H PSYD	11/23/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2008 MORSE AVENUE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
186102	Fee-for-Service	1104133016	1104133016	1	1	BYOUS, ERIN M LMFT	5/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
186108	Fee-for-Service	1235405952	1235405952	1	1	BALDUZZI, JEFFREY D MD	7/7/2022	207KA0200X	NA	Other	026	PHYSICIANS	173115	None	None	0	In state provider	None	4628 GEORGETOWN PL	None	STOCKTON	CA	95207	6204	39	06077	37.9893781	-121.313486	San Joaquin County
186122	Fee-for-Service	1831137264	1831137264	1	1	BAJAJ, ANITA M MD	6/21/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	44672	30	Radiology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
186147	Fee-for-Service	1063420727	1063420727	1	1	BORGO, DOUGLAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 S 3RD ST	None	MONTROSE	CO	81401	4212	00	None	38.480076	-107.868969	Montrose County
186211	Fee-for-Service	1023166980	1023166980	1	2	BAYAN, RUBY P MD	6/16/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	36859	-	NOT APPLICABLE	0	In state provider	None	720 WOOD ST	None	EUREKA	CA	95501	4413	12	06023	40.78118068	-124.1607622	Humboldt County
186224	Fee-for-Service	1386096345	1386096345	1	1	BRANA, CHRISTOPHER J MD	7/27/2020	207R00000X	NA	Other	026	PHYSICIANS	162291	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
186237	Fee-for-Service	1841850336	1841850336	1	1	BAUMAN, ASHLEY L PSYD	10/5/2022	225C00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
186238	Fee-for-Service	1689841629	1689841629	1	1	BRYAN, KATHRYN LMFT	4/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2716 S VERMONT AVE	UNIT 9	LOS ANGELES	CA	90007	2671	19	06037	34.029891	-118.2915225	Los Angeles County
186272	Fee-for-Service	1346485067	1346485067	1	1	BECKETT, MICHAEL P MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112563	20	Orthopedic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
186307	Fee-for-Service	1174785232	1174785232	1	2	BOULOM, VALY MD	12/12/2017	208600000X	NA	General Surgery	026	PHYSICIANS	130020	None	None	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	5212	07	06013	37.925712	-122.021856	Contra Costa County
186309	Fee-for-Service	1174646590	1174646590	1	1	BAILEY-WALTON, PAULA L MD	6/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70461	41	Internal Medicine	0	In state provider	None	5912 SANTA MONICA BLVD	None	LOS ANGELES	CA	90038	2043	19	06037	34.09072606	-118.3175287	Los Angeles County
186312	Fee-for-Service	1780285395	1780285395	1	1	BABY BOOMERS HOSPICE CARE	2/16/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	17817 CHATSWORTH ST	UNIT 220	GRANADA HILLS	CA	91344	5612	19	06037	34.2649235	-118.5222015	Los Angeles County
186353	Fee-for-Service	1013974625	1013974625	1	1	BARTHELOW, JOEL I MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	94358	None	None	0	In state provider	None	1026 MANGROVE AVE	STE 10	CHICO	CA	95926	3556	04	06007	39.73971182	-121.8368837	Butte County
186354	Fee-for-Service	1255847414	1255847414	1	1	BEHROUZIAN, KIMYA	11/14/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
186379	Fee-for-Service	1194854927	1194854927	1	1	BAILEY, SHELLI S LMFT	4/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
186385	Fee-for-Service	1467084764	1467084764	1	1	BEYKIN, GALA G MD	6/10/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186409	Fee-for-Service	1972826774	1972826774	1	1	BEVERLY RADIOLOGY MEDICAL	3/22/2010	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	947 S ANAHEIM BLVD	STE 100	ANAHEIM	CA	92805	5590	30	06059	33.82164135	-117.909385	Orange County
186451	Fee-for-Service	1073804332	1073804332	1	1	BALDAUF, CLAIRE E MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125948	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
186466	Fee-for-Service	1578872347	1578872347	1	1	BRASILE, LINDSAY A MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80320	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
186470	Fee-for-Service	1427108232	1427108232	1	1	BAYUBAY, REYNALDO B MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	39268	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
186585	Fee-for-Service	1033107438	1033107438	2	1	B & B PHARMACY SERVICES, LLC	6/15/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2020 COFFEE RD	STE C2	MODESTO	CA	95355	2407	50	06099	37.672569	-120.9757125	Stanislaus County
186597	Fee-for-Service	1780285395	1780285395	1	1	BABY BOOMERS HOSPICE CARE	2/16/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	17817 CHATSWORTH ST	UNIT 220	GRANADA HILLS	CA	91344	5612	19	06037	34.2649235	-118.5222015	Los Angeles County
186598	Fee-for-Service	1477627669	1477627669	1	1	BLOCK, ROBERT M MD	9/1/1995	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	64896	04	Otology, Laryngology, Rhinology	0	In state provider	None	1095 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65804253	-121.6451894	Monterey County
186605	Fee-for-Service	1508816299	1508816299	1	1	BLUE STAR HOME HEALTH,	4/10/2004	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	21731 VENTURA BLVD	STE 210	WOODLAND HILLS	CA	91364	5111	19	06037	34.16839279	-118.6016172	Los Angeles County
186630	Fee-for-Service	1073983144	1073983144	1	1	BJRX PHARMACY LTC INC	11/12/2015	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1801 E MARCH LANE	B270	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
186643	Fee-for-Service	1407977226	1407977226	1	1	BERG, RYAN A MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	79105	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	110 NORTH VALERIA STREET	STE 508	FRESNO	CA	93701	2168	10	06019	36.74388938	-119.7847725	Fresno County
186665	Fee-for-Service	1013964311	1013964311	1	1	BOURKE, SEAN E MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65939	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
186687	Fee-for-Service	1841700093	1841700093	1	1	BLYTHE, DIA M CNP	12/11/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2760 FLETCHER PKWY	None	EL CAJON	CA	92020	2110	37	06073	32.80015674	-117.0036982	San Diego County
186697	Fee-for-Service	1770584054	1770584054	1	1	BABAK RASHIDI MD	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3501 N SCOTTSDALE RD	STE 140	SCOTTSDALE	AZ	85251	5649	00	None	33.489027	-111.9254265	Maricopa County
186716	Fee-for-Service	1861704249	1861704249	1	1	BISHOP, KRISTIN E CRNA	5/3/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
186739	Fee-for-Service	1073804332	1073804332	1	1	BALDAUF, CLAIRE E MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125948	01	General Practice	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
186757	Fee-for-Service	1154852689	1154852689	1	1	BLACK, NICHOLAS D MD	6/24/2021	207P00000X	NA	Other	026	PHYSICIANS	157708	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
186774	Fee-for-Service	1831608090	1831608090	1	1	BALURAN, JONATHAN P D NP	10/3/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
186775	Fee-for-Service	1568542918	1568542918	1	1	BURNS, MICHAEL MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31974	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
186798	Fee-for-Service	1245474378	1245474378	1	1	BOROUJERDIRAD, LALEH MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114199	45	Nephrology (Renal-Kidney)	0	In state provider	None	14350 W WHITTIER BLVD	STE 101	WHITTIER	CA	90605	1824	19	06037	33.95501294	-118.0185665	Los Angeles County
186799	Fee-for-Service	1588125504	1588125504	1	1	BHATTARAI, ASHOK MD	9/9/2022	207P00000X	NA	Other	026	PHYSICIANS	178371	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
186819	Fee-for-Service	1518117753	1518117753	1	1	BARR, NICOLE E NP	11/8/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186823	Fee-for-Service	1194758623	1194758623	1	1	BHC ALHAMBRA HOSP	2/21/1997	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	4619 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1478	19	06037	34.08871316	-118.073569	Los Angeles County
186835	Fee-for-Service	1023315827	1023315827	1	1	BARBER, JAMELA L PT	12/18/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	830 S CITRUS AVE	SUITE 203	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
186852	Fee-for-Service	1174574917	1174574917	1	1	BOYLE, NOEL GERARD	7/9/1995	174400000X	NA	Other	026	PHYSICIANS	53732	None	None	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
186856	Fee-for-Service	1730358516	1730358516	1	1	BITAR, SOMER B CRNA	6/12/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
186857	Fee-for-Service	1346349909	1346349909	1	1	BOLD, MICHAEL S OD	3/8/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5422 LA PALMA AVE	None	LA PALMA	CA	90623	1705	30	06059	33.84625899	-118.0382415	Orange County
186878	Fee-for-Service	1295129856	1295129856	1	1	BENDA, ASHLEY C DO	8/20/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2190 LYNN RD	STE 300	THOUSAND OAKS	CA	91360	8024	56	06111	34.20728091	-118.8855456	Ventura County
186890	Fee-for-Service	1053069450	1053069450	1	2	BYRON COLLIER DPM INC	9/23/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1525 E MAIN ST	STE B	SANTA MARIA	CA	93454	4803	42	06083	34.95287831	-120.4100054	Santa Barbara County
186896	Fee-for-Service	1215019393	1215019393	1	1	BARBA, GERALD F PHD	7/24/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9449 E IMPERIAL HWY	None	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
186898	Fee-for-Service	1184086142	1184086142	1	1	BOWMAN, CHRISTOPHER MD	6/20/2019	207ZP0101X	NA	Other	026	PHYSICIANS	153358	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
186906	Fee-for-Service	1023403847	1023403847	1	1	BAMFO, NANA	8/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
186936	Fee-for-Service	1336571553	1336571553	1	1	BACHTLER, THOMAS F CRNA	5/5/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10850 ARROW ROUTE	None	RANCHO CUCAMONGA	CA	91730	0044	36	06071	34.0991609	-117.5680267	San Bernardino County
186950	Fee-for-Service	1255653309	1255653309	1	1	BSEIKRI, MUSTAFA R MD	6/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110452	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
186975	Fee-for-Service	1548384191	1548384191	1	1	BEAHM, BRENT W MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	34129	30	Radiology	0	In state provider	None	21 SANTA ROSA ST	STE 250	SAN LUIS OBISPO	CA	93405	5814	40	06079	35.29304729	-120.6676791	San Luis Obispo County
187012	Fee-for-Service	1447472857	1447472857	1	1	BOOKER, JEROME D MD	12/3/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	99445	40	Pediatrics	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
187018	Fee-for-Service	1073286985	1073286985	1	1	BISCHOFF, BLAKE MD	10/28/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2 UPPER RAGSDALE DR	STE B-210	MONTEREY	CA	93940	7851	27	06053	36.57940327	-121.8142876	Monterey County
187022	Fee-for-Service	1831262872	1831262872	1	1	BOLLINGER, LYNN C	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
187025	Fee-for-Service	1962845081	1962845081	1	1	BELANI, HRISHIKESH K MD MPH	2/16/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	140141	-	NOT APPLICABLE	0	In state provider	None	5850 S MAIN ST	RM 1017,2010,2017, 203	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
187044	Fee-for-Service	1891046272	1891046272	1	1	BLACK, KAREN G LMFT	10/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28465 OLD TOWN FRONT ST	STE 221	TEMECULA	CA	92590	1822	33	06065	33.49566437	-117.1516462	Riverside County
187049	Fee-for-Service	1831162338	1831162338	1	1	BROOKS, EDWARD M MD	3/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79184	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
187065	Fee-for-Service	1568542918	1568542918	1	1	BURNS, MICHAEL MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31974	77	Infectious Disease	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
187085	Fee-for-Service	1538717475	1538717475	1	1	BROWN, SHANTEL	2/25/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3751 E SHIELDS AVE	None	FRESNO	CA	93726	0000	10	06019	36.7796958	-119.7618088	Fresno County
187095	Fee-for-Service	1164106175	1164106175	1	1	BROADWAY MED GROUP, INC	2/6/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 E BROADWAY	STE A	GLENDALE	CA	91205	4528	19	06037	34.14632152	-118.245339	Los Angeles County
187105	Fee-for-Service	1861462251	1861462251	1	1	BAILEY, LISA MD	5/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	46868	02	General Surgery	0	In state provider	None	2500 MILVIA ST	STE 120	BERKELEY	CA	94704	2636	01	06001	37.86338897	-122.2698455	Alameda County
187111	Fee-for-Service	1326059700	1326059700	1	1	BHATIA, RAVI MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60702	None	None	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
187113	Fee-for-Service	1194758623	1194758623	1	1	BHC ALHAMBRA HOSP	2/21/1997	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	4619 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1478	19	06037	34.08871316	-118.073569	Los Angeles County
187147	Fee-for-Service	1437511649	1437511649	1	1	BHULLAR, ANNUM A MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153993	01	General Practice	0	In state provider	None	191 S BUENA VISTA ST	STE 150	BURBANK	CA	91505	4522	19	06037	34.15872557	-118.3283863	Los Angeles County
187190	Fee-for-Service	1295932317	1295932317	1	1	BARRAZA, JESUS LMFT	8/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
187204	Fee-for-Service	1992724017	1992724017	1	1	BRINGHURST, JOHN R MD	1/31/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60854	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
187229	Fee-for-Service	1518118124	1518118124	1	1	BREIDENSTEIN, BRENDA MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121728	18	Ophthalmology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
187269	Fee-for-Service	1740615749	1740615749	1	1	BAUMER, DONALD NP	6/6/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	None	EL CAJON	CA	92021	4994	37	06073	32.80773552	-116.9384985	San Diego County
187280	Fee-for-Service	1649503319	1649503319	1	4	BEAVER MEDICAL GROUP LP	10/23/2006	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5957 W RAMSEY ST	None	BANNING	CA	92220	3508	33	06065	33.92937645	-116.942463	Riverside County
187289	Fee-for-Service	1871893040	1871893040	1	1	BASURCO, DANIELLE L MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122293	08	Family Practice	0	In state provider	None	2755 ALAMO STREET	SUITE 100	SIMI VALLEY	CA	93065	1345	56	06111	34.28643348	-118.742904	Ventura County
187301	Fee-for-Service	1194767160	1194767160	1	1	BALESTRERY, FRANK G OD	4/25/1996	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2680 N TRACY BLVD	STE 2	TRACY	CA	95376	7771	39	06077	37.756269	-121.434952	San Joaquin County
187330	Fee-for-Service	1659320406	1659320406	1	1	BOECHAT, MARIA I MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	42822	30	Radiology	0	In state provider	UCLA RADIOLOGY MED GRP	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
187342	Fee-for-Service	1306939038	1306939038	1	1	BORCK, VICKY K OD	1/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	11284	36	Psychiatry	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
187372	Fee-for-Service	1063776466	1063776466	1	1	BALLIET, MEGAN DPM	2/5/2024	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
187374	Fee-for-Service	1083644579	1083644579	1	1	BATTLE CREEK HEALTH SYSTEM	3/8/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	300 NORTH AVENUE	None	BATTLE CREEK	MI	49017	3307	00	None	42.331185	-85.177935	Calhoun County
187400	Fee-for-Service	1194758623	1194758623	1	1	BHC ALHAMBRA HOSP	2/21/1997	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	4619 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1478	19	06037	34.08871316	-118.073569	Los Angeles County
187417	Fee-for-Service	1659323244	1659323244	1	1	BLACK, DAVID K MD	8/19/2008	207L00000X	NA	Other	026	PHYSICIANS	66927	05	Anesthesiology	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
187456	Fee-for-Service	1548769284	1548769284	1	1	BAY IMAGING CONSULTANTS MEDI	8/17/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CAL GROUP, INC.	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
187477	Fee-for-Service	1134162225	1134162225	1	1	BENNETT-STEWART	8/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98469	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CHRISTINA D MD	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
187489	Fee-for-Service	1871547356	1871547356	1	1	BUNUEL-JORDANA, MARTA MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
187491	Fee-for-Service	1316959307	1316959307	1	1	BRITT, DEBORAH S MD	7/31/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42312	40	Pediatrics	0	In state provider	None	990 SONOMA AVE	STE 5	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
187503	Fee-for-Service	1770640393	1770640393	1	1	BARNES, JEFFREY G DO	8/20/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	7218	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
187575	Fee-for-Service	1679505572	1679505572	1	1	BLUFF ENTERPRISES, INC	2/28/1979	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	510 MILL ST	None	FOLSOM	CA	95630	2607	34	06067	38.679282	-121.1682465	Sacramento County
187576	Fee-for-Service	1871893040	1871893040	1	1	BASURCO, DANIELLE L MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122293	01	General Practice	0	In state provider	None	2755 ALAMO STREET	SUITE 100	SIMI VALLEY	CA	93065	1345	56	06111	34.28643348	-118.742904	Ventura County
187580	Fee-for-Service	1164624839	1164624839	1	1	BARRIOS JR, CRISTOBAL MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87771	89	Surgery-Traumatic	0	In state provider	None	101 THE CITY DR S	STE B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
187581	Fee-for-Service	1598751729	1598751729	1	1	BRYON BURRUP D.O.	7/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1221 HIGHLAND AVE	None	CLARKSTON	WA	99403	2829	00	None	46.40360847	-117.054558	Asotin County
187661	Fee-for-Service	1538627559	1538627559	1	2	BERNOUS PSYCHOLOGICAL SERVIC	7/6/2022	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ES INC	1451 QUAIL ST	102	NEWPORT BEACH	CA	92660	2747	30	06059	33.66105363	-117.8688433	Orange County
187662	Fee-for-Service	1083644579	1083644579	1	1	BATTLE CREEK HEALTH SYSTEM	3/8/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	300 NORTH AVENUE	None	BATTLE CREEK	MI	49017	3307	00	None	42.331185	-85.177935	Calhoun County
187667	Fee-for-Service	1699304642	1699304642	1	1	BRAHMASHETTAR, VIJAYALAKSHMI	11/9/2023	207R00000X	NA	Other	026	PHYSICIANS	191735	None	None	0	In state provider	M MD	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
187676	Fee-for-Service	1629396627	1629396627	1	1	BRICKNER, ANGELA D SP	10/19/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7098	34	06067	38.56554	-121.4664615	Sacramento County
187708	Fee-for-Service	1356997720	1356997720	1	1	BIELENBERG, JENNIFER D PSYD	11/13/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
187737	Fee-for-Service	1528159340	1528159340	1	1	BROWNLEY, RICHARD H	12/24/1989	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	66382	45	Nephrology (Renal-Kidney)	0	In state provider	None	251 COHASSET RD	None	CHICO	CA	95926	2241	04	06007	39.75090044	-121.8522609	Butte County
187748	Fee-for-Service	1497861231	1497861231	1	1	BRASLAU, DANIEL L MD	4/30/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	69037	47	Miscellaneous	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
187789	Fee-for-Service	1679588370	1679588370	1	1	BARI, MOHAMMAD A	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46396	None	None	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
187810	Fee-for-Service	1942940697	1942940697	1	1	BOLIVAR, SAMUEL A MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	188400	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
187816	Fee-for-Service	1811973860	1811973860	1	1	BLOCK, EDWARD J MD	4/30/1985	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	45827	10	Gastroenterology (M.D. only)	0	In state provider	None	24411 HEALTH CENTER DR	STE 550	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
187830	Fee-for-Service	1336102003	1336102003	1	1	BRICKNER, ELIZABETH MARY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
187852	Fee-for-Service	1942752852	1942752852	1	1	BAGGA, STEVE K LMFT	3/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
187854	Fee-for-Service	1518045012	1518045012	1	1	BHAUMIK, MANJITA MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64016	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
187870	Fee-for-Service	1801862289	1801862289	1	1	BRAR, RUPINDER S MD	4/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67489	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	969 PLUMAS ST	STE 200	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
187948	Fee-for-Service	1538627559	1538627559	1	2	BERNOUS PSYCHOLOGICAL SERVIC	7/6/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ES INC	1451 QUAIL ST	102	NEWPORT BEACH	CA	92660	2747	30	06059	33.66105363	-117.8688433	Orange County
187952	Fee-for-Service	1578605044	1578605044	1	1	BROADWAY SURGICAL INSTITUTE	4/26/2011	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1451 S BROADWAY ST	None	SANTA MONICA	CA	90404	2711	19	06037	34.02343955	-118.4834348	Los Angeles County
187954	Fee-for-Service	1093013476	1093013476	1	1	BERGER, JEFF LMFT	3/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	450 BRAND	638	GLENDALE	CA	91203	2347	19	06037	34.152633	-118.254971	Los Angeles County
188034	Fee-for-Service	1497861231	1497861231	1	1	BRASLAU, DANIEL L MD	4/30/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	69037	30	Radiology	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
188044	Fee-for-Service	1467444844	1467444844	1	1	BUTLER, KIM J OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1273 BROADWAY	None	EL CAJON	CA	92021	4902	37	06073	32.8076517	-116.9371028	San Diego County
188067	Fee-for-Service	1720177157	1720177157	1	1	BECK, ROBERT K MD	8/16/2019	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	45504	66	Emergency Medicine (Urgent Care)	0	In state provider	None	29997 CANYON HILLS RD	STE 1604	LAKE ELSINORE	CA	92532	2581	33	06065	33.66754378	-117.2623698	Riverside County
188094	Fee-for-Service	1144433731	1144433731	1	1	BERNHARDT, CHAD M MD	7/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100341	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
188100	Fee-for-Service	1265479950	1265479950	1	1	BRADLEY S. BUTLER, M.D.	6/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
188170	Fee-for-Service	1922111020	1922111020	1	1	BITTLES, MARK A MD	10/28/2020	2085R0204X	NA	Other	026	PHYSICIANS	165655	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
188182	Fee-for-Service	1124030028	1124030028	1	1	BUDDE, LIHUA E MD	2/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122611	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
188206	Fee-for-Service	1598849846	1598849846	1	1	BAGHDASSARIAN, SAHAG MD	6/6/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	40105	18	Ophthalmology	0	In state provider	None	1500 S CENTRAL AVE	STE 221	GLENDALE	CA	91204	2555	19	06037	34.12736888	-118.257777	Los Angeles County
188208	Fee-for-Service	1649356155	1649356155	1	1	BERNAL, MARIA PILAR MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	40203	36	Psychiatry	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
188214	Fee-for-Service	1235558875	1235558875	1	1	BEHNAWA, SUSAN B MD	2/21/2020	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	142141	38	Geriatrics	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
188219	Fee-for-Service	1265847057	1265847057	1	1	BHATT, BHAVNI D NP	2/5/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
188264	Fee-for-Service	1891936258	1891936258	1	1	BAKER, TIMOTHY E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31732	07	Dermatology	0	In state provider	None	PO BOX 696	None	DAVIS	CA	95617	0696	57	06113	0	0	None
188280	Fee-for-Service	1679875116	1679875116	1	1	BECCIO, BRANDON M LMFT	8/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
188323	Fee-for-Service	1265506570	1265506570	1	1	BROWN, ANDREW R MD	8/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	39075	40	Pediatrics	0	In state provider	None	27303 SLEEPY HOLLOW S	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
188341	Fee-for-Service	1811971195	1811971195	1	1	BLANTON, ANN K	8/1/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
188359	Fee-for-Service	1760580930	1760580930	2	1	BARTEL, TWYLA B MD	3/31/2023	2085N0904X	NA	Other	026	PHYSICIANS	17604	None	None	0	In state provider	None	1955 CITRACADO PKWY	STE 100	ESCONDIDO	CA	92029	4158	37	06073	33.11301099	-117.1202081	San Diego County
188362	Fee-for-Service	1174628325	1174628325	2	1	BARRAGAN, ALFONSO L MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	29368	02	General Surgery	0	In state provider	None	850 S ATLANTIC BLVD	SUITE 305	MONTEREY PARK	CA	91754	6714	19	06037	34.05097684	-118.1379979	Los Angeles County
188370	Fee-for-Service	1558360032	1558360032	2	1	BERNARD, GARY S DO	3/19/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	8186	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
188378	Fee-for-Service	1205926839	1205926839	1	1	BERNHISEL, KURT T MD	6/27/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N MEDICAL DR	None	SALT LAKE CTY	UT	84132	0001	00	None	40.77197161	-111.8352608	Salt Lake County
188393	Fee-for-Service	1710011176	1710011176	1	1	BLUESKYES, ROMAN N LMFT	8/13/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3831 HUGHES AVE	SUITE 708	CULVER CITY	CA	90232	6842	19	06037	34.02243278	-118.3981492	Los Angeles County
188395	Fee-for-Service	1124223565	1124223565	1	1	BOLDT, DAVID W MD	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117430	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
188407	Fee-for-Service	1982699567	1982699567	1	1	BARROW NEUROSURGICAL ASSOC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NEUROSURICAL ASSOC LTD	2910 N 3RD AVE	None	PHOENIX	AZ	85013	0000	00	None	33.4805218	-112.0782792	Maricopa County
188470	Fee-for-Service	1124030028	1124030028	1	1	BUDDE, LIHUA E MD	2/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122611	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
188493	Fee-for-Service	1275849283	1275849283	1	2	BORREGO COMMUNITY HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12520 PALM DR	None	DESERT HOT SPRING	CA	92240	4559	33	06065	33.957549	-116.501291	Riverside County
188497	Fee-for-Service	1376844993	1376844993	1	1	BUCKLEY, MARTHA P OD	8/24/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	STE P-25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
188515	Fee-for-Service	1649858606	1649858606	1	1	BEGUR, MAEDHA	5/16/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
188526	Fee-for-Service	1518965011	1518965011	1	1	BARBER, FRANCIS	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	49647	07	Dermatology	0	In state provider	None	15525 POMERADO RD	STE A2	POWAY	CA	92064	2425	37	06073	32.99479918	-117.0579468	San Diego County
188588	Fee-for-Service	1790998979	1790998979	1	1	BRAVERMAN, GREGORY MD	3/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88823	36	Psychiatry	0	In state provider	None	660 SOUTH BERNARDO AVE	#2	SUNNYVALE	CA	94087	7683	43	06085	37.37158915	-122.057058	Santa Clara County
188613	Fee-for-Service	1962479881	1962479881	1	1	BLACK, JAMES A MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
188618	Fee-for-Service	1699306407	1699306407	1	1	BODY AND MIND PHYSICAL THERA	11/2/2023	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PY INC	1125 E 17TH ST	STE W237	SANTA ANA	CA	92701	2205	30	06059	33.76004145	-117.854838	Orange County
188624	Fee-for-Service	1285600478	1285600478	1	1	BARRY, RICHARD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41905	20	Orthopedic Surgery	0	In state provider	None	2031 ANDERSON RD	None	DAVIS	CA	95616	0621	57	06113	38.56133924	-121.7586174	Yolo County
188651	Fee-for-Service	1043398712	1043398712	1	1	BRENNAN, ANNE P MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	36371	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
188663	Fee-for-Service	1275932378	1275932378	1	1	BAGLEY, STEPHANIE A LCSW	3/24/2020	390200000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13620 LINCOLN WAY	380	AUBURN	CA	95603	3261	31	06061	38.93032866	-121.0549381	Placer County
188665	Fee-for-Service	1205926839	1205926839	1	1	BERNHISEL, KURT T MD	6/27/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N MEDICAL DR	None	SALT LAKE CTY	UT	84132	0001	00	None	40.77197161	-111.8352608	Salt Lake County
188750	Fee-for-Service	1942529821	1942529821	1	1	BUI, JACK D MD	6/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97419	22	Pathology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9011	37	06073	32.7537975	-117.1658298	San Diego County
188780	Fee-for-Service	1275849283	1275849283	1	2	BORREGO COMMUNITY HEALTH	12/31/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12520 PALM DR	None	DESERT HOT SPRING	CA	92240	4559	33	06065	33.957549	-116.501291	Riverside County
188788	Fee-for-Service	1700413457	1700413457	1	1	BECHLER, KAMERON MD	7/11/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	182140	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
188829	Fee-for-Service	1548414378	1548414378	1	1	BEAMESDERFER, JACOB S	10/24/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3980 W FLORIDA AVE	STE 102	HEMET	CA	92545	5258	33	06065	33.74575495	-117.0140414	Riverside County
188847	Fee-for-Service	1245768787	1245768787	1	1	BOUTROS, MATTHEW	11/24/2023	207R00000X	NA	Other	026	PHYSICIANS	16673	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
188877	Fee-for-Service	1770512030	1770512030	1	1	BASS, JASON T MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86183	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
188882	Fee-for-Service	1538378997	1538378997	1	1	BANDSTRA, BELINDA S MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103958	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
188885	Fee-for-Service	1902339021	1902339021	1	1	BURNIER, ANDRE M MD	3/2/2023	207P00000X	NA	Other	026	PHYSICIANS	157069	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
188967	Fee-for-Service	1598993248	1598993248	1	1	BROWN, IAN E MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108671	89	Surgery-Traumatic	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
188969	Fee-for-Service	1114125226	1114125226	1	1	BENITAH, NICOLE R MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118091	18	Ophthalmology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
188976	Fee-for-Service	1639246598	1639246598	1	1	BARTON, ROBERT C JR MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	34553	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
189005	Fee-for-Service	1417998253	1417998253	1	1	BASH, SUZANNE C MD	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72175	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
189031	Fee-for-Service	1548591456	1548591456	1	1	BUDHRAJA, ARUN M D INC	8/1/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39298	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	17822 BEACH BLVD	STE 173	HUNTINGTON BEACH	CA	92647	7177	30	06059	33.70331388	-117.9890471	Orange County
189050	Fee-for-Service	1720299886	1720299886	1	1	BARBIERI, JOANNE C LMFT	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
189090	Fee-for-Service	1730532201	1730532201	1	1	BATTH, PAVANDEEP	11/16/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
189093	Fee-for-Service	1154632057	1154632057	1	1	BRINDLE, TED I MD	8/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112507	41	Internal Medicine	0	In state provider	None	TWO MEDICAL PLAZA	#205	ROSEVILLE	CA	95661	3088	31	06061	38.76507948	-121.2477476	Placer County
189096	Fee-for-Service	1548520737	1548520737	1	1	BARONI, ARPA DO	12/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13413	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
189114	Fee-for-Service	1669550760	1669550760	1	1	BIGMAN, ORIN L MD INC	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	45125	36	Psychiatry	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
189168	Fee-for-Service	1518932680	1518932680	1	1	BORNA, DEVIN F MD	4/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78437	05	Anesthesiology	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
189199	Fee-for-Service	1811550353	1811550353	1	1	BAMNOLKER, ADI MD	8/11/2023	207R00000X	NA	Other	026	PHYSICIANS	20238	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
189208	Fee-for-Service	1316401045	1316401045	1	1	BARBATSIS, HEATHER A LCSW	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
189219	Fee-for-Service	1902998511	1902998511	1	1	BOLES, RICHARD G MD	3/20/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65717	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189222	Fee-for-Service	1932592342	1932592342	1	2	BUNTING, VIVIANA LMFT	11/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27851 BRADLEY RD	130L	MENIFEE	CA	92686	0001	33	06065	33.71630969	-117.1904696	Riverside County
189234	Fee-for-Service	1578136081	1578136081	1	1	BUI, NATALIE K NP	4/29/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
189249	Fee-for-Service	1366508046	1366508046	1	1	BROADDUS, JONELLE S	12/28/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
189256	Fee-for-Service	1598993248	1598993248	1	1	BROWN, IAN E MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108671	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
189261	Fee-for-Service	1528775798	1528775798	1	1	BADAROU, LISA L	6/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16195 SISKIYOU RD.	120B	APPLE VALLEY	CA	92307	1346	36	06071	34.54549098	-117.2671509	San Bernardino County
189264	Fee-for-Service	1992344097	1992344097	1	1	BURGER, ALEXIS LPCC	6/13/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6276 N 1ST ST	103	FRESNO	CA	93710	5400	10	06019	36.82794977	-119.7721574	Fresno County
189284	Fee-for-Service	1841562816	1841562816	1	1	BOATRIGHT, SEAN CPO	2/21/2012	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	120 LA CASA VIA	#202	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
189297	Fee-for-Service	1952789422	1952789422	1	1	BRUETT, LINDSEY D PSY	12/8/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
189351	Fee-for-Service	1033671292	1033671292	1	1	BIERMANN, MITCH MD	1/24/2023	207R00000X	NA	Other	026	PHYSICIANS	179158	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
189355	Fee-for-Service	1639351687	1639351687	1	1	BERGER, OMRI MD	2/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100794	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
189379	Fee-for-Service	1770605834	1770605834	1	1	BESSEN, HOWARD MD	10/31/1982	207P00000X	NA	Other	026	PHYSICIANS	39575	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 S SUSANA RD	None	COMPTON	CA	90221	5418	19	06037	33.87386619	-118.2070981	Los Angeles County
189384	Fee-for-Service	1598758203	1598758203	1	1	BIDAIR, MOHAMED MD	12/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	67528	34	Urology and Urological Surgery	0	In state provider	None	6699 ALVARADO RD	STE 2207	SAN DIEGO	CA	92120	5240	37	06073	32.77665383	-117.0540279	San Diego County
189405	Fee-for-Service	1740495183	1740495183	1	1	BUU, THI D OD	7/21/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25321 RAILROAD CANYON RD	STE 503	LAKE ELSINORE	CA	92532	2702	33	06065	33.66660166	-117.2650807	Riverside County
189408	Fee-for-Service	1578617692	1578617692	1	1	BELLAS, VALERIE PHD	2/3/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
189413	Fee-for-Service	1255446415	1255446415	1	1	BETHEL LUTHERAN HOME	3/1/1966	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2280 DOCKERY AVE	None	SELMA	CA	93662	3898	10	06019	36.566415	-119.6018115	Fresno County
189421	Fee-for-Service	1083690127	1083690127	2	1	BIOHORIZON MEDICAL INC	11/6/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3882 DEL AMO BLVD	SUITE 604	TORRANCE	CA	90503	2184	19	06037	33.846732	-118.355067	Los Angeles County
189426	Fee-for-Service	1346251832	1346251832	1	1	BHARAT CORPORATION	8/4/1987	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2100 E 1ST ST	None	LOS ANGELES	CA	90033	3918	19	06037	34.0448029	-118.2136091	Los Angeles County
189435	Fee-for-Service	1326385659	1326385659	1	1	BHATT, DEVAL M MD	12/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136646	67	Endocrinology	0	In state provider	None	1541 FLORIDA AVENUE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
189467	Fee-for-Service	1629212840	1629212840	1	1	BEAUMONT RADIOLOGY SERVICES	5/20/2013	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	LLC	81 S HIGHLAND SPRINGS AV	STE 102	BEAUMONT	CA	92223	3170	33	06065	33.919204	-116.9467869	Riverside County
189481	Fee-for-Service	1003412339	1003412339	1	1	BHATIA, SHARUTI D NP	3/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	703 MAGNOLIA AVE	None	CORONA	CA	92879	3118	33	06065	33.85828352	-117.5557208	Riverside County
189495	Fee-for-Service	1154373165	1154373165	1	1	BUFFETT, WENDY O MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80799	08	Family Practice	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
189504	Fee-for-Service	1770517526	1770517526	1	1	BERMEJO, JUAN J	12/1/2003	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2201 MOUNT VERNON AVE	STE 109	BAKERSFIELD	CA	93306	3312	15	06029	35.38781796	-118.9673567	Kern County
189508	Fee-for-Service	1902998511	1902998511	1	1	BOLES, RICHARD G MD	3/20/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65717	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189518	Fee-for-Service	1699112185	1699112185	1	1	BENNETT, RICHARD J MD	11/13/2020	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
189549	Fee-for-Service	1588332456	1588332456	1	1	BEBAWY, MARIZ H LMFT	1/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
189558	Fee-for-Service	1629780622	1629780622	1	1	BRAZIER, BREANNA M DOULA	2/15/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
189560	Fee-for-Service	1518158146	1518158146	1	1	BELL, CHRISTOPHER M PT	1/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1145 LINDERO CANYON RD	STE. D7	WESTLAKE VILLAGE	CA	91362	5475	56	06111	34.184952	-118.788264	Ventura County
189562	Fee-for-Service	1871729822	1871729822	1	1	BHARADWAJ, ADITYA S MD	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118498	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
189570	Fee-for-Service	1710339650	1710339650	1	1	BANIWAS, KATHLEEN LMFT	8/7/2020	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
189576	Fee-for-Service	1881344521	1881344521	1	2	BEST LINE TRANSPORTATION INC	10/10/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1219 N PACIFIC AVE	C	GLENDALE	CA	91202	1619	19	06037	34.16393139	-118.2651381	Los Angeles County
189593	Fee-for-Service	1952931362	1952931362	1	1	BOGH, CHRISTIAN G LMFT	3/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CLINICAL COUNSELOR INC	5790 MAGNOLIA AVE	202	RIVERSIDE	CA	92506	1874	33	06065	33.96267292	-117.3905848	Riverside County
189622	Fee-for-Service	1962900217	1962900217	1	1	BRINK, MICHELLE L LPCC	5/12/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
189661	Fee-for-Service	1114368990	1114368990	1	1	BOYS, JOSHUA A MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125954	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
189667	Fee-for-Service	1700185352	1700185352	1	1	BENYI, STEPHANIE L CCC-SLP	7/31/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3518 JEFFERSON AVE	None	REDWOOD CITY	CA	94062	3136	41	06081	37.46715891	-122.2492205	San Mateo County
189668	Fee-for-Service	1366059586	1366059586	1	1	BENIGNO, DIANNE MAE A CNP	6/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7096 N WEST AVE	None	FRESNO	CA	93711	0462	10	06019	36.83875103	-119.8262343	Fresno County
189683	Fee-for-Service	1356349492	1356349492	1	1	BUITRAGO, MARTHA O. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2900 CORTEZ AVE	None	IDAHO FALLS	ID	83404	7554	00	None	43.47172669	-111.9887351	Bonneville County
189723	Fee-for-Service	1326385659	1326385659	1	1	BHATT, DEVAL M MD	12/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136646	01	General Practice	0	In state provider	None	1541 FLORIDA AVENUE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
189728	Fee-for-Service	1225047541	1225047541	1	1	BUENAVENTURA, GRACE OD	2/23/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
189741	Fee-for-Service	1669935045	1669935045	1	1	BOR, ALEXANDRA K MD	10/17/2024	207L00000X	NA	Other	026	PHYSICIANS	182439	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
189749	Fee-for-Service	1770611824	1770611824	1	1	BIXLER, MARCELLA LPCC	7/6/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1085 I ST	STE 208	ARCATA	CA	95521	5589	12	06023	40.8707065	-124.0873395	Humboldt County
189765	Fee-for-Service	1235162686	1235162686	1	1	BRUNK, TAMMY M CNM	11/4/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
189770	Fee-for-Service	1003430430	1003430430	1	1	BROWN, ALLISON L PSYD	7/11/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5005 CANYON CREST DR	None	RIVERSIDE	CA	92507	7721	33	06065	33.95957554	-117.3311659	Riverside County
189772	Fee-for-Service	1912015363	1912015363	1	1	BENDER, FRANK D MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	33933	None	None	0	In state provider	None	649 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475346	-117.0732063	San Diego County
189804	Fee-for-Service	1225355431	1225355431	1	1	BRYANT, TIFFANY NP	4/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
189858	Fee-for-Service	1811279763	1811279763	1	4	BARTZ ALTADONNA COMMUNITY	7/2/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2520 E PALMDALE BLVD	SUITE A	PALMDALE	CA	93550	4914	19	06037	34.58007573	-118.0842838	Los Angeles County
189880	Fee-for-Service	1295730935	1295730935	1	1	BUNKER-ALBERTS, MICHELE V NP	1/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
189892	Fee-for-Service	1710741327	1710741327	1	1	BENJAMIN J COHEN, MD, A MEDI	5/2/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6325 TOPANGA CANYON BLVD	None	WOODLAND HILLS	CA	91367	2013	19	06037	34.184934	-118.6059175	Los Angeles County
189912	Fee-for-Service	1760995765	1760995765	1	1	BIANCONI, TRAN N	11/24/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
189914	Fee-for-Service	1073710489	1073710489	1	1	BEKEMEIER, KIMBERLY A DO	11/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	10741	01	General Practice	0	In state provider	None	17500 FOOTHILL BLVD	None	FONTANA	CA	92335	3798	36	06071	34.1067065	-117.4218885	San Bernardino County
189999	Fee-for-Service	1235388901	1235388901	1	1	BALLAS, LESLIE K MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111990	01	General Practice	0	In state provider	None	3531 FASHION WAY	None	TORRANCE	CA	90503	4807	19	06037	33.8352235	-118.348254	Los Angeles County
190007	Fee-for-Service	1861649345	1861649345	2	1	BONELI, LAURA MD	10/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117107	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
190059	Fee-for-Service	1184304776	1184304776	1	1	BUCKELEW PROGRAMS	11/27/2024	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 NEOTOMAS AVE	None	SANTA ROSA	CA	95405	7575	49	06097	38.433069	-122.6862135	Sonoma County
190081	Fee-for-Service	1518319086	1518319086	1	1	BELLO GERMINO, DANIELA A MD	4/18/2022	390200000X	NA	Other	026	PHYSICIANS	175157	None	None	0	In state provider	None	11883 AMETHYST RD	203	VICTORVILLE	CA	92392	9224	36	06071	34.466292	-117.3643015	San Bernardino County
190091	Fee-for-Service	1992871651	1992871651	1	2	BOETTIGER, MARILYN S LCSW	5/25/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13 HAWKRIDGE	None	IRVINE	CA	92604	4611	30	06059	33.67772255	-117.7874681	Orange County
190105	Fee-for-Service	1356350557	1356350557	1	1	BANGURA, IBRAHIM	9/22/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AMEN MED SUPPLIES	1383 REDONDO AVE	STE 104	LONG BEACH	CA	90804	2895	19	06037	33.784119	-118.1524695	Los Angeles County
190111	Fee-for-Service	1134144165	1134144165	1	1	BORREGO COMMUNITY HEALTH	8/12/2004	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	4343 YAQUI PASS RD	None	BORREGO SPRINGS	CA	92004	0000	37	06073	33.19398291	-116.330373	San Diego County
190127	Fee-for-Service	1407353303	1407353303	1	1	BRAUN, TARA L MD	11/20/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	191661	None	None	0	In state provider	None	1300 AVENIDA VISTA HERMO	150	SAN CLEMENTE	CA	92673	6315	30	06059	33.45766933	-117.5920941	Orange County
190136	Fee-for-Service	1700965837	1700965837	1	1	BATSON, GIA M MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96751	08	Family Practice	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
190145	Fee-for-Service	1811279763	1811279763	1	4	BARTZ ALTADONNA COMMUNITY	7/2/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2520 E PALMDALE BLVD	SUITE A	PALMDALE	CA	93550	4914	19	06037	34.58007573	-118.0842838	Los Angeles County
190188	Fee-for-Service	1750438511	1750438511	1	1	BOYD & GARCIA MED GROUP	10/5/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	1201 W LA VETA AVE	STE 401	ORANGE	CA	92868	4209	30	06059	33.78034779	-117.8655767	Orange County
190234	Fee-for-Service	1508932120	1508932120	2	1	BIRJANDI, NAHID B DPM	8/18/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 130	MISSION VIEJO	CA	92691	6334	30	06059	33.558534	-117.6641255	Orange County
190241	Fee-for-Service	1538350392	1538350392	1	1	BERJIS, AMIR MD INC	9/1/2007	208G00000X	NA	General Surgery	026	PHYSICIANS	75137	02	General Surgery	0	In state provider	None	9900 STOCKDALE HWY	STE 206	BAKERSFIELD	CA	93311	3634	15	06029	35.35412167	-119.1124089	Kern County
190249	Fee-for-Service	1255441457	1255441457	1	1	BOVONE, SUZANNE C	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71488	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
190280	Fee-for-Service	1548308281	1548308281	1	1	BRANDT GROUP HOMES INC	4/3/2000	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5421 HARRISON ST	None	NORTH HIGHLANDS	CA	95660	5042	34	06067	38.665602	-121.369356	Sacramento County
190289	Fee-for-Service	1437237922	1437237922	1	1	BEH, GOFFA O MD	2/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91311	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
190317	Fee-for-Service	1508943457	1508943457	1	1	BRYANT, CHRISTINA S MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80106	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
190319	Fee-for-Service	1326029794	1326029794	1	1	BOMMER, WILLIAM J MD	8/8/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	33462	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
190342	Fee-for-Service	1477794758	1477794758	1	1	BARKMEIER-KRAEMER, JULIE MD	8/25/2011	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
190360	Fee-for-Service	1821326810	1821326810	1	1	BHALLA, JAGMINDER S MD INC	5/8/2014	207R00000X	NA	Other	026	PHYSICIANS	25813	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 405	ANAHEIM	CA	92801	1830	30	06059	33.8506615	-117.946413	Orange County
190373	Fee-for-Service	1033192984	1033192984	1	1	BROOKE, CYNTHIA L MD	4/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50221	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1303 EAST HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
190399	Fee-for-Service	1134144165	1134144165	1	1	BORREGO COMMUNITY HEALTH	6/11/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	4343 YAQUI PASS RD	None	BORREGO SPRINGS	CA	92004	0000	37	06073	33.19398291	-116.330373	San Diego County
190433	Fee-for-Service	1427450691	1427450691	1	1	BOWMAN, ARIEL J MD	6/5/2017	207P00000X	NA	Other	026	PHYSICIANS	132528	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
190454	Fee-for-Service	1346783560	1346783560	1	1	BOUCHER, CHARLEEN LPT	3/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
190457	Fee-for-Service	1659959286	1659959286	1	1	BEIGHLEY, ADAM H MD	12/27/2022	390200000X	NA	Other	026	PHYSICIANS	182261	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
190486	Fee-for-Service	1104237353	1104237353	1	1	BHATIA, SHAGUN K MD	6/26/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	154902	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
190490	Fee-for-Service	1497287619	1497287619	1	1	BECERRA, BRIAN J MD	5/5/2020	390200000X	NA	Other	026	PHYSICIANS	160166	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
190514	Fee-for-Service	1629142583	1629142583	1	1	BABA, ATSUKO MD	9/19/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76550	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
190527	Fee-for-Service	1538350392	1538350392	1	1	BERJIS, AMIR MD INC	9/1/2007	208G00000X	NA	General Surgery	026	PHYSICIANS	75137	33	Thoracic Surgery	0	In state provider	None	9900 STOCKDALE HWY	STE 206	BAKERSFIELD	CA	93311	3634	15	06029	35.35412167	-119.1124089	Kern County
190560	Fee-for-Service	1679989859	1679989859	1	1	BOWLING, ANNA MD	6/15/2018	390200000X	NA	Other	026	PHYSICIANS	140558	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
190597	Fee-for-Service	1376919118	1376919118	1	1	BERKENSTADT, EDON A LMFT	9/16/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5100 MARLBOROUGH DRIVE	#103	SAN DIEGO	CA	92116	2020	37	06073	32.770305	-117.1064575	San Diego County
190602	Fee-for-Service	1427001163	1427001163	1	1	BRASH, STEWART MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	42066	41	Internal Medicine	0	In state provider	None	1520 ARIZONA AVE	None	SANTA MONICA	CA	90404	1208	19	06037	34.02656749	-118.4857708	Los Angeles County
190621	Fee-for-Service	1912949603	1912949603	1	1	BROOSKBY, NOLAN R. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	150 W 100 N	None	VERNAL	UT	84078	2036	00	None	40.45713947	-109.531368	Uintah County
190631	Fee-for-Service	1043741473	1043741473	1	1	BARKLEY, KEVIN A MD	9/3/2021	207L00000X	NA	Other	026	PHYSICIANS	172691	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
190647	Fee-for-Service	1265775928	1265775928	1	1	BURRITT, DANIEL MD	5/21/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
190649	Fee-for-Service	1821326810	1821326810	1	1	BHALLA, JAGMINDER S MD INC	5/8/2014	207R00000X	NA	Other	026	PHYSICIANS	25813	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 W ROMNEYA DR	STE 405	ANAHEIM	CA	92801	1830	30	06059	33.8506615	-117.946413	Orange County
190676	Fee-for-Service	1811279763	1811279763	1	1	BARTZ ALTADONNA COMMUNITY	6/1/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	43322 GINGHAM AVE	SUITE 104 & 105	LANCASTER	CA	93535	4569	19	06037	34.67013731	-118.1222748	Los Angeles County
190679	Fee-for-Service	1083626238	1083626238	1	1	BOYD, JOHN B MD	12/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51955	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA STE 46	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
190687	Fee-for-Service	1134144165	1134144165	1	1	BORREGO COMMUNITY HEALTH	11/1/2006	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	4343 YAQUI PASS RD	None	BORREGO SPRINGS	CA	92004	0000	37	06073	33.19398291	-116.330373	San Diego County
190699	Fee-for-Service	1629101621	1629101621	1	1	BAKERSFIELD PROSTHETICS	5/3/2007	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	& ORTHOTICS CENTER INC	49 N HOCKETT ST	None	PORTERVILLE	CA	93257	0000	54	06107	36.06562159	-119.0171599	Tulare County
190712	Fee-for-Service	1376385138	1376385138	1	1	BURT'S PHARMACY DIRECT, INC	10/29/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3579 OLD CONEJO RD	None	THOUSAND OAKS	CA	91320	2122	56	06111	34.194204	-118.952199	Ventura County
190733	Fee-for-Service	1144244278	1144244278	1	1	BLANKS, JEFF P LMFT	1/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
190739	Fee-for-Service	1972938363	1972938363	1	1	BUN, SILEN MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145319	01	General Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 210	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
190757	Fee-for-Service	1528231743	1528231743	1	1	BOYD, SCOTT D MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97205	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
190831	Fee-for-Service	1154329209	1154329209	1	1	BRACHO, FRANCISCO A MD	1/31/1995	2080P0207X	NA	Hematology	026	PHYSICIANS	79747	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
190869	Fee-for-Service	1467030015	1467030015	1	1	BELLO, CHRISTOFER MD	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
190882	Fee-for-Service	1972826774	1972826774	1	2	BEVERLY RADIOLOGY MEDICAL	11/1/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	710 NORTH EUCLID STREET	SUITE 102	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
190902	Fee-for-Service	1649375015	1649375015	1	1	BOWER, ANDREA MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36954	01	General Practice	0	In state provider	None	27640 EUCALYPTUS AVENUE	None	MORENO VALLEY	CA	92555	4557	33	06065	33.93749258	-117.1807371	Riverside County
190916	Fee-for-Service	1144497306	1144497306	1	2	BENNETT, MATTHEW	8/23/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NSULTING	701 E SANTA CLARA ST	SUITE 28-D	VENTURA	CA	93001	5960	56	06111	34.27957166	-119.289727	Ventura County
190933	Fee-for-Service	1942374970	1942374970	1	1	BUCH, DHIREN Y MD	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52065	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
190934	Fee-for-Service	1578061891	1578061891	1	1	BUENROSTRO, NORMA A NP	3/11/2019	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	801 SANTA FE WAY	None	SHAFTER	CA	93263	3158	15	06029	35.49142021	-119.260004	Kern County
190966	Fee-for-Service	1164429031	1164429031	1	1	BUETOW, PETER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	STE B10	BELLINGHAM	WA	98225	1854	00	None	48.77211992	-122.473101	Whatcom County
190970	Fee-for-Service	1598843963	1598843963	1	1	BART, DILYS J	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83984	None	None	0	In state provider	None	3838 CALIFORNIA ST	SUITE 410	SAN FRANCISCO	CA	94118	1504	38	06075	37.78591809	-122.4575439	San Francisco County
190975	Fee-for-Service	1134144165	1134144165	1	1	BORREGO COMMUNITY HEALTH	6/11/2004	207Q00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	4343 YAQUI PASS RD	None	BORREGO SPRINGS	CA	92004	0000	37	06073	33.19398291	-116.330373	San Diego County
190977	Fee-for-Service	1922090075	1922090075	1	1	BRENEMAN, JOHN C MD	3/18/2021	2085R0001X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
191007	Fee-for-Service	1578647269	1578647269	1	1	BLANDO, LUIS M MD INC	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	41127	08	Family Practice	0	In state provider	None	430 PARK AVE	None	PORT HUENEME	CA	93041	2553	56	06111	34.15663821	-119.194201	Ventura County
191015	Fee-for-Service	1376781724	1376781724	1	1	BURNER, ELIZABETH R MD	8/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106544	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
191041	Fee-for-Service	1407968308	1407968308	1	1	BIO-MEDICAL APPLICATION OF	12/1/1977	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	EUREKA	2765 TIMBER RIDGE LN	None	EUREKA	CA	95503	4885	12	06023	40.78006948	-124.137018	Humboldt County
191055	Fee-for-Service	1164428082	1164428082	1	1	BOBINSKI, MACIEK MD	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87311	30	Radiology	0	In state provider	None	2801 K ST	STE 115	SACRAMENTO	CA	95816	5118	34	06067	38.572947	-121.46904	Sacramento County
191058	Fee-for-Service	1942206123	1942206123	1	1	BAIER, RICK R MD	6/1/1984	207ZP0102X	NA	Other	026	PHYSICIANS	37943	22	Pathology (M.D. only)	0	In state provider	None	1325 MELROSE AVE	None	MODESTO	CA	95350	5508	50	06099	37.66257726	-120.9871212	Stanislaus County
191089	Fee-for-Service	1598710030	1598710030	1	1	BRANNIGAN, THOMAS J MD	8/31/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	65789	30	Radiology	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 1	LA MESA	CA	91942	3000	37	06073	32.77978322	-117.0094766	San Diego County
191102	Fee-for-Service	1932162518	1932162518	1	1	BRINKMAN, WILLIAM J MD	3/28/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	169236	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
191121	Fee-for-Service	1891889366	1891889366	1	1	BRUCE, DANIEL J LCSW	2/12/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3300 TULLY RD	STE C-1	MODESTO	CA	95350	0849	50	06099	37.68597355	-121.012414	Stanislaus County
191134	Fee-for-Service	1023453966	1023453966	1	1	BUTALA, NEETI A MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148500	05	Anesthesiology	0	In state provider	None	757 WESTWWOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
191143	Fee-for-Service	1598140428	1598140428	1	1	BARTLETT, AMY	1/1/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2914 RADNOR	None	LONG BEACH	CA	90815	1233	19	06037	33.80877059	-118.1178261	Los Angeles County
191152	Fee-for-Service	1750020376	1750020376	1	1	BREATHE SOUTHERN CALIFORNIA	3/14/2024	171W00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	5858 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	4509	19	06037	34.06244916	-118.3563027	Los Angeles County
191164	Fee-for-Service	1215120381	1215120381	1	1	BRAZINSKY, BRUCE A	2/12/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6699 ALVARADO RD	STE 2201	SAN DIEGO	CA	92120	5253	37	06073	32.77665383	-117.0540279	San Diego County
191190	Fee-for-Service	1982195913	1982195913	1	1	BHOLAT, TASNEEM J LMFT	5/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
191216	Fee-for-Service	1770627333	1770627333	1	1	BRIGHT, LISA L LMFT	8/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
191223	Fee-for-Service	1306372891	1306372891	1	2	BOLSA MEDICAL MTM PHARMA INC	4/16/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6552 BOLSA AVE	STE A	HUNTINGTON BEACH	CA	92647	2656	30	06059	33.74431776	-118.0144684	Orange County
191275	Fee-for-Service	1053952770	1053952770	1	1	BEMIS, HEATHER PHD	12/3/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
191302	Fee-for-Service	1881878429	1881878429	1	1	BIDISHA RAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
191314	Fee-for-Service	1720524739	1720524739	1	1	BAKER, SARA LMFT	1/21/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
191318	Fee-for-Service	1598205585	1598205585	1	1	BOUSSELAIRE, DANIELLE LCSW	8/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
191320	Fee-for-Service	1528255494	1528255494	1	1	BRAHAM, SABRINA J MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101021	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
191386	Fee-for-Service	1912325184	1912325184	1	1	BAXTER, SALLY MD	7/22/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	140952	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191400	Fee-for-Service	1831135722	1831135722	1	1	BRINKS, HEINRICH A MD	6/11/1998	207L00000X	NA	Other	026	PHYSICIANS	37555	05	Anesthesiology	0	In state provider	MEDICAL SERVICES PLUS	177 WEBSTER ST	# 234	MONTEREY	CA	93940	3119	27	06053	36.59628352	-121.8939409	Monterey County
191406	Fee-for-Service	1902435159	1902435159	1	1	BARSKY, BRANDON W MD	8/1/2024	2080S0010X	NA	Orthopedic Surgery	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
191432	Fee-for-Service	1598140428	1598140428	1	1	BARTLETT, AMY	1/1/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2914 RADNOR	None	LONG BEACH	CA	90815	1233	19	06037	33.80877059	-118.1178261	Los Angeles County
191433	Fee-for-Service	1952590747	1952590747	1	1	BALGUDE, AMIT P MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114317	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
191451	Fee-for-Service	1902267867	1902267867	1	1	BEHARIE, DANIELLE K DO	8/20/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18872	None	None	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 330	PLEASANTON	CA	94588	5802	01	06001	37.69214859	-121.8796532	Alameda County
191459	Fee-for-Service	1619904950	1619904950	1	1	BEKMEZIAN, ARPI MD	4/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84458	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
191463	Fee-for-Service	1649781501	1649781501	1	1	BARLAM, JORDAN S LCSW	9/15/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2200 PACIFIC COAST HWY	STE 102	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
191487	Fee-for-Service	1619173929	1619173929	1	1	BALAJI MEDICAL CORPORATION	8/14/2007	261QP2300X	NA	Other	026	PHYSICIANS	51012	01	General Practice	0	In state provider	None	1406 PARK ST	STE 100	ALAMEDA	CA	94501	4558	01	06001	37.76447173	-122.2425877	Alameda County
191493	Fee-for-Service	1548644081	1548644081	1	1	BHATT, NEERAJ MD	1/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167531	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
191498	Fee-for-Service	1932289790	1932289790	1	1	BACH Y RITA, GEORGE MD	9/1/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21358	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
191520	Fee-for-Service	1750642237	1750642237	1	1	BALDEOSINGH, SACHA C MD	10/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149303	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
191585	Fee-for-Service	1851626394	1851626394	1	1	BRENEISEN, JEFFREY R MD INC	4/7/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	86677	41	Internal Medicine	0	In state provider	None	1261 TRAVIS BLVD	STE 200	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
191604	Fee-for-Service	1013059872	1013059872	1	1	BAKER, CHRISTOPHER B MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94232	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
191613	Fee-for-Service	1215923172	1215923172	1	1	BOEHM, DOUGLAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	777 HOSPITAL WAY	BLDG A	POCATELLO	ID	83201	5162	00	None	42.87385929	-112.4189402	Bannock County
191629	Fee-for-Service	1902111909	1902111909	1	1	BADKOOBEHI, HALEH MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121218	20	Orthopedic Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
191653	Fee-for-Service	1336310101	1336310101	1	1	BEHR, SPENCER C MD	5/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112206	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191659	Fee-for-Service	1174716765	1174716765	1	1	BHADURI, SARBANI MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53146	45	Nephrology (Renal-Kidney)	0	In state provider	None	10170 SORRENTO VALLEY RD	STE 200	SAN DIEGO	CA	92121	1604	37	06073	32.88947089	-117.2089084	San Diego County
191680	Fee-for-Service	1063479020	1063479020	1	1	BODE, GEORGIA K MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40295	05	Anesthesiology	0	In state provider	None	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
191697	Fee-for-Service	1861430043	1861430043	1	1	BAKER, RALPH S OD INC	7/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	531 OAK ST	STE 2	ROSEVILLE	CA	95678	2615	31	06061	38.74555386	-121.2863963	Placer County
191701	Fee-for-Service	1598377640	1598377640	1	1	BARAL, KRANTIKIRAN MD	10/16/2023	207R00000X	NA	Other	026	PHYSICIANS	191214	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
191740	Fee-for-Service	1902977804	1902977804	1	1	BALTAZAR, JOHN J MD	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72797	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
191782	Fee-for-Service	1235143264	1235143264	1	1	BRONSTEIN, ANDREW J MD	4/15/2023	174400000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	10135 W TWAIN AVE	SUITE 100	LAS VEGAS	NV	89147	6720	00	None	36.12253856	-115.3134079	Clark County
191787	Fee-for-Service	1801819917	1801819917	2	1	BRADEN PARTNERS LP	9/25/2018	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2420 GRAND AVE	STE A	VISTA	CA	92081	7827	37	06073	33.15533266	-117.2236231	San Diego County
191834	Fee-for-Service	1972189322	1972189322	1	1	BE HEARD SPEECH THERAPY, INC	7/27/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.	13225 PHILADELPHIA ST	E13	WHITTIER	CA	90601	4321	19	06037	33.97911953	-118.0341225	Los Angeles County
191849	Fee-for-Service	1790340917	1790340917	1	1	BYRD, ROSEMARIE C MD	4/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178249	08	Family Practice	0	In state provider	None	8641 WILSHIRE BLVD	210	BEVERLY HILLS	CA	90211	2900	19	06037	34.06614972	-118.3798912	Los Angeles County
191872	Fee-for-Service	1851626394	1851626394	1	1	BRENEISEN, JEFFREY R MD INC	4/7/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	86677	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1261 TRAVIS BLVD	STE 200	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
191891	Fee-for-Service	1013059872	1013059872	1	1	BAKER, CHRISTOPHER B MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94232	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
191899	Fee-for-Service	1679100911	1679100911	1	2	BENDITO MEDICAL CORPORATION	3/1/2023	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1780 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	4618	36	06071	34.13588446	-117.248634	San Bernardino County
191907	Fee-for-Service	1447276449	1447276449	1	1	BULL, ANTHONY P MD	3/31/1983	207L00000X	NA	Other	026	PHYSICIANS	40336	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
191933	Fee-for-Service	1659386019	1659386019	1	1	BHUSRI, PRIYA MD	9/1/2000	207R00000X	NA	Other	026	PHYSICIANS	64694	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
191973	Fee-for-Service	1235385675	1235385675	1	1	BOCKLI, KAREN A MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127843	40	Pediatrics	0	In state provider	None	2200 O'FARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
191979	Fee-for-Service	1386683084	1386683084	1	1	BIRNBERG, FREDERICK A MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	37627	02	General Surgery	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
191997	Fee-for-Service	1396061008	1396061008	1	1	BELFIORE, PAULA MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121147	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
192010	Fee-for-Service	1124298856	1124298856	1	1	BOYAPALLI, RENUKA R MD	10/29/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56036	None	None	0	In state provider	INC	3640 LOMITA BLVD	STE 305	TORRANCE	CA	90505	3959	19	06037	33.81475516	-118.3486533	Los Angeles County
192042	Fee-for-Service	1154459535	1154459535	1	1	BRASIC, NATASHA MD	4/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94322	30	Radiology	0	In state provider	None	400 PARNASSUS AVENUE	BOX 0648	SAN FRANCISCO	CA	94143	3202	38	06075	37.76344756	-122.4581992	San Francisco County
192103	Fee-for-Service	1508901695	1508901695	1	1	BERGAM, KATHERINE R	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44399	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1527	19	06037	33.8188341	-118.1923297	Los Angeles County
192137	Fee-for-Service	1790340917	1790340917	1	1	BYRD, ROSEMARIE C MD	4/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178249	39	Preventive (M.D. only)	0	In state provider	None	8641 WILSHIRE BLVD	210	BEVERLY HILLS	CA	90211	2900	19	06037	34.06614972	-118.3798912	Los Angeles County
192151	Fee-for-Service	1760562292	1760562292	1	1	BAUM, MARTI F MD	4/13/1981	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44373	40	Pediatrics	0	In state provider	None	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
192177	Fee-for-Service	1407020639	1407020639	1	1	BAREFIELD, WILLIE J LMFT	10/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15731 MAIN ST	None	HESPERIA	CA	92345	3400	36	06071	34.42413074	-117.319518	San Bernardino County
192223	Fee-for-Service	1962764480	1962764480	1	1	BECKETT, JOEL S MD	9/21/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	135568	14	Neurological Surgery	0	In state provider	None	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
192263	Fee-for-Service	1235385675	1235385675	1	1	BOCKLI, KAREN A MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127843	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2200 O'FARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
192281	Fee-for-Service	1043325186	1043325186	1	1	BACHHAWAT, REETU MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55079	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
192282	Fee-for-Service	1891182093	1891182093	1	1	BARLOW, STEWART H MD	10/7/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163354	15	Obstetrics (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192306	Fee-for-Service	1184129314	1184129314	1	1	BINDRUP, JAMES E DO	10/19/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
192343	Fee-for-Service	1881143832	1881143832	1	1	BORJA-JOHNSON, STEPHANIE	1/23/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
192362	Fee-for-Service	1962570051	1962570051	1	3	BLANK, MARCIA S	6/4/2019	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 W 155TH ST	107	GARDENA	CA	90247	4049	19	06037	33.89049013	-118.2982407	Los Angeles County
192389	Fee-for-Service	1811279763	1811279763	1	2	BARTZ ALTADONNA COMMUNITY	6/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	43322 GINGHAM AVE	STE 104 & 105	LANCASTER	CA	93535	4569	19	06037	34.67013731	-118.1222748	Los Angeles County
192392	Fee-for-Service	1588958540	1588958540	1	1	BHAGAT, AMRITA MD	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131084	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
192396	Fee-for-Service	1255434825	1255434825	1	1	BOWMAN, CAROL A	2/5/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50085	04	Otology, Laryngology, Rhinology	0	In state provider	None	361 HOSPITAL RD	STE 325	NEWPORT BEACH	CA	92663	3524	30	06059	33.62579141	-117.9299554	Orange County
192421	Fee-for-Service	1396806998	1396806998	1	1	BALDWIN GARDENS NURSING	5/1/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER CORPORATION	10786 LIVE OAK AVE	None	TEMPLE CITY	CA	91780	2944	19	06037	34.10665328	-118.0357251	Los Angeles County
192423	Fee-for-Service	1942707989	1942707989	1	1	BHINDER, HARSIMRAN K MD	10/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174149	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
192452	Fee-for-Service	1427173061	1427173061	1	1	BENNETT, JAMES W MD	9/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84345	40	Pediatrics	0	In state provider	None	4145 CLARES ST	STE A	CAPITOLA	CA	95010	2053	44	06087	36.97837345	-121.964319	Santa Cruz County
192453	Fee-for-Service	1801543202	1801543202	1	1	BHUPINDER S VIRK MD INC	4/12/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	None	None	0	In state provider	None	15035 E 14TH ST	STE G	SAN LEANDRO	CA	94578	1901	01	06001	37.70496067	-122.1281915	Alameda County
192463	Fee-for-Service	1184117897	1184117897	1	1	BERMAN, JOSEPH S MD	8/4/2023	207P00000X	NA	Other	026	PHYSICIANS	184003	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
192485	Fee-for-Service	1740206457	1740206457	1	2	BELFER, HOWARD MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	41237	13	Neurology (M.D. only)	0	In state provider	None	101 N EL CAMINO REAL	STE 5	SAN MATEO	CA	94401	2795	41	06081	37.56697933	-122.3300993	San Mateo County
192507	Fee-for-Service	1326565219	1326565219	1	1	BROWN, TATIANNA LCSW	12/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8329 BRIMHALL RD	804	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
192524	Fee-for-Service	1992207393	1992207393	1	1	BUHAY, JOSE MARTIN	4/12/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
192537	Fee-for-Service	1912217803	1912217803	1	1	BELTRAN, THAOMY V	4/21/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2200 OFARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
192568	Fee-for-Service	1891182093	1891182093	1	1	BARLOW, STEWART H MD	10/7/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163354	09	Gynecology (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192581	Fee-for-Service	1518158435	1518158435	1	1	BICER, ELAD MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
192596	Fee-for-Service	1366402711	1366402711	1	1	BERENSON, YEHUDA A MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65080	41	Internal Medicine	0	In state provider	None	600 CITY PARKWAY WEST	STE 400	ORANGE	CA	92868	2900	30	06059	33.78299646	-117.89694	Orange County
192624	Fee-for-Service	1285138362	1285138362	1	1	BEKERMAN, VLADISLAV MD	7/21/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	177459	None	None	0	In state provider	None	751 DAILY DR	STE 110	CAMARILLO	CA	93010	6077	56	06111	34.21880533	-119.0593374	Ventura County
192630	Fee-for-Service	1457796070	1457796070	1	1	BOUTRID, HINDA MD	10/16/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	160397	68	Hematology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
192649	Fee-for-Service	1962570051	1962570051	1	3	BLANK, MARCIA S	6/4/2019	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1300 W 155TH ST	107	GARDENA	CA	90247	4049	19	06037	33.89049013	-118.2982407	Los Angeles County
192677	Fee-for-Service	1811279763	1811279763	1	2	BARTZ ALTADONNA COMMUNITY	6/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	43322 GINGHAM AVE	STE 104 & 105	LANCASTER	CA	93535	4569	19	06037	34.67013731	-118.1222748	Los Angeles County
192685	Fee-for-Service	1255434825	1255434825	1	1	BOWMAN, CAROL A	2/5/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50085	13	Neurology (M.D. only)	0	In state provider	None	361 HOSPITAL RD	STE 325	NEWPORT BEACH	CA	92663	3524	30	06059	33.62579141	-117.9299554	Orange County
192691	Fee-for-Service	1376122036	1376122036	1	1	BISHT, ROY MD	7/19/2024	390200000X	NA	Other	026	PHYSICIANS	182369	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
192729	Fee-for-Service	1649503319	1649503319	1	11	BEAVER MEDICAL GROUP LP	3/8/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1600 E CITRUS AVENUE	None	REDLANDS	CA	92374	4270	36	06071	34.05557272	-117.1468659	San Bernardino County
192734	Fee-for-Service	1528366200	1528366200	1	1	BRARA, SONU M MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109615	13	Neurology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
192771	Fee-for-Service	1871729962	1871729962	1	1	BODTKE, SUSAN K MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88460	08	Family Practice	0	In state provider	None	4311 THIRD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
192785	Fee-for-Service	1710670906	1710670906	1	1	BIOSPORT PHYSICAL THERAPY TR	1/30/2024	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ACY INC	2156 W GRANT LINE RD	STE 215	TRACY	CA	95377	7337	39	06077	37.75400147	-121.4554725	San Joaquin County
192792	Fee-for-Service	1457600405	1457600405	2	1	BATCHU, VERA MD	10/17/2023	207R00000X	NA	Other	026	PHYSICIANS	159017	None	None	0	In state provider	TCHU	2215 OAKMONT WAY	None	SACRAMENTO	CA	95691	3022	34	06067	38.57628249	-121.539787	Yolo County
192852	Fee-for-Service	1891927463	1891927463	1	2	BRANDMAN, DELEYS	3/25/2019	174400000X	NA	Other	026	PHYSICIANS	32912	41	Internal Medicine	0	In state provider	None	2830 GLENDESSARY LN	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
192858	Fee-for-Service	1891182093	1891182093	1	1	BARLOW, STEWART H MD	10/7/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163354	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192872	Fee-for-Service	1124749544	1124749544	1	1	BREKKE, ELIZABETH ANN	7/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
192882	Fee-for-Service	1477882413	1477882413	1	1	BEART, ROBERT W JR MD	3/2/2010	208600000X	NA	General Surgery	026	PHYSICIANS	76196	28	Proctology (colon and rectal)	0	In state provider	A PROFESSIONAL MED CORP	222 W EULALIA ST	STE 100A	GLENDALE	CA	91204	2849	19	06037	34.12653215	-118.257121	Los Angeles County
192884	Fee-for-Service	1316902000	1316902000	1	1	BRAUNSTEIN, ANNE S MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	63298	08	Family Practice	0	In state provider	None	2 MEDICAL PLAZA	STE 130	ROSEVILLE	CA	95661	3038	31	06061	38.76507948	-121.2477476	Placer County
192892	Fee-for-Service	1750950499	1750950499	1	5	BARTON MEDICAL FOUNDATION	3/24/2025	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	1139 3RD ST	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
192901	Fee-for-Service	1093748444	1093748444	1	1	BELOGORSKY, EUGENE MD	7/1/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	29625	29	Pulmonary Diseases (M.D. only)	0	In state provider	INC	585 W COLLEGE AVE	None	SANTA ROSA	CA	95401	5000	49	06097	38.445903	-122.735601	Sonoma County
192918	Fee-for-Service	1710039193	1710039193	1	1	BAKALCHUK, MARINA CRNA	5/3/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
192919	Fee-for-Service	1144727694	1144727694	1	1	BRASE, JASON MD	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
192935	Fee-for-Service	1003817537	1003817537	1	1	BROWN, KENNETH S MD	9/30/1991	207R00000X	NA	Other	026	PHYSICIANS	30456	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 102	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
192947	Fee-for-Service	1831493501	1831493501	1	1	BARNES, RYAN M DO	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12870	02	General Surgery	0	In state provider	None	7910 FROST STREET	SUITE 450	SAN DIEGO	CA	92123	2756	37	06073	32.80027449	-117.153846	San Diego County
192953	Fee-for-Service	1417245846	1417245846	1	1	BENSON, NICHOLAS J	11/29/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
192958	Fee-for-Service	1912943325	1912943325	1	1	BERGER-CHEN, SLOANE MD	10/18/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83356	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
192964	Fee-for-Service	1811279763	1811279763	1	2	BARTZ ALTADONNA COMMUNITY	2/8/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	43322 GINGHAM AVE	STE 104 & 105	LANCASTER	CA	93535	4569	19	06037	34.67013731	-118.1222748	Los Angeles County
192983	Fee-for-Service	1861010316	1861010316	1	1	BAST, NICHOLAS DO	4/29/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	20110	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
192998	Fee-for-Service	1518615277	1518615277	1	1	BARRIGA, STEFANY NP	6/7/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
193029	Fee-for-Service	1225038961	1225038961	1	1	BAEZ, CARLOS A MD	8/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85745	08	Family Practice	0	In state provider	None	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
193038	Fee-for-Service	1952477523	1952477523	1	1	BRADLEY-WINDELL, ELLEN LCSW	1/10/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28494 WESTINGHOUSE PL	SUITE 213	VALENCIA	CA	91355	0930	19	06037	34.44221561	-118.5989564	Los Angeles County
193045	Fee-for-Service	1073900536	1073900536	1	1	BERNARDI, MARK T MD	3/30/2021	207P00000X	NA	Other	026	PHYSICIANS	168873	None	None	0	In state provider	None	1225 WILSHIRE BOULEVARD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
193053	Fee-for-Service	1497996185	1497996185	1	1	BOWEN, DAVID W AUD	4/17/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1630 EAST SHAW AVENUE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
193071	Fee-for-Service	1750778635	1750778635	1	1	BARTKOVSKY, BRENDA CNP	9/21/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3851 SOTO STREET	None	VERNON	CA	90058	1718	19	06037	34.00717527	-118.2197322	Los Angeles County
193090	Fee-for-Service	1174542252	1174542252	1	1	BAGHERI, KAVEH MD	5/22/1996	207RP1001X	NA	Pulmonology	026	PHYSICIANS	52496	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8851 CENTER DR	STE 300	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
193110	Fee-for-Service	1942358767	1942358767	1	1	BRONSTEIN, SCOTT W MD	5/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86458	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
193113	Fee-for-Service	1548289093	1548289093	1	1	BALASUBRAMANIAN, VIJAY P	12/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94876	41	Internal Medicine	0	In state provider	MD	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
193145	Fee-for-Service	1285752832	1285752832	1	1	BENDANA, RAUL J MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	40680	01	General Practice	0	In state provider	None	2005 JAMES M WOOD BLVD	STE 109	LOS ANGELES	CA	90006	3000	19	06037	34.05302563	-118.2779011	Los Angeles County
193156	Fee-for-Service	1144901349	1144901349	1	1	BLANCO, AMANDA D CRNA	11/6/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
193170	Fee-for-Service	1316902000	1316902000	1	1	BRAUNSTEIN, ANNE S MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	63298	41	Internal Medicine	0	In state provider	None	2 MEDICAL PLAZA	STE 130	ROSEVILLE	CA	95661	3038	31	06061	38.76507948	-121.2477476	Placer County
193180	Fee-for-Service	1982688321	1982688321	1	1	BERNEIKE, JOHN A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1250 E 3900 S	STE 260	SALT LAKE CTY	UT	84124	1371	00	None	40.68704883	-111.8558593	Salt Lake County
193206	Fee-for-Service	1710462478	1710462478	1	1	BCH ACUPUNCTURE & HERBAL MED	9/18/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ICINE, INC.	22706 ASPAN ST	STE 300	LAKE FOREST	CA	92630	1603	30	06059	33.63302585	-117.7156522	Orange County
193216	Fee-for-Service	1841302122	1841302122	1	1	BATRA, RAJ K MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	84851	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
193217	Fee-for-Service	1073788378	1073788378	1	1	BRIGHT EXPECTIONS INC	11/21/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5593 AVENUE JUAN BAUTIST	None	RIVERSIDE	CA	92509	5614	33	06065	33.98649888	-117.4335714	Riverside County
193265	Fee-for-Service	1568469815	1568469815	1	1	BREWSTER, SCOT A	5/9/1989	208G00000X	NA	General Surgery	026	PHYSICIANS	46084	33	Thoracic Surgery	0	In state provider	None	9834 GENESEE AVE	STE 300	LA JOLLA	CA	92037	1215	37	06073	32.884074	-117.225855	San Diego County
193289	Fee-for-Service	1922161298	1922161298	1	1	BELL, RICHARD E MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57271	40	Pediatrics	0	In state provider	None	1850 PENNSYLVANIA AVE	# 102B	FAIRFIELD	CA	94533	3515	48	06095	38.26176599	-122.049827	Solano County
193294	Fee-for-Service	1477075208	1477075208	1	1	BARKER, LAUREN J LMFT	12/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4929 WILSHIRE BLVD	SUITE 245	LOS ANGELES	CA	90010	3859	19	06037	34.0621435	-118.3380975	Los Angeles County
193319	Fee-for-Service	1740991470	1740991470	1	1	BRACAMONTES, MICHAEL C PT	10/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25467 MEDICAL CENTER DR	100	MURRIETA	CA	92562	1501	33	06065	33.55711632	-117.1860368	Riverside County
193346	Fee-for-Service	1417177148	1417177148	1	1	BARNES, CALVIN L MD	10/4/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	136511	None	None	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
193352	Fee-for-Service	1831564483	1831564483	1	1	BIO GENETISYS, INC.	10/31/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	471 W LAMBERT RD	SUITE 104	BREA	CA	92821	3921	30	06059	33.92480512	-117.9008294	Orange County
193375	Fee-for-Service	1174542252	1174542252	1	1	BAGHERI, KAVEH MD	5/22/1996	207RP1001X	NA	Pulmonology	026	PHYSICIANS	52496	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8851 CENTER DR	STE 300	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
193401	Fee-for-Service	1548289093	1548289093	1	1	BALASUBRAMANIAN, VIJAY P	12/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94876	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
193409	Fee-for-Service	1376012567	1376012567	1	1	BIRONDO, CARL EVAN M NP	1/18/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1701 ZONAL AVE.	None	LOS ANGELES	CA	90033	1065	19	06037	34.06219051	-118.2106555	Los Angeles County
193412	Fee-for-Service	1295863520	1295863520	1	1	BUNCKE, GEOFFREY H MD	1/19/2022	2082S0105X	NA	General Surgery	026	PHYSICIANS	56613	None	None	0	In state provider	None	2633 RUMBLE	None	MODESTO	CA	95350	0154	50	06099	37.6822661	-121.0435185	Stanislaus County
193416	Fee-for-Service	1518505197	1518505197	1	1	BABAKHANYAN, ARMEN E CNP	8/5/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2975 NORTH SYCAMORE DR.	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
193430	Fee-for-Service	1982857967	1982857967	1	2	BRIGHT HEALTH PHYSICIANS OF	10/27/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PIH	12675 LA MIRANDA BLVD	SUITE 401	MIRANDA	CA	90638	2235	12	06023	33.91589551	-118.0119734	Los Angeles County
193449	Fee-for-Service	1194169292	1194169292	1	1	BALHAN, SUKHRAJ MD	11/1/2018	207RC0200X	NA	Other	026	PHYSICIANS	156756	41	Internal Medicine	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
193457	Fee-for-Service	1871276386	1871276386	1	1	BRYAN DIEFFENBACH, INC.	9/1/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	550 WASHINGTON ST	SUITE 641	SAN DIEGO	CA	92103	2229	37	06073	32.75003652	-117.1603431	San Diego County
193462	Fee-for-Service	1194869248	1194869248	1	1	BROOKVIEW MEDICAL	3/31/1992	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43368	None	None	0	In state provider	CORPORATION	1000 E LATHAM AVE	SUITE C	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
193463	Fee-for-Service	1386722064	1386722064	1	1	BEIL, JEFFREY MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	44982	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
193488	Fee-for-Service	1861421570	1861421570	1	1	BOODOO, ROGER MD	5/2/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	92879	30	Radiology	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
193498	Fee-for-Service	1659781367	1659781367	1	1	BRIDGEWATER, LINDSAY K DO	2/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	15	Obstetrics (D.O. only)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
193520	Fee-for-Service	1770577652	1770577652	1	1	BOTT, ALLEN D MD	1/1/1979	2084N0400X	NA	Neurology	026	PHYSICIANS	27329	13	Neurology (M.D. only)	0	In state provider	None	400 29TH ST	STE 402	OAKLAND	CA	94609	3210	01	06001	37.81784861	-122.2652263	Alameda County
193527	Fee-for-Service	1417240698	1417240698	1	1	BEREZAY, ALISSA LMFT	6/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	201 E ORANGEBURG AVE	SUITE F	MODESTO	CA	95350	5355	50	06099	37.66368555	-120.9906419	Stanislaus County
193551	Fee-for-Service	1679992481	1679992481	1	1	BEHAN, JAMES W MD	8/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140813	01	General Practice	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
193552	Fee-for-Service	1568469815	1568469815	1	1	BREWSTER, SCOT A	5/9/1989	208G00000X	NA	General Surgery	026	PHYSICIANS	46084	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9834 GENESEE AVE	STE 300	LA JOLLA	CA	92037	1215	37	06073	32.884074	-117.225855	San Diego County
193583	Fee-for-Service	1427016005	1427016005	1	1	BURNS, JANET M DO	1/2/2009	204D00000X	NA	Other	026	PHYSICIANS	10416	12	Manipulative Therapy (D.O. only)	0	In state provider	None	160 GLEN COVE MARINA RD	STE 103	VALLEJO	CA	94591	7290	48	06095	38.07062486	-122.2124251	Solano County
193586	Fee-for-Service	1114248564	1114248564	1	1	BABU, NINA S DPM	5/6/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
193592	Fee-for-Service	1750069894	1750069894	1	1	BAUGHMAN, HANNAH L OT	1/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8282 WHITE OAK AVE	107, 108, AND 111	RANCHO CUCAMONGA	CA	91730	7680	36	06071	34.10361339	-117.5644472	San Bernardino County
193599	Fee-for-Service	1043379654	1043379654	1	1	BRAUN, DAVID MD	5/31/1985	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	51440	40	Pediatrics	0	In state provider	None	3850 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1502	38	06075	37.78587201	-122.4578677	San Francisco County
193636	Fee-for-Service	1770927972	1770927972	1	1	BROWN-BERCHTOLD, LAUREN K MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143541	01	General Practice	0	In state provider	None	1133 WEST SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
193642	Fee-for-Service	1609308741	1609308741	1	1	BATH, KULWANT S MD	7/25/2023	246ZN0300X	NA	Other	026	PHYSICIANS	173687	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
193664	Fee-for-Service	1174542252	1174542252	1	1	BAGHERI, KAVEH MD	5/22/1996	207RP1001X	NA	Pulmonology	026	PHYSICIANS	52496	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	STE 300	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
193670	Fee-for-Service	1821400227	1821400227	1	1	BANDOLIN, NORKAMARI S MD	9/11/2019	207P00000X	NA	Other	026	PHYSICIANS	143300	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
193677	Fee-for-Service	1497937775	1497937775	1	1	BLAIR, VINCENT LMFT	1/12/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
193678	Fee-for-Service	1376614354	1376614354	1	1	BARKER, BEL MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86227	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
193706	Fee-for-Service	1548337835	1548337835	1	1	BROWN, DAVID WESLEY DC	4/30/1992	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4545 PARK BLVD	STE 105	SAN DIEGO	CA	92116	2668	37	06073	32.75996149	-117.1462424	San Diego County
193719	Fee-for-Service	1982857967	1982857967	1	2	BRIGHT HEALTH PHYSICIANS OF	10/27/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	PIH	12675 LA MIRANDA BLVD	SUITE 401	MIRANDA	CA	90638	2235	12	06023	33.91589551	-118.0119734	Los Angeles County
193738	Fee-for-Service	1992292148	1992292148	1	1	BAFFOE-BONNIE, MAAME-AMA S M	7/27/2021	261QU0200X	NA	Other	026	PHYSICIANS	163572	None	None	0	In state provider	D	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
193739	Fee-for-Service	1245825835	1245825835	1	1	BANH, KHIEM S PT	12/11/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	800 S. RAYMOND AVE	None	PASADENA	CA	91105	3229	19	06037	34.13185488	-118.1487468	Los Angeles County
193745	Fee-for-Service	1619992203	1619992203	1	1	BRAR, MANDEEP K MD	5/10/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55862	09	Gynecology (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
193746	Fee-for-Service	1740862770	1740862770	1	1	BAILEY, JAMES M NP	12/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
193783	Fee-for-Service	1659781367	1659781367	1	1	BRIDGEWATER, LINDSAY K DO	2/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	09	Gynecology (D.O. only)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
193794	Fee-for-Service	1184687782	1184687782	1	1	BHANGOO, SARUPINDER S MD	4/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	40294	41	Internal Medicine	0	In state provider	None	6001B TRUXTUN AVE	STE 260	BAKERSFIELD	CA	93309	0611	15	06029	35.36254873	-119.0727158	Kern County
193796	Fee-for-Service	1245282227	1245282227	1	1	BRIGHAM CITY HOSPITAL	11/3/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	950 SOUTH MEDICAL DR	None	BRIGHAM CITY	UT	84302	4724	00	None	41.49156616	-112.0242085	Box Elder County
193801	Fee-for-Service	1184069692	1184069692	1	1	BASEN, TYLER A MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141359	03	Allergy	0	In state provider	None	26726 CROWN VALLEY PKWY	STE 200	MISSION VIEJO	CA	92691	8003	30	06059	33.56385623	-117.6639538	Orange County
193807	Fee-for-Service	1770577652	1770577652	1	1	BOTT, ALLEN D MD	1/1/1979	2084N0400X	NA	Neurology	026	PHYSICIANS	27329	14	Neurological Surgery	0	In state provider	None	400 29TH ST	STE 402	OAKLAND	CA	94609	3210	01	06001	37.81784861	-122.2652263	Alameda County
193845	Fee-for-Service	1972210128	1972210128	1	2	BEST RIDE TRANSPORTATION LLC	5/28/2023	2278P4000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	16003 FORMBY DRIVE	None	LA MIRADA	CA	90638	4925	19	06037	33.89746991	-117.9908538	Los Angeles County
193861	Fee-for-Service	1073538104	1073538104	1	1	BERRIS, CRAIG MD	8/1/1995	174400000X	NA	Other	026	PHYSICIANS	32698	18	Ophthalmology	0	In state provider	None	77 SCRIPPS DR	STE 201	SACRAMENTO	CA	95825	6209	34	06067	38.57238	-121.410756	Sacramento County
193866	Fee-for-Service	1811090111	1811090111	1	1	BRAGIN, STEPHEN D MD	7/25/2019	208800000X	NA	Other	026	PHYSICIANS	30255	34	Urology and Urological Surgery	0	In state provider	None	1225 WILSHIRE BLVD	1206(D) OUTPATIENT CLINI	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
193891	Fee-for-Service	1780690677	1780690677	1	1	BAILEY, BRADLEY B MD	3/19/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85086	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193910	Fee-for-Service	1255710083	1255710083	1	1	BUZSAKI, LILI A	8/10/2023	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	158698	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
193912	Fee-for-Service	1437630274	1437630274	1	1	BOURKE, DANIEL D CRNA	10/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
193958	Fee-for-Service	1225116718	1225116718	1	1	BERGSTROM, MELISSA A MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60684	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
193996	Fee-for-Service	1699078220	1699078220	1	1	BOLLA, VEMA H V R MD	8/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118142	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
194001	Fee-for-Service	1619354941	1619354941	1	1	BETTI, SARA L LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
194033	Fee-for-Service	1619992203	1619992203	1	1	BRAR, MANDEEP K MD	5/10/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55862	15	Obstetrics (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
194057	Fee-for-Service	1306219472	1306219472	1	1	BECHERER, KELLEY D	9/20/2017	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
194084	Fee-for-Service	1245282227	1245282227	1	1	BRIGHAM CITY HOSPITAL	11/3/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	950 SOUTH MEDICAL DR	None	BRIGHAM CITY	UT	84302	4724	00	None	41.49156616	-112.0242085	Box Elder County
194151	Fee-for-Service	1215070214	1215070214	1	1	BIONDI, TRACI S MD	1/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109159	05	Anesthesiology	0	In state provider	None	1500 DUARTE RD	BLDG 149	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
194154	Fee-for-Service	1235102690	1235102690	1	1	BOTHWELL REG HLTH CENTER	12/21/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 E 14TH ST	None	SADALIA	MO	65301	5972	00	None	38.69905601	-93.22158939	Pettis County
194183	Fee-for-Service	1205330818	1205330818	1	1	BACHOURA, PATRICK J MD	9/16/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173899	None	None	0	In state provider	None	1514 VALLEY VISTA DR	None	DIAMOND BAR	CA	91765	3929	19	06037	33.99491668	-117.8399137	Los Angeles County
194201	Fee-for-Service	1467030858	1467030858	1	1	BLAKE, MALCOLM MD	12/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	555 TACHEVAH DR	SUITE 2E-107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
194210	Fee-for-Service	1467513226	1467513226	1	1	BLAKELEY, LINDA PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	420 S BEVERLY DR	STE 100	BEVERLY HILLS	CA	90212	4410	19	06037	34.05860174	-118.3978013	Los Angeles County
194235	Fee-for-Service	1437189545	1437189545	1	1	BILASH, TIMOTHY D MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	71910	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	19942	3019	37	06073	32.781483	-117.007182	San Diego County
194242	Fee-for-Service	1831622091	1831622091	1	1	BURKE, CATHERINE MD	6/9/2020	208M00000X	NA	Other	026	PHYSICIANS	159435	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
194282	Fee-for-Service	1164426953	1164426953	1	1	BAHREMAN, AMIRHASSAN MD	12/12/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	97322	13	Neurology (M.D. only)	0	In state provider	None	5555 GROSSMONT CNETER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
194311	Fee-for-Service	1467972158	1467972158	1	1	BAYUDAN, ALEXIS MD	11/5/2024	207R00000X	NA	Other	026	PHYSICIANS	169588	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
194319	Fee-for-Service	1780642884	1780642884	1	1	BUGBEE, WILLIAM D MD	9/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	66930	20	Orthopedic Surgery	0	In state provider	None	4150 REGENTS PARK ROW	STE 300	LA JOLLA	CA	92037	1417	37	06073	32.87272099	-117.2175656	San Diego County
194357	Fee-for-Service	1871735050	1871735050	1	1	BANAYAN, EMIL MD	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109335	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
194380	Fee-for-Service	1760610141	1760610141	1	1	BRAUNSTEIN, STEVE MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115050	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
194413	Fee-for-Service	1891012696	1891012696	1	1	BARRET, WILLIAM A MD	1/13/2020	2085R0204X	NA	Other	026	PHYSICIANS	153029	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
194426	Fee-for-Service	1336299148	1336299148	1	1	BAGGS, AARON G MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	87505	02	General Surgery	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
194441	Fee-for-Service	1407020639	1407020639	2	1	BAREFIELD, WILLIE J LMFT	12/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LLIANCES	14075 HESPERIA RD.	STE 105	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
194445	Fee-for-Service	1235102690	1235102690	1	1	BOTHWELL REG HLTH CENTER	12/21/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 E 14TH ST	None	SADALIA	MO	65301	5972	00	None	38.69905601	-93.22158939	Pettis County
194476	Fee-for-Service	1700060431	1700060431	1	1	BORCH-CHRISTENSEN, BO MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
194496	Fee-for-Service	1740404649	1740404649	1	1	BJERREGAARD, JENS MD	7/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119753	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
194507	Fee-for-Service	1629024955	1629024955	1	1	BOO GHEE,LOW	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MARICOPA MEDICAL CENTER	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
194555	Fee-for-Service	1407273600	1407273600	1	1	BUI, MINDY T MD DO	6/25/2019	2278C0205X	NA	Other	026	PHYSICIANS	17127	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
194610	Fee-for-Service	1124734421	1124734421	1	1	BICOASTAL MEDICAL TRANSPORTA	5/3/2023	347E00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TION, LLC	500 N STATE COLLEGE BLVD	STE 1114	ORANGE	CA	92868	1625	30	06059	33.79565477	-117.8893624	Orange County
194620	Fee-for-Service	1063590958	1063590958	1	1	BUI, HO Q MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70885	08	Family Practice	0	In state provider	MEDICAL OFFICE	1515 CONTRA COSTA BLVD	None	PLEASANT HILL	CA	94523	3054	07	06013	37.95552398	-122.0603308	Contra Costa County
194636	Fee-for-Service	1033193941	1033193941	1	1	BAKER, DANIEL M MD	4/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	148578	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
194645	Fee-for-Service	1821316209	1821316209	1	1	BAEK, SIMON S MD	9/17/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	77818	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
194662	Fee-for-Service	1801811047	1801811047	1	1	BATZDORF, ULRICH MD	11/28/1985	207T00000X	NA	General Surgery	026	PHYSICIANS	5819	None	None	0	In state provider	CNTR FOR HEALTH SCI	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
194668	Fee-for-Service	1245618669	1245618669	1	1	BUSH, COLTON MD	10/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186628	30	Radiology	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
194693	Fee-for-Service	1164743399	1164743399	1	1	BHARDWAJ, VIRINDER K MD INC	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	50673	34	Urology and Urological Surgery	0	In state provider	None	386 N VILLA	STE B	PORTERVILLE	CA	93257	3303	54	06107	36.07299176	-119.0306144	Tulare County
194702	Fee-for-Service	1285705038	1285705038	1	1	BOOKWALTER, MATTHEW M DPM	12/14/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3258 TIMBER FALL CT	None	EUREKA	CA	95503	4888	12	06023	40.77919128	-124.1360589	Humboldt County
194707	Fee-for-Service	1811285356	1811285356	1	1	BUGAS, JOHN S PHD	6/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
194710	Fee-for-Service	1417486440	1417486440	1	1	BELTRAN, JANETTE	4/27/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
194731	Fee-for-Service	1033169339	1033169339	1	1	BROCHERT, ADAM J MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92244	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
194748	Fee-for-Service	1831357631	1831357631	1	1	BOHON, CARA PHD	7/13/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
194780	Fee-for-Service	1134125206	1134125206	1	1	BUXTON, JOHN A MD	9/2/2014	208600000X	NA	General Surgery	026	PHYSICIANS	34570	None	None	0	In state provider	None	2521 G STREET	None	BAKERSFIELD	CA	93301	2811	15	06029	35.382393	-119.0223575	Kern County
194801	Fee-for-Service	1356668065	1356668065	1	1	BANERJEE, NATASHA MD	8/6/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	118784	68	Hematology	0	In state provider	None	16133 VENTURA BLVD	SUITE 470	ENCINO	CA	91436	2402	19	06037	34.15656164	-118.4849569	Los Angeles County
194825	Fee-for-Service	1083652838	1083652838	1	1	BRIAN D COLEY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
194849	Fee-for-Service	1437860285	1437860285	1	1	BJORKLUND, ANNA-KARIN LMFT	1/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
194927	Fee-for-Service	1639227572	1639227572	1	1	BUCHANAN, BERNARD MD	8/1/1998	2084P0800X	NA	Psychiatry	026	PHYSICIANS	65240	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
194934	Fee-for-Service	1902148810	1902148810	1	1	BANDY, ANDREW J MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154150	22	Pathology (M.D. only)	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
194973	Fee-for-Service	1801260872	1801260872	1	1	BRESSIE, COLLEEN E LMFT	1/25/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
194989	Fee-for-Service	1245525096	1245525096	1	1	BATTAINI, JESSICA S LCSW	9/18/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 HOPE ST	STE 350	SOUTH PASADENA	CA	91030	2628	19	06037	34.11679363	-118.150088	Los Angeles County
195091	Fee-for-Service	1962835876	1962835876	1	1	BERDY, SARA E NP	4/20/2023	208800000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	3A20	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
195110	Fee-for-Service	1568857589	1568857589	1	1	BONITA SPRINGS HOME HEALTH	2/7/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	8545 MONTEREY STREET	SUITE A	GILROY	CA	95020	4273	43	06085	37.02054622	-121.5754058	Santa Clara County
195145	Fee-for-Service	1578872453	1578872453	1	1	BLOEM, FELICIA G PHD	3/9/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
195154	Fee-for-Service	1104143197	1104143197	1	2	BANERJEE, POONAM N	10/10/2024	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8382 NEWMAN AVENUE	None	HUNTINGTON BEACH	CA	92647	7095	30	06059	33.70483894	-117.9824498	Orange County
195158	Fee-for-Service	1689752479	1689752479	1	1	BRINDIS, RALPH G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37831	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
195206	Fee-for-Service	1144993353	1144993353	1	1	BERG, TYLER K PT	8/15/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	81 CERNON ST.	None	VACAVILLE	CA	95688	2803	48	06095	38.36102104	-121.9906107	Solano County
195258	Fee-for-Service	1528093820	1528093820	1	1	BERGMAN, R LINDSEY PHD	4/1/1998	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
195259	Fee-for-Service	1043299100	1043299100	1	1	BARRERA, HUGO H. MD	5/16/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	79280	01	General Practice	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
195296	Fee-for-Service	1477807667	1477807667	1	1	BYRAM HEALTHCARE CENTERS INC	12/4/2012	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1340 STORM PKWY	None	TORRANCE	CA	90501	5041	19	06037	33.8169271	-118.3012127	Los Angeles County
195322	Fee-for-Service	1942610142	1942610142	1	1	BEARDSLEY, MEGAN LPCC	1/16/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
195330	Fee-for-Service	1689025132	1689025132	1	1	BERMAN, JESSE M MD	6/25/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172271	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195336	Fee-for-Service	1710072475	1710072475	1	1	BINGHAM, DAVID B MD	6/30/1995	207ZP0101X	NA	Other	026	PHYSICIANS	78972	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
195373	Fee-for-Service	1306232061	1306232061	1	1	BERENSTEIN, CARRIE CRNA	6/15/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
195405	Fee-for-Service	1962679753	1962679753	1	1	BUTTAR, AMANPREET MD	3/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116791	78	Neoplastic Diseases/Oncology	0	In state provider	None	6380 CLARK AVENUE	None	DUBLIN	CA	94568	3036	01	06001	37.70451998	-121.9205494	Alameda County
195425	Fee-for-Service	1932562550	1932562550	1	1	BHAMRA, MANJEET S MD	8/13/2021	207RR0500X	NA	Other	026	PHYSICIANS	157941	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
195438	Fee-for-Service	1801175716	1801175716	1	1	BERRY, CHRISTEL S LMFT	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
195449	Fee-for-Service	1326722679	1326722679	1	1	BALBIN, JAMES P CNP	8/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
195455	Fee-for-Service	1134133572	1134133572	1	1	BOBZIEN, BONNIE MD	4/30/1984	207ZP0102X	NA	Other	026	PHYSICIANS	48863	22	Pathology (M.D. only)	0	In state provider	None	3102 VIA SOMBRA	None	CARLSBAD	CA	92010	1359	37	06073	33.1732284	-117.3174211	San Diego County
195507	Fee-for-Service	1043714462	1043714462	1	1	BHATIA, RITWIK MD	5/25/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	176921	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
195510	Fee-for-Service	1366861379	1366861379	1	1	BARISH, PETER N MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150156	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
195530	Fee-for-Service	1588693055	1588693055	1	1	BALDWIN, SUSAN M OD	7/1/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	& ASSOCIATES	5900 SUNRISE MALL	None	CITRUS HEIGHTS	CA	95610	6902	34	06067	38.672721	-121.269204	Sacramento County
195548	Fee-for-Service	1043299100	1043299100	1	1	BARRERA, HUGO H. MD	5/16/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	79280	02	General Surgery	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
195549	Fee-for-Service	1245505411	1245505411	1	1	BHARGAVA, SAMHITA MD	9/30/2021	390200000X	NA	Other	026	PHYSICIANS	174043	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
195569	Fee-for-Service	1083243554	1083243554	1	1	BUI, HA MD	5/24/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187962	08	Family Practice	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
195654	Fee-for-Service	1073620704	1073620704	1	1	BLOMELEY, HEATHER I MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86806	05	Anesthesiology	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
195658	Fee-for-Service	1851562144	1851562144	1	1	BERGMAN, JONATHAN MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99523	34	Urology and Urological Surgery	0	In state provider	None	200 MED PLZ	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
195661	Fee-for-Service	1770563462	1770563462	2	1	BURDO-HARTMAN, WENDELIN A MD	1/18/2017	2080P0008X	NA	Neurology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
195665	Fee-for-Service	1710543111	1710543111	1	1	BARNARD, LUKE R MD	10/24/2024	207WX0009X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
195667	Fee-for-Service	1316979925	1316979925	1	1	BLUMBERG, KIMBERLY M MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91038	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
195691	Fee-for-Service	1174712962	1174712962	1	1	BROWN, ROBERT J MD	8/20/2009	2080P0207X	NA	Hematology	026	PHYSICIANS	108632	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
195705	Fee-for-Service	1639756257	1639756257	1	1	BADIAL, TAJINDER P DO	9/30/2024	207R00000X	NA	Other	026	PHYSICIANS	22680	41	Internal Medicine	0	In state provider	None	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	34	06067	38.65086	-121.531833	Sacramento County
195721	Fee-for-Service	1386941029	1386941029	1	1	BEAZLEY, DOUGLAS NP	5/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
195741	Fee-for-Service	1861543563	1861543563	1	1	BOUCK, ANN L NP	11/21/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	910 SYCAMORE AVE	SUITE 102	VISTA	CA	92081	7833	37	06073	33.15991913	-117.2205623	San Diego County
195757	Fee-for-Service	1396249165	1396249165	1	1	BAGHRAMIAN, ARGIN MD	1/27/2023	207R00000X	NA	Other	026	PHYSICIANS	164905	None	None	0	In state provider	None	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
195795	Fee-for-Service	1073812970	1073812970	1	1	BROWN, BERNARD JOSEPH M III	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143255	30	Radiology	0	In state provider	MD	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
195816	Fee-for-Service	1316102569	1316102569	1	1	BHOLA, ARPNA P DO	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10203	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
195820	Fee-for-Service	1427251271	1427251271	1	1	BOHL, ERIC J LMFT	1/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4990 SPEAK LN.	SUITE 100	SAN JOSE	CA	95118	2776	43	06085	37.25938828	-121.8783413	Santa Clara County
195839	Fee-for-Service	1043299100	1043299100	1	1	BARRERA, HUGO H. MD	5/16/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	79280	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
195841	Fee-for-Service	1629646286	1629646286	1	1	BARCARSE, VICTOR JOHN NP	6/18/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8601 S BROADWAY	None	LOS ANGELES	CA	90003	3319	19	06037	33.9598857	-118.2783041	Los Angeles County
195885	Fee-for-Service	1649503319	1649503319	1	1	BEAVER MEDICAL GROUP LP	2/27/2020	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1690 BARTON RD	2ND FLOOR	REDLANDS	CA	92373	4229	36	06071	34.04836346	-117.2125293	San Bernardino County
195910	Fee-for-Service	1174725162	1174725162	1	1	BARTOLOME, JESSIE LYN P	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102737	41	Internal Medicine	0	In state provider	MD	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
195929	Fee-for-Service	1841237666	1841237666	1	1	BOOTH, SCOTT L MD	12/2/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	59035	30	Radiology	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
195931	Fee-for-Service	1740484807	1740484807	1	1	BAI, CHARLOTTE J MD	9/23/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	86631	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
195958	Fee-for-Service	1114340528	1114340528	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	360 E YOSEMITE AVE	200	MERCED	CA	95340	8201	24	06047	37.33211252	-120.464307	Merced County
195977	Fee-for-Service	1609183771	1609183771	1	1	BELCH, JAMES A	9/12/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	844 BRIDGE ST	STE C	COLUSA	CA	95932	2836	06	06011	39.20645023	-122.0035419	Colusa County
195981	Fee-for-Service	1174712962	1174712962	1	1	BROWN, ROBERT J MD	8/20/2009	2080P0207X	NA	Hematology	026	PHYSICIANS	108632	40	Pediatrics	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
195983	Fee-for-Service	1811049273	1811049273	1	1	BRYANT, TODD A MD	11/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86815	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
196000	Fee-for-Service	1265639231	1265639231	1	1	BULTMAN, CHARLES K LMFT	10/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
196024	Fee-for-Service	1417480708	1417480708	1	1	BURTON, ADAM R DO	5/31/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	17383	25	Physical Medicine and Rehabilitation	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
196040	Fee-for-Service	1861069098	1861069098	1	1	BRYANT-BATTLE, JAMIEE LMFT	5/22/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
196048	Fee-for-Service	1669708657	1669708657	1	1	BUSH, JOSHUA CRNA	7/30/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
196060	Fee-for-Service	1407043375	1407043375	1	1	BONHAMA, RICHARD LMFT	3/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12304 SANTA MONICA BLVD	SUITE 205	LOS ANGELES	CA	90025	2587	19	06037	34.03948285	-118.4656304	Los Angeles County
196082	Fee-for-Service	1154791895	1154791895	1	1	BELLFLOWER POST ACUTE, LLC	9/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9710 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6638	19	06037	33.87473656	-118.1271786	Los Angeles County
196091	Fee-for-Service	1386825503	1386825503	1	1	BAYVIEW HUNTERS POINT	7/1/1993	251C00000X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ADHC	1250 LA SALLE AVE	None	SAN FRANCISCO	CA	94124	2414	38	06075	37.73183079	-122.3823329	San Francisco County
196111	Fee-for-Service	1609808195	1609808195	1	1	BASTIDAS, JEFFERSON A MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	77498	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	# 1200	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
196171	Fee-for-Service	1649503319	1649503319	1	1	BEAVER MEDICAL GROUP LP	8/25/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1690 BARTON RD	2ND FLOOR	REDLANDS	CA	92373	4229	36	06071	34.04836346	-117.2125293	San Bernardino County
196191	Fee-for-Service	1316925282	1316925282	1	1	BOUFFARD, MANUEL OT	7/7/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4010 ORANGE AVE	None	LONG BEACH	CA	90807	3717	19	06037	33.831612	-118.176291	Los Angeles County
196205	Fee-for-Service	1114969029	1114969029	1	1	BOUTELLER, JOHN MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	34049	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	415 E HARDING WAY	None	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
196211	Fee-for-Service	1962627885	1962627885	1	1	B&M, INC	3/7/2003	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3271 SUSAN DR	None	SAN BRUNO	CA	94066	1639	41	06081	37.63527496	-122.4598445	San Mateo County
196222	Fee-for-Service	1609841899	1609841899	1	1	BRUNI, ROBERTA MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51854	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
196247	Fee-for-Service	1700804325	1700804325	1	1	BETTINGER, BRADLEY I MD	6/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	18780	30	Radiology	0	In state provider	None	869 N CHERRY STREET	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
196254	Fee-for-Service	1235869959	1235869959	1	1	BASS, DESTINEE	12/15/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
196256	Fee-for-Service	1396150355	1396150355	1	1	BANDA-RODRIGUEZ, VALERIE LC	2/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
196270	Fee-for-Service	1174712962	1174712962	1	1	BROWN, ROBERT J MD	8/20/2009	2080P0207X	NA	Hematology	026	PHYSICIANS	108632	68	Hematology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
196308	Fee-for-Service	1215202627	1215202627	1	1	BAYNE, DAVID B MD	3/26/2018	208800000X	NA	Other	026	PHYSICIANS	129219	34	Urology and Urological Surgery	0	In state provider	None	1001 POTRERO AVE	3A20	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
196309	Fee-for-Service	1568804326	1568804326	1	1	BYRNE, JENNIFER M NP	2/9/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
196353	Fee-for-Service	1366917692	1366917692	1	1	BRIGHT FUTURE HOME HEALTH	2/27/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	22151 VENTURA BLVD	SUITE 202	WOODLAND HILLS	CA	91364	5738	19	06037	34.16870042	-118.6099445	Los Angeles County
196355	Fee-for-Service	1700068111	1700068111	1	1	BUTLER VALLEY INC	10/17/1985	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3971 F ST	None	EUREKA	CA	95503	6003	12	06023	40.77000607	-124.163662	Humboldt County
196366	Fee-for-Service	1881893519	1881893519	1	1	BECKHAM, STEPHEN M MD	5/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105153	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
196388	Fee-for-Service	1275566200	1275566200	1	1	BANNER ESTRELLA MED CTR	2/21/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
196411	Fee-for-Service	1124681887	1124681887	1	1	BAZANOS, VICTORIA L CNP	8/14/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
196423	Fee-for-Service	1295822393	1295822393	1	1	BLEVINS, LEWIS S JR MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87956	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
196429	Fee-for-Service	1083878581	1083878581	1	1	BEN-OZER, ELITE Y MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115230	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
196442	Fee-for-Service	1114198975	1114198975	1	1	BASSLER, KARL D MD INC	2/8/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	64015	None	None	0	In state provider	None	23961 MAGDALENA	STE 520	LAGUNA HILLS	CA	92653	7622	30	06059	33.60918911	-117.7104355	Orange County
196482	Fee-for-Service	1740270891	1740270891	1	1	BERRY, PAUL S MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72073	13	Neurology (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
196492	Fee-for-Service	1023648169	1023648169	1	1	BALCHAS, LINA G LPCC	6/10/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
196509	Fee-for-Service	1720048200	1720048200	1	1	BURCHELL, SHERRY A MD	7/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84172	66	Emergency Medicine (Urgent Care)	0	In state provider	INC APC	999 N TUSTIN AVE	STE 116	SANTA ANA	CA	92705	6505	30	06059	33.754167	-117.834191	Orange County
196514	Fee-for-Service	1902805831	1902805831	1	1	BRITTON, JOSEPH C MD	6/30/1992	207P00000X	NA	Other	026	PHYSICIANS	71840	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
196519	Fee-for-Service	1629618723	1629618723	1	1	BREAKINGTHROUGH SAN DIEGO PH	7/5/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	YSICAL THERAPY	2424 VISTA WAY	120	OCEANSIDE	CA	92054	6169	37	06073	33.18326195	-117.3355017	San Diego County
196535	Fee-for-Service	1376660217	1376660217	1	1	BJUR, KARA A MD	3/23/2022	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
196538	Fee-for-Service	1154640860	1154640860	1	1	BERAUER, JOHN-PAUL MD	5/14/2019	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	156606	10	Gastroenterology (M.D. only)	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
196540	Fee-for-Service	1457381824	1457381824	1	1	BAKER, MICHAEL J MD	7/18/2022	207P00000X	NA	Other	026	PHYSICIANS	171759	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4900	39	06077	37.80110374	-121.1974853	San Joaquin County
196541	Fee-for-Service	1104237577	1104237577	1	1	BENDALE, SUNITA S CRNA	10/30/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
196548	Fee-for-Service	1710034467	1710034467	1	1	BRUCKER, MICHAEL JOHN MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79133	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
196554	Fee-for-Service	1164839528	1164839528	1	1	BODAPATI, NAGA VENKATA MD	6/4/2020	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	154649	-	NOT APPLICABLE	0	In state provider	None	3117 WILSON	None	BAKERSFIELD	CA	93304	5319	15	06029	35.33217251	-119.0385045	Kern County
196563	Fee-for-Service	1962532028	1962532028	1	1	BAUTISTA, CHARLOTTE LMFT	1/12/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49467	-	NOT APPLICABLE	0	In state provider	None	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1711	19	06037	34.08461594	-118.2570874	Los Angeles County
196594	Fee-for-Service	1558985192	1558985192	1	1	BROGAN, HALEY PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
196631	Fee-for-Service	1760511257	1760511257	1	1	BATEMAN, BRIAN T MD	6/29/2021	207L00000X	NA	Other	026	PHYSICIANS	173116	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
196659	Fee-for-Service	1508892621	1508892621	1	1	BROWN, PAUL R MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54298	30	Radiology	0	In state provider	None	2110 PROFESSIONAL DR	STE 100	ROSEVILLE	CA	95661	3752	31	06061	38.74234873	-121.2521259	Placer County
196661	Fee-for-Service	1194913988	1194913988	1	1	BELL, BILL G MD	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	25820	01	General Practice	0	In state provider	None	2451 ROCKWOOD AVE	STE 114	CALEXICO	CA	92231	4405	13	06025	32.69552366	-115.4975945	Imperial County
196666	Fee-for-Service	1588197487	1588197487	1	1	BARIL, ROGER P MD	8/23/2024	207P00000X	NA	Other	026	PHYSICIANS	22672	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
196678	Fee-for-Service	1275566200	1275566200	1	1	BANNER ESTRELLA MED CTR	2/21/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
196680	Fee-for-Service	1508806753	1508806753	1	1	BENDER, SEAN MD	12/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2551 W 84TH AVE	None	WESTMINSTER	CO	80031	3807	00	None	39.84905501	-105.0182452	Adams County
196685	Fee-for-Service	1508876228	1508876228	1	1	BREWER, ALLISON V MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144499	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2170 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
196694	Fee-for-Service	1184013518	1184013518	1	1	BONES SPINE SURGERY INC	3/15/2016	261QP2300X	NA	Other	026	PHYSICIANS	62867	20	Orthopedic Surgery	0	In state provider	None	25805 BARTON ROAD	SUITE A106	LOMA LINDA	CA	92354	3814	36	06071	34.04825223	-117.2408371	San Bernardino County
196697	Fee-for-Service	1700883592	1700883592	2	1	B & Y MANAGEMENT, INC	2/16/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	292 S LA CIENEGA BLVD	SUITE 325	BEVERLY HILLS	CA	90211	3330	19	06037	34.06283371	-118.3761195	Los Angeles County
196711	Fee-for-Service	1316961055	1316961055	1	1	BURKE, CHRISTOPHER D MD	12/1/1998	207P00000X	NA	Other	026	PHYSICIANS	67371	41	Internal Medicine	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
196724	Fee-for-Service	1245636570	1245636570	1	1	BAUTISTA, KENNETH Y OT	5/18/2020	225XP0019X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
196733	Fee-for-Service	1063668309	1063668309	1	1	BEHRENS, PAULA M	8/14/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94553	3552	48	06095	38.26109552	-122.0470245	Solano County
196757	Fee-for-Service	1821542929	1821542929	1	1	BISSAR, LINA MD	12/4/2017	207R00000X	NA	Other	026	PHYSICIANS	80200	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
196758	Fee-for-Service	1437717048	1437717048	1	1	BRUNOZZI, SABRINA C MD	10/18/2023	390200000X	NA	Other	026	PHYSICIANS	185965	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
196765	Fee-for-Service	1750564605	1750564605	1	1	BUGOS, KELLY G NP	9/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
196770	Fee-for-Service	1740270891	1740270891	1	1	BERRY, PAUL S MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72073	01	General Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
196783	Fee-for-Service	1972898757	1972898757	1	1	BONNICI, DANIEL M MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122701	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
196784	Fee-for-Service	1831572338	1831572338	1	1	BERGIN, MICHAEL W MD	8/13/2019	207L00000X	NA	Other	026	PHYSICIANS	143819	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
196797	Fee-for-Service	1720048200	1720048200	1	1	BURCHELL, SHERRY A MD	7/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84172	02	General Surgery	0	In state provider	INC APC	999 N TUSTIN AVE	STE 116	SANTA ANA	CA	92705	6505	30	06059	33.754167	-117.834191	Orange County
196806	Fee-for-Service	1699129668	1699129668	1	1	BAVARSAD SHAHRIPOUR, REZA M	10/3/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	164805	None	None	0	In state provider	D	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
196844	Fee-for-Service	1609081447	1609081447	1	1	BRYSON, JULIA E MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106988	13	Neurology (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	SUITE 300	LOS ANGELES	CA	90067	2006	19	06037	34.05887194	-118.4122914	Los Angeles County
196848	Fee-for-Service	1205882081	1205882081	1	1	BRYAN L BARNESS MD	11/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1210 W 18TH ST	None	SIOUX FALLS	SD	57104	4647	00	None	43.537329	-96.743223	Minnehaha County
196854	Fee-for-Service	1225640535	1225640535	1	1	BAKER, ASHLEY L LMFT	7/2/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	133151	-	NOT APPLICABLE	0	In state provider	None	7233 SOUTH DELIVERY RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88418172	-121.2882227	San Joaquin County
196857	Fee-for-Service	1528420890	1528420890	1	1	BERGIN, SAMUEL W MD	5/6/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2375 E PRATER WAY	None	SPARKS	NV	89434	9641	00	None	39.54247495	-119.6975356	Washoe County
196902	Fee-for-Service	1114196862	1114196862	1	1	BARROSO, ERIC F MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	162614	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVENUE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
196904	Fee-for-Service	1427088830	1427088830	1	1	BUTLER, FREDERICK MD	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73853	None	None	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
196927	Fee-for-Service	1356704043	1356704043	1	1	BARBAS, ADRIENNE F NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
196948	Fee-for-Service	1194913988	1194913988	1	1	BELL, BILL G MD	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	25820	18	Ophthalmology	0	In state provider	None	2451 ROCKWOOD AVE	STE 114	CALEXICO	CA	92231	4405	13	06025	32.69552366	-115.4975945	Imperial County
196952	Fee-for-Service	1588958748	1588958748	1	1	BERMAN, DARREN P MD	8/6/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	95413	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
197008	Fee-for-Service	1528189651	1528189651	1	1	BENNINGHOVEN, SCOTT W MD	1/1/1994	208600000X	NA	General Surgery	026	PHYSICIANS	55118	89	Surgery-Traumatic	0	In state provider	None	9460 N NAME UNO	STE 250	GILROY	CA	95020	3538	43	06085	37.037781	-121.570965	Santa Clara County
197015	Fee-for-Service	1356904015	1356904015	1	1	BHASKAR, RAHUL D MD	12/27/2022	207R00000X	NA	Other	026	PHYSICIANS	181225	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
197016	Fee-for-Service	1083709653	1083709653	1	3	BHC HERITAGE OAKS HOSP	10/29/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2945 RAMCO STREET	SUITE 180	WEST SACRAMENTO	CA	95691	5995	57	06113	38.55460926	-121.562961	Yolo County
197018	Fee-for-Service	1417648346	1417648346	1	1	BUSH, KORTNEY AU	12/5/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
197020	Fee-for-Service	1144721770	1144721770	1	1	BARRONS DIALYSIS LLC	11/18/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	12456 BEACH BLVD	None	STANTON	CA	90680	3930	30	06059	33.78195	-117.9927325	Orange County
197040	Fee-for-Service	1497147235	1497147235	1	1	BLACK, JUANITA I LMFT	4/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12881 KNOTT STREET	STE 106	GARDEN GROVE	CA	92841	3939	30	06059	33.77542911	-118.0080111	Orange County
197062	Fee-for-Service	1003345364	1003345364	1	1	BASUALDO, ASHLEY LCSW	11/17/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
197080	Fee-for-Service	1558666461	1558666461	1	1	BUSER, KATE V PHD	2/10/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
197091	Fee-for-Service	1588823553	1588823553	1	1	BANNER DEL E WEBB MEDICAL	9/8/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	14502 W MEEKER BLVD	None	SUN CITY WEST	AZ	85375	5282	00	None	33.660657	-112.3736175	Maricopa County
197107	Fee-for-Service	1679544225	1679544225	1	1	BRUCE WAYNE HIGGINBOTHAM MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	530 BOGACHIEL WAY	None	FORKS	WA	98331	9120	00	None	47.946141	-124.3931915	Clallam County
197190	Fee-for-Service	1427346931	1427346931	1	1	BROOK, SCOTT D MD INC	3/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116376	78	Neoplastic Diseases/Oncology	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E-218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
197203	Fee-for-Service	1023481785	1023481785	1	1	BAKERSFIELD COMMUNITY	9/17/2018	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	IMAGING SOLUTIONS INC	3400 CALLOWAY DR	SUITE 102	BAKERSFIELD	CA	93312	3936	15	06029	35.39110123	-119.1097878	Kern County
197207	Fee-for-Service	1437364486	1437364486	1	2	BRIT IN HOME PHYSICAL	4/15/2013	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10808 MACOUBA PL	None	SAN DIEGO	CA	92124	2044	37	06073	32.82284887	-117.0959843	San Diego County
197256	Fee-for-Service	1518089531	1518089531	1	1	BACANI, HEIDI L LMFT	7/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24050 MADISON ST	STE 108	TORRANCE	CA	90505	6016	19	06037	33.80594851	-118.348558	Los Angeles County
197263	Fee-for-Service	1225115371	1225115371	1	1	BONILLA, HECTOR F MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134184	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197297	Fee-for-Service	1528189651	1528189651	1	1	BENNINGHOVEN, SCOTT W MD	1/1/1994	208600000X	NA	General Surgery	026	PHYSICIANS	55118	02	General Surgery	0	In state provider	None	9460 N NAME UNO	STE 250	GILROY	CA	95020	3538	43	06085	37.037781	-121.570965	Santa Clara County
197298	Fee-for-Service	1942252085	1942252085	1	1	BOWLUS, CHRISTOPHER L MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72028	None	None	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
197304	Fee-for-Service	1952459992	1952459992	1	1	BUSFIELD, BENJAMIN T MD	7/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82241	20	Orthopedic Surgery	0	In state provider	None	365 LENNON LN	STE 250	WALNUT CREEK	CA	94598	5915	07	06013	37.92784983	-122.0301444	Contra Costa County
197333	Fee-for-Service	1609824481	1609824481	1	1	BEBLA, SARGON MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	79656	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
197335	Fee-for-Service	1053638932	1053638932	1	1	BOUCHER, MICHAEL L MD	3/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121151	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.07067	-118.4432445	Los Angeles County
197342	Fee-for-Service	1023216116	1023216116	1	1	BAZO, EVE LCSW	1/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
197368	Fee-for-Service	1114109030	1114109030	1	1	BABAYAN, THOMAS LMFT	5/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
197378	Fee-for-Service	1588823553	1588823553	1	1	BANNER DEL E WEBB MEDICAL	9/8/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	14502 W MEEKER BLVD	None	SUN CITY WEST	AZ	85375	5282	00	None	33.660657	-112.3736175	Maricopa County
197381	Fee-for-Service	1619422755	1619422755	1	1	BEHAVIORAL HEALTH SERVICES	5/26/2017	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	9100 S SEPULVEDA BLVD	STE 105	LOS ANGELES	CA	90045	4849	19	06037	33.954147	-118.396111	Los Angeles County
197402	Fee-for-Service	1508062530	1508062530	1	1	BROWN, ROXANNE LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
197413	Fee-for-Service	1871606327	1871606327	1	1	BARRUS, KIM B PHD	4/8/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30423 CANWOOD ST	SUITE 138	AGOURA HILLS	CA	91301	4315	19	06037	34.14710182	-118.7842501	Los Angeles County
197450	Fee-for-Service	1114473972	1114473972	1	1	BURBANK SPINE AND PAIN SURGE	10/23/2020	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGERY CENTER	2211 W MAGNOLIA BLVD	SUITE 270	BURBANK	CA	91506	1756	19	06037	34.1728873	-118.3320905	Los Angeles County
197464	Fee-for-Service	1891979332	1891979332	1	1	BIO-MEDICAL APPLICATIONS	12/10/2008	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	269 E CAROLINE ST	STE A	SAN BERNARDINO	CA	92408	3748	36	06071	34.06143255	-117.2796975	San Bernardino County
197480	Fee-for-Service	1427346931	1427346931	1	1	BROOK, SCOTT D MD INC	3/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116376	68	Hematology	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E-218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
197519	Fee-for-Service	1740701572	1740701572	1	1	BEGLUYAN, RAFAEL NP	5/9/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 S CENTRAL AVENUE	200,210,250	GLENDALE	CA	91204	4614	19	06037	34.13746423	-118.2578296	Los Angeles County
197527	Fee-for-Service	1518186774	1518186774	1	1	BODEAU, AMY L MD	1/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102917	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
197529	Fee-for-Service	1023076858	1023076858	1	1	BAZZO, DAVID E MD	4/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72291	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
197541	Fee-for-Service	1518719426	1518719426	1	1	BORNTOBEBALANCED.COM, INC	8/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23832 ROCKFIELD BLVD	120	LAKE FOREST	CA	92630	2885	30	06059	33.6263651	-117.7142932	Orange County
197549	Fee-for-Service	1225115371	1225115371	1	1	BONILLA, HECTOR F MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134184	77	Infectious Disease	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197553	Fee-for-Service	1790024578	1790024578	1	1	BUXBAUM, ANNE K LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
197623	Fee-for-Service	1356537633	1356537633	1	1	BARZIN, ARIO MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100978	24	Plastic Surgery	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
197624	Fee-for-Service	1073184354	1073184354	1	1	BERRUECOS, STEVE DO	9/30/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	22848	40	Pediatrics	0	In state provider	None	1215 34TH ST	None	BAKERSFIELD	CA	93301	2107	15	06029	35.39050249	-119.015775	Kern County
197655	Fee-for-Service	1073141974	1073141974	1	1	BALL, BRUCE D MD	10/2/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	190723	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
197659	Fee-for-Service	1053549048	1053549048	1	1	BROADY, AUTUMN J MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142657	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	350 30TH ST	STE 208	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
197694	Fee-for-Service	1699942839	1699942839	1	1	BAKER, AARON C MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106298	02	General Surgery	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
197696	Fee-for-Service	1205140480	1205140480	1	1	BRACY, HOLLY D DO	12/4/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13453	None	None	0	In state provider	None	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
197739	Fee-for-Service	1356623839	1356623839	1	1	BECK, HARALD R PSYD	8/9/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
197742	Fee-for-Service	1508839457	1508839457	1	1	BENSCH, GEORGE W MD	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34965	03	Allergy	0	In state provider	None	445 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.743354	-121.432495	San Joaquin County
197747	Fee-for-Service	1811912835	1811912835	1	1	BIN, STEVEN S MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55650	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
197753	Fee-for-Service	1487610333	1487610333	1	1	BOLLAY ANN L MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78858	None	None	0	In state provider	None	1428 PHILLIPS LN	STE 203	SAN LUIS OBISPO	CA	93401	2551	40	06079	35.28794905	-120.6574321	San Luis Obispo County
197832	Fee-for-Service	1851770622	1851770622	1	1	BRANCH, CODY R MD	7/27/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173118	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
197852	Fee-for-Service	1033506134	1033506134	1	1	BHARDWAJ, SHARONLIN MD	5/23/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	162761	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
197867	Fee-for-Service	1568528990	1568528990	1	1	BONNESS, SHANNON M MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55574	05	Anesthesiology	0	In state provider	None	5900 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
197868	Fee-for-Service	1497257083	1497257083	1	1	BARKER, COURTNEY B	10/26/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
197878	Fee-for-Service	1285144840	1285144840	1	1	BIO MEDICAL APPLICATIONS OF	10/22/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	38910 TRADE CENTER DR	None	PALMDALE	CA	93551	3715	19	06037	34.58854409	-118.1430626	Los Angeles County
197913	Fee-for-Service	1891789764	1891789764	1	1	BARCAY, DAVID MD	7/1/2002	207P00000X	NA	Other	026	PHYSICIANS	34270	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
197926	Fee-for-Service	1770674368	1770674368	1	1	BRMP PROFESSIONAL MEDICAL	3/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62609	18	Ophthalmology	0	In state provider	CORPORATION	1314 S EUCLID STREET	SUITE 103	ANAHEIM	CA	92802	2000	30	06059	33.815502	-117.9413935	Orange County
197955	Fee-for-Service	1487180642	1487180642	1	1	BALYOZIAN, DAVID M MD	10/23/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157351	40	Pediatrics	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
197956	Fee-for-Service	1598314437	1598314437	1	2	BILLIONTOONE, INC.	1/28/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3200 WHIPPLE RD	None	UNION CITY	CA	94587	1217	01	06001	37.60561302	-122.0794659	Alameda County
197973	Fee-for-Service	1619940095	1619940095	1	1	BARCO, ERIC P MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92850	41	Internal Medicine	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
197980	Fee-for-Service	1619400645	1619400645	1	1	BRYANT, BRITTANY E LCSW	5/6/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
197989	Fee-for-Service	1568027449	1568027449	1	1	BETTER IMAGE OPTOMETRY, INC.	8/9/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1811 HILLSDALE AVE	None	SAN JOSE	CA	95124	3027	43	06085	37.265202	-121.9188375	Santa Clara County
198016	Fee-for-Service	1700294972	1700294972	1	1	BROOKDALE HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	2919 FRUITVALE AVE	None	OAKLAND	CA	94602	2108	01	06001	37.79351912	-122.2188931	Alameda County
198032	Fee-for-Service	1982956843	1982956843	1	1	BANH, ANDREW	4/8/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DR	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
198038	Fee-for-Service	1033188149	1033188149	1	1	BONNER, LORRAINE MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	37622	01	General Practice	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
198055	Fee-for-Service	1922070283	1922070283	1	1	BRIGGSMORE KIDNEY CENTER	9/4/2002	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	2200 PLAZA PKWY	SUITES B1-B4	MODESTO	CA	95350	6222	50	06099	37.67159122	-121.0338871	Stanislaus County
198064	Fee-for-Service	1033352414	1033352414	1	1	BENGGON, MICHAEL A MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113307	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
198082	Fee-for-Service	1821482217	1821482217	1	1	BEST CARE LLC	12/11/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8705 GREAT COURT	None	ELK GROVE	CA	95624	1873	34	06067	38.416095	-121.3803855	Sacramento County
198096	Fee-for-Service	1508260340	1508260340	1	1	BONAPARTE, PATRICK MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147804	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
198121	Fee-for-Service	1760936884	1760936884	1	1	BEVERLYCARE	4/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	101 E BEVERLY BLVD	SUITE 303	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
198143	Fee-for-Service	1497016315	1497016315	1	2	BATOU, AUGEN B DO	11/9/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	16549	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
198148	Fee-for-Service	1720253719	1720253719	2	1	BENEDITH, PETER C MD	6/2/2023	207R00000X	NA	Other	026	PHYSICIANS	140700	None	None	0	In state provider	NE AND URGENT CARE	580 CALIFORNIA ST	12 FLOOR	SAN FRANCISCO	CA	94104	1000	38	06075	37.79274908	-122.404103	San Francisco County
198158	Fee-for-Service	1407852098	1407852098	1	1	BECKER, SUZANNE K MD	7/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84157	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
198201	Fee-for-Service	1700381647	1700381647	1	1	BECK, TIM N MD	11/18/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	3838 SAN DIMAS ST	STE A 100	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
198220	Fee-for-Service	1578820544	1578820544	1	1	BERNARDO, NAPOLEON T JR MD	10/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122881	41	Internal Medicine	0	In state provider	None	3 MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
198264	Fee-for-Service	1770726754	1770726754	1	1	BOSTANJIAN, DAVID MD INC	11/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97613	08	Family Practice	0	In state provider	None	501 W GLENOAKS BLVD	STE 14	GLENDALE	CA	91202	4047	19	06037	34.15965514	-118.2645161	Los Angeles County
198265	Fee-for-Service	1487271243	1487271243	1	1	BOWIN, DAVID E OD	8/4/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 E STOWELL RD	None	SANTA MARIA	CA	93454	7001	42	06083	34.93834649	-120.422502	Santa Barbara County
198267	Fee-for-Service	1104809110	1104809110	1	1	BORGES, GABRIEL S DO	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	7049	-	NOT APPLICABLE	0	In state provider	None	4825 J STREET	SUITE 120	SACRAMENTO	CA	95819	3747	34	06067	38.567169	-121.4428995	Sacramento County
198274	Fee-for-Service	1972919801	1972919801	1	1	BAIG, AYESHA MD	9/18/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	169830	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
198295	Fee-for-Service	1235108929	1235108929	1	1	BARMANDA,ADAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE BONE JOINT CLINIC	501 N GRAHAM SR	STE # 200	PORTLAND	OR	97227	0000	00	None	45.54285348	-122.671035	Multnomah County
198325	Fee-for-Service	1033188149	1033188149	1	1	BONNER, LORRAINE MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	37622	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
198338	Fee-for-Service	1417393307	1417393307	1	1	BRAR, SIMERJEET K MD	8/3/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144765	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
198356	Fee-for-Service	1326787565	1326787565	1	1	BECK, TAYLOR M AU	12/30/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
198360	Fee-for-Service	1144791500	1144791500	1	1	BEVERLY COMMUNITY CLINIC	11/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FQHC CLINIC	2252 BEVERLY BLVD	STE 103	LOS ANGELES	CA	90057	2225	19	06037	34.06771646	-118.2728448	Los Angeles County
198362	Fee-for-Service	1215937859	1215937859	1	1	BUI, TAM M MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	59804	04	Otology, Laryngology, Rhinology	0	In state provider	None	11180 WARNER AVE	STE 459	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
198383	Fee-for-Service	1598020968	1598020968	1	1	BARGER, MELISSA L MD	10/4/2017	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	131643	77	Infectious Disease	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
198392	Fee-for-Service	1861794489	1861794489	1	1	BLACHMAN, JORDANA L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71772	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
198394	Fee-for-Service	1861547945	1861547945	1	1	BAKER,WILLIAM MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU STREET	None	HONOLULU	HI	96838	0019	00	None	21.30030321	-157.8342762	Honolulu County
198407	Fee-for-Service	1760936884	1760936884	1	1	BEVERLYCARE	4/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	101 E BEVERLY BLVD	SUITE 303	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
198418	Fee-for-Service	1114099934	1114099934	1	1	BASIT, FAUZIA R MD	3/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53145	08	Family Practice	0	In state provider	None	1333 DORIS AVE	None	OXNARD	CA	93030	4409	56	06111	34.20805748	-119.1929805	Ventura County
198467	Fee-for-Service	1184785586	1184785586	1	1	BERMANN, ARLENE R LCSW	7/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
198480	Fee-for-Service	1356375810	1356375810	1	1	BRITTEN, CAROLYN D MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73704	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
198509	Fee-for-Service	1730611658	1730611658	1	1	BOUCEKKINE, HOUDA MD	3/18/2021	208M00000X	NA	Other	026	PHYSICIANS	163219	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
198520	Fee-for-Service	1679766091	1679766091	1	1	BOYD, PAWEL P PHD	5/15/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
198528	Fee-for-Service	1942456165	1942456165	1	1	BURKE, PATRICK B MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132773	41	Internal Medicine	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
198530	Fee-for-Service	1801944780	1801944780	1	1	BOGANEY, RAE F MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84385	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
198534	Fee-for-Service	1689761157	1689761157	1	1	BISHAI, BAHGAT S M MD	12/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	34282	34	Urology and Urological Surgery	0	In state provider	None	112 N MADISON AVE	None	PASADENA	CA	91101	1710	19	06037	34.147926	-118.1383915	Los Angeles County
198549	Fee-for-Service	1134119308	1134119308	1	2	BAUTISTA RURAL MED CLIN	6/30/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43293	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
198554	Fee-for-Service	1487412912	1487412912	1	1	BAYAMDZHYAN, SUSAN NP	2/20/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17559 CHATSWORTH ST	None	GRANADA HILLS	CA	91344	5720	19	06037	34.26489548	-118.517301	Los Angeles County
198563	Fee-for-Service	1477373835	1477373835	1	1	BISBEE, SOFIA M	11/1/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
198572	Fee-for-Service	1124318167	1124318167	1	1	BUI, DIEM K MD	5/25/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	156155	18	Ophthalmology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
198592	Fee-for-Service	1215089180	1215089180	1	1	BISWAS, NAVANEEL MD	9/27/2023	207R00000X	NA	Other	026	PHYSICIANS	125688	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
198618	Fee-for-Service	1457663221	1457663221	1	1	BOESCH, BRANDON J DO	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12048	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
198638	Fee-for-Service	1528033222	1528033222	1	1	BARNETT,FAITH H MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84188	70	Clinic (mixed specialty)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
198650	Fee-for-Service	1144791500	1144791500	1	1	BEVERLY COMMUNITY CLINIC	11/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FQHC CLINIC	2252 BEVERLY BLVD	STE 103	LOS ANGELES	CA	90057	2225	19	06037	34.06771646	-118.2728448	Los Angeles County
198654	Fee-for-Service	1275996142	1275996142	1	1	BLITZER, DAVID MD	9/4/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	186757	None	None	0	In state provider	None	2000 OUTLET CENTER DR	SUITE 225	OXNARD	CA	93036	0607	56	06111	34.220935	-119.1483716	Ventura County
198674	Fee-for-Service	1689975781	1689975781	1	1	BROWN, ALEV A MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	114421	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
198696	Fee-for-Service	1760936884	1760936884	1	1	BEVERLYCARE	4/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	101 E BEVERLY BLVD	SUITE 303	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
198697	Fee-for-Service	1740569334	1740569334	1	1	BURR, HEATHER L	10/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
198699	Fee-for-Service	1720462245	1720462245	1	1	BUCHANAN, ALYSSA D OD	8/14/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36921 COOK ST	STE 104	PALM DESERT	CA	92211	6070	33	06065	33.78003284	-116.3558511	Riverside County
198700	Fee-for-Service	1316936933	1316936933	1	1	BAROUDI, SAM MD	5/22/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67327	41	Internal Medicine	0	In state provider	None	130 CEDAR RD	# 340	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
198704	Fee-for-Service	1871526301	1871526301	1	1	BAHRAMI, POUYA DO	1/16/2023	207R00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1414 S GRAND AVE	STE 100	LOS ANGELES	CA	90015	3067	19	06037	34.03661142	-118.2657227	Los Angeles County
198705	Fee-for-Service	1184068736	1184068736	1	2	BAART BEHAVIORAL HEALTH SERV	7/5/2017	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
198714	Fee-for-Service	1437123312	1437123312	1	2	BALLINGER, KATHARINE A MD	6/20/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	88464	-	NOT APPLICABLE	0	In state provider	None	10 N SAN PEDRO ROAD	SUITE 1015,1018,1019	SAN RAFAEL	CA	94903	4155	21	06041	37.99529182	-122.5300426	Marin County
198721	Fee-for-Service	1912969064	1912969064	1	1	BON SECOURS RICHMOND MEMOR	8/8/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8260 ATLEE RD	None	MECHANICSVLLE	VA	23116	1844	00	None	37.62926537	-77.3880811	Hanover County
198727	Fee-for-Service	1376715417	1376715417	1	1	BERMUDEZ, MARGARITA LCSW	6/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	327 COLLEGE ST	SUITE 105	WOODLAND	CA	95695	3400	57	06113	38.67801116	-121.7746923	Yolo County
198733	Fee-for-Service	1437540564	1437540564	1	1	BARNES, DENA S T LMFT	6/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2201 F STREET	None	BAKERSFIELD	CA	93301	3850	15	06029	35.379342	-119.023506	Kern County
198764	Fee-for-Service	1356375810	1356375810	1	1	BRITTEN, CAROLYN D MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73704	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
198771	Fee-for-Service	1508424698	1508424698	1	1	BELTON, SAMANTHA CCC-SLP	12/14/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
198781	Fee-for-Service	1144238429	1144238429	1	1	BRAZILL, JOHN L MD	2/8/2015	207LP2900X	NA	Other	026	PHYSICIANS	67118	05	Anesthesiology	0	In state provider	None	2323 16TH STREET	SUITE 504	BAKERSFIELD	CA	93301	3454	30	06059	35.37238027	-119.0288508	Kern County
198812	Fee-for-Service	1558366054	1558366054	1	1	BIEGEL, HEIDI A CNM	10/23/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1141 PEAR TREE LN	None	NAPA	CA	94558	6484	28	06055	38.32125908	-122.2921523	Napa County
198816	Fee-for-Service	1942456165	1942456165	1	1	BURKE, PATRICK B MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132773	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
198830	Fee-for-Service	1477938306	1477938306	1	1	BAILEY, JESSICA D	2/8/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
198842	Fee-for-Service	1942510540	1942510540	1	1	BHATIA, RAVI MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122700	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
198861	Fee-for-Service	1508833179	1508833179	1	1	BOORMAN, ERIC M MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
198869	Fee-for-Service	1336444686	1336444686	1	1	BELOVA, ALEKSANDRA N MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133082	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
198885	Fee-for-Service	1336503713	1336503713	1	1	BON, TAO R PT	3/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12402 INDUSTRIAL BLVD	SUITE B2-B5	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
198901	Fee-for-Service	1497311609	1497311609	1	1	BARTZ, KATHERINE S MD	6/22/2023	207L00000X	NA	Other	026	PHYSICIANS	182130	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
198909	Fee-for-Service	1023118049	1023118049	1	1	BROSNAHAN, GODELA M MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
198927	Fee-for-Service	1154424158	1154424158	1	1	BALESTRERI, LAURA E MD	4/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86928	40	Pediatrics	0	In state provider	None	20126 STANTON AVE	STE 200	CASTRO VALLEY	CA	94546	5270	01	06001	37.69722866	-122.090936	Alameda County
198959	Fee-for-Service	1679649024	1679649024	1	1	BRENNER, DAVID	7/1/1985	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54658	10	Gastroenterology (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
198973	Fee-for-Service	1811239577	1811239577	1	1	BUENO, ROSE MARY PSYD	3/24/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
198977	Fee-for-Service	1164678223	1164678223	1	1	BAY IMAGING CONSULTANTS	6/13/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	5730 TELEGRAPH AVE	None	OAKLAND	CA	94609	1710	01	06001	37.84360608	-122.2614314	Alameda County
198996	Fee-for-Service	1497970586	1497970586	1	1	BROWN, CLAIRE E MD	4/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145213	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
199005	Fee-for-Service	1922175785	1922175785	1	1	BUTTERFIELD, BRIAN E OD	9/12/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 CALIFORNIA ST	None	REDLANDS	CA	92374	2910	36	06071	34.07159807	-117.2263378	San Bernardino County
199013	Fee-for-Service	1093998122	1093998122	1	2	BEVERLY RADIOLOGY MED GR	12/26/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	630 S RAYMOND AVE	SUITE 210	PASADENA	CA	91105	3206	19	06037	34.13505223	-118.1487761	Los Angeles County
199021	Fee-for-Service	1518099894	1518099894	1	1	BOWEN, ELLEN L LCSW	12/5/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	421 HUMBOLDT ST	None	SANTA ROSA	CA	95404	4214	49	06097	38.442276	-122.7136725	Sonoma County
199024	Fee-for-Service	1831159490	1831159490	1	1	BAILEY, SCOTT D MD	7/6/2021	207P00000X	NA	Other	026	PHYSICIANS	77725	None	None	0	In state provider	None	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
199035	Fee-for-Service	1205136272	1205136272	1	1	BERRY, SHARON P PHD	1/21/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
199055	Fee-for-Service	1871720524	1871720524	1	1	BRIAN DRIVER	1/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
199114	Fee-for-Service	1184678245	1184678245	1	1	BENITEZ, GILBERT PA	9/25/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11396	-	NOT APPLICABLE	0	In state provider	None	942 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	4004	19	06037	34.01922246	-118.1576303	Los Angeles County
199133	Fee-for-Service	1336793454	1336793454	1	1	BIRD, CHRISTOPHER	3/4/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
199138	Fee-for-Service	1912448358	1912448358	1	2	BAGHDASARYAN, PATRICK A MD	10/11/2021	208M00000X	NA	Other	026	PHYSICIANS	163370	None	None	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
199142	Fee-for-Service	1104904754	1104904754	1	1	BRADLEY, DAVID M MD	8/14/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72225	20	Orthopedic Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
199163	Fee-for-Service	1629336128	1629336128	1	1	BRADFORD, BENJAMIN D MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126409	02	General Surgery	0	In state provider	None	11370 ANDERSON STREET	SUITE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
199175	Fee-for-Service	1770633661	1770633661	1	1	BERMAN, REBECCA A	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156782	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
199180	Fee-for-Service	1831283597	1831283597	1	1	BUCKLEY, THERESA M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67936	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
199223	Fee-for-Service	1639683998	1639683998	1	1	BUONGIORNO, AMANDA M LCSW	7/26/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 E OLIVE AVE	STE 400	BURBANK	CA	91502	1214	19	06037	34.18145335	-118.3081834	Los Angeles County
199231	Fee-for-Service	1497846364	1497846364	1	1	BRYANT-SMITH,GWENDOLYN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 MARSHALL STREET	SLOT 653	LITTLE ROCK	AR	72202	3510	00	None	34.74346583	-92.29154425	Pulaski County
199251	Fee-for-Service	1336472620	1336472620	1	2	BUSI, YURI MD INC	11/7/2007	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40872	41	Internal Medicine	0	In state provider	None	1030 S GLENDALE AVE	STE 302	GLENDALE	CA	91205	5612	19	06037	34.13381535	-118.2519184	Los Angeles County
199281	Fee-for-Service	1497970586	1497970586	1	1	BROWN, CLAIRE E MD	4/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145213	77	Infectious Disease	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
199297	Fee-for-Service	1649848581	1649848581	1	1	BURKEY FONG, LEIGH A OT	12/1/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 GATE 5 RD	None	SAUSALITO	CA	94965	2805	21	06041	37.86963558	-122.5000199	Marin County
199328	Fee-for-Service	1760457659	1760457659	1	1	BANSAL, RADHEY S MD	7/23/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	39293	41	Internal Medicine	0	In state provider	None	432 LEXINGTON ST	STE C	DELANO	CA	93215	3696	15	06029	35.762706	-119.2407725	Kern County
199362	Fee-for-Service	1548265234	1548265234	1	1	BARANSKI, JOEL J MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	67559	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
199430	Fee-for-Service	1104904754	1104904754	1	1	BRADLEY, DAVID M MD	8/14/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72225	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
199433	Fee-for-Service	1861725442	1861725442	1	1	BRADBURY, NANCY C LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
199451	Fee-for-Service	1417908062	1417908062	1	1	BLISS, LEWIS S MD	1/28/2021	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	5773 GREENBACK LANE	None	SACRAMENTO	CA	95841	2013	34	06067	38.682576	-121.3271415	Sacramento County
199482	Fee-for-Service	1821228487	1821228487	1	1	BLEDSOE, IAN O MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116577	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
199493	Fee-for-Service	1255981668	1255981668	1	1	BRADLEY, LISA NP	9/19/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
199494	Fee-for-Service	1669549135	1669549135	1	1	BLEVINS, DEWEY M	1/16/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
199542	Fee-for-Service	1336472620	1336472620	1	2	BUSI, YURI MD INC	11/7/2007	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40872	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1030 S GLENDALE AVE	STE 302	GLENDALE	CA	91205	5612	19	06037	34.13381535	-118.2519184	Los Angeles County
199578	Fee-for-Service	1902080500	1902080500	1	1	BOUVET, SEAN C MD	2/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115777	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
199592	Fee-for-Service	1275131930	1275131930	1	1	BEST LEVEL HOSPICE INC	3/14/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17337 VENTURA BLVD	STE #303	ENCINO	CA	91316	4919	19	06037	34.16102943	-118.5108514	Los Angeles County
199609	Fee-for-Service	1568422657	1568422657	1	1	BLOCH, ROBERT S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3735 EASTON NAZARETH HWY	None	EASTON	PA	18045	8338	00	None	40.71156733	-75.28176561	Northampton County
199616	Fee-for-Service	1760457659	1760457659	1	1	BANSAL, RADHEY S MD	7/23/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	39293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	432 LEXINGTON ST	STE C	DELANO	CA	93215	3696	15	06029	35.762706	-119.2407725	Kern County
199650	Fee-for-Service	1548265234	1548265234	1	1	BARANSKI, JOEL J MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	67559	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
199653	Fee-for-Service	1508901133	1508901133	2	1	BESTCARE PHARMACY INC	4/28/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5317 BEACH	None	BUENA PARK	CA	90621	1231	30	06059	33.882894	-117.9969709	Orange County
199664	Fee-for-Service	1770685968	1770685968	1	1	BOUTROS, RAJA MD INC	4/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	25485 MEDICAL CENTER DR	STE 208	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
199714	Fee-for-Service	1033379268	1033379268	1	1	BLODGET, EMILY MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104323	77	Infectious Disease	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06287152	-118.2029433	Los Angeles County
199721	Fee-for-Service	1295095271	1295095271	1	1	BUSCH, JEREMY A DPM	3/28/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	16850 BEAR VALLEY ROAD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
199732	Fee-for-Service	1720068067	1720068067	1	1	BRAYLEY, KERRY J D MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	82277	01	General Practice	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
199738	Fee-for-Service	1417908062	1417908062	1	1	BLISS, LEWIS S MD	3/17/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42178	None	None	0	In state provider	GROUP	5773 GREENBACK LANE	None	SACRAMENTO	CA	95841	2013	34	06067	38.682576	-121.3271415	Sacramento County
199753	Fee-for-Service	1568488518	1568488518	1	1	BENCOMO, CHRISTOPHER MD	2/3/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60404	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
199756	Fee-for-Service	1669484549	1669484549	1	1	BROOKER, GEORGE A DO	7/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8435	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
199780	Fee-for-Service	1730435025	1730435025	1	1	BUTLER, BRENT M	5/18/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9280 W STOCKTON BLVD	SUITE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
199801	Fee-for-Service	1780830646	1780830646	1	1	BROWN, CASEY L MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97678	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
199807	Fee-for-Service	1801103114	1801103114	1	1	BOJALIAN, OSHIN MD	4/15/2013	207N00000X	NA	Dermatology	026	PHYSICIANS	25620	None	None	0	In state provider	None	633 N CENTRAL AVE	STE 310	GLENDALE	CA	91203	1821	19	06037	34.155054	-118.2579675	Los Angeles County
199851	Fee-for-Service	1750814554	1750814554	1	1	BOSCH, LIAM MD	3/12/2025	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	156923	20	Orthopedic Surgery	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
199854	Fee-for-Service	1205557071	1205557071	1	1	BERGAL, SHANA PT	12/9/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
199878	Fee-for-Service	1275131930	1275131930	1	1	BEST LEVEL HOSPICE INC	3/14/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17337 VENTURA BLVD	STE #303	ENCINO	CA	91316	4919	19	06037	34.16102943	-118.5108514	Los Angeles County
199929	Fee-for-Service	1780779371	1780779371	1	1	BETANCOURT, NELHS MD	12/16/2019	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	71771	41	Internal Medicine	0	In state provider	None	2362 MORSE AVE	None	IRVINE	CA	92614	6234	30	06059	33.68212476	-117.8489973	Orange County
199947	Fee-for-Service	1396276754	1396276754	1	1	BEHDIN, MORVARID DO	10/19/2020	207R00000X	NA	Other	026	PHYSICIANS	16865	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
199966	Fee-for-Service	1538525225	1538525225	1	1	BELMUSTAKOV, STEPHEN MD	9/11/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
199985	Fee-for-Service	1487219044	1487219044	1	1	BARNETT, MELANIE K LMFT	7/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ND CONSULTING	1433 11TH ST	STE I	ARCATA	CA	95521	5712	12	06023	40.87202203	-124.0927329	Humboldt County
200002	Fee-for-Service	1033379268	1033379268	1	1	BLODGET, EMILY MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104323	41	Internal Medicine	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06287152	-118.2029433	Los Angeles County
200022	Fee-for-Service	1235140559	1235140559	1	1	BURNY, ILYAS MD	3/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53612	40	Pediatrics	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
200030	Fee-for-Service	1679008650	1679008650	1	1	BURTON, LINDSAY M MD	8/3/2023	390200000X	NA	Other	026	PHYSICIANS	181823	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
200045	Fee-for-Service	1528407780	1528407780	1	1	BACH, DANIEL Q MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
200059	Fee-for-Service	1760687560	1760687560	1	1	BRENT, DALE J MD AMC	3/13/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	STE 411	SHERMAN OAKS	CA	91403	1824	19	06037	34.160805	-118.4487295	Los Angeles County
200085	Fee-for-Service	1578990230	1578990230	1	1	BARNARD, MARGARET NP	8/1/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
200124	Fee-for-Service	1396330676	1396330676	1	1	BEHMANESH, KIAN DO	3/24/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22398	08	Family Practice	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
200134	Fee-for-Service	1720132343	1720132343	1	1	BRANNAN, M D CRNA	2/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
200166	Fee-for-Service	1568687424	1568687424	1	1	BHATIA, PERMINDER J MD	7/31/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61797	06	Cardiovascular Disease (M.D. only)	0	In state provider	NEURO PAIN MEDICAL CENTR	736 E BULLARD AVE	STE 101	FRESNO	CA	93710	5473	10	06019	36.82313353	-119.7736695	Fresno County
200190	Fee-for-Service	1306807862	1306807862	1	1	BERN, SAMUEL A MD	8/31/1992	208200000X	NA	General Surgery	026	PHYSICIANS	60603	24	Plastic Surgery	0	In state provider	None	1280 S VICTORIA AVE	STE 201	VENTURA	CA	93003	6551	56	06111	34.26344767	-119.2119344	Ventura County
200192	Fee-for-Service	1669897658	1669897658	1	1	BC CAB INC	11/5/2018	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1922 NAOMI WAY	None	SACRAMENTO	CA	95815	1938	34	06067	38.621349	-121.420692	Sacramento County
200217	Fee-for-Service	1447782693	1447782693	1	1	BONILLA, KELSEY MD	7/20/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	186284	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
200219	Fee-for-Service	1114169810	1114169810	1	1	BERMUDEZ WAGNER, KARLA M MD	2/11/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	108445	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
200227	Fee-for-Service	1518046655	1518046655	1	1	BRENNAN, INGRID K MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67040	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
200256	Fee-for-Service	1164778858	1164778858	1	1	BERMUDEZ, CATHERINE B PT	10/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
200265	Fee-for-Service	1700953643	1700953643	1	1	BUCHANAN, WILLIAM J MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	53002	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
200270	Fee-for-Service	1366589640	1366589640	1	1	BIFFL, SUSAN E MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151768	25	Physical Medicine and Rehabilitation	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
200276	Fee-for-Service	1538275938	1538275938	1	1	BESHAY, MAGUED F MD	1/31/1990	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	45609	41	Internal Medicine	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
200284	Fee-for-Service	1023016524	1023016524	1	1	BUTI, REBECCA L NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
200303	Fee-for-Service	1104269224	1104269224	1	1	BRAICH, KARENDIP K MD	11/17/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	153780	45	Nephrology (Renal-Kidney)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
200310	Fee-for-Service	1235140559	1235140559	1	1	BURNY, ILYAS MD	3/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53612	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
200314	Fee-for-Service	1184954455	1184954455	1	1	BAKER, JON L MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	64312	08	Family Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
200334	Fee-for-Service	1467511030	1467511030	1	1	BATTERSBY, GERALD A MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30169	68	Hematology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
200346	Fee-for-Service	1275697658	1275697658	1	1	BLC GLENWOOD GARDENS SNF LH	8/31/2006	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	350 CALLOWAY DR	BLDG C	BAKERSFIELD	CA	93312	2974	15	06029	35.360793	-119.115932	Kern County
200350	Fee-for-Service	1720583032	1720583032	1	1	BI, MICHAEL W MD	8/3/2022	390200000X	NA	Other	026	PHYSICIANS	173827	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
200427	Fee-for-Service	1669840369	1669840369	1	1	BROWN, PILAR E LCSW	12/3/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	335 E AVENUE I	RM 2D15, 2D16, CONF. RM.	LANCASTER	CA	93535	1916	19	06037	34.7041113	-118.1247548	Los Angeles County
200454	Fee-for-Service	1699890533	1699890533	1	1	BLAKELEY, MATTHEW P	3/2/2020	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
200455	Fee-for-Service	1568687424	1568687424	1	1	BHATIA, PERMINDER J MD	7/31/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61797	66	Emergency Medicine (Urgent Care)	0	In state provider	NEURO PAIN MEDICAL CENTR	736 E BULLARD AVE	STE 101	FRESNO	CA	93710	5473	10	06019	36.82313353	-119.7736695	Fresno County
200489	Fee-for-Service	1487929972	1487929972	1	1	BALOGUN, RAHMAT A DO	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14037	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
200508	Fee-for-Service	1922421288	1922421288	1	1	BROMAN, GRETCHEN L CNP	11/19/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16773 BERNARDO CENTER DR	None	SAN DIEGO	CA	92128	2525	37	06073	33.01874412	-117.0752752	San Diego County
200522	Fee-for-Service	1578299889	1578299889	1	1	BADALYAN, TEREZA	8/17/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
200538	Fee-for-Service	1487632865	1487632865	1	1	BETHEL, DENNIS W MD	3/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70522	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
200556	Fee-for-Service	1700953643	1700953643	1	1	BUCHANAN, WILLIAM J MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	53002	20	Orthopedic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
200557	Fee-for-Service	1114058930	1114058930	1	1	BURT, RANDY R OD INC	1/31/1987	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GLENDORA OPTOMETRIC	852 S GRAND AVE	None	GLENDORA	CA	91740	4806	19	06037	34.12313508	-117.8725303	Los Angeles County
200611	Fee-for-Service	1194854927	1194854927	1	2	BAILEY, SHELLI S LMFT	6/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 NORTH ORANGE STREET	SUITE E	REDLANDS	CA	92374	3208	36	06071	34.060518	-117.1825535	San Bernardino County
200632	Fee-for-Service	1467511030	1467511030	1	1	BATTERSBY, GERALD A MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30169	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
200650	Fee-for-Service	1518115476	1518115476	1	1	BOKHARI, AQIBA MD	6/26/2020	207ZP0101X	NA	Other	026	PHYSICIANS	106123	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
200659	Fee-for-Service	1144302126	1144302126	1	1	BISHOP, BARBARA M MD	2/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	29985	08	Family Practice	0	In state provider	None	142 BONVIEW ST	None	SAN FRANCISCO	CA	94110	5147	38	06075	37.74204242	-122.4174941	San Francisco County
200720	Fee-for-Service	1740408707	1740408707	1	1	BANE, GINA MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	130157	05	Anesthesiology	0	In state provider	None	2450 ASHBY AVENUE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
200724	Fee-for-Service	1851379796	1851379796	1	1	BONALDI, LAWRENCE P	1/11/2011	174400000X	NA	Other	026	PHYSICIANS	34176	41	Internal Medicine	0	In state provider	None	1331 CAMDEN AVENUE	None	CAMPBELL	CA	95008	6701	43	06085	37.26916632	-121.9450299	Santa Clara County
200748	Fee-for-Service	1821594318	1821594318	1	1	BENDER, EMILY A MD	7/26/2024	208M00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
200759	Fee-for-Service	1821074196	1821074196	1	1	BOULDER COMMUNITY HOSP	7/1/1997	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1100 BALSAM AVE	None	BOULDER	CO	80304	3404	00	None	40.02670649	-105.2833275	Boulder County
200782	Fee-for-Service	1952548182	1952548182	1	1	BROWN, TIMOTHY A PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
200807	Fee-for-Service	1801017769	1801017769	2	1	BURKE, KRISTINE MD	12/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79569	08	Family Practice	0	In state provider	None	2390 E BIDWELL STREET	SUITE 100	FOLSOM	CA	95630	3873	34	06067	38.664882	-121.1381055	Sacramento County
200817	Fee-for-Service	1508093725	1508093725	1	1	BLANCO, GRACIELA D LMFT	8/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6089 N 1ST ST	104	FRESNO	CA	93710	5464	10	06019	36.82574354	-119.7724848	Fresno County
200826	Fee-for-Service	1215362298	1215362298	1	1	BANSI CORPORATION	12/10/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1657 E 6TH ST	None	BEAUMONT	CA	92223	5765	33	06065	33.9292497	-116.9501334	Riverside County
200856	Fee-for-Service	1568566008	1568566008	1	1	BUCKLEY, KEVIN D MD	2/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87482	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
200911	Fee-for-Service	1467511030	1467511030	1	1	BATTERSBY, GERALD A MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30169	78	Neoplastic Diseases/Oncology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
200930	Fee-for-Service	1073925467	1073925467	1	1	BRANDT, KENNETH G DO	7/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
200936	Fee-for-Service	1407971427	1407971427	1	1	BRIX, RONALD D MD	3/1/1999	207P00000X	NA	Other	026	PHYSICIANS	47024	02	General Surgery	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
200948	Fee-for-Service	1144302126	1144302126	1	1	BISHOP, BARBARA M MD	2/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	29985	41	Internal Medicine	0	In state provider	None	142 BONVIEW ST	None	SAN FRANCISCO	CA	94110	5147	38	06075	37.74204242	-122.4174941	San Francisco County
200992	Fee-for-Service	1023299070	1023299070	1	1	BREBES MENSAH, NAOMI LAC	2/20/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NESS SPA	672 HIGUERA ST	100	SAN LUIS OBISPO	CA	93401	3545	40	06079	35.27858839	-120.6650563	San Luis Obispo County
201025	Fee-for-Service	1225101256	1225101256	1	1	BALDWIN, ANDREW J MD	6/20/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153200	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
201044	Fee-for-Service	1548467962	1548467962	1	1	BACK, NICHOLAS N MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105946	05	Anesthesiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
201046	Fee-for-Service	1821074196	1821074196	1	1	BOULDER COMMUNITY HOSP	7/1/1997	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1100 BALSAM AVE	None	BOULDER	CO	80304	3404	00	None	40.02670649	-105.2833275	Boulder County
201053	Fee-for-Service	1396066619	1396066619	1	1	BLAU, JONATHAN M MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141061	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
201062	Fee-for-Service	1609175173	1609175173	1	1	BARHOUM, DINO N MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129880	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
201066	Fee-for-Service	1699783233	1699783233	1	1	BUTERA, DONALD J MD	11/30/1983	207P00000X	NA	Other	026	PHYSICIANS	42097	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1210 ROYAL OAKS DR	None	DUARTE	CA	91010	1771	19	06037	34.14321596	-117.9788088	Los Angeles County
201070	Fee-for-Service	1982257390	1982257390	1	1	BENSON, SARA J NP	12/16/2021	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
201073	Fee-for-Service	1336566603	1336566603	1	1	BURKE, COLIN T MD	6/17/2020	390200000X	NA	Other	026	PHYSICIANS	138588	30	Radiology	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
201085	Fee-for-Service	1184819237	1184819237	1	1	BERCOVITCH, ROBERT S MD	8/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102916	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
201102	Fee-for-Service	1215431168	1215431168	1	1	BARMAN, NAMAN MD	9/23/2021	207R00000X	NA	Other	026	PHYSICIANS	174838	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
201117	Fee-for-Service	1902950405	1902950405	1	1	BOXRUD, CYNTHIA A MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50569	18	Ophthalmology	0	In state provider	None	2232 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2312	19	06037	34.0306404	-118.4775425	Los Angeles County
201120	Fee-for-Service	1972800837	1972800837	1	1	BELTHUR, MOHAN V MD	6/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
201158	Fee-for-Service	1346275575	1346275575	1	1	BROWN, ROBERT L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50186	36	Psychiatry	0	In state provider	None	1400 EMELINE AVE	FL 2	SANTA CRUZ	CA	95060	1976	44	06087	36.99276804	-122.0178271	Santa Cruz County
201177	Fee-for-Service	1306234778	1306234778	1	1	BEYOND SPEECH THERAPY INC	10/5/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6965 SAN LUIS AVE	None	ATASCADERO	CA	93422	5201	40	06079	35.48021573	-120.6597811	San Luis Obispo County
201221	Fee-for-Service	1407971427	1407971427	1	1	BRIX, RONALD D MD	3/1/1999	207P00000X	NA	Other	026	PHYSICIANS	47024	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
201245	Fee-for-Service	1205249398	1205249398	1	1	BILLINGS, TARA L DO MD	5/19/2018	390200000X	NA	Other	026	PHYSICIANS	14620	40	Pediatrics	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
201251	Fee-for-Service	1669940003	1669940003	1	2	BUENA MEDICAL GROUP	5/4/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	905 S A ST	STE 1	OXNARD	CA	93030	9252	56	06111	34.19225229	-119.178671	Ventura County
201267	Fee-for-Service	1356508733	1356508733	1	1	BELL, JAYSON P MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126315	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
201269	Fee-for-Service	1932215944	1932215944	1	1	BULATOV, MARINA V MD	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67737	25	Physical Medicine and Rehabilitation	0	In state provider	None	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
201274	Fee-for-Service	1346333440	1346333440	2	1	BURSTEIN, MARINA MD	12/8/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53604	01	General Practice	0	In state provider	None	24013 VENTURA BLVD	STE 101	CALABASAS	CA	91302	1094	19	06037	34.15456072	-118.6518547	Los Angeles County
201294	Fee-for-Service	1093244964	1093244964	1	1	BURKS, JOSHUA D MD	7/21/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
201339	Fee-for-Service	1144612532	1144612532	1	1	BURPEE, JESSICA E LCSW	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	75518	-	NOT APPLICABLE	0	In state provider	None	1200 N MAIN ST	STE 100B, 301, 500	SANTA ANA	CA	92701	3630	30	06059	33.755175	-117.8676195	Orange County
201342	Fee-for-Service	1932263860	1932263860	1	1	BARAN, JOAN M PHD	6/1/1999	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
201343	Fee-for-Service	1083709653	1083709653	1	1	BHC HERITAGE OAKS HOSP	12/1/1996	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	34	06067	38.642832	-121.3649325	Sacramento County
201344	Fee-for-Service	1134396070	1134396070	1	1	BRODESKE, LAURA F PHD	10/29/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2030 E 4TH ST	SUITE 140	SANTA ANA	CA	92705	3940	30	06059	33.74808045	-117.8378273	Orange County
201354	Fee-for-Service	1790915262	1790915262	1	1	BENTON, DAVID A DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11118	25	Physical Medicine and Rehabilitation	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
201366	Fee-for-Service	1245399864	1245399864	1	1	BONDESSON, JEFFERY D MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45718	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
201421	Fee-for-Service	1346236106	1346236106	1	1	BRETHREN HILLCREST HOMES	12/15/1970	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WOODS HEALTH SERVICES	2600 A ST	None	LA VERNE	CA	91750	4303	19	06037	34.10484014	-117.77507	Los Angeles County
201423	Fee-for-Service	1073546404	1073546404	1	1	BONDS, CURLEY L II MD	3/23/1994	2084P0800X	NA	Psychiatry	026	PHYSICIANS	78535	36	Psychiatry	0	In state provider	None	337 E FOOTHILL BLVD	None	POMONA	CA	91767	1405	19	06037	34.10730764	-117.7426794	Los Angeles County
201431	Fee-for-Service	1255628780	1255628780	1	1	BERG, JENNIFER A PSYD	10/11/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
201463	Fee-for-Service	1255461133	1255461133	1	1	BROWN, ROSCHE PHD	7/3/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
201506	Fee-for-Service	1467938332	1467938332	1	1	BANES, KELSEY E	12/22/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
201530	Fee-for-Service	1528425816	1528425816	1	1	BARTE, KARLO D G	3/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
201541	Fee-for-Service	1720366230	1720366230	1	1	BONILLA, CRISTINA LCSW	2/27/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8001 VENTURA CANYON AVE	#MOB 51	PANORAMA CITY	CA	91402	6312	19	06037	34.21619623	-118.4287605	Los Angeles County
201543	Fee-for-Service	1760518914	1760518914	1	1	BROWN, JULIE A LCSW	10/14/2011	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4452 PARK BLVD	SUITE 205	SAN DIEGO	CA	92116	4039	37	06073	32.758281	-117.1462795	San Diego County
201560	Fee-for-Service	1346333440	1346333440	2	1	BURSTEIN, MARINA MD	12/8/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53604	40	Pediatrics	0	In state provider	None	24013 VENTURA BLVD	STE 101	CALABASAS	CA	91302	1094	19	06037	34.15456072	-118.6518547	Los Angeles County
201568	Fee-for-Service	1417112939	1417112939	1	1	BERMAN, BRETT J MD	2/23/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78854	06	Cardiovascular Disease (M.D. only)	0	In state provider	PROFESSIONAL CORPORATION	321 E ST	STE A	CHULA VISTA	CA	91910	2667	37	06073	32.64457385	-117.0820661	San Diego County
201592	Fee-for-Service	1255587788	1255587788	1	1	BESSER, LORA A LCSW	2/22/2021	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
201595	Fee-for-Service	1619068277	1619068277	1	1	BAUMAN, NORA S DC	3/29/1984	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	12926 RIVERSIDE DR	STE A	SHERMAN OAKS	CA	91423	2292	19	06037	34.15760253	-118.414539	Los Angeles County
201627	Fee-for-Service	1255441044	1255441044	1	1	BANSAL, RADHEY S MD INC	2/1/2000	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	COMPREHN MED GRP OF KERN	1230 JEFFERSON ST	None	DELANO	CA	93215	2204	15	06029	35.77274103	-119.2450573	Kern County
201632	Fee-for-Service	1083709653	1083709653	1	1	BHC HERITAGE OAKS HOSP	12/1/1996	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	34	06067	38.642832	-121.3649325	Sacramento County
201645	Fee-for-Service	1356703995	1356703995	1	1	BHATTACHARYYA, SARATHI MD	10/14/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	151469	None	None	0	In state provider	None	3828 SCHAUFELE AVENUE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
201649	Fee-for-Service	1477633550	1477633550	1	1	BHATIA, NITIN N MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71581	20	Orthopedic Surgery	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
201662	Fee-for-Service	1982921292	1982921292	1	1	BRAXTON, DAVID R MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137362	22	Pathology (M.D. only)	0	In state provider	None	ONE HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
201671	Fee-for-Service	1609142082	1609142082	1	1	BOZORGFAR, PANTEA LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
201730	Fee-for-Service	1194848812	1194848812	1	1	BEMIS, SUSAN M PT	10/26/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27107 TOURNEY RD	None	SANTA CLARITA	CA	91355	1860	19	06037	34.41607441	-118.5761057	Los Angeles County
201742	Fee-for-Service	1952718819	1952718819	1	1	BUI, YEN H OD	9/1/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
201756	Fee-for-Service	1922089614	1922089614	1	1	BANSAL, RINA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3300 GALLOWS RD	None	FALLS CHURCH	VA	22042	3307	00	None	38.858193	-77.226426	City of Fairfax
201784	Fee-for-Service	1396857769	1396857769	1	1	BESTARD, EDWARD H MD	11/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	50298	20	Orthopedic Surgery	0	In state provider	STE 102	653 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2808	30	06059	33.45767098	-117.6495718	Orange County
201805	Fee-for-Service	1417543539	1417543539	1	1	BEATUS HOSPICE CARE INC	11/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	SUITE 2A	NORTH HOLLYWOOD	CA	91601	2354	19	06037	34.17212154	-118.3819905	Los Angeles County
201831	Fee-for-Service	1548443229	1548443229	1	1	BARRY, TIMOTHY P LCSW	3/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
201845	Fee-for-Service	1003102856	1003102856	1	1	BAI, JILIN MD	7/29/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	130116	01	General Practice	0	In state provider	None	631 COLORADO ST	STE C	GLENDALE	CA	91205	5318	19	06037	34.14269752	-118.2474	Los Angeles County
201852	Fee-for-Service	1801868898	1801868898	1	1	BRENT J. GEAR, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	515 N MESA DR	None	MESA	AZ	85201	5914	00	None	33.424767	-111.8219445	Maricopa County
201854	Fee-for-Service	1417112939	1417112939	1	1	BERMAN, BRETT J MD	2/23/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78854	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	321 E ST	STE A	CHULA VISTA	CA	91910	2667	37	06073	32.64457385	-117.0820661	San Diego County
201861	Fee-for-Service	1043626898	1043626898	1	1	BAHN, JOSEPH H DPM	1/22/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
201903	Fee-for-Service	1386031870	1386031870	1	1	BEATTIE, GENNA MD	7/26/2023	208600000X	NA	General Surgery	026	PHYSICIANS	148516	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
201910	Fee-for-Service	1487093951	1487093951	1	1	BRERETON, DANIEL S DO	4/16/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13592	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
201920	Fee-for-Service	1083709653	1083709653	1	1	BHC HERITAGE OAKS HOSP	12/1/1996	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	34	06067	38.642832	-121.3649325	Sacramento County
201932	Fee-for-Service	1659566826	1659566826	1	1	BURNS, JOHN W III	5/25/2010	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	24655 MONROE AVE	None	MURRIETA	CA	92562	9587	33	06065	33.56697691	-117.2021843	Riverside County
201961	Fee-for-Service	1124646393	1124646393	1	1	BOWRING, ANN MARIE NP	10/8/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
201990	Fee-for-Service	1700947322	1700947322	1	1	BOYDEN, STEPHANIE N PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
202003	Fee-for-Service	1750755435	1750755435	1	1	BRACAMONTE, MARIA	8/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
202018	Fee-for-Service	1831358977	1831358977	1	1	BHATT, ANAND B MD	4/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115774	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
202031	Fee-for-Service	1588995260	1588995260	1	1	BAGHERI, BRUCE B MD INC	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70830	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1560 E CHEVY CHASE DR	STE 445	GLENDALE	CA	91206	4154	19	06037	34.15290734	-118.2302295	Los Angeles County
202041	Fee-for-Service	1003111386	1003111386	1	1	BERNAL, MARIA LMFT	7/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
202081	Fee-for-Service	1114540614	1114540614	1	1	BOGDAN, NATALIE E CCC-SLP	6/7/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
202090	Fee-for-Service	1124023882	1124023882	1	1	BRANDON ALLARD M.D.	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
202096	Fee-for-Service	1417543539	1417543539	1	1	BEATUS HOSPICE CARE INC	11/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	SUITE 2A	NORTH HOLLYWOOD	CA	91601	2354	19	06037	34.17212154	-118.3819905	Los Angeles County
202107	Fee-for-Service	1568589752	1568589752	1	1	BROCK, DAVID W DO	1/11/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
202140	Fee-for-Service	1780675348	1780675348	1	1	BROWN, JANET L	6/26/2009	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7177 BROCKTON AVENUE	STE 104	RIVERSIDE	CA	92506	2631	33	06065	33.94289496	-117.3943941	Riverside County
202143	Fee-for-Service	1417112939	1417112939	1	1	BERMAN, BRETT J MD	2/23/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78854	42	Nuclear Medicine	0	In state provider	PROFESSIONAL CORPORATION	321 E ST	STE A	CHULA VISTA	CA	91910	2667	37	06073	32.64457385	-117.0820661	San Diego County
202151	Fee-for-Service	1073069183	1073069183	1	1	BUTLER, ERIN M LCSW	5/3/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
202177	Fee-for-Service	1144397084	1144397084	1	1	BRUMLEY, RICHARD D MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	40582	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
202182	Fee-for-Service	1518227164	1518227164	1	1	BLOUNT, SUMMER E MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
202201	Fee-for-Service	1003329095	1003329095	1	1	BANGO, JACQUELINE M	7/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
202223	Fee-for-Service	1720213085	1720213085	1	1	BEST GROUP PHARMACY INC	8/19/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CITRUS PHARMACY	511 AMIGOS DR	SUITE B	REDLANDS	CA	92373	6283	36	06071	34.05995779	-117.2232327	San Bernardino County
202230	Fee-for-Service	1508052960	1508052960	2	1	BERNSTEIN, JONATHAN A MD	2/15/2019	207SG0201X	NA	Other	026	PHYSICIANS	88387	01	General Practice	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
202231	Fee-for-Service	1831661529	1831661529	1	1	BENEVOLENCE INDUSTRIES INC	7/23/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	12610 GLENOAKS BLVD	1ST FLOOR	SYLMAR	CA	91342	4783	19	06037	34.299351	-118.4390254	Los Angeles County
202242	Fee-for-Service	1548447899	1548447899	1	1	BRAHMANDAM, VISHNU S MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102356	13	Neurology (M.D. only)	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
202249	Fee-for-Service	1659933729	1659933729	1	1	BROWN, ASHLEY NP	10/2/2024	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
202292	Fee-for-Service	1629098116	1629098116	1	1	BORODULIN-SMIK, IRINA DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	SMIK CHIROPRACTIC INC	20445 PROSPECT RD	STE 1	SAN JOSE	CA	95129	4663	43	06085	37.29414075	-122.0309684	Santa Clara County
202297	Fee-for-Service	1740658681	1740658681	1	1	BERNAD, DANIEL M MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135078	78	Neoplastic Diseases/Oncology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
202318	Fee-for-Service	1588995260	1588995260	1	1	BAGHERI, BRUCE B MD INC	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70830	41	Internal Medicine	0	In state provider	None	1560 E CHEVY CHASE DR	STE 445	GLENDALE	CA	91206	4154	19	06037	34.15290734	-118.2302295	Los Angeles County
202330	Fee-for-Service	1417982331	1417982331	1	1	BOASBERG, PETER D MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	20643	78	Neoplastic Diseases/Oncology	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
202332	Fee-for-Service	1083713002	1083713002	1	1	BIGONI, BRIAN J MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55249	30	Radiology	0	In state provider	None	17065 CAMINO SAN BERNARD	# 400	SAN DIEGO	CA	92127	5709	37	06073	33.02106138	-117.1014226	San Diego County
202376	Fee-for-Service	1770518250	1770518250	1	1	BECHINI, DENNIS G DD	10/13/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PROFESSIONAL CORPORATION	969 PLUMAS ST	STE 206	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
202390	Fee-for-Service	1437569613	1437569613	1	1	BANSAL, AMY P	9/21/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	167507	None	None	0	In state provider	None	3484 E 1ST ST	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
202413	Fee-for-Service	1457476038	1457476038	1	1	BLACKWATER, NORMA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	83912	01	General Practice	0	In state provider	None	1125 W 6TH ST	STE 103	LOS ANGELES	CA	90017	1896	19	06037	34.05441139	-118.2628642	Los Angeles County
202415	Fee-for-Service	1235408972	1235408972	1	1	BARMAK, SHANT A PSYD	5/11/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
202429	Fee-for-Service	1558675124	1558675124	1	1	BARRAGAN, LAURA E LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	94102	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
202450	Fee-for-Service	1497252423	1497252423	1	1	BRENNSTUHL, LAURA LCSW	12/5/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
202471	Fee-for-Service	1154951358	1154951358	1	1	BUTTON, COURTNEY E LCSW	9/3/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
202481	Fee-for-Service	1942458013	1942458013	1	1	BURRUSS, SIGRID K MD	12/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108486	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
202493	Fee-for-Service	1205100526	1205100526	1	1	BROWN, KIMBERLY M MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123420	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
202502	Fee-for-Service	1720485543	1720485543	1	1	BERIAU, KATHLEEN M	1/5/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 B MISSION INN AVE	None	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
202538	Fee-for-Service	1740524552	1740524552	1	1	BARDOWELL, RICHARD MD INC	1/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41037	None	None	0	In state provider	None	2701 W ALAMEDA AVE	STE 303	BURBANK	CA	91505	4408	19	06037	34.15751343	-118.3303715	Los Angeles County
202568	Fee-for-Service	1699224972	1699224972	1	1	BEYER, COURTNEY E	1/9/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
202586	Fee-for-Service	1164965893	1164965893	1	1	BLODGETT, JAMES R CRNA	5/9/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
202590	Fee-for-Service	1962423889	1962423889	1	3	BI-VALLEY MEDICAL CLINIC, IN	1/3/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
202595	Fee-for-Service	1053925057	1053925057	1	1	BANATHY-SULLIVAN, GABRIELLE	10/1/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	580 MANZANITA AVE	SUITE 5	CHICO	CA	95926	1338	04	06007	39.75502914	-121.8433208	Butte County
202599	Fee-for-Service	1023404027	1023404027	1	1	BEERS, CATHERINE E	7/20/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
202617	Fee-for-Service	1417982331	1417982331	1	1	BOASBERG, PETER D MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	20643	41	Internal Medicine	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
202638	Fee-for-Service	1639294135	1639294135	1	1	BASSERI, ERAJ MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91969	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
202663	Fee-for-Service	1770518250	1770518250	1	1	BECHINI, DENNIS G DD	10/13/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PROFESSIONAL CORPORATION	969 PLUMAS ST	STE 206	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
202693	Fee-for-Service	1952689119	1952689119	1	1	BERGSTROM, JESSICA A	12/19/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
202751	Fee-for-Service	1427153360	1427153360	1	1	BIDERMAN, PHILIP MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	46349	02	General Surgery	0	In state provider	None	13320 RIVERSIDE DR	STE 110	SHERMAN OAKS	CA	91423	2519	19	06037	34.15758348	-118.423233	Los Angeles County
202758	Fee-for-Service	1225021462	1225021462	2	1	BASILIOS, MAGED Z MD	7/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61990	08	Family Practice	0	In state provider	None	4505 E SLAUSON AVE	STE E	MAYWOOD	CA	90270	4955	19	06037	33.98719828	-118.1849335	Los Angeles County
202790	Fee-for-Service	1649503319	1649503319	1	2	BEAVER MEDICAL GROUP LP	2/17/1995	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1690 BARTON RD	STE 104	REDLANDS	CA	92373	4229	36	06071	34.04836346	-117.2125293	San Bernardino County
202797	Fee-for-Service	1871324905	1871324905	1	1	BREMPONG, JOYCE NP	12/23/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	30	06059	33.62609529	-117.7293191	Orange County
202826	Fee-for-Service	1427490184	1427490184	1	1	BUTCHER, CAMERON F LCSW	5/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
202856	Fee-for-Service	1770521734	1770521734	1	1	BIEBUYCK, RICHARD M MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78684	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
202861	Fee-for-Service	1548439664	1548439664	1	1	BARBER, CATHERINE L LMFT	1/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
202869	Fee-for-Service	1184675902	1184675902	1	1	BASSLER, ROBERT C MD	4/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74208	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
202876	Fee-for-Service	1962423889	1962423889	1	3	BI-VALLEY MEDICAL CLINIC, IN	1/3/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
202900	Fee-for-Service	1255827861	1255827861	1	1	BENAVIDES, ROXANA CNP	4/3/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
202924	Fee-for-Service	1639690845	1639690845	1	2	BEHRMANN, LORENA NP	9/1/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
202927	Fee-for-Service	1306483920	1306483920	1	1	BULKLEY, SHANE E LCSW	8/13/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27955 SMYTH DR	STE 101	VALENCIA	CA	91355	4037	19	06037	34.44222724	-118.5700483	Los Angeles County
202929	Fee-for-Service	1891287678	1891287678	1	1	BUCKLE, MICHAEL E PHD	12/7/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
202931	Fee-for-Service	1245573187	1245573187	1	1	BAHK, JASON E MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134278	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
202947	Fee-for-Service	1801189667	1801189667	1	1	BABVANI, LILIAN N MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124506	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	#200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
202966	Fee-for-Service	1396232211	1396232211	1	1	BUTLER, MICHAEL MD	11/18/2021	208M00000X	NA	Other	026	PHYSICIANS	166585	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
202986	Fee-for-Service	1508100629	1508100629	1	1	BAUTISTA, NANCY I LCSW	4/26/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	1818 W. BEVERLY BLVD.	207	MONTEBELLO	CA	90640	3966	19	06037	34.02000009	-118.1188413	Los Angeles County
203040	Fee-for-Service	1245736370	1245736370	1	1	BATTU, MADHULIKA	7/8/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	189686	40	Pediatrics	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
203046	Fee-for-Service	1689046617	1689046617	1	1	BENJAMIN, SHAMIRAN LMFT	8/10/2020	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 N MARKET	STE 950	SAN JOSE	CA	95113	1112	43	06085	37.33791617	-121.8939388	Santa Clara County
203066	Fee-for-Service	1386997310	1386997310	1	1	BARR, KASANDRA F LMFT	5/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41760 IVY STREET	SUITE 204	MURRIETA	CA	92562	0000	33	06065	33.55331844	-117.2081759	Riverside County
203094	Fee-for-Service	1598731291	1598731291	1	1	BLAIR, GREGORY R MD	2/28/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	65481	78	Neoplastic Diseases/Oncology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
203149	Fee-for-Service	1821014085	1821014085	2	1	BOGIKIAN, AZAT MD	9/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	84922	08	Family Practice	0	In state provider	None	247 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2951	19	06037	34.15983348	-118.2585375	Los Angeles County
203169	Fee-for-Service	1053093773	1053093773	1	1	BAILEY, DYLAN PT	9/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	585 SATURN	STE A	SAN DIEGO	CA	92154	4721	37	06073	32.586336	-117.088506	San Diego County
203221	Fee-for-Service	1568533487	1568533487	1	1	BISHIT, ASHA MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89345	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
203227	Fee-for-Service	1801820857	1801820857	1	3	BHARATHI S VAYUVEGULA MD PHD	12/4/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	130 W ROUTE 66	SUITE 212	GLENDORA	CA	91740	6251	19	06037	34.12865951	-117.8651745	Los Angeles County
203233	Fee-for-Service	1447398094	1447398094	1	1	BALLINGER, RENEE L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
203274	Fee-for-Service	1083788178	1083788178	1	1	BASERGA,C MARIANA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
203275	Fee-for-Service	1104921725	1104921725	1	1	BALKIN, PETER W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	STRAUB CLINIC & HOSPITAL	888 S KING ST	None	HONOLULU	HI	96813	3009	00	None	21.30218603	-157.8505732	Honolulu County
203288	Fee-for-Service	1659798973	1659798973	1	1	BABBEL, LEE A DO	11/16/2018	207L00000X	NA	Other	026	PHYSICIANS	16695	05	Anesthesiology	0	In state provider	None	4053 LONE TREE WAY	100	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
203293	Fee-for-Service	1497754931	1497754931	1	1	BENZIAN, JAMES M MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54335	30	Radiology	0	In state provider	None	320 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4311	42	06083	34.42954414	-119.7230551	Santa Barbara County
203319	Fee-for-Service	1295841864	1295841864	1	1	BURROWS, CRAIG M MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	82195	01	General Practice	0	In state provider	None	488 E VALLEY PKWY	STE 314	ESCONDIDO	CA	92025	3376	37	06073	33.12523814	-117.0769715	San Diego County
203327	Fee-for-Service	1467870071	1467870071	1	1	BROWN, KATHRYN LMFT	3/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
203332	Fee-for-Service	1356818728	1356818728	1	1	BROWN, JOELIDA	10/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
203344	Fee-for-Service	1164639662	1164639662	1	1	BADER, RACHEL PSYD	9/26/2022	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
203381	Fee-for-Service	1598731291	1598731291	1	1	BLAIR, GREGORY R MD	2/28/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	65481	68	Hematology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
203395	Fee-for-Service	1700895927	1700895927	1	1	BENNETT MICHAEL T MD INC	10/6/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	37728	01	General Practice	0	In state provider	None	3405 KENYON ST	STE 502	SAN DIEGO	CA	92110	5008	37	06073	32.74866031	-117.2135544	San Diego County
203396	Fee-for-Service	1013413319	1013413319	1	1	BUTLER, APRIL H MD	12/26/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185898	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
203407	Fee-for-Service	1598961435	1598961435	1	1	BENTLE, YVONNE LMFT	9/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
203445	Fee-for-Service	1669621165	1669621165	1	1	BRENES, DANIELLE LCSW	3/26/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
203483	Fee-for-Service	1518024702	1518024702	1	1	BRIEN, EARL W MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	61297	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
203495	Fee-for-Service	1457058521	1457058521	1	1	BELOVED DOULA SERVICES, LLC	2/9/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	55	06109	0	0	None
203512	Fee-for-Service	1801820857	1801820857	1	3	BHARATHI S VAYUVEGULA MD PHD	12/4/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	130 W ROUTE 66	SUITE 212	GLENDORA	CA	91740	6251	19	06037	34.12865951	-117.8651745	Los Angeles County
203519	Fee-for-Service	1235698929	1235698929	1	1	BAILEY, MARY R	6/3/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
203557	Fee-for-Service	1902515273	1902515273	1	1	B811 MEDICAL TRANSPORTATION	11/19/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERVICE	4820 BUSINESS CENTER DR	110	FAIRFIELD	CA	94534	1696	48	06095	38.22055392	-122.1386622	Solano County
203561	Fee-for-Service	1295740173	1295740173	1	1	BALADI, NAOUM A MD	7/27/1987	208G00000X	NA	General Surgery	026	PHYSICIANS	43839	None	None	0	In state provider	None	690 MONTEREY BLVD	None	SAN FRANCISCO	CA	94127	2347	38	06075	37.73157109	-122.4508371	San Francisco County
203579	Fee-for-Service	1629183066	1629183066	1	1	BUCHBINDER, SUSAN PAMELA	1/31/1990	207R00000X	NA	Other	026	PHYSICIANS	59694	01	General Practice	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
203582	Fee-for-Service	1114932571	1114932571	1	1	BALON, GALINA MD	10/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51287	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
203584	Fee-for-Service	1548314339	1548314339	1	1	BROWN, TIMOTHY E	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
203598	Fee-for-Service	1073505327	1073505327	1	1	BORDOFSKY, MICHAEL C MD	2/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	75364	41	Internal Medicine	0	In state provider	None	2320 BATH ST	STE 201	SANTA BARBARA	CA	93105	4344	42	06083	34.43082689	-119.7223032	Santa Barbara County
203650	Fee-for-Service	1750630331	1750630331	1	1	BAKERSFIELD UPRIGHT MRI	1/8/2013	261QM1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	9802 STOCKDALE HWY	SUITE 106A	BAKERSFIELD	CA	93311	3653	15	06029	35.3544067	-119.1113372	Kern County
203666	Fee-for-Service	1700092426	1700092426	1	1	BANSIL, NELSON H DO	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10149	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	SUITE 108	LOMA LINDA	CA	90074	4701	36	06071	34.049547	-117.264078	San Bernardino County
203680	Fee-for-Service	1649346636	1649346636	1	1	BERSTON, EMANUEL D MD	7/22/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81364	40	Pediatrics	0	In state provider	None	1500 SOUTHGATE AVE	STE 104	DALY CITY	CA	94015	2205	41	06081	37.67558248	-122.4750825	San Mateo County
203685	Fee-for-Service	1720040389	1720040389	1	1	BETZ, WILLIAM B MD	4/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	92242	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
203704	Fee-for-Service	1871333989	1871333989	1	1	BUCK, JAMES W PT	9/6/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
203717	Fee-for-Service	1194142562	1194142562	2	1	BUI, CHAU Q DO	12/2/2021	163WG0000X	NA	Other	026	PHYSICIANS	14247	None	None	0	In state provider	None	10301 BOLSA AVE	STE 102	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
203722	Fee-for-Service	1609168277	1609168277	1	1	BANERJEE, CHANDANA MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130950	01	General Practice	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
203725	Fee-for-Service	1205968815	1205968815	1	1	BROWN, LORENZO M D INC	8/17/2011	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	30457	04	Otology, Laryngology, Rhinology	0	In state provider	None	103 S LOCUST ST	None	INGLEWOOD	CA	90301	1812	19	06037	33.962814	-118.3504055	Los Angeles County
203734	Fee-for-Service	1417282617	1417282617	1	1	BARBA, VANESSA V LCSW	5/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
203740	Fee-for-Service	1508251992	1508251992	1	1	BURGDORFF, COURTNEY MD	8/30/2019	207L00000X	NA	Other	026	PHYSICIANS	144548	05	Anesthesiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
203798	Fee-for-Service	1164684882	1164684882	1	1	BASARAB-TUNG, JENNIFER R MD	5/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112562	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
203804	Fee-for-Service	1457410169	1457410169	1	1	BINGO, ALICE A OD	9/12/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2295 S VINEYARD	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
203808	Fee-for-Service	1174751747	1174751747	1	1	BUTCHER, KARIN Y MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119645	08	Family Practice	0	In state provider	None	11600 INDIAN HILL RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
203817	Fee-for-Service	1407106875	1407106875	1	1	BURNEY, SARAH LCSW	1/30/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	4000 BIRCH ST	SUITE 112A	NEWPORT BEACH	CA	92660	2211	30	06059	33.66463772	-117.8698289	Orange County
203823	Fee-for-Service	1417908229	1417908229	1	1	BOIN, FRANCESCO MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135286	83	Rheumatology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
203855	Fee-for-Service	1811469349	1811469349	2	1	BLOOMBERG, LAURA LMFT	2/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	322 CANYON CREST LANE	None	LAKE ARROWHEAD	CA	92352	0000	36	06071	34.24581392	-117.1841812	San Bernardino County
203868	Fee-for-Service	1114932571	1114932571	1	1	BALON, GALINA MD	10/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51287	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
203870	Fee-for-Service	1417348319	1417348319	1	1	BHAT, JYOTI MD INC	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110293	41	Internal Medicine	0	In state provider	None	2182 EAST ST	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
203929	Fee-for-Service	1144564527	1144564527	1	1	BANJ HEALTH CENTER INC	11/20/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3620 MLK JR BLVD	None	LYNWOOD	CA	90262	2607	19	06037	33.93169754	-118.2033151	Los Angeles County
203937	Fee-for-Service	1124769534	1124769534	1	1	BUTCON, PAULA ANN	3/31/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
203958	Fee-for-Service	1023155629	1023155629	1	1	BILECKI, MARY-ANN	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2451 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	7815	49	06097	38.441646	-122.6621475	Sonoma County
203978	Fee-for-Service	1306469614	1306469614	1	1	BHATTI, FARAAZ	6/28/2023	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
204008	Fee-for-Service	1134277072	1134277072	1	1	BERNHARDT, MARK MD	3/31/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	58469	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
204058	Fee-for-Service	1952842692	1952842692	1	1	BOEHM, NATALIE A NP	11/30/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
204086	Fee-for-Service	1649330069	1649330069	1	1	BROOKINS, ANTIONETTE D LMFT	6/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5275 N FIRST	None	FRESNO	CA	93710	7007	10	06019	36.8135277	-119.7724365	Fresno County
204146	Fee-for-Service	1316029317	1316029317	1	1	BARAJAS, DANIEL MD INC	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54362	None	None	0	In state provider	None	222 N SUNSET AVE	STE E	WEST COVINA	CA	91790	2278	19	06037	34.07397524	-117.9354429	Los Angeles County
204147	Fee-for-Service	1790932457	1790932457	1	1	BAJPAI, URMILA D MD	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100242	83	Rheumatology	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
204158	Fee-for-Service	1417348319	1417348319	1	1	BHAT, JYOTI MD INC	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110293	67	Endocrinology	0	In state provider	None	2182 EAST ST	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
204176	Fee-for-Service	1891855466	1891855466	1	1	BRESNAHAN, GERALD F MD	1/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	14924	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	501 E HARDY ST	STE 201	INGLEWOOD	CA	90301	4086	19	06037	33.9491005	-118.348857	Los Angeles County
204183	Fee-for-Service	1316486368	1316486368	1	1	BELLA NIRVANA CENTER, INC.	8/5/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 SIBLEY ST	None	FOLSOM	CA	95630	3274	34	06067	38.665224	-121.172931	Sacramento County
204184	Fee-for-Service	1316185101	1316185101	1	1	BLUE & GREEN PHARMACY IN	6/18/2009	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8131 W MANCHESTER AVE	None	PLAYA DEL REY	CA	90293	8211	19	06037	33.95849327	-118.438298	Los Angeles County
204225	Fee-for-Service	1104040997	1104040997	1	1	BEECH, JOHN P DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	607 E OLIVE AVE	None	TURLOCK	CA	95380	4013	50	06099	37.49829054	-120.8429636	Stanislaus County
204231	Fee-for-Service	1275849283	1275849283	1	1	BORREGO COMMUNITY HEALTH	1/30/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	66675 PIERSON BLVD	None	DESERT HOT SPRING	CA	92240	3737	33	06065	33.96138951	-116.498223	Riverside County
204245	Fee-for-Service	1508535246	1508535246	1	1	BLUE MONARCH MEDICAL TRANSPO	6/20/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RT	5750 SUNRISE BLVD	STE 130-G	CITRUS HEIGHTS	CA	95610	7634	34	06067	38.670858	-121.271049	Sacramento County
204247	Fee-for-Service	1477894400	1477894400	1	1	BROUMAND, ALEXANDER A MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124947	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
204267	Fee-for-Service	1447784996	1447784996	1	1	BHANDARI, SHFALI MD	9/9/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
204319	Fee-for-Service	1831349315	1831349315	1	1	BRADLEY B BAILEY MD & ROGER	4/24/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15611 POMERADO RD	STE 200	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
204322	Fee-for-Service	1073546107	1073546107	1	1	BAJAJ, MADHU S MD	5/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42630	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
204348	Fee-for-Service	1528112604	1528112604	1	1	BOROVINA, RACHEL MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81763	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
204350	Fee-for-Service	1588253116	1588253116	1	1	BALDERAS, JESSICA A LMFT	10/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
204372	Fee-for-Service	1386637726	1386637726	1	1	BARNSDALE, JOHN S MD INC	9/30/1991	207L00000X	NA	Other	026	PHYSICIANS	34272	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
204382	Fee-for-Service	1912992413	1912992413	1	2	BLACKWELDER, ROBERT E MD	7/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	24853	34	Urology and Urological Surgery	0	In state provider	None	1165 S DORA ST	STE B1	UKIAH	CA	95482	6353	23	06045	39.13602308	-123.2095502	Mendocino County
204399	Fee-for-Service	1649794710	1649794710	1	1	BIEDA, JENNIFER A LP	8/21/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
204416	Fee-for-Service	1639199292	1639199292	1	1	BURROWS, WILLIAM M JR MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	16236	01	General Practice	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
204419	Fee-for-Service	1336244623	1336244623	1	1	BHATIA, SURUCHI MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60704	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
204430	Fee-for-Service	1336551548	1336551548	1	1	BHALLA, SAMIR MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149468	41	Internal Medicine	0	In state provider	None	200 MEDI PLAZA	365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
204448	Fee-for-Service	1508496886	1508496886	1	1	BRADY, LOIS CCC-SLP	10/5/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	955 WALNUT AVE	None	VALLEJO	CA	94592	1021	48	06095	38.0960736	-122.2701348	Solano County
204463	Fee-for-Service	1780763813	1780763813	1	1	BROOKSHIRE, MEREDYTH MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49580	36	Psychiatry	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
204466	Fee-for-Service	1770164360	1770164360	1	1	BRENNER, ABIGAIL M MD	7/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
204467	Fee-for-Service	1245464981	1245464981	1	1	BHE, EMILIE MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118654	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
204494	Fee-for-Service	1568492700	1568492700	1	1	BUTTE HOME HEALTH INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10 CONSTITUTION DR	None	CHICO	CA	95973	4903	04	06007	39.77132143	-121.8740637	Butte County
204520	Fee-for-Service	1275849283	1275849283	1	1	BORREGO COMMUNITY HEALTH	7/16/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	66675 PIERSON BLVD	None	DESERT HOT SPRING	CA	92240	3737	33	06065	33.96138951	-116.498223	Riverside County
204524	Fee-for-Service	1730178633	1730178633	1	1	BEKAL, PRADEEP MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2925 VERNON PL	STE 100	CINCINNATI	OH	45219	0000	00	None	39.13304552	-84.49973739	Hamilton County
204583	Fee-for-Service	1902454002	1902454002	1	1	BARAJAS, TIFFANY L CNP	5/19/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18785 BROOKHURST STREET	STE 101	FOUNTAIN VALLEY	CA	92708	7300	30	06059	33.68987636	-117.9542321	Orange County
204595	Fee-for-Service	1780315051	1780315051	1	1	BUSS, BLAKE OT	11/14/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
204609	Fee-for-Service	1073546107	1073546107	1	1	BAJAJ, MADHU S MD	5/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42630	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
204612	Fee-for-Service	1063454486	1063454486	1	1	BEDELL, KIMBERLY K MD	3/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79189	25	Physical Medicine and Rehabilitation	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
204616	Fee-for-Service	1366837304	1366837304	1	1	BUCK, JOSEPH S MD	10/14/2022	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	177636	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
204626	Fee-for-Service	1053871731	1053871731	1	1	BERG, ARI R MD	5/1/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
204634	Fee-for-Service	1629103866	1629103866	1	1	BHUTANI, VINOD K MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52042	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	STANFORD	CA	94305	0000	43	06085	37.43721275	-122.1744449	Santa Clara County
204645	Fee-for-Service	1659561595	1659561595	1	1	BOLOTAULO, CLAIRE A MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111222	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
204669	Fee-for-Service	1366622490	1366622490	1	1	BARTON DIRECT INC	6/27/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	5725 W HIGHWAY 290	STE 105B	AUSTIN	TX	78735	8722	00	None	30.23588631	-97.84673442	Travis County
204691	Fee-for-Service	1891256749	1891256749	1	1	BAHDI, FIRAS MD	1/29/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	177345	10	Gastroenterology (M.D. only)	0	In state provider	None	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
204701	Fee-for-Service	1629123070	1629123070	1	1	BEMANIAN, SHAHROOZ MD	4/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85501	41	Internal Medicine	0	In state provider	None	441 N LAKWOOD AVE	None	ANAHEIM	CA	92807	0000	30	06059	33.86746909	-117.8151655	Orange County
204709	Fee-for-Service	1336244623	1336244623	1	1	BHATIA, SURUCHI MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60704	67	Endocrinology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
204724	Fee-for-Service	1770974065	1770974065	1	1	BIRING, SABHRUP K MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144624	01	General Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
204735	Fee-for-Service	1104958156	1104958156	1	1	BOSSHARDT, THOMAS L MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78405	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
204745	Fee-for-Service	1790023828	1790023828	1	1	BALDWIN, BEVERLY D LMFT	9/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 IRON POINT RD	STE 180	FOLSOM	CA	95630	8835	34	06067	38.643048	-121.145328	Sacramento County
204758	Fee-for-Service	1275503476	1275503476	1	1	BARNES, ALISA R OD	2/8/2015	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	623 W 6TH ST	None	LOS ANGELES	CA	90017	3201	19	06037	34.04911584	-118.2557355	Los Angeles County
204767	Fee-for-Service	1235523515	1235523515	1	1	BROWN, LAURA E MD	6/1/2020	207ZP0105X	NA	Other	026	PHYSICIANS	154688	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
204768	Fee-for-Service	1861544082	1861544082	1	1	BALABAN, JASON S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	35854	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
204781	Fee-for-Service	1568492700	1568492700	1	1	BUTTE HOME HEALTH INC	1/22/1985	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10 CONSTITUTION DR	None	CHICO	CA	95973	4903	04	06007	39.77132143	-121.8740637	Butte County
204808	Fee-for-Service	1275849283	1275849283	1	1	BORREGO COMMUNITY HEALTH	1/30/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	66675 PIERSON BLVD	None	DESERT HOT SPRING	CA	92240	3737	33	06065	33.96138951	-116.498223	Riverside County
204823	Fee-for-Service	1437367513	1437367513	1	1	BARRY A MCKENZIE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2900 12TH AVE N #355W	None	BILLINGS	MT	59101	0000	00	None	45.792225	-108.518706	Yellowstone County
204889	Fee-for-Service	1396935680	1396935680	1	1	BELTRAN, DANIEL M OD INC	3/5/1985	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13959 AMAR RD	None	LA PUENTE	CA	91746	1679	19	06037	34.05257141	-117.9728516	Los Angeles County
204896	Fee-for-Service	1013086420	1013086420	1	1	BARON, ARI D MD	7/31/1991	174400000X	NA	Other	026	PHYSICIANS	72619	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
204903	Fee-for-Service	1619933132	1619933132	1	1	BENJAMIN, MICHAEL S MD	6/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86460	None	None	0	In state provider	None	7320 WOODLAKE AVE	STE 330	WEST HILLS	CA	91307	1486	19	06037	34.20245266	-118.6321273	Los Angeles County
204980	Fee-for-Service	1275585697	1275585697	1	1	BROTHERS, JOHN A MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82513	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
204985	Fee-for-Service	1891256749	1891256749	1	1	BAHDI, FIRAS MD	1/29/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	177345	41	Internal Medicine	0	In state provider	None	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
204994	Fee-for-Service	1740767243	1740767243	1	1	BAKAL, VERONIKA RCP	10/5/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
205004	Fee-for-Service	1851349757	1851349757	1	1	BIRGERSDOTTER-GREEN, U	5/31/1990	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49525	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
205008	Fee-for-Service	1336674969	1336674969	1	1	BRAR, BOBBY MD	10/25/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	102 E 6TH ST	STE 200	CORONA	CA	92879	1450	33	06065	33.87540602	-117.5666997	Riverside County
205030	Fee-for-Service	1659824837	1659824837	1	1	BORREGO COMMUNITY HEALTH	12/23/2016	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	68555 RAMON ROAD	BLDG D-105	CATHEDRAL CITY	CA	92234	3310	33	06065	33.8158285	-116.4648113	Riverside County
205039	Fee-for-Service	1639308257	1639308257	1	1	BAJAJ, AMIT MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119751	40	Pediatrics	0	In state provider	None	311 WEST I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
205052	Fee-for-Service	1548027832	1548027832	1	1	BRUNS, PAMELA D RCP	2/28/2025	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
205069	Fee-for-Service	1568492700	1568492700	1	1	BUTTE HOME HEALTH INC	1/1/1988	251E00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10 CONSTITUTION DR	None	CHICO	CA	95973	4903	04	06007	39.77132143	-121.8740637	Butte County
205071	Fee-for-Service	1821284670	1821284670	1	1	BLOOM, MELODY LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205127	Fee-for-Service	1093203408	1093203408	1	1	BOPARAI, JASDEEP S MD	5/18/2022	390200000X	NA	Other	026	PHYSICIANS	174667	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
205140	Fee-for-Service	1023166808	1023166808	1	1	BOYARSKY, IGOR A DO	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
205142	Fee-for-Service	1730702952	1730702952	1	1	BEGERT, SARAH DO	10/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20738	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
205160	Fee-for-Service	1831100270	1831100270	1	1	BIO-MEDICAL APPLICATION	3/6/1992	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF FREMONT	39505 PASEO PADRE PKWY	None	FREMONT	CA	94538	2391	01	06001	37.55004126	-121.9745029	Alameda County
205168	Fee-for-Service	1154454668	1154454668	1	1	BONANDER, RUTH E OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	541 N GOLDEN STATE BLVD	None	TURLOCK	CA	95380	3918	50	06099	37.49822665	-120.8486593	Stanislaus County
205169	Fee-for-Service	1659313906	1659313906	1	1	BROOKWOOD HLTH SERVICES	5/9/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2010 BROOKWOOD MED CTR	None	BIRMINGHAM	AL	35209	6804	00	None	33.46310667	-86.77645664	Jefferson County
205244	Fee-for-Service	1669730990	1669730990	1	1	BEN-ADERET, MICHAEL A MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130046	77	Infectious Disease	0	In state provider	None	8700 BEVERLY BLVD	None	W HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
205275	Fee-for-Service	1598227910	1598227910	1	1	BREAKING THE CYCLE OF ADDICT	3/2/2020	101YA0400X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	, LLC	6011 STACY AVE	None	SACRAMENTO	CA	95823	3945	34	06067	38.482083	-121.429728	Sacramento County
205277	Fee-for-Service	1710131164	1710131164	1	1	BELL, DIANA M MD	7/29/2021	207ZP0101X	NA	Other	026	PHYSICIANS	172229	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
205291	Fee-for-Service	1851349757	1851349757	1	1	BIRGERSDOTTER-GREEN, U	5/31/1990	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49525	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
205299	Fee-for-Service	1831490820	1831490820	1	1	BROWNE, TARAH B DO	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	10885	38	Geriatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
205358	Fee-for-Service	1134141328	1134141328	1	1	BLOCK, BARRY S MD	11/27/1985	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	38712	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
205393	Fee-for-Service	1700506912	1700506912	1	1	BHARDWAJ, SONIKA	10/31/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
205411	Fee-for-Service	1801138151	1801138151	1	1	BRAUNER, NOAH A MD	9/9/2019	2085R0204X	NA	Other	026	PHYSICIANS	133128	30	Radiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
205460	Fee-for-Service	1659313906	1659313906	1	1	BROOKWOOD HLTH SERVICES	5/9/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2010 BROOKWOOD MED CTR	None	BIRMINGHAM	AL	35209	6804	00	None	33.46310667	-86.77645664	Jefferson County
205463	Fee-for-Service	1821159286	1821159286	1	1	BECERRA, CHRISTINA I	5/30/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1760 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13015449	-122.2521178	Solano County
205466	Fee-for-Service	1306245386	1306245386	1	1	BURBANK PLASTIC SURGERY MEDI	1/19/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CAL GROUP	2301 W ALAMEDA AVE	None	BURBANK	CA	91506	2938	19	06037	34.15887607	-118.3262582	Los Angeles County
205469	Fee-for-Service	1891847307	1891847307	1	1	BAYO, PABLO LMFT	10/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	539 G STREET	101	EUREKA	CA	95501	1044	12	06023	40.80141234	-124.1647338	Humboldt County
205479	Fee-for-Service	1790481521	1790481521	1	1	BUENAVENTURA, MARVIN NP	1/27/2025	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
205495	Fee-for-Service	1477081974	1477081974	1	1	BICKEL, KYLE L MD	7/1/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158828	None	None	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
205513	Fee-for-Service	1538553466	1538553466	1	1	BENJAMIN, STEPHANIE B MD	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	146851	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
205532	Fee-for-Service	1669730990	1669730990	1	1	BEN-ADERET, MICHAEL A MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130046	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	W HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
205549	Fee-for-Service	1316477011	1316477011	1	1	BROWN, DUSTIN P MD	11/5/2024	2085B0100X	NA	MRI Provider	026	PHYSICIANS	166255	30	Radiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
205556	Fee-for-Service	1255361838	1255361838	1	1	BROOK, MICHAEL MD	10/2/2008	207L00000X	NA	Other	026	PHYSICIANS	63429	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
205559	Fee-for-Service	1083703805	1083703805	1	1	BELEZZUOLI, ERNEST V MD	9/30/1991	207U00000X	NA	Other	026	PHYSICIANS	74168	30	Radiology	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
205571	Fee-for-Service	1164993952	1164993952	1	1	BLEVINS, ALICIA RCP	3/29/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
205578	Fee-for-Service	1588626832	1588626832	1	1	BROOKWOOD INTERNAL MED	1/8/2002	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES INC	500 DOYLE PARK DR	STE 304	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
205585	Fee-for-Service	1356754683	1356754683	1	1	BALL, BRIAN J MD	10/2/2020	207RH0000X	NA	Hematology	026	PHYSICIANS	169947	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
205608	Fee-for-Service	1831134097	1831134097	1	1	BYRNE, JAMES D MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74780	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
205613	Fee-for-Service	1033819958	1033819958	1	1	BRADLEY, WILLIAM NP	5/19/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 6100,6300,7200,7300	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
205618	Fee-for-Service	1578510731	1578510731	1	1	BOSTICK, LAURIE A MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75484	40	Pediatrics	0	In state provider	DR BANUELOS	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
205654	Fee-for-Service	1366570707	1366570707	1	1	BAUMGARTEN, ADAM J MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92273	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
205674	Fee-for-Service	1639162506	1639162506	1	1	BROWN, LORI W MD	9/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80343	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
205707	Fee-for-Service	1467530352	1467530352	1	1	BROSTOFF, WILLIAM S MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	22664	41	Internal Medicine	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
205727	Fee-for-Service	1497895726	1497895726	1	1	BATES, STEVEN J MD	8/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79104	24	Plastic Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
205738	Fee-for-Service	1447447164	1447447164	1	1	BUU, MYMY C MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100865	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
205739	Fee-for-Service	1427163229	1427163229	1	1	BAY PSYCHIATRIC ASSOC	3/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL CORPORATION	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
205746	Fee-for-Service	1508156910	1508156910	1	1	BRINCKHAUS, NATHAN D MD	7/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124994	01	General Practice	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
205765	Fee-for-Service	1245661164	1245661164	1	1	BASHAM, NICOLE E	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10200 TRINITY PKWY	STE 205	STOCKTON	CA	95219	7288	39	06077	38.04745959	-121.3721294	San Joaquin County
205768	Fee-for-Service	1306151758	1306151758	1	1	BATTH, DILDEEP S MD	9/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123167	41	Internal Medicine	0	In state provider	None	525 WEST ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
205816	Fee-for-Service	1437637238	1437637238	1	1	BARRERA PACHECO, MARIA L	6/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3021 CITRUS CIR	240	WALNUT CREEK	CA	94598	2692	07	06013	37.92845517	-122.0144911	Contra Costa County
205851	Fee-for-Service	1982197554	1982197554	1	1	BERNARDO, CHRISTIAN HENRY S	8/9/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166871	None	None	0	In state provider	MD	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
205866	Fee-for-Service	1093711996	1093711996	2	1	BETTER LIVING NOW INC	7/13/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	400 OSER AVE	SUITE 1950	HAUPPAUGE	NY	11788	3619	00	None	40.817331	-73.266336	Suffolk County
205885	Fee-for-Service	1376809087	1376809087	1	1	BERDAHL, CARL T MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126646	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
206005	Fee-for-Service	1982742672	1982742672	1	1	BARROWS, DIANA MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	27969	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13057 PERRIS BLVD	None	MORENO VALLEY	CA	92553	4214	33	06065	33.93111111	-117.2263159	Riverside County
206006	Fee-for-Service	1417213505	1417213505	1	1	BROWN, ETHAN G MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129619	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
206018	Fee-for-Service	1831754472	1831754472	1	1	BAINS, NAINJOT K MD	12/15/2022	207R00000X	NA	Other	026	PHYSICIANS	180442	None	None	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
206025	Fee-for-Service	1235167925	1235167925	1	1	BRAUN, JONATHAN MD	5/31/1992	207ZF0201X	NA	Other	026	PHYSICIANS	51811	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
206031	Fee-for-Service	1174751382	1174751382	1	1	BOZOGHLANIAN, VARAZ MD	5/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115637	03	Allergy	0	In state provider	None	11500 W OLYMPIC BLVD	SUITE 630	LOS ANGELES	CA	90064	1538	19	06037	34.03617514	-118.4445122	Los Angeles County
206056	Fee-for-Service	1033536073	1033536073	1	1	BERRY, BENJAMIN MD	9/29/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	138031	36	Psychiatry	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
206099	Fee-for-Service	1417409301	1417409301	1	1	BMAC RX CORPORATION	4/7/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8342 GARDEN GROVE BLVD	STE 2	GARDEN GROVE	CA	92844	1151	30	06059	33.7737429	-117.9861937	Orange County
206129	Fee-for-Service	1144308222	1144308222	1	1	BOUCH, CHARLES W MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93162	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
206170	Fee-for-Service	1689921652	1689921652	1	1	BARRY, KATHRYN E PT	7/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
206212	Fee-for-Service	1851970735	1851970735	1	1	BORDBARI, MATTHEW DO	9/5/2023	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
206217	Fee-for-Service	1952317604	1952317604	1	1	BAO,YERAN MD	12/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81228	38	Geriatrics	0	In state provider	None	23430 HAWTHORNE BLVD	STE 105	TORRANCE	CA	90505	4777	19	06037	33.81316465	-118.3510077	Los Angeles County
206239	Fee-for-Service	1922365022	1922365022	1	1	BARKSDALE, JASON E MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106983	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
206272	Fee-for-Service	1922030238	1922030238	1	1	BAKER, MICHAEL PAUL MD	3/1/1998	207P00000X	NA	Other	026	PHYSICIANS	60273	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
206274	Fee-for-Service	1346392156	1346392156	1	1	BASTACKY, SAMUEL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31957	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
206292	Fee-for-Service	1104087683	1104087683	1	1	BADAKHSH, ORODE MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110161	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
206307	Fee-for-Service	1275741167	1275741167	1	3	BHIMJI, ALTAF A LCSW	1/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	518 EL CERRITO	None	EL CERRITO	CA	94530	4006	07	06013	37.89865085	-122.300278	Contra Costa County
206317	Fee-for-Service	1174751382	1174751382	1	1	BOZOGHLANIAN, VARAZ MD	5/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115637	41	Internal Medicine	0	In state provider	None	11500 W OLYMPIC BLVD	SUITE 630	LOS ANGELES	CA	90064	1538	19	06037	34.03617514	-118.4445122	Los Angeles County
206333	Fee-for-Service	1659317592	1659317592	1	1	BHANDARI, RASHMI P PHD	8/23/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206335	Fee-for-Service	1821169897	1821169897	1	1	BAE, JULIA H MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67015	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
206336	Fee-for-Service	1386961415	1386961415	1	1	BORNICK, GEMMA	11/1/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
206338	Fee-for-Service	1215013719	1215013719	1	1	BHANOT, PREETE MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86518	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
206344	Fee-for-Service	1811162522	1811162522	1	1	BANANKHAH, SOUDABEH K CRNA	4/22/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
206348	Fee-for-Service	1811056484	1811056484	1	1	BOYKIN, VERNA J MD	10/31/1985	207R00000X	NA	Other	026	PHYSICIANS	39039	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
206368	Fee-for-Service	1700800604	1700800604	1	1	BOZUK, MICHAEL I MD	1/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73703	02	General Surgery	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
206376	Fee-for-Service	1396788253	1396788253	1	1	BLOOM, ALLAN I MD	8/7/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66188	30	Radiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
206386	Fee-for-Service	1174265102	1174265102	1	1	BAIS, HAZEL MAY A NP	12/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
206399	Fee-for-Service	1083993984	1083993984	1	1	BEAN, AARON S DPM INC	1/31/2012	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	47647 CALEO BAY DR	STE 200	LA QUINTA	CA	92253	8854	33	06065	33.70305235	-116.2936509	Riverside County
206412	Fee-for-Service	1871026625	1871026625	1	1	BAKER, JESSA M MD	6/9/2021	390200000X	NA	Other	026	PHYSICIANS	161309	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
206457	Fee-for-Service	1326254921	1326254921	1	1	BASSHAM, BRIAN S MD	1/1/2022	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
206485	Fee-for-Service	1205912722	1205912722	1	1	BHATIA, JAGPRETT K MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77467	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
206491	Fee-for-Service	1538229232	1538229232	1	1	BERNSTEIN, MARILYN B.	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3152 MISSION DR	None	SANTA CRUZ	CA	95065	1824	44	06087	36.98983498	-121.9805053	Santa Cruz County
206497	Fee-for-Service	1790046506	1790046506	1	1	BALIDO, KATRINA A M DO	10/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13339	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
206539	Fee-for-Service	1245649474	1245649474	1	1	BOUNAMA, HADJER T MD	8/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17981	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
206559	Fee-for-Service	1851549158	1851549158	1	1	BALTASAR, RACHEL C MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121144	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
206565	Fee-for-Service	1013995802	1013995802	1	1	BHARGAVA, RAJESH	10/15/2022	207R00000X	NA	Other	026	PHYSICIANS	145409	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
206578	Fee-for-Service	1922191253	1922191253	1	1	BRYANT, MICHAEL D MD	2/24/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	66182	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
206604	Fee-for-Service	1730574500	1730574500	1	1	BROADHEAD, JUSTIN DO	9/20/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23043	30	Radiology	0	In state provider	None	6412 LAUREL AVE	None	MOUNTAIN MESA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
206618	Fee-for-Service	1801939384	1801939384	1	1	BOREN, MATTHEW J DO	10/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11375	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
206623	Fee-for-Service	1821169897	1821169897	1	1	BAE, JULIA H MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67015	03	Allergy	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
206629	Fee-for-Service	1720174238	1720174238	1	1	BROWNING, JARED C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82048	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206641	Fee-for-Service	1598970535	1598970535	1	1	BEST CARE HOME HEALTH	2/20/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY, INC	2204 TORRANCE BLVD	STE 104A	TORRANCE	CA	90501	0504	19	06037	33.83638629	-118.3217142	Los Angeles County
206796	Fee-for-Service	1053802074	1053802074	1	1	BOUNVILAY, MIXAYPHONE CNM	10/14/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
206831	Fee-for-Service	1760484299	1760484299	1	1	BHAVANI LAGADAPATI MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 LATTNER CT	STE 100	MORRISVILLE	NC	27560	6843	00	None	35.83125	-78.852717	Wake County
206852	Fee-for-Service	1508164443	1508164443	1	1	BARRAZA CONRAD, VERONICA NP	7/29/2020	163WP0200X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
206872	Fee-for-Service	1710262738	1710262738	1	1	BLANCO, FRANCES LCSW	9/10/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	5870 ARLINGTON AVE	SUITE 103	RIVERSIDE	CA	92504	2037	33	06065	33.94592702	-117.4313099	Riverside County
206901	Fee-for-Service	1114069390	1114069390	1	1	BURBANK FAMILY OPTOMETRY INC	8/25/2006	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	907 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4326	19	06037	34.18664771	-118.3166612	Los Angeles County
206944	Fee-for-Service	1215341896	1215341896	1	1	BOYER, BRIAN C OD	7/11/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2443 FOOTHILL BLVD	None	LA VERNE	CA	91750	3028	19	06037	34.11136123	-117.7588874	Los Angeles County
206965	Fee-for-Service	1104919257	1104919257	1	1	BRANDON, MICHAEL S MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85343	05	Anesthesiology	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
206970	Fee-for-Service	1720016637	1720016637	1	1	BENSON, T LEROY MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	28884	05	Anesthesiology	0	In state provider	SOHNER PLAZA	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
206987	Fee-for-Service	1407907736	1407907736	1	1	BONINCONTRO, GERTRUDE A LMFT	5/6/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
207012	Fee-for-Service	1366589947	1366589947	1	1	BELL, LESLIE C LCSW	9/28/2015	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2127 ASHBY AVE	None	BERKELEY	CA	94705	1884	01	06001	37.85549356	-122.2653094	Alameda County
207031	Fee-for-Service	1215991534	1215991534	1	1	BOLIVAR FAMILY MEDICAL	3/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINIC INC	10327 HOLE AVE	None	RIVERSIDE	CA	92505	1747	33	06065	33.91543085	-117.4653361	Riverside County
207081	Fee-for-Service	1700958451	1700958451	1	2	BUDAYR, AMER A MD	10/13/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41703	-	NOT APPLICABLE	0	In state provider	None	1820 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87536985	-122.2622489	Alameda County
207121	Fee-for-Service	1952526220	1952526220	1	1	BROWN, MATTHEW J	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
207126	Fee-for-Service	1568657682	1568657682	1	1	BARRON, SUSAN P PHD	9/25/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	8395 JACKSON RD	None	SACRAMENTO	CA	95826	3904	34	06067	38.546001	-121.3947675	Sacramento County
207150	Fee-for-Service	1346598133	1346598133	1	1	BERNACKI, JESSICA M PHD	2/24/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	509 MARIN STREET	SUITE 234	THOUSAND OAKS	CA	91360	4231	56	06111	34.18371146	-118.8824904	Ventura County
207155	Fee-for-Service	1437118650	1437118650	2	1	BE, VIET A MD	10/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48753	01	General Practice	0	In state provider	None	16169 HARBOR BLVD	None	FOUNTAIN VALLEY	CA	92708	1305	30	06059	33.72848079	-117.9200292	Orange County
207181	Fee-for-Service	1689162398	1689162398	1	1	BARACH, DEBRA L MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	59278	40	Pediatrics	0	In state provider	None	17609 VENTURA BLVD	STE 106	ENCINO	CA	91316	3866	19	06037	34.16197507	-118.5167485	Los Angeles County
207190	Fee-for-Service	1710950589	1710950589	1	1	BENSCH, GREGORY W	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61795	None	None	0	In state provider	None	4628 GEORGETOWN PL	None	STOCKTON	CA	95207	6204	39	06077	37.9893781	-121.313486	San Joaquin County
207197	Fee-for-Service	1730206442	1730206442	1	1	BETJEMANN, JOHN P MD	3/10/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	108484	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
207228	Fee-for-Service	1831498781	1831498781	1	1	BAYVIEW HUNTERS POINT	9/28/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION FOR COMMUNITY	1625 CARROLL AVE	2ND FLOOR	SAN FRANCISCO	CA	94124	3219	38	06075	37.72518613	-122.3938382	San Francisco County
207264	Fee-for-Service	1992700983	1992700983	1	1	BAYLOR MEDICAL CENTER AT IRV	1/28/2003	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - IRVING	1901 N MACARTHUR BLVD	None	IRVING	TX	75061	2220	00	None	32.834691	-96.95924802	Dallas County
207322	Fee-for-Service	1497912695	1497912695	1	1	BURG, WILLIAM C LMFT	6/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6060 SUNRISE VISTA DRIVE	STE 1110 C	CITRUS HEIGHTS	CA	95610	7003	34	06067	38.676861	-121.263903	Sacramento County
207332	Fee-for-Service	1194120030	1194120030	1	1	BLYTHE POST ACUTE LLC	1/14/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	285 WEST CHANSLOR WAY	None	BLYTHE	CA	92225	1246	33	06065	33.61761549	-114.5994076	Riverside County
207338	Fee-for-Service	1275925141	1275925141	1	1	BRASEL, BRIANA D LMFT	11/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
207347	Fee-for-Service	1114029329	1114029329	1	1	BHADURI, ADITI MD	3/16/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	55649	67	Endocrinology	0	In state provider	None	2510 DOUGLAS BLVD	#300	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
207363	Fee-for-Service	1649893231	1649893231	1	1	BOYD, ALICIA L PSYD	6/27/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
207365	Fee-for-Service	1912021932	1912021932	1	1	BAILEY, CHALANDA Z LMFT	11/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE	STE 565	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
207370	Fee-for-Service	1235198789	1235198789	1	1	BLAYLARK, WANDA J MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48420	41	Internal Medicine	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
207379	Fee-for-Service	1619326774	1619326774	1	1	BRODAK, DANIKA MD	8/8/2019	207P00000X	NA	Other	026	PHYSICIANS	162009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
207434	Fee-for-Service	1215347489	1215347489	1	1	BALDESHWILER, MARK J MD	8/23/2022	207P00000X	NA	Other	026	PHYSICIANS	138726	None	None	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
207445	Fee-for-Service	1437118650	1437118650	2	1	BE, VIET A MD	10/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48753	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16169 HARBOR BLVD	None	FOUNTAIN VALLEY	CA	92708	1305	30	06059	33.72848079	-117.9200292	Orange County
207449	Fee-for-Service	1922034891	1922034891	1	1	BRIDGE, STEPHEN S MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44719	34	Urology and Urological Surgery	0	In state provider	None	4060 4TH AVE	STE 310	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
207465	Fee-for-Service	1568709269	1568709269	1	2	BROWN, JENNIFER L LCSW	4/1/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2145 MYRTLE AVE	None	EUREKA	CA	95501	3323	12	06023	40.78805993	-124.1328194	Humboldt County
207479	Fee-for-Service	1841270451	1841270451	1	1	BRANCO, NELSON MD	5/30/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60826	40	Pediatrics	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
207491	Fee-for-Service	1295770337	1295770337	1	1	BARKER, LEW MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52075	08	Family Practice	0	In state provider	None	1015 E MAIN ST	None	TURLOCK	CA	95380	3406	50	06099	37.50297054	-120.8343858	Stanislaus County
207517	Fee-for-Service	1932499472	1932499472	1	1	BIENIA, SEBASTIAN N MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154389	05	Anesthesiology	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
207553	Fee-for-Service	1992700983	1992700983	1	1	BAYLOR MEDICAL CENTER AT IRV	1/28/2003	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - IRVING	1901 N MACARTHUR BLVD	None	IRVING	TX	75061	2220	00	None	32.834691	-96.95924802	Dallas County
207557	Fee-for-Service	1063916013	1063916013	1	1	BLAUVELT, CHRISTINE MD	6/21/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166426	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
207588	Fee-for-Service	1376857847	1376857847	1	1	BLANCHARD, CLARISE A LMFT	4/16/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	32977	-	NOT APPLICABLE	0	In state provider	None	480 MANOR PLAZA	None	PACIFICA	CA	94044	1839	41	06081	37.64988472	-122.4917972	San Mateo County
207614	Fee-for-Service	1528049723	1528049723	1	1	BLANCK, CHARLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
207625	Fee-for-Service	1336142892	1336142892	1	1	BLANTON, CHRISTOPHER L	10/1/1994	207W00000X	NA	Ophthalmology	026	PHYSICIANS	61733	None	None	0	In state provider	None	1900 E WASHINGTON ST	None	COLTON	CA	92324	4614	36	06071	34.04839685	-117.2950602	San Bernardino County
207630	Fee-for-Service	1669531273	1669531273	1	1	BISI, JAMES D DO	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7866	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
207634	Fee-for-Service	1710067285	1710067285	1	1	BLISH, CATHERINE A MD	12/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54975	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
207637	Fee-for-Service	1992099022	1992099022	1	1	BAILEY, ELIZABETH E MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121963	07	Dermatology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
207641	Fee-for-Service	1487626222	1487626222	1	1	BARBER, BRENT J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
207652	Fee-for-Service	1457462525	1457462525	1	1	BROOKS, DOBERNE	11/4/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PATTANACHINDA MEDICAL	2950 SYCAMORE DR	STE 200	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
207654	Fee-for-Service	1174758031	1174758031	1	1	BINDER, PRATIBHA S MD	11/14/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	149945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
207669	Fee-for-Service	1669852844	1669852844	1	1	BURN, SEAN D MD	6/17/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171343	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
207711	Fee-for-Service	1154957074	1154957074	1	1	BARBOZA, JONATHAN O MD	6/14/2023	390200000X	NA	Other	026	PHYSICIANS	176857	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
207730	Fee-for-Service	1437118650	1437118650	2	1	BE, VIET A MD	10/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48753	08	Family Practice	0	In state provider	None	16169 HARBOR BLVD	None	FOUNTAIN VALLEY	CA	92708	1305	30	06059	33.72848079	-117.9200292	Orange County
207733	Fee-for-Service	1548589476	1548589476	1	1	B & B SUPPLY INC	1/19/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	14129 CRENSHAW BLVD	None	HAWTHORNE	CA	90250	7817	19	06037	33.9023661	-118.326597	Los Angeles County
207750	Fee-for-Service	1225130081	1225130081	1	1	BECKER, DANIEL J MD	10/7/2019	207L00000X	NA	Other	026	PHYSICIANS	113973	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
207753	Fee-for-Service	1538113048	1538113048	1	1	BIDDLE, ROYCE J MD	2/23/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38773	30	Radiology	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
207802	Fee-for-Service	1326238072	1326238072	1	1	BARKLEY, JENNIFER A MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114849	08	Family Practice	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
207842	Fee-for-Service	1144617879	1144617879	1	1	BARNES, KAYLA MD	7/27/2021	390200000X	NA	Other	026	PHYSICIANS	172490	None	None	0	In state provider	None	9300 VALLEY CHILRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
207851	Fee-for-Service	1043240443	1043240443	1	1	BATKIN, FRED H MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	56425	25	Physical Medicine and Rehabilitation	0	In state provider	None	701 E 28TH ST	STE 416	LONG BEACH	CA	90806	2787	19	06037	33.80803441	-118.1847137	Los Angeles County
207875	Fee-for-Service	1831534932	1831534932	1	1	BABU, ANNA MD	10/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156062	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
207895	Fee-for-Service	1811422777	1811422777	1	1	BUSSIS, KYLE MD	7/10/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
207913	Fee-for-Service	1710067285	1710067285	1	1	BLISH, CATHERINE A MD	12/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54975	77	Infectious Disease	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
207934	Fee-for-Service	1639538556	1639538556	1	1	BULLER, JEANETTE LCSW	10/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
207941	Fee-for-Service	1962950741	1962950741	1	1	BK PHARMACY CORP	3/11/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6741 N WILLOW AVE	106	FRESNO	CA	93710	5955	10	06019	36.834615	-119.7301145	Fresno County
207942	Fee-for-Service	1992927230	1992927230	1	1	BERCU, TRACY E MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103530	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	0000	19	06037	33.81253631	-118.3435557	Los Angeles County
207961	Fee-for-Service	1285662239	1285662239	1	1	BROWARD GENERAL MED CNTR	12/6/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1600 S ANDREWS AVE	None	FT LAUDERDALE	FL	33316	2510	00	None	26.102142	-80.1408645	Broward County
208001	Fee-for-Service	1013020833	1013020833	1	1	BERZANSKY, MARC B DO	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8064	None	None	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
208005	Fee-for-Service	1487724290	1487724290	1	1	BERG, MARY A MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	61587	01	General Practice	0	In state provider	None	8911 LAKEWOOD DR	STE 13	WINDSOR	CA	95492	7857	49	06097	38.55034733	-122.8042316	Sonoma County
208018	Fee-for-Service	1144255753	1144255753	1	2	BRADBURY, EDWARD T MD A	2/1/2011	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	23889	20	Orthopedic Surgery	0	In state provider	PROFESSIONAL CORPORATION	150 CARNATION DR	STE 2	FREEDOM	CA	95019	3132	44	06087	36.93711696	-121.7705737	Santa Cruz County
208025	Fee-for-Service	1487802385	1487802385	1	1	BUKARI, MOHAMMED S MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150043	78	Neoplastic Diseases/Oncology	0	In state provider	None	2335 E KASHIAN LANE	STE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
208052	Fee-for-Service	1588704449	1588704449	1	2	BOUNDLESS CARE, INC.	1/31/2022	251J00000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5988 SILVER CREEK VALLEY	STE 60	SAN JOSE	CA	95138	1077	43	06085	37.25855046	-121.7855027	Santa Clara County
208059	Fee-for-Service	1942499884	1942499884	1	1	BOTA, DANIELA A MD	11/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101786	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
208061	Fee-for-Service	1477135390	1477135390	1	1	BLANCO, THEOPHANY ANNE C MD	11/5/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
208090	Fee-for-Service	1326238072	1326238072	1	1	BARKLEY, JENNIFER A MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114849	40	Pediatrics	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
208095	Fee-for-Service	1639450935	1639450935	1	1	BERBERICH, DEBORAH A PHD	9/22/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1210 NORTH JEFFERSON ST	UNIT F	ANAHEIM	CA	92807	1630	30	06059	33.85958896	-117.8369926	Orange County
208147	Fee-for-Service	1881953255	1881953255	1	1	BORODYANSKAYA, MARIYA DO	8/8/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17450	36	Psychiatry	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208152	Fee-for-Service	1760680243	1760680243	1	1	BAUTISTA, MARIVIC A MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100478	08	Family Practice	0	In state provider	None	8110 MANGO AVENUE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
208157	Fee-for-Service	1114060183	1114060183	1	1	BRAR, BARBARA P MD	1/1/1989	207L00000X	NA	Other	026	PHYSICIANS	58162	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	None	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
208178	Fee-for-Service	1669770939	1669770939	1	1	BOND, KIMBERLEE A	12/5/2016	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92013	9001	37	06073	32.7537975	-117.1658298	San Diego County
208199	Fee-for-Service	1184940033	1184940033	1	2	BAKHSH, KHAZENAY MD	8/1/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	21001	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
208229	Fee-for-Service	1366079899	1366079899	1	1	BLOSSER, NICHELE DO	8/4/2023	207R00000X	NA	Other	026	PHYSICIANS	20523	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
208253	Fee-for-Service	1205333796	1205333796	1	1	BERLIN, EVAN M MD	7/7/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	176586	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
208254	Fee-for-Service	1023220266	1023220266	1	1	BAIRD, FRANK F LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
208279	Fee-for-Service	1366540544	1366540544	1	1	BOTLA, RAVI MD	7/11/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	51599	10	Gastroenterology (M.D. only)	0	In state provider	None	782 EAST HARDING WAY	None	STOCKTON	CA	95204	6101	39	06077	37.96910043	-121.284224	San Joaquin County
208281	Fee-for-Service	1881614378	1881614378	2	1	BLESA, MARTA I MD	4/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	31530	None	None	0	In state provider	None	5821 TEMPLE CITY BLVD	None	TEMPLE CITY	CA	91780	1837	19	06037	34.10555463	-118.0607065	Los Angeles County
208296	Fee-for-Service	1427256957	1427256957	1	4	BEVERLY HILLS ONCOLOGY MEDIC	11/22/2024	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	8929 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	1938	19	06037	34.06709669	-118.386182	Los Angeles County
208315	Fee-for-Service	1487802385	1487802385	1	1	BUKARI, MOHAMMED S MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150043	68	Hematology	0	In state provider	None	2335 E KASHIAN LANE	STE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
208316	Fee-for-Service	1467530568	1467530568	1	1	BURGESS, JAMES E MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72364	41	Internal Medicine	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
208332	Fee-for-Service	1053499947	1053499947	1	1	BAUER, BARBARA J MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47827	08	Family Practice	0	In state provider	None	2615 I ST	None	SACRAMENTO	CA	95816	4395	34	06067	38.575656	-121.470867	Sacramento County
208341	Fee-for-Service	1083611594	1083611594	1	1	BAJWA, RANDEEP S MD	1/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104576	45	Nephrology (Renal-Kidney)	0	In state provider	None	2350 N CALIFORNIA ST	# 228	STOCKTON	CA	95204	5506	39	06077	37.97506325	-121.2908551	San Joaquin County
208368	Fee-for-Service	1952663627	1952663627	1	1	BUI, GIANG T MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152181	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
208370	Fee-for-Service	1174979108	1174979108	2	1	BEAVER VALLEY HOSPITAL	5/1/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1109 N 100 W	None	BEAVER	UT	84713	7746	00	None	38.28916369	-112.6431749	Beaver County
208423	Fee-for-Service	1962584920	1962584920	1	1	BAYATI, REZA MD	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34499	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
208431	Fee-for-Service	1881953255	1881953255	1	1	BORODYANSKAYA, MARIYA DO	8/8/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17450	26	Psychiatry (child)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208445	Fee-for-Service	1710262738	1710262738	1	2	BLANCO, FRANCES LCSW	6/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
208507	Fee-for-Service	1366487357	1366487357	1	1	BHATT, JATIN C MD	11/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50059	01	General Practice	0	In state provider	None	3621 E MARTIN LUTHER	KING JR BLVD STE 8	LYNWOOD	CA	90262	3512	19	06037	33.93082719	-118.2024698	Los Angeles County
208516	Fee-for-Service	1417074907	1417074907	1	1	BLANCO, ROY L NP	7/10/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
208531	Fee-for-Service	1790099919	1790099919	1	1	BINDRA, SUPREET S MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125247	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	4121	43	06085	37.43920432	-122.162109	Santa Clara County
208552	Fee-for-Service	1255942793	1255942793	1	1	BARLOW, JOSHUA A LCSW	9/15/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
208557	Fee-for-Service	1801458906	1801458906	1	1	BUCUR, JOHN A CRNA	8/3/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
208584	Fee-for-Service	1427256957	1427256957	1	4	BEVERLY HILLS ONCOLOGY MEDIC	11/22/2024	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8929 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	1938	19	06037	34.06709669	-118.386182	Los Angeles County
208589	Fee-for-Service	1942261201	1942261201	1	1	BUCHHOLZ,GARY D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2421 NE DOCTORS DRIVE	None	BEND	OR	97701	0000	00	None	44.06992657	-121.2668619	Deschutes County
208598	Fee-for-Service	1124221932	1124221932	1	1	BATTH, KIRANDEEP K MD	7/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97323	41	Internal Medicine	0	In state provider	None	1180 EAST SHAW	STE 125	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
208602	Fee-for-Service	1487802385	1487802385	1	1	BUKARI, MOHAMMED S MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150043	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
208620	Fee-for-Service	1740428069	1740428069	1	1	BAYDOUN, JAMIE M MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESSTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
208635	Fee-for-Service	1245324169	1245324169	1	1	BASIN AMBULANCE SERVICE	10/1/1998	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	BASIN VOLUNTEER AMB SVCS	24971 HWY 39	None	MERRILL	OR	97633	0000	00	None	41.99836665	-121.5195952	Klamath County
208639	Fee-for-Service	1649513797	1649513797	1	1	BABEY, MURIEL E MD	5/2/2017	390200000X	NA	Other	026	PHYSICIANS	138517	41	Internal Medicine	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
208667	Fee-for-Service	1720071822	1720071822	1	1	BATES, NELSON R OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2625 W ALAMEDA AVE	STE 208	BURBANK	CA	91505	4823	19	06037	34.1577056	-118.329779	Los Angeles County
208714	Fee-for-Service	1801107669	1801107669	1	1	BRADY, EMILY F MD	2/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150157	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
208732	Fee-for-Service	1518024744	1518024744	1	1	BLANCK, NICOLE E	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
208735	Fee-for-Service	1831140953	1831140953	1	1	BAZZAZ, SHEILA MD	5/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84773	18	Ophthalmology	0	In state provider	None	1211 W LA PALMA AVE	STE 201	ANAHEIM	CA	92801	2810	30	06059	33.84718298	-117.933758	Orange County
208765	Fee-for-Service	1790735033	1790735033	1	1	BUCHER, DAVID F MD INC	4/25/1972	No Taxonomy Provided	NA	None	026	PHYSICIANS	30242	01	General Practice	0	In state provider	None	587 E ELDER ST	None	FALLBROOK	CA	92028	3003	37	06073	33.38014649	-117.245448	San Diego County
208768	Fee-for-Service	1831382829	1831382829	1	2	BUENO AND SONS INC	10/19/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	924 BUENA VISTA ST	SUITE 102	DUARTE	CA	91010	1779	19	06037	34.141653	-117.977523	Los Angeles County
208769	Fee-for-Service	1336566843	1336566843	1	1	BABAKHANYAN, KARINE LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE	UNIT 6	MISSION HILLS	CA	91345	3205	19	06037	34.25726849	-118.4664285	Los Angeles County
208776	Fee-for-Service	1326727686	1326727686	1	1	BETANCOURT, SANDY CCC-SLP	10/30/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
208872	Fee-for-Service	1427256957	1427256957	1	4	BEVERLY HILLS ONCOLOGY MEDIC	11/22/2024	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	8929 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	1938	19	06037	34.06709669	-118.386182	Los Angeles County
208873	Fee-for-Service	1205912656	1205912656	1	1	BALEKIAN, ALEX A	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96050	None	None	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
208906	Fee-for-Service	1508851775	1508851775	1	1	BERGERON, CHRISTOPHER M	10/24/2008	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	87110	04	Otology, Laryngology, Rhinology	0	In state provider	MD	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
208910	Fee-for-Service	1043679699	1043679699	1	1	BECKER, CHAD W DO	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	15907	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
208929	Fee-for-Service	1881087047	1881087047	1	1	BINCKLEY, SHANNON L MD	3/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144202	01	General Practice	0	In state provider	None	58471 29 PALMS HWY	STE 303	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
208954	Fee-for-Service	1043379704	1043379704	1	1	BEARD, DAVID B MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45826	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
208994	Fee-for-Service	1699299073	1699299073	1	1	BAYLOSIS, IVAN CRNA	2/12/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
209014	Fee-for-Service	1972024420	1972024420	1	1	BELLA VITA CONGREGATE LIVING	8/26/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16092 CONSTABLE ROAD	None	RIVERSIDE	CA	92504	5664	33	06065	33.88595916	-117.3979408	Riverside County
209024	Fee-for-Service	1467159939	1467159939	1	1	BAKERSFIELD CARE PHARMACY, I	2/20/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4701 PANAMA LANE	E2	BAKERSFIELD	CA	93313	3407	15	06029	35.29590053	-119.0544782	Kern County
209049	Fee-for-Service	1790735033	1790735033	1	1	BUCHER, DAVID F MD INC	4/25/1972	No Taxonomy Provided	NA	None	026	PHYSICIANS	30242	40	Pediatrics	0	In state provider	None	587 E ELDER ST	None	FALLBROOK	CA	92028	3003	37	06073	33.38014649	-117.245448	San Diego County
209150	Fee-for-Service	1881603074	1881603074	1	1	BERLINER, ROSS A DPM	10/11/2002	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	24845 NARBONNE AVE	None	LOMITA	CA	90717	1549	19	06037	33.79846168	-118.3200179	Los Angeles County
209167	Fee-for-Service	1902648009	1902648009	1	1	BREBNER, PAMELA CCC-SLP	10/28/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
209189	Fee-for-Service	1780700252	1780700252	1	1	BOMBASE, ALVIN Y PT	5/23/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
209192	Fee-for-Service	1396084307	1396084307	1	1	BREUER, ROSWITHA MD A	10/31/2018	261QP2300X	NA	Other	026	PHYSICIANS	36236	01	General Practice	0	In state provider	PROFESSIONAL MEDICAL COR	146 E 4TH ST	None	PERRIS	CA	92570	2125	33	06065	33.78239945	-117.227331	Riverside County
209196	Fee-for-Service	1114242591	1114242591	1	1	BRANDON BONEWELL	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
209202	Fee-for-Service	1619117181	1619117181	1	1	BRAR, MANPREET DPM	3/10/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
209243	Fee-for-Service	1043379704	1043379704	1	1	BEARD, DAVID B MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45826	68	Hematology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
209250	Fee-for-Service	1962664706	1962664706	1	1	BERNARDO, EDSELL C MD	4/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55975	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
209280	Fee-for-Service	1891277588	1891277588	1	1	BHANGU, SUNDEEP S PT	3/25/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
209285	Fee-for-Service	1629149984	1629149984	1	1	BALLARD & BALLARD MDS	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FAMILY PRACTICE	1115 WHISKEYTOWN CT	None	REDDING	CA	96001	0227	45	06089	40.58505639	-122.4126224	Shasta County
209302	Fee-for-Service	1326109430	1326109430	1	1	BIO MEDICAL APPLICATIONS OF	10/19/2009	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1550 HEARTWOOD DRIVE	None	MCKINLEYVILLE	CA	95519	3984	12	06023	40.93953318	-124.1028628	Humboldt County
209317	Fee-for-Service	1083708572	1083708572	1	1	BOSLER, PAULA K	10/1/2004	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	433 2ND ST	STE 101	WOODLAND	CA	95695	4065	57	06113	38.676564	-121.7718515	Yolo County
209337	Fee-for-Service	1275292179	1275292179	1	1	BELONGING & HEALING THERAPY	2/21/2022	261QM0801X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	308 W STATE ST	STE 3D	REDLANDS	CA	92373	4653	36	06071	34.05649746	-117.18603	San Bernardino County
209338	Fee-for-Service	1437199304	1437199304	2	1	BAO, WEI MD	3/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	66842	02	General Surgery	0	In state provider	None	17595 ALMANHURST ST	STE 202	ROWLAND HEIGHTS	CA	91748	5148	19	06037	33.99174345	-117.9215033	Los Angeles County
209344	Fee-for-Service	1154401792	1154401792	1	1	BHOWN, NIVEDITA B MD	6/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56156	05	Anesthesiology	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
209353	Fee-for-Service	1194193185	1194193185	1	1	BENDIGO, PAULA	2/22/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
209366	Fee-for-Service	1154858215	1154858215	1	1	BOSE, VIVEK MD	6/21/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	172095	None	None	0	In state provider	None	3445 PACIFIC COAST HIGHW	100	TORRANCE	CA	90505	6659	19	06037	33.80164353	-118.3452355	Los Angeles County
209376	Fee-for-Service	1528127123	1528127123	1	1	BUTLER, ROBERT L MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78182	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
209397	Fee-for-Service	1821348251	1821348251	1	1	BEHAN, MARGARET K CNP	4/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
209409	Fee-for-Service	1881776094	1881776094	1	1	BHINDER, SUMEET K	3/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97529	83	Rheumatology	0	In state provider	None	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5733	15	06029	35.39412578	-119.0082617	Kern County
209415	Fee-for-Service	1215602883	1215602883	1	1	BREEDON, HILARY J CNP	10/12/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
209421	Fee-for-Service	1013318112	1013318112	2	1	BRISTOL HOSPICE-INLAND	8/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	VALLEY LLC	7365 CARNELIAN ST	STE 240	RANCHO CUCAMONGA	CA	91730	1136	36	06071	34.12038413	-117.6160525	San Bernardino County
209440	Fee-for-Service	1437471810	1437471810	1	1	BAREA, JAIME J MD	3/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111622	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
209445	Fee-for-Service	1700945201	1700945201	1	1	BERGESEN, DAVID J LMFT	7/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43 QUAIL COURT	SUITE 105	WALNUT CREEK	CA	94596	4854	07	06013	37.88807861	-122.0553842	Contra Costa County
209470	Fee-for-Service	1164088746	1164088746	1	1	BUI DU, TRINH LMFT	12/16/2022	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
209487	Fee-for-Service	1346267002	1346267002	1	1	BRY, WILLIAM I MD	4/1/2004	204F00000X	NA	General Surgery	026	PHYSICIANS	47221	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2340 CLAY ST	FL 4	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
209494	Fee-for-Service	1942475405	1942475405	1	1	BRIDGES, LETITIA T MD	5/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71838	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
209498	Fee-for-Service	1588612477	1588612477	1	1	BAKER, ELLEN MAE MD	10/31/1991	207P00000X	NA	Other	026	PHYSICIANS	75305	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
209518	Fee-for-Service	1073604732	1073604732	1	1	BEAULIEU, CHRISTOPHER F	8/1/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	78532	30	Radiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
209549	Fee-for-Service	1235161795	1235161795	1	1	BURHAN, NINDYA D MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74826	40	Pediatrics	0	In state provider	None	1215 PLUMAS ST	STE 800	YUBA CITY	CA	95991	4084	51	06101	39.14709336	-121.6175316	Sutter County
209550	Fee-for-Service	1194959049	1194959049	1	1	BISHOP, CHRISTINE I MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118677	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
209572	Fee-for-Service	1750525432	1750525432	1	1	BARSOOM, RAAFAT S MD	4/1/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
209578	Fee-for-Service	1700977352	1700977352	1	1	BHANDIA, ANITA KOTHARI	7/31/1991	207R00000X	NA	Other	026	PHYSICIANS	46590	41	Internal Medicine	0	In state provider	None	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	01	06001	37.54845774	-121.9773463	Alameda County
209585	Fee-for-Service	1124111547	1124111547	1	1	BIRD, JANICE M	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INNOVATIVE SPEECH SOLUTI	2900 JOSEPH AVE	None	SACRAMENTO	CA	95864	7732	34	06067	38.582118	-121.395744	Sacramento County
209596	Fee-for-Service	1730586553	1730586553	1	1	BECKEL, DACHA	11/21/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3612 GOLDEN EAGLE WAY	None	SACRAMENTO	CA	95827	3519	34	06067	38.55969	-121.3272045	Sacramento County
209624	Fee-for-Service	1063409472	1063409472	1	1	BAY CREST CARE CENTER	8/15/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	3750 GARNET ST	None	TORRANCE	CA	90503	3305	19	06037	33.84315648	-118.352853	Los Angeles County
209625	Fee-for-Service	1437199304	1437199304	2	1	BAO, WEI MD	3/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	66842	41	Internal Medicine	0	In state provider	None	17595 ALMANHURST ST	STE 202	ROWLAND HEIGHTS	CA	91748	5148	19	06037	33.99174345	-117.9215033	Los Angeles County
209631	Fee-for-Service	1558531053	1558531053	1	1	BUELLTON MEDICAL CENTER	11/12/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	195 W HWY 246	None	BUELLTON	CA	93427	9459	42	06083	34.61514868	-120.1976747	Santa Barbara County
209635	Fee-for-Service	1093026999	1093026999	1	1	BABB, AARON C MD	9/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125947	20	Orthopedic Surgery	0	In state provider	None	37491 ENTERPRISE DRIVE	None	BURNEY	CA	96013	4379	45	06089	40.88784451	-121.6526265	Shasta County
209637	Fee-for-Service	1982971644	1982971644	1	1	BERTIN, REBECCA C MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119104	08	Family Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
209649	Fee-for-Service	1982671491	1982671491	1	1	BAPTIST ST ANTHONY'S	11/17/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	1600 WALLACE BLVD	None	AMARILLO	TX	79106	1789	00	None	35.19634143	-101.9178866	Potter County
209656	Fee-for-Service	1124341672	1124341672	1	1	BANNER IRONWOOD MEDICAL	1/7/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	37000 N GANTZEL ROAD	None	SAN TAN VALLEY	AZ	85140	7303	00	None	33.21531	-111.565503	Pinal County
209659	Fee-for-Service	1740605799	1740605799	1	1	BROWN, RYAN P CRNA	12/16/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
209664	Fee-for-Service	1912008871	1912008871	1	1	BROCK, LEE J MD	1/18/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	90803	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
209682	Fee-for-Service	1720265044	1720265044	1	1	BALIKAI, SHILPA C DO	6/17/2022	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
209696	Fee-for-Service	1881776094	1881776094	1	1	BHINDER, SUMEET K	3/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97529	41	Internal Medicine	0	In state provider	None	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5733	15	06029	35.39412578	-119.0082617	Kern County
209713	Fee-for-Service	1013318112	1013318112	2	1	BRISTOL HOSPICE-INLAND	8/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	VALLEY LLC	7365 CARNELIAN ST	STE 240	RANCHO CUCAMONGA	CA	91730	1136	36	06071	34.12038413	-117.6160525	San Bernardino County
209771	Fee-for-Service	1316567308	1316567308	1	1	BRYANT, MIEKE N LCSW	8/2/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
209775	Fee-for-Service	1346267002	1346267002	1	1	BRY, WILLIAM I MD	4/1/2004	204F00000X	NA	General Surgery	026	PHYSICIANS	47221	02	General Surgery	0	In state provider	None	2340 CLAY ST	FL 4	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
209811	Fee-for-Service	1366459893	1366459893	1	1	BERMUDEZ, JOSEPH A MD	1/30/1997	207L00000X	NA	Other	026	PHYSICIANS	51867	05	Anesthesiology	0	In state provider	SAMUEL MERRITT HOSPITAL	HAWTHORNE & WEBSTER ST	None	OAKLAND	CA	94609	0000	01	06001	37.820763	-122.26293	Alameda County
209828	Fee-for-Service	1881100949	1881100949	1	1	BOCHYNSKI, LUCY M PT	10/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
209836	Fee-for-Service	1275622896	1275622896	1	1	BIRCHALL, ISAAC A DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4678 N 1ST ST	None	FRESNO	CA	93726	0903	10	06019	36.802791	-119.7722135	Fresno County
209861	Fee-for-Service	1740327568	1740327568	1	1	BASI, AMRIK S MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92203	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
209884	Fee-for-Service	1730586553	1730586553	1	1	BECKEL, DACHA	11/21/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3612 GOLDEN EAGLE WAY	None	SACRAMENTO	CA	95827	3519	34	06067	38.55969	-121.3272045	Sacramento County
209890	Fee-for-Service	1982124418	1982124418	1	1	BLUMENTHALER, ALISA N MD	8/8/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
209891	Fee-for-Service	1629145537	1629145537	1	1	BOUMA, CURT L MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70751	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
209917	Fee-for-Service	1871870048	1871870048	1	1	BRUST, LAUREL K LCSW	3/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
209933	Fee-for-Service	1558970194	1558970194	1	1	BANDARU, TEJASWINI MD	10/16/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186281	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
209936	Fee-for-Service	1124341672	1124341672	1	1	BANNER IRONWOOD MEDICAL	1/7/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	37000 N GANTZEL ROAD	None	SAN TAN VALLEY	AZ	85140	7303	00	None	33.21531	-111.565503	Pinal County
209937	Fee-for-Service	1982671491	1982671491	1	1	BAPTIST ST ANTHONY'S	6/20/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	1600 WALLACE BLVD	None	AMARILLO	TX	79106	1789	00	None	35.19634143	-101.9178866	Potter County
209939	Fee-for-Service	1164440905	1164440905	1	1	BEL AIR MARKET INC	3/28/2006	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3250 ARENA BLVD	None	SACRAMENTO	CA	95834	1098	34	06067	38.642085	-121.5336555	Sacramento County
209946	Fee-for-Service	1235183435	1235183435	1	1	BISKER, JEFFREY S MD	8/25/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	133012	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
209956	Fee-for-Service	1699860023	1699860023	1	1	BAKER, SEAN S LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 GRANADA ST	STE N	CAMARILLO	CA	93010	7866	56	06111	34.21527102	-119.0535007	Ventura County
209970	Fee-for-Service	1891121364	1891121364	1	1	BERNSTEIN, LAUREL K CNM	2/26/2018	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
209981	Fee-for-Service	1023110301	1023110301	1	1	BERGREN, JOHN D MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	79510	08	Family Practice	0	In state provider	None	13350 BIG BASIN WAY	None	BOULDER CREEK	CA	95006	9237	44	06087	37.12492123	-122.1245364	Santa Cruz County
209983	Fee-for-Service	1669014742	1669014742	1	1	BRADLEY, ANNA O NP	8/19/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210030	Fee-for-Service	1194081984	1194081984	1	1	BYSRITSKY, RACHEL J MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142468	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210049	Fee-for-Service	1366812588	1366812588	1	1	BOLLENDORF, KRISTINA A LMFT	9/19/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	43033	-	NOT APPLICABLE	0	In state provider	None	1816 SCENIC AVENUE	None	BERKELEY	CA	94709	1324	01	06001	37.87558576	-122.2622904	Alameda County
210095	Fee-for-Service	1376609347	1376609347	1	1	BOWDEN, VICTORIA L CRNA	3/16/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
210131	Fee-for-Service	1740327568	1740327568	1	1	BASI, AMRIK S MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92203	08	Family Practice	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
210147	Fee-for-Service	1114937646	1114937646	1	1	BRAR, INDERJEET MD	9/14/2019	207RC0200X	NA	Other	026	PHYSICIANS	155922	41	Internal Medicine	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
210152	Fee-for-Service	1033266721	1033266721	1	1	BATTULA, SIREESHA DPM	4/16/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
210155	Fee-for-Service	1164464137	1164464137	1	1	BHATIA, PRAKASH K	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74848	None	None	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
210193	Fee-for-Service	1801899646	1801899646	1	1	BAY EYE MEDICAL GROUP	11/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1665 DOMINICAN WAY	STE 124	SANTA CRUZ	CA	95065	1528	44	06087	36.99032886	-121.9811968	Santa Cruz County
210201	Fee-for-Service	1730389826	1730389826	1	1	BONSALLS SHOES INC	12/13/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4701 HAMILTON AVE	705	SAN JOSE	CA	95130	1789	43	06085	37.2921038	-121.9850473	Santa Clara County
210218	Fee-for-Service	1336145739	1336145739	1	1	BURICHIN, JUDITH J MD	4/12/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139108	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
210243	Fee-for-Service	1104826619	1104826619	1	1	BORSARI, BRADLEY E MD	2/20/2008	174400000X	NA	Other	026	PHYSICIANS	76554	41	Internal Medicine	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3473	30	06059	33.89344341	-117.9338865	Orange County
210289	Fee-for-Service	1467871442	1467871442	1	1	BARTHELEMY, ERNEST J MD	6/22/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	172632	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210294	Fee-for-Service	1649737016	1649737016	1	1	BROOKS-MOTL, MARYJO LMFT	9/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
210315	Fee-for-Service	1639345705	1639345705	1	1	BHOOT, NILESH H MD	8/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94735	02	General Surgery	0	In state provider	None	1510 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2542	19	06037	34.12709764	-118.2577911	Los Angeles County
210325	Fee-for-Service	1346639614	1346639614	1	1	BOOKER, BRITTNEE R NP	2/3/2021	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210328	Fee-for-Service	1861886814	1861886814	1	1	BAYKINA, YELIZAVETA V	10/26/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
210364	Fee-for-Service	1699137885	1699137885	1	1	BOBBITT, LOUISE R	1/19/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
210367	Fee-for-Service	1356567945	1356567945	1	1	BISHOP, CAROL MFT	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17706	-	NOT APPLICABLE	0	In state provider	None	7101 BAIRD AVE	None	RESEDA	CA	91335	4150	19	06037	34.1995012	-118.5373824	Los Angeles County
210414	Fee-for-Service	1013100338	1013100338	1	1	BUI, CHARLES Q MD	10/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101681	08	Family Practice	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
210425	Fee-for-Service	1659804623	1659804623	1	1	BROSTER, LUCAS S MD	7/14/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157545	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
210453	Fee-for-Service	1083899322	1083899322	1	1	BALAJI, ANUPAMA MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142595	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
210482	Fee-for-Service	1801899646	1801899646	1	1	BAY EYE MEDICAL GROUP	1/23/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1665 DOMINICAN WAY	STE 124	SANTA CRUZ	CA	95065	1528	44	06087	36.99032886	-121.9811968	Santa Cruz County
210536	Fee-for-Service	1053632349	1053632349	1	1	BOYD, MICHAEL D MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112566	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
210555	Fee-for-Service	1558467514	1558467514	1	1	BROUDY, CORRIE D MD	6/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82832	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
210556	Fee-for-Service	1639796071	1639796071	1	1	BROWN, DARCIE D LMFT	9/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
210560	Fee-for-Service	1487639605	1487639605	1	1	BACH, HUONG T MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63357	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
210569	Fee-for-Service	1285878132	1285878132	1	1	BERGANCIA, JASON R CCC-SLP	3/15/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7262 IDYLLWILD LANE	None	RIVERSIDE	CA	92505	7111	33	06065	33.9616642	-117.4769903	Riverside County
210588	Fee-for-Service	1194111393	1194111393	1	1	BAUER, INGRID W MD	2/28/2019	390200000X	NA	Other	026	PHYSICIANS	146416	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
210607	Fee-for-Service	1508380551	1508380551	1	1	BANGALORE HOMBALEGOWDA, RADH	4/1/2021	390200000X	NA	Other	026	PHYSICIANS	171990	None	None	0	In state provider	IKA MD	2509 W MARCH LANE	SUITE 250	STOCKTON	CA	95207	8222	39	06077	37.98503764	-121.3384384	San Joaquin County
210622	Fee-for-Service	1447813332	1447813332	1	1	BEHNAM EBRAHIMI MD INC	9/27/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	None	None	None	0	In state provider	None	1910 ROYALTY DR	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
210643	Fee-for-Service	1649298704	1649298704	1	1	BEAMESDERFER, TIMOTHY N	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	79412	41	Internal Medicine	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
210654	Fee-for-Service	1336371681	1336371681	1	1	BHATIA, TARUNA MD	1/24/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	156164	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
210696	Fee-for-Service	1528031051	1528031051	1	1	BHAT, NIRMALA MD	12/1/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37770	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
210722	Fee-for-Service	1275728719	1275728719	1	1	BYRNE, BRIANNE LMFT	1/5/2024	104100000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
210732	Fee-for-Service	1538607460	1538607460	1	1	BI-BETT	2/17/2017	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2901 PROSPECT AVE	None	CONCORD	CA	94518	1024	07	06013	37.97169766	-122.0263249	Contra Costa County
210783	Fee-for-Service	1538748520	1538748520	1	2	BADA, FEHINTOLU G NP	10/12/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95017080	-	NOT APPLICABLE	0	In state provider	None	320 E PALMDALE BLVD	None	PALMDALE	CA	93550	4598	19	06037	34.57983613	-118.1240079	Los Angeles County
210797	Fee-for-Service	1588789838	1588789838	1	1	BAGNIS, DAHLIA LCSW	7/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
210821	Fee-for-Service	1659665065	1659665065	1	1	BANCROFT, KARI K MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147265	05	Anesthesiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
210843	Fee-for-Service	1558467514	1558467514	1	1	BROUDY, CORRIE D MD	6/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82832	83	Rheumatology	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
210880	Fee-for-Service	1962720011	1962720011	1	1	BEYER, AMY OT	3/13/2025	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1149 W 190TH ST	STE 2300	GARDENA	CA	90248	4350	19	06037	33.85834052	-118.2958065	Los Angeles County
210885	Fee-for-Service	1790882603	1790882603	1	1	BAKER, VALERIE L MD	4/30/1992	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	67713	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
210895	Fee-for-Service	1053496836	1053496836	1	1	BUI, ANH X OD	2/18/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	38024 MARTHA AVE	None	FREMONT	CA	94536	3809	01	06001	37.5611278	-121.9922569	Alameda County
210927	Fee-for-Service	1184120701	1184120701	1	1	BARROGA, HANNAH MARIA DO	5/6/2020	390200000X	NA	Other	026	PHYSICIANS	17923	08	Family Practice	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
210964	Fee-for-Service	1164701132	1164701132	1	1	BANKS, SARAH J PHD	9/18/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
210984	Fee-for-Service	1942687090	1942687090	1	1	BZDYRA, PIOTR MD	2/16/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	167695	None	None	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
210989	Fee-for-Service	1407388572	1407388572	1	1	BOYLE, EMMALEE MD	2/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183462	None	None	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
211005	Fee-for-Service	1720814577	1720814577	1	1	BASS, MONIQUE K CD	12/10/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
211015	Fee-for-Service	1245490325	1245490325	1	1	BUI, PHI-YEN N MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120632	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
211064	Fee-for-Service	1184703654	1184703654	1	1	BEADLEY,DAVID J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 E MEDICAL CENTER	DRIVE	ANN ARBOR	MI	48109	5204	00	None	42.28391347	-83.72716554	Washtenaw County
211077	Fee-for-Service	1376546846	1376546846	1	1	BROWN, ELISA C MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	70140	40	Pediatrics	0	In state provider	None	194 COHASSET RD	None	CHICO	CA	95926	2202	04	06007	39.75187316	-121.8530022	Butte County
211129	Fee-for-Service	1528773827	1528773827	1	1	BRIGHT, EVELYN OFOSUAA	2/16/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	28301 BAY AVE	None	MORENO VALLEY	CA	92555	6131	33	06065	33.92094129	-117.1687887	Riverside County
211131	Fee-for-Service	1649632373	1649632373	1	1	BALD, MATTHEW R MD	4/13/2021	208M00000X	NA	Other	026	PHYSICIANS	155151	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
211136	Fee-for-Service	1629400999	1629400999	1	1	BATES, LAUREN E NP	10/1/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
211162	Fee-for-Service	1518078443	1518078443	1	1	BONOVICH, DAVID C MD	1/15/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	71726	36	Psychiatry	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
211187	Fee-for-Service	1881222677	1881222677	1	1	BENTER, BRADLEY J LMFT	8/16/2023	103T00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10116 JIBBOOM ST	6	TRUCKEE	CA	96161	0101	29	06057	39.3282514	-120.1862351	Nevada County
211189	Fee-for-Service	1205418969	1205418969	1	1	BRING, KATHLEEN E MD	10/16/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
211233	Fee-for-Service	1447253034	1447253034	1	1	BROWNING, DAVID OD	9/19/1994	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	560 LAKEPORT BLVD	None	LAKEPORT	CA	95453	5420	17	06033	39.03467947	-122.9200628	Lake County
211297	Fee-for-Service	1962691576	1962691576	1	1	BIRGER, ALEXEI MD	2/8/2015	207LP2900X	NA	Other	026	PHYSICIANS	99858	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
211317	Fee-for-Service	1609909241	1609909241	1	1	BENITES, PRISCILLA L LMFT	4/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25050 AVE KEARNY	215	VALENCIA	CA	91355	1854	19	06037	34.43517857	-118.5722781	Los Angeles County
211331	Fee-for-Service	1033255633	1033255633	1	1	BANERJEE, SRABONI MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70347	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
211353	Fee-for-Service	1326137589	1326137589	1	1	BARBOUR, CLAYTON O II MD	9/14/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73985	41	Internal Medicine	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
211360	Fee-for-Service	1437126182	1437126182	1	1	BRAHMBHATT, BHOOMI M MD	8/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91358	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8010 FROST ST	STE 301	SAN DIEGO	CA	92123	4237	37	06073	32.80026879	-117.1520059	San Diego County
211385	Fee-for-Service	1215024492	1215024492	1	1	BROMLEY ELIZABETH A MD	4/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83792	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	0000	19	06037	34.07671715	-118.3799413	Los Angeles County
211389	Fee-for-Service	1053464818	1053464818	1	1	BOWMAN, BRETT P OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	APC	370 W GRAND BLVD	STE 110	CORONA	CA	92882	2175	33	06065	33.87826645	-117.5732887	Riverside County
211401	Fee-for-Service	1750867784	1750867784	1	1	BASAK, RYAN MD	9/20/2021	207R00000X	NA	Other	026	PHYSICIANS	174399	None	None	0	In state provider	None	28400 MCCALL BLVD	SUITE B10	MENIFEE	CA	92585	9658	33	06065	33.71805454	-117.1672547	Riverside County
211410	Fee-for-Service	1356729552	1356729552	1	1	BASHOURA, HELEN G MD	1/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151146	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
211418	Fee-for-Service	1528773827	1528773827	1	1	BRIGHT, EVELYN OFOSUAA	2/16/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	28301 BAY AVE	None	MORENO VALLEY	CA	92555	6131	33	06065	33.92094129	-117.1687887	Riverside County
211439	Fee-for-Service	1407903842	1407903842	1	1	BALBONI, IMELDA M MD	7/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74553	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
211525	Fee-for-Service	1033261524	1033261524	1	1	BURGOS, ANTHONY E MD	6/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80458	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
211547	Fee-for-Service	1346767308	1346767308	1	1	BRYANT, JESSIONA A LCSW	8/18/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	SUITE 210	SAN DIEGO	CA	92108	3104	37	06073	32.76632791	-117.1616245	San Diego County
211548	Fee-for-Service	1184013492	1184013492	1	1	BEARD, CHRISTINE LMFT	8/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	163 2ND ST	None	WOODLAND	CA	95695	3316	57	06113	38.68060768	-121.7718082	Yolo County
211556	Fee-for-Service	1326580598	1326580598	1	1	BELTRANO, MICHAEL V LMFT	6/21/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
211565	Fee-for-Service	1053391185	1053391185	1	1	BARSOUM, NOHA R MD	6/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64657	41	Internal Medicine	0	In state provider	None	15211 VANOWEN ST	STE 300	VAN NUYS	CA	91405	3617	19	06037	34.19395411	-118.4642527	Los Angeles County
211570	Fee-for-Service	1225206279	1225206279	1	1	BAIG, SHAHIDA MD	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101749	None	None	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
211600	Fee-for-Service	1083824502	1083824502	1	1	BAN, KATHRYN E MD	3/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
211623	Fee-for-Service	1174848089	1174848089	1	1	BABYNA, MARIYA MD	11/6/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	124087	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
211627	Fee-for-Service	1417196924	1417196924	1	1	BUSCH, AMY L PHD	10/26/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
211641	Fee-for-Service	1326137589	1326137589	1	1	BARBOUR, CLAYTON O II MD	9/14/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73985	01	General Practice	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
211644	Fee-for-Service	1770545832	1770545832	1	1	BHAVARAJU,VASUDHA MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
211726	Fee-for-Service	1295232601	1295232601	1	1	BIEL, TERRY J MD	9/5/2023	207L00000X	NA	Other	026	PHYSICIANS	188011	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
211738	Fee-for-Service	1083827992	1083827992	1	1	BOYNTON, SAMUEL J MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129931	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
211740	Fee-for-Service	1144657537	1144657537	1	1	BARNETT, CHALON A LCSW	6/11/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
211763	Fee-for-Service	1770992752	1770992752	1	1	BEMANIAN, SHAHROKH	9/12/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	174637	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
211802	Fee-for-Service	1043623531	1043623531	1	1	BENITEZ, MAYA S MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142378	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
211819	Fee-for-Service	1942269147	1942269147	1	1	BAKER, STEVEN C MD	5/13/2020	207ZP0102X	NA	Other	026	PHYSICIANS	167942	22	Pathology (M.D. only)	0	In state provider	None	2625 COFFEE RD	STE S	MODESTO	CA	95355	2050	50	06099	37.67888506	-120.9759048	Stanislaus County
211823	Fee-for-Service	1124052543	1124052543	1	1	BRESLER, MICHAEL MD	1/2/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27620	66	Emergency Medicine (Urgent Care)	0	In state provider	None	45 ROBERTA DR	None	WOODSIDE	CA	94062	2524	41	06081	37.41892582	-122.2559831	San Mateo County
211843	Fee-for-Service	1063516144	1063516144	1	1	BASCON, ROSA T MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	85053	40	Pediatrics	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4398	13	06025	32.78144947	-115.568541	Imperial County
211854	Fee-for-Service	1962474049	1962474049	1	1	BIELAWSKI, HARRIET ANN	3/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48958	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
211855	Fee-for-Service	1518995158	1518995158	1	1	BRIAN R RAH MD	8/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
211867	Fee-for-Service	1861413320	1861413320	1	1	BRAWLEY, JOHN G MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95949	None	None	0	In state provider	None	751 BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
211875	Fee-for-Service	1760936884	1760936884	1	5	BEVERLYCARE	7/10/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	101 E BEVERLY BLVD	SUITE 301	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
211884	Fee-for-Service	1073023677	1073023677	1	2	BEHAVIORAL HEALTH SERVICES	5/6/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1000 EAST DOMINIGUEZ ST	SUITE 110	CARSON	CA	90746	3600	19	06037	33.8404157	-118.2575491	Los Angeles County
211896	Fee-for-Service	1730576414	1730576414	1	1	BAYFRONT YOUTH AND FAMILY	10/6/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	16444 PARAMOUNT BLVD	SUITE 203	PARAMOUNT	CA	90723	5454	19	06037	33.8848179	-118.1599671	Los Angeles County
211938	Fee-for-Service	1215165147	1215165147	1	1	BHATT, KANDARP Y MD	8/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	SUITE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
211942	Fee-for-Service	1952583874	1952583874	1	1	BOULAY, GENEVIEVE M C CR	4/1/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
211948	Fee-for-Service	1952356594	1952356594	1	1	BATIZY, LEVENTE G DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
211949	Fee-for-Service	1275732703	1275732703	1	1	BRUHN, ARON M MD	2/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121828	34	Urology and Urological Surgery	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
211963	Fee-for-Service	1265708408	1265708408	1	1	BADALYAN, IRINA MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118883	41	Internal Medicine	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
211969	Fee-for-Service	1851479943	1851479943	1	1	BREWER, LYNNE L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30770	22	Pathology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
212008	Fee-for-Service	1518019793	1518019793	1	1	BANERJEE, SUBHAS MD	11/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77220	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
212028	Fee-for-Service	1659392256	1659392256	1	1	BLACK, MICHAEL D MD	2/8/2015	208G00000X	NA	General Surgery	026	PHYSICIANS	52781	33	Thoracic Surgery	0	In state provider	None	2100 WEBSTER ST	STE 511	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
212030	Fee-for-Service	1891787594	1891787594	2	1	BREG INC	11/6/2023	335E00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2382 FARADAY AVE	300	CARLSBAD	CA	92008	7220	37	06073	33.13594663	-117.274685	San Diego County
212069	Fee-for-Service	1750494183	1750494183	1	1	BERNABA, BASEM Z MD	7/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88361	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	15	06029	35.3655	-118.985202	Kern County
212089	Fee-for-Service	1740703420	1740703420	1	1	BESTCARE EXPRESS INC	8/29/2017	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3941 HOLLY DR	#C	TRACY	CA	95304	1652	39	06077	37.76565446	-121.4260268	San Joaquin County
212106	Fee-for-Service	1871740936	1871740936	1	1	BARAGI, RASHMI V MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121724	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
212133	Fee-for-Service	1902864275	1902864275	1	1	BRUNSWICK, J E MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2865 DAGGETT AVENUE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
212164	Fee-for-Service	1760936884	1760936884	1	5	BEVERLYCARE	7/10/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	101 E BEVERLY BLVD	SUITE 301	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
212169	Fee-for-Service	1073023677	1073023677	1	2	BEHAVIORAL HEALTH SERVICES	5/6/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1000 EAST DOMINIGUEZ ST	SUITE 110	CARSON	CA	90746	3600	19	06037	33.8404157	-118.2575491	Los Angeles County
212178	Fee-for-Service	1568542462	1568542462	1	2	BENNETT, MURRAY W.R. MD	12/13/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	55097	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
212213	Fee-for-Service	1023044559	1023044559	1	1	BRAH, SUKHJINDER S MD	4/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91687	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
212259	Fee-for-Service	1760639983	1760639983	1	1	BIXBY, JONATHAN C MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127136	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
212275	Fee-for-Service	1205369337	1205369337	1	1	BECKA, CHANDRA M MD	9/20/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
212294	Fee-for-Service	1518019793	1518019793	1	1	BANERJEE, SUBHAS MD	11/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77220	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
212295	Fee-for-Service	1306889142	1306889142	1	1	BIANCHINI, ERIC S MD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70838	05	Anesthesiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
212304	Fee-for-Service	1962639203	1962639203	1	1	BRUNETTE, LAURIE L MD	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114320	None	None	0	In state provider	None	1441 EASTLAKE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
212318	Fee-for-Service	1659392256	1659392256	1	1	BLACK, MICHAEL D MD	2/8/2015	208G00000X	NA	General Surgery	026	PHYSICIANS	52781	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2100 WEBSTER ST	STE 511	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
212319	Fee-for-Service	1295204204	1295204204	1	1	BONNIN, MAY A NP	7/13/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5400 ALDRIN CT	None	BAKERSFIELD	CA	93313	2103	15	06029	35.31652652	-119.062791	Kern County
212345	Fee-for-Service	1578521118	1578521118	1	1	BIJLANI, SMITA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	135 BARCLAY CIR	None	ROCHESTER HLS	MI	48307	4599	00	None	42.64294508	-83.12897734	Oakland County
212395	Fee-for-Service	1407329162	1407329162	1	1	BOYD, JOEL V RCP	1/22/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
212495	Fee-for-Service	1033312822	1033312822	1	1	BLOCK, WENDY N LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
212496	Fee-for-Service	1356430797	1356430797	1	1	BROWN, TARA L MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85440	18	Ophthalmology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
212498	Fee-for-Service	1558785444	1558785444	1	1	BLESSING BIRTH CENTER	1/27/2016	No Taxonomy Provided	NA	None	052	ALTERNATIVE BIRTH CENTERS - SPECIALTY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	230 HOSPITAL DR	SUITE A	UKIAH	CA	95482	4563	23	06045	39.15171639	-123.2035457	Mendocino County
212529	Fee-for-Service	1093876245	1093876245	2	1	BRUNO, YOVANA G MD	2/21/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80031	40	Pediatrics	0	In state provider	None	1828 CESAR CHAVEZ	STE B218	LOS ANGELES	CA	90033	2464	19	06037	34.05023174	-118.2154927	Los Angeles County
212530	Fee-for-Service	1538715891	1538715891	1	1	BARRIER, KIMBERLY A NP	11/15/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16000 APPLE VALLEY RD	STE C3	APPLE VALLEY	CA	92307	7815	36	06071	34.5421391	-117.2732764	San Bernardino County
212553	Fee-for-Service	1710902051	1710902051	1	1	BISHOP, ELIJAH J PT	2/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50-225 CESAR CHAVEZ ST.	SUITE 103	COACHELLA	CA	92253	7243	33	06065	33.67309459	-116.181558	Riverside County
212563	Fee-for-Service	1720387970	1720387970	1	1	BLUTH, BENJAMIN E MD	10/18/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	125952	20	Orthopedic Surgery	0	In state provider	None	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
212580	Fee-for-Service	1427765627	1427765627	1	1	BALLANTYNE, RACHEL CNP	1/26/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19121 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2307	30	06059	33.685155	-117.988868	Orange County
212600	Fee-for-Service	1356357537	1356357537	1	1	BENSON, MELINDA L	6/8/2004	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SPEECH LANGUAGE & LEARN	1044 MANGROVE AVE	None	CHICO	CA	95926	3509	04	06007	39.74053676	-121.8373879	Butte County
212668	Fee-for-Service	1376761940	1376761940	1	1	BENEVOLENCE INDUSTRIES INC	1/2/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3533 W PICO BLVD	None	LOS ANGELES	CA	90019	4534	19	06037	34.04721925	-118.3197384	Los Angeles County
212677	Fee-for-Service	1407200496	1407200496	1	1	BAINS, JAZMIN MD	7/3/2019	207R00000X	NA	Other	026	PHYSICIANS	152471	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
212691	Fee-for-Service	1245310184	1245310184	1	1	BERNER CALDERWOOD, ANNE L	5/21/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	97 SCOTT ST	COTTAGE	MURPHYS	CA	95247	9489	05	06009	38.13685039	-120.4596083	Calaveras County
212693	Fee-for-Service	1841497757	1841497757	1	1	BHANDERI, SUDIPKUMAR K MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	#101	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
212708	Fee-for-Service	1740818350	1740818350	1	1	BERTHET, BENJAMIN	3/12/2025	207R00000X	NA	Other	026	PHYSICIANS	23241	41	Internal Medicine	0	In state provider	None	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
212729	Fee-for-Service	1790195758	1790195758	1	1	BRYANT, JESSICA MD	4/13/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	137766	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
212732	Fee-for-Service	1073929337	1073929337	1	1	BERA, ARUNIMA MD	7/16/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	148150	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
212733	Fee-for-Service	1326436874	1326436874	1	1	BELLEVUE UNION SCHOOL	7/1/2014	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	3150 EDUCATION DRIVE	None	SANTA ROSA	CA	95407	2767	49	06097	38.40050206	-122.7099859	Sonoma County
212734	Fee-for-Service	1992892764	1992892764	1	1	BERCIER, PAULA J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 BURDICK EXPY E	None	MINOT	ND	58701	4768	00	None	48.23257948	-101.286117	Ward County
212739	Fee-for-Service	1316904725	1316904725	1	1	BHAT, NARAS K MD	4/24/1987	207K00000X	NA	Other	026	PHYSICIANS	25677	03	Allergy	0	In state provider	None	1545 N TEXAS ST	STE 311	FAIRFIELD	CA	94533	5623	48	06095	38.25794306	-122.034205	Solano County
212801	Fee-for-Service	1336498518	1336498518	1	1	BRILLANTES, SUZETTE Y LCSW	9/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1025 STANFORD AVE	None	OAKLAND	CA	94608	2317	01	06001	37.84212586	-122.279882	Alameda County
212812	Fee-for-Service	1871558197	1871558197	1	1	BROWN, DONALD G MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	60957	41	Internal Medicine	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
212837	Fee-for-Service	1932261351	1932261351	1	1	BODYWORKSPT, INC.	8/28/2024	225100000X	NA	Physical Therapist	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5122 CASA LOMA AVE	None	YORBA LINDA	CA	92886	3943	30	06059	33.886521	-117.8237435	Orange County
212861	Fee-for-Service	1467676148	1467676148	1	1	BRATTELI, CHRISTOPHER W MD	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	107099	30	Radiology	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
212870	Fee-for-Service	1104003516	1104003516	1	1	BIAN, JIA-YI DO	12/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9320	05	Anesthesiology	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
212894	Fee-for-Service	1265504096	1265504096	1	1	BERGIN, JACK M MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	32310	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	C B O VALLEJO	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
212916	Fee-for-Service	1124481940	1124481940	1	1	BRASLOW, JOSHUA MD	8/23/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152692	08	Family Practice	0	In state provider	None	100A SAN PABLO TOWNE CTR	None	SAN PABLO	CA	94806	0000	07	06013	37.95446487	-122.3326626	Contra Costa County
212930	Fee-for-Service	1457754020	1457754020	1	1	BUCKNELL, LOVIE LMFT	4/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	673 S AUBURN ST	STE B	GRASS VALLEY	CA	95945	7576	29	06057	39.2060146	-121.0613316	Nevada County
212956	Fee-for-Service	1376761940	1376761940	1	1	BENEVOLENCE INDUSTRIES INC	1/2/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3533 W PICO BLVD	None	LOS ANGELES	CA	90019	4534	19	06037	34.04721925	-118.3197384	Los Angeles County
212962	Fee-for-Service	1114130697	1114130697	1	1	BALARDI, VINCENT F MD	10/31/1985	207P00000X	NA	Other	026	PHYSICIANS	47966	01	General Practice	0	In state provider	None	5095 MONACO DR	None	PLEASANTON	CA	94566	7677	01	06001	37.65454558	-121.8784492	Alameda County
212965	Fee-for-Service	1174787642	1174787642	1	1	BUTLIG, RICHARD M MD INC	6/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77702	41	Internal Medicine	0	In state provider	None	1000 E DOMINGUEZ STREET	SUITE 110	CARSON	CA	90746	3690	19	06037	33.8404157	-118.2575491	Los Angeles County
212966	Fee-for-Service	1962892679	1962892679	1	1	BUI, MICHELLE A	8/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
213011	Fee-for-Service	1982632501	1982632501	1	1	BROWN, LINDA MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75467	40	Pediatrics	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
213025	Fee-for-Service	1639385180	1639385180	1	1	BORYS, DARUISZ MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100251	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
213041	Fee-for-Service	1588083281	1588083281	1	1	BIRNHAK, STEFANI H DO	9/26/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20814	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
213059	Fee-for-Service	1780694307	1780694307	1	1	BLUMOFE, NOAH A DPM	3/11/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
213102	Fee-for-Service	1194796417	1194796417	1	1	BUCKLEY, ROBERT G MD	8/8/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63633	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
213112	Fee-for-Service	1699267146	1699267146	1	1	BELLEVUE EYE MEDICAL CENTER,	10/12/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1936 UNIVERSITY AVE	STE 112	BERKELEY	CA	94704	1003	01	06001	37.87159283	-122.2722026	Alameda County
213143	Fee-for-Service	1457326209	1457326209	1	1	BROWN, PHILIP J MD	10/15/2014	207L00000X	NA	Other	026	PHYSICIANS	42562	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
213171	Fee-for-Service	1134472939	1134472939	1	1	BATTENBERG, ANDREW K MD	5/20/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	128371	20	Orthopedic Surgery	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
213187	Fee-for-Service	1912007790	1912007790	1	1	BOLING, WARREN W JR MD	6/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142036	14	Neurological Surgery	0	In state provider	None	25455 BARTON RD	STE A108	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
213191	Fee-for-Service	1922424902	1922424902	1	1	BLANCO FAMILY MEDICINE INC	5/23/2014	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	380 W BADILLO ST	None	COVINA	CA	91723	1827	19	06037	34.0862457	-117.8963889	Los Angeles County
213235	Fee-for-Service	1003304189	1003304189	2	1	BENHURI, DANIEL MD	5/19/2023	207R00000X	NA	Other	026	PHYSICIANS	174435	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
213245	Fee-for-Service	1376761940	1376761940	1	1	BENEVOLENCE INDUSTRIES INC	2/1/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3533 W PICO BLVD	None	LOS ANGELES	CA	90019	4534	19	06037	34.04721925	-118.3197384	Los Angeles County
213258	Fee-for-Service	1093343014	1093343014	1	1	BUCHANAN, JACK H MD	10/16/2024	390200000X	NA	Other	026	PHYSICIANS	192424	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
213266	Fee-for-Service	1669497731	1669497731	1	1	BARNARD, DENISE D MD	5/31/1990	207R00000X	NA	Other	026	PHYSICIANS	65241	01	General Practice	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
213270	Fee-for-Service	1245286509	1245286509	1	1	BAKHSH, GAITI A. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10000 TELEGRAPH RD	None	TAYLOR	MI	48180	3330	00	None	42.235191	-83.276514	Wayne County
213286	Fee-for-Service	1811990468	1811990468	1	1	BRADSHAW, DAVID C MD	11/13/1982	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	38599	25	Physical Medicine and Rehabilitation	0	In state provider	None	2200 HAYES ST	None	SAN FRANCISCO	CA	94117	1013	38	06075	37.77302042	-122.45342	San Francisco County
213287	Fee-for-Service	1699068106	1699068106	1	1	BURNBAUM, JAKE M MD	2/9/2022	207L00000X	NA	Other	026	PHYSICIANS	174984	None	None	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
213313	Fee-for-Service	1639385180	1639385180	1	1	BORYS, DARUISZ MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100251	22	Pathology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
213346	Fee-for-Service	1770648628	1770648628	1	1	BIEN, RALPH D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34558	36	Psychiatry	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
213369	Fee-for-Service	1053602540	1053602540	1	1	BILLS, ADAM D DPM	8/9/2017	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 100	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
213373	Fee-for-Service	1881740678	1881740678	1	1	BADGER,JOANNA C MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64732	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
213391	Fee-for-Service	1194796417	1194796417	1	1	BUCKLEY, ROBERT G MD	8/8/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63633	01	General Practice	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
213411	Fee-for-Service	1588288849	1588288849	1	1	BLUE RIVER HOSPICE, INC	11/19/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	171 N ALTADENA DR	STE 235	PASADENA	CA	91107	7319	19	06037	34.14902931	-118.0986299	Los Angeles County
213424	Fee-for-Service	1629506605	1629506605	1	1	BALABHADRA, SAMYUKTHA MD	4/4/2023	390200000X	NA	Other	026	PHYSICIANS	177637	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
213432	Fee-for-Service	1245379858	1245379858	1	1	BARTH, NEIL M MD	11/8/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	37824	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
213443	Fee-for-Service	1003102567	1003102567	1	1	BARTLOTTI TELESZ, JENNIFER N	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136630	05	Anesthesiology	0	In state provider	MD	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92592	6837	33	06065	33.5580705	-117.1835458	Riverside County
213448	Fee-for-Service	1629286505	1629286505	1	1	BATRA, REEMA R MD	6/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118846	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
213477	Fee-for-Service	1619295185	1619295185	1	1	BERRY, REBECCA R PHD	9/24/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
213488	Fee-for-Service	1205382033	1205382033	1	1	BEARD, CHERITA	2/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3610 CENTRAL AVE	SUITE 500	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
213498	Fee-for-Service	1124110069	1124110069	1	1	BASKYS, ANDRIUS MD	12/10/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	64874	36	Psychiatry	0	In state provider	None	795 E SECOND ST	STE 5	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
213502	Fee-for-Service	1932390861	1932390861	1	1	BENNETT, KATHY LCSW	4/24/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
213508	Fee-for-Service	1780020610	1780020610	1	1	BUNCH, STEVEN J MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142289	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
213520	Fee-for-Service	1811197494	1811197494	1	1	BADILLO, ANGELINA G MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80207	41	Internal Medicine	0	In state provider	MGA OFFICE	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
213535	Fee-for-Service	1558924621	1558924621	1	1	BHANDAL, MANJIT K MD	10/30/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176299	None	None	0	In state provider	None	2008 MORSE AVENUE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
213539	Fee-for-Service	1972198711	1972198711	1	1	BALANCED LIFE COUPLE FAMILY	5/15/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	127 E LEXINGTON AVE	None	EL CAJON	CA	92020	4511	37	06073	32.79269801	-116.9617323	San Diego County
213547	Fee-for-Service	1598788754	1598788754	1	1	BRAUNSTEIN, MARK B MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64033	08	Family Practice	0	In state provider	None	4955 VAN NUYS BLVD	STE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
213570	Fee-for-Service	1699704858	1699704858	1	1	BRYLEWSKI, PAUL PA	2/3/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	6500 MORRO ROAD	C & D	ATASCADERO	CA	93422	4142	40	06079	35.48364845	-120.6655946	San Luis Obispo County
213606	Fee-for-Service	1578883781	1578883781	1	1	BREM, ELIZABETH A MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143521	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
213607	Fee-for-Service	1740293018	1740293018	1	1	BACHRACH, LELA R MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85300	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
213614	Fee-for-Service	1356348890	1356348890	1	1	BARTON HEALTHCARE SYSTEM	12/1/1977	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2092 LAKE TAHOE BLVD	SUITE 500	SOUTH LAKE TAHOE	CA	96150	6429	09	06017	38.91521892	-120.0014062	El Dorado County
213651	Fee-for-Service	1730718917	1730718917	1	1	BARONE, LAURA LCSW	3/11/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
213677	Fee-for-Service	1851503593	1851503593	1	1	BLACKLOCK, DAVID M MD	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95723	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3100	01	06001	37.819368	-122.263902	Alameda County
213700	Fee-for-Service	1588288849	1588288849	1	1	BLUE RIVER HOSPICE, INC	11/19/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	171 N ALTADENA DR	STE 235	PASADENA	CA	91107	7319	19	06037	34.14902931	-118.0986299	Los Angeles County
213733	Fee-for-Service	1962722439	1962722439	1	1	BOSLETT, BRYN A MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125322	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
213736	Fee-for-Service	1629286505	1629286505	1	1	BATRA, REEMA R MD	6/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118846	78	Neoplastic Diseases/Oncology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
213737	Fee-for-Service	1326453663	1326453663	1	1	BITAR, HEATHER N DO	2/15/2018	390200000X	NA	Other	026	PHYSICIANS	14599	08	Family Practice	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
213785	Fee-for-Service	1508153024	1508153024	1	1	BRITTON, IAN N MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141529	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
213806	Fee-for-Service	1174804744	1174804744	1	1	BHAT, NANDINI MD	10/14/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	180979	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
213809	Fee-for-Service	1700579190	1700579190	1	1	BEAUTY FOR ASHES MATERNAL WE	10/10/2023	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
213834	Fee-for-Service	1336211085	1336211085	1	1	BHARGAVA, REENA MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54131	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
213842	Fee-for-Service	1518219955	1518219955	1	1	BORDEN, ANDREA ROSE	11/8/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
213864	Fee-for-Service	1689871527	1689871527	1	1	BARRIAC, FIONA E MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128609	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13855 EAST 14TH STREET	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
213873	Fee-for-Service	1285795385	1285795385	1	1	BROWN, CHINUE A PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
213886	Fee-for-Service	1740213222	1740213222	1	1	BEVERLY HILLS MEDICAL	5/1/2002	193400000X	NA	Other	026	PHYSICIANS	69816	01	General Practice	0	In state provider	CORPORATION	4560 ADMIRALTY WAY	SUITE 303	MARINA DEL REY	CA	90292	5426	19	06037	33.98364904	-118.4449069	Los Angeles County
213889	Fee-for-Service	1992918692	1992918692	1	1	BORCHERT, CATHERINE M	3/19/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	63425	None	None	0	In state provider	None	3333 MISSION DRIVE	None	SANTA CRUZ	CA	95065	1827	44	06087	36.99144769	-121.9801727	Santa Cruz County
213890	Fee-for-Service	1043328644	1043328644	1	1	BAUER, JOHN R MD	7/31/1990	207P00000X	NA	Other	026	PHYSICIANS	42901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
213894	Fee-for-Service	1578883781	1578883781	1	1	BREM, ELIZABETH A MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143521	68	Hematology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
213904	Fee-for-Service	1073934220	1073934220	1	1	BAROI, ORRIN R	11/22/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
213926	Fee-for-Service	1215565114	1215565114	1	1	BIGELOW, ELSIE R	7/3/2024	207L00000X	NA	Other	026	PHYSICIANS	188314	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
213937	Fee-for-Service	1326231978	1326231978	1	1	BARAN, JOSEPH JR MD INC	5/6/2003	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	71723	66	Emergency Medicine (Urgent Care)	0	In state provider	None	890 EASTLAKE PARK	SUITE 301	CHULA VISTA	CA	91914	4522	37	06073	32.65223126	-116.9677279	San Diego County
213941	Fee-for-Service	1316048382	1316048382	1	1	BRUCE-LYLE, LESLIE A MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	51441	18	Ophthalmology	0	In state provider	None	555 N THIRTEENTH AVE	None	UPLAND	CA	91786	4500	36	06071	34.10042233	-117.6335451	San Bernardino County
214007	Fee-for-Service	1750918256	1750918256	1	1	BRADLEY, SARA DO	6/22/2023	207P00000X	NA	Other	026	PHYSICIANS	20572	None	None	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
214017	Fee-for-Service	1316107642	1316107642	1	1	BRADLEY CLARK	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
214019	Fee-for-Service	1235397621	1235397621	1	1	BOBKO, JOSHUA P MD	9/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112209	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
214035	Fee-for-Service	1912921875	1912921875	1	1	BATTEN, D GARY MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6687	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
214053	Fee-for-Service	1336475409	1336475409	1	1	BAO, FEI MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124720	22	Pathology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
214082	Fee-for-Service	1962529776	1962529776	1	1	BAKER, RACHEL F PHD	11/25/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
214086	Fee-for-Service	1992883656	1992883656	1	1	BEERNINK, DOUGLAS H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23433	18	Ophthalmology	0	In state provider	None	PO BOX 696	None	DAVIS	CA	95617	0696	57	06113	0	0	None
214123	Fee-for-Service	1760559462	1760559462	1	3	BAY AREA PEDIATRIC	4/28/1998	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	1800 SULLIVAN AVE	RM 202	DALY CITY	CA	94015	2222	41	06081	37.68077723	-122.4728941	San Mateo County
214126	Fee-for-Service	1245575828	1245575828	1	1	BURROWS, LISA M	3/8/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
214131	Fee-for-Service	1730574559	1730574559	1	1	BEEM, ASHLEY B MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139491	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
214162	Fee-for-Service	1073056735	1073056735	1	1	BUDDIGA, PRAVEEN MD INC	2/6/2017	207KA0200X	NA	Other	026	PHYSICIANS	90273	03	Allergy	0	In state provider	None	7105 N CHESTNUT AVE	STE 103	FRESNO	CA	93720	0357	10	06019	36.84028853	-119.7377105	Fresno County
214180	Fee-for-Service	1578883781	1578883781	1	1	BREM, ELIZABETH A MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143521	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
214205	Fee-for-Service	1356799027	1356799027	1	1	BARRAGAN, MARIANA V LCSW	3/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
214223	Fee-for-Service	1588358089	1588358089	1	1	BESHEM PHARMA INC	7/5/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18840 VENTURA BLVD	120	TARZANA	CA	91356	3301	19	06037	34.17204394	-118.5442921	Los Angeles County
214229	Fee-for-Service	1326231978	1326231978	1	1	BARAN, JOSEPH JR MD INC	5/6/2003	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	71723	77	Infectious Disease	0	In state provider	None	890 EASTLAKE PARK	SUITE 301	CHULA VISTA	CA	91914	4522	37	06073	32.65223126	-116.9677279	San Diego County
214272	Fee-for-Service	1982857967	1982857967	1	1	BRIGHT HEALTH PHYSICIANS OF	10/27/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	PIH	12675 LA MIRANDA BLVD	SUITE 201	MIRANDA	CA	90638	2235	12	06023	33.91589551	-118.0119734	Los Angeles County
214305	Fee-for-Service	1164910949	1164910949	1	1	BROWNSTEIN, ADAM J MD	2/21/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	175018	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
214310	Fee-for-Service	1508193913	1508193913	1	1	BUENVIAJE-SMITH, ENVAP PC	9/17/2011	193200000X	NA	Other	026	PHYSICIANS	52647	05	Anesthesiology	0	In state provider	None	18145 US HIGHWAY 18	STE B	APPLE VALLEY	CA	92307	2210	36	06071	34.5404119	-117.2678454	San Bernardino County
214350	Fee-for-Service	1831119486	1831119486	1	1	BARBARA, JOSEPH C MD INC	11/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	28075	01	General Practice	0	In state provider	GILROY MEDICAL PARK	7880 WREN AVE	STE C133	GILROY	CA	95020	7801	43	06085	37.00983795	-121.5870382	Santa Clara County
214384	Fee-for-Service	1114010162	1114010162	1	1	BESCOBY, WILLIAM A OD	1/31/1987	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	LOMA LINDA UNIVERSITY	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
214400	Fee-for-Service	1790384170	1790384170	1	1	BUENO, JASON LMFT	10/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	811 W. 7TH ST.	12TH FLOOR	LOS ANGELES	CA	90017	3403	19	06037	34.0489635	-118.2591312	Los Angeles County
214408	Fee-for-Service	1265752828	1265752828	1	1	BARNES, DANIELLE M MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	125243	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
214435	Fee-for-Service	1245399179	1245399179	1	1	BROWN, EDEN LCSW	8/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
214448	Fee-for-Service	1033616941	1033616941	1	1	BOZYCH, MARC A	10/28/2024	207LP3000X	NA	Other	026	PHYSICIANS	17673	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
214479	Fee-for-Service	1952557878	1952557878	1	1	BAIK, CHARLES C DPM INC	9/16/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	17400 IRVINE BLVD	STE H	TUSTIN	CA	92780	3030	30	06059	33.74814651	-117.828558	Orange County
214482	Fee-for-Service	1396901278	1396901278	1	1	BUI, ANN H MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121395	05	Anesthesiology	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
214484	Fee-for-Service	1386415347	1386415347	1	1	BROWN, NAOMI KOU	3/13/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9745 OLD PLACERVILLE RD	35	SACRAMENTO	CA	95827	3370	34	06067	38.558133	-121.331853	Sacramento County
214494	Fee-for-Service	1679019202	1679019202	1	1	BALDWIN HILLS PEDIATRICS	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	68336	40	Pediatrics	0	In state provider	None	3756 SANTA ROSALIA DR	STE 320	LOS ANGELES	CA	90008	3615	19	06037	34.00888336	-118.3389334	Los Angeles County
214503	Fee-for-Service	1548565781	1548565781	1	1	BRADY, MICHAEL J LMFT	8/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53248	-	NOT APPLICABLE	0	In state provider	None	1869-1871 9TH ST	None	SANTA MONICA	CA	90404	4501	19	06037	34.01309593	-118.4821062	Los Angeles County
214505	Fee-for-Service	1952560914	1952560914	1	1	BANNER BOSWELL MEDICAL	9/1/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10401 W THUNDERBIRD BLVD	None	SUN CITY	AZ	85351	3004	00	None	33.603885	-112.2831765	Maricopa County
214524	Fee-for-Service	1912248972	1912248972	1	1	BRIGHTON CONVALESCENT LLC	5/1/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1836 N FAIR OAKS AVE	None	PASADENA	CA	91103	1619	19	06037	34.17734264	-118.1507347	Los Angeles County
214530	Fee-for-Service	1548259401	1548259401	1	1	BRAND, JONATHAN L MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50045	36	Psychiatry	0	In state provider	None	5970 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1150	19	06037	33.985584	-118.256433	Los Angeles County
214550	Fee-for-Service	1265414486	1265414486	1	1	BATTLE, NOEL C MD	12/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137753	01	General Practice	0	In state provider	None	100A SAN PABLO TOWN CTR	None	SAN PABLO	CA	94806	1111	07	06013	37.95446487	-122.3326626	Contra Costa County
214561	Fee-for-Service	1982857967	1982857967	1	1	BRIGHT HEALTH PHYSICIANS OF	10/27/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PIH	12675 LA MIRANDA BLVD	SUITE 201	MIRANDA	CA	90638	2235	12	06023	33.91589551	-118.0119734	Los Angeles County
214562	Fee-for-Service	1770593386	1770593386	1	1	BOWEN, WILLIAM W MD	4/5/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	28722	20	Orthopedic Surgery	0	In state provider	None	84 MADRONE ST	None	WILLITS	CA	95490	4249	23	06045	39.40096275	-123.3520916	Mendocino County
214575	Fee-for-Service	1902343833	1902343833	1	1	BALL, KELLY R NP	5/24/2017	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
214578	Fee-for-Service	1396190567	1396190567	1	1	BET-LACHIN, ANNA M MD	7/19/2021	390200000X	NA	Other	026	PHYSICIANS	154864	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
214586	Fee-for-Service	1548372691	1548372691	1	1	BORN, STEPHEN C MD	10/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	57100	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
214588	Fee-for-Service	1821629973	1821629973	1	1	BLUE RIBBON HOSPICE INC	3/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	187 E WILBUR RD	SUITE 9	THOUSAND OAKS	CA	91360	7931	56	06111	34.18625162	-118.8722073	Ventura County
214638	Fee-for-Service	1376999151	1376999151	1	1	BERGER, MAX MD	5/13/2020	207P00000X	NA	Other	026	PHYSICIANS	167725	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
214666	Fee-for-Service	1528315413	1528315413	1	1	BAJPAI, ABHISHEK A OD	10/18/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
214674	Fee-for-Service	1497730691	1497730691	1	1	BRUHNS, KARL A OD	9/15/1984	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	515 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8342	08	06015	41.77269652	-124.199019	Del Norte County
214696	Fee-for-Service	1265752828	1265752828	1	1	BARNES, DANIELLE M MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	125243	10	Gastroenterology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
214719	Fee-for-Service	1972235158	1972235158	1	1	BERMUDEZ, HEATHER M OT	12/30/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7313 WHITTIER AVE	None	WHITTIER	CA	90602	1132	19	06037	33.975027	-118.043219	Los Angeles County
214723	Fee-for-Service	1871973149	1871973149	1	1	BELCHER, SHAUNYE M MD	8/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153694	08	Family Practice	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
214727	Fee-for-Service	1720164239	1720164239	1	1	BARRETTO, GWENDOLYN C MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76974	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
214736	Fee-for-Service	1376980946	1376980946	1	1	BEE, JEREMIAH J CRNA	7/14/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
214745	Fee-for-Service	1962030023	1962030023	1	1	BRAR, DAVINDEEP S MD	8/1/2023	207P00000X	NA	Other	026	PHYSICIANS	187267	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
214753	Fee-for-Service	1730278391	1730278391	1	1	BATLIVALA, SAROSH P	8/2/2022	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
214764	Fee-for-Service	1891722294	1891722294	1	1	BASKIN, LAURENCE S MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	61586	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	# A610	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
214766	Fee-for-Service	1518906874	1518906874	1	1	BEATIE, CHRISTOPHER D MD	5/31/1994	207L00000X	NA	Other	026	PHYSICIANS	64285	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
214769	Fee-for-Service	1346239613	1346239613	1	1	BENABAYE, ALBINA G. MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33749	41	Internal Medicine	0	In state provider	None	2800 N CALIFORNIA ST	STE 16	STOCKTON	CA	95204	3759	39	06077	37.97782434	-121.2919633	San Joaquin County
214773	Fee-for-Service	1386415347	1386415347	1	1	BROWN, NAOMI KOU	3/13/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9745 OLD PLACERVILLE RD	35	SACRAMENTO	CA	95827	3370	34	06067	38.558133	-121.331853	Sacramento County
214776	Fee-for-Service	1295802015	1295802015	1	1	BRAVO, JULISA MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64999	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
214788	Fee-for-Service	1669805362	1669805362	1	1	BRADLEY OPTOMETRY INC	2/28/2014	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1160 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528537	-121.6208248	Sutter County
214790	Fee-for-Service	1952560914	1952560914	1	1	BANNER BOSWELL MEDICAL	9/1/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10401 W THUNDERBIRD BLVD	None	SUN CITY	AZ	85351	3004	00	None	33.603885	-112.2831765	Maricopa County
214810	Fee-for-Service	1689600546	1689600546	1	1	BURCH, SHANE MD	8/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88487	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
214830	Fee-for-Service	1760432793	1760432793	1	1	BUTLER, MICHELE P DO	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CENTER LN	None	LK HAVASU CTY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
214843	Fee-for-Service	1821421843	1821421843	1	1	BRAY, SUSAN E AU	9/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	612 W DUARTE RD	SUITE 601	ARCADIA	CA	91007	9240	19	06037	34.12647805	-118.051994	Los Angeles County
214855	Fee-for-Service	1528325818	1528325818	1	1	BRIZUELA, ARNOLD A MD	3/19/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	129336	None	None	0	In state provider	None	630 S RAYMOND AVE	STE 310	PASADENA	CA	91105	3278	19	06037	34.13505223	-118.1487761	Los Angeles County
214875	Fee-for-Service	1821629973	1821629973	1	1	BLUE RIBBON HOSPICE INC	3/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	187 E WILBUR RD	SUITE 9	THOUSAND OAKS	CA	91360	7931	56	06111	34.18625162	-118.8722073	Ventura County
214907	Fee-for-Service	1043398001	1043398001	1	1	BAIRAMIAN, DIKRAN MD	9/30/1993	207T00000X	NA	General Surgery	026	PHYSICIANS	52757	14	Neurological Surgery	0	In state provider	None	1604 FORD AVE	STE 9	MODESTO	CA	95350	4655	50	06099	37.66748595	-120.9836064	Stanislaus County
214915	Fee-for-Service	1942760814	1942760814	1	1	BAWITLUNG, ZAILA OT	10/17/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8282 WHITE OAK AVE	107, 108, AND 111	RANCHO CUCAMONGA	CA	91730	7680	36	06071	34.10361339	-117.5644472	San Bernardino County
214938	Fee-for-Service	1225153091	1225153091	1	1	BLACK, GREGORY A	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10200 TRINITY PKWY	STE 205	STOCKTON	CA	95219	7288	39	06077	38.04745959	-121.3721294	San Joaquin County
214942	Fee-for-Service	1730289471	1730289471	1	1	BOLOTIN, ELLEN D MD	8/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54526	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
214963	Fee-for-Service	1720853153	1720853153	1	1	BIRGER, VIKTORIYA CNP	2/14/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2777 LONG BEACH BLVD	STE 200	LONG BEACH	CA	90806	1513	19	06037	33.80734327	-118.189472	Los Angeles County
214967	Fee-for-Service	1124108204	1124108204	1	1	BANY-MOHAMMED, FAYEZ M	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52053	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
215003	Fee-for-Service	1215040522	1215040522	1	2	BUNKER, CLINTON J CRNA	12/16/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
215015	Fee-for-Service	1801020391	1801020391	1	1	BHULLER, JEANIE K DO	9/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12267	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
215070	Fee-for-Service	1831434596	1831434596	1	1	BIRKELAND, SUZANNE M CRNA	9/21/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
215118	Fee-for-Service	1992948491	1992948491	1	1	BRAWNER, BRANDON L PHD	8/21/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
215121	Fee-for-Service	1053573642	1053573642	1	1	BOGOJE, KASEY M LMFT	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50070	-	NOT APPLICABLE	0	In state provider	None	44447 N 10TH ST WEST	BUILDING C	LANCASTER	CA	93534	3324	19	06037	34.69104127	-118.1480655	Los Angeles County
215123	Fee-for-Service	1407591522	1407591522	1	1	BAINIWAL, AJAY MD	11/4/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
215124	Fee-for-Service	1366077323	1366077323	1	1	BOERE, NICOLE K CNP	1/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
215125	Fee-for-Service	1477582997	1477582997	1	1	BRUNSTING, DAVID MD	1/1/1991	207R00000X	NA	Other	026	PHYSICIANS	61409	41	Internal Medicine	0	In state provider	None	5030 BONITA RD	None	BONITA	CA	91902	1701	37	06073	32.66930417	-117.022787	San Diego County
215150	Fee-for-Service	1700215548	1700215548	1	1	BAE, SEONG GON MD INC	11/17/2015	208600000X	NA	General Surgery	026	PHYSICIANS	123341	02	General Surgery	0	In state provider	None	3000 W OLYMPIC BLVD	STE 201	LOS ANGELES	CA	90006	2588	19	06037	34.05260947	-118.3003335	Los Angeles County
215156	Fee-for-Service	1487130043	1487130043	1	1	BLUE IRIS HOME HEALTH INC	6/14/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3820 DEL AMO BLVD	STE 228	TORRANCE	CA	90503	2154	19	06037	33.84858354	-118.354707	Los Angeles County
215227	Fee-for-Service	1730289471	1730289471	1	1	BOLOTIN, ELLEN D MD	8/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54526	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
215268	Fee-for-Service	1124108204	1124108204	1	1	BANY-MOHAMMED, FAYEZ M	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52053	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	BLDG 29A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
215271	Fee-for-Service	1417353723	1417353723	1	1	BLESSED HEART HOME CARE INC	9/7/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	353 E ANGELENO AVE	STE J	BURBANK	CA	91502	1310	19	06037	34.18199046	-118.3057438	Los Angeles County
215289	Fee-for-Service	1518340751	1518340751	1	1	BOTWIN, JEANETTE B NP	10/18/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
215320	Fee-for-Service	1366489197	1366489197	1	1	BALANCE AND HEARING RESOURCE	3/1/2002	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2211 W. MAGNOLIA BLVD	SUITE 100	BURBANK	CA	91506	1755	19	06037	34.1728873	-118.3320905	Los Angeles County
215416	Fee-for-Service	1962792192	1962792192	1	1	BRUCKER, RICHARD A MD	11/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130777	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
215431	Fee-for-Service	1154559151	1154559151	1	1	BENNETT, DIANA H LMFT	8/16/2021	225400000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
215437	Fee-for-Service	1588916381	1588916381	1	2	BONDI-BOYD, BREA	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122806	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
215515	Fee-for-Service	1730289471	1730289471	1	1	BOLOTIN, ELLEN D MD	8/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54526	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
215520	Fee-for-Service	1508969452	1508969452	1	1	BASA, NICOLE R MD	9/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80752	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
215552	Fee-for-Service	1033160692	1033160692	1	1	BEN-ZEEV, DEVORAH MD	3/31/1991	207R00000X	NA	Other	026	PHYSICIANS	75386	41	Internal Medicine	0	In state provider	None	801 S CHEVY CHASE DR	None	GLENDALE	CA	91205	4431	19	06037	34.136757	-118.2396195	Los Angeles County
215559	Fee-for-Service	1033181185	1033181185	1	1	BURKARD, JOSEPH F CRNA	12/19/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
215569	Fee-for-Service	1851106223	1851106223	1	1	BARNES, HAYLEY MD	2/25/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
215632	Fee-for-Service	1679500904	1679500904	1	1	BURNETT, MARGARET E MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83639	13	Neurology (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	STE 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
215654	Fee-for-Service	1073815072	1073815072	1	1	BONDI, KAREN L H PHD	2/6/2017	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
215720	Fee-for-Service	1295841500	1295841500	1	1	BOWLER, ARTHUR T PSY	4/17/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18050	-	NOT APPLICABLE	0	In state provider	None	1919 N BEACHWOOD DR	None	LOS ANGELES	CA	90068	4006	19	06037	34.105806	-118.3213065	Los Angeles County
215752	Fee-for-Service	1730292889	1730292889	1	1	BATT, MURRAY D MD	9/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	25319	41	Internal Medicine	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
215796	Fee-for-Service	1609887678	1609887678	1	1	BAHMANI, PARVANEH MD	3/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81644	41	Internal Medicine	0	In state provider	None	9301 WILSHIRE BLVD	STE 405	BEVERLY HILLS	CA	90210	6138	19	06037	34.06707307	-118.3946743	Los Angeles County
215810	Fee-for-Service	1912967324	1912967324	2	1	BLITZER, JONATHAN B MD	12/21/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62021	41	Internal Medicine	0	In state provider	None	2840 LONG BEACH BLVD	STE 130	LONG BEACH	CA	90806	1516	19	06037	33.808743	-118.189341	Los Angeles County
215824	Fee-for-Service	1508801994	1508801994	1	1	BORIS VAISMAN MEDICAL	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92266	08	Family Practice	0	In state provider	CORPORATION INC	22600 VENTURA BLVD	STE 101	WOODLAND HILLS	CA	91364	1430	19	06037	34.16733862	-118.6190131	Los Angeles County
215830	Fee-for-Service	1124087366	1124087366	1	1	BUNYI-TEOPENGCO, ELLEN F	11/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72273	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	MD	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
215833	Fee-for-Service	1801038385	1801038385	1	1	BARUA, RUDRA D MD	4/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	140563	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
215877	Fee-for-Service	1609063429	1609063429	1	3	BHASKAR, SHYAM MD INC	4/8/2009	207R00000X	NA	Other	026	PHYSICIANS	74116	40	Pediatrics	0	In state provider	None	231 W NOBLE AVENUE	None	VISALIA	CA	93277	2631	54	06107	36.326133	-119.294091	Tulare County
215896	Fee-for-Service	1760035224	1760035224	1	1	BIAGINI, AMANDINE PT	9/25/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6759 SIERRA CT	SUITE A	DUBLIN	CA	94568	2670	01	06001	37.70825702	-121.9144925	Alameda County
215909	Fee-for-Service	1770621070	1770621070	1	1	BELLOSO, TANYA M LCSW	8/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
215972	Fee-for-Service	1225265481	1225265481	1	1	BEBEREIA, DANIEL J MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115593	05	Anesthesiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	5463	37	06073	32.781483	-117.007182	San Diego County
215977	Fee-for-Service	1861617268	1861617268	1	1	BRINDIS, SETH L MD	2/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94150	40	Pediatrics	0	In state provider	None	1100 WEST STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
215993	Fee-for-Service	1992332662	1992332662	1	1	BANH, VIVIAN DO	2/5/2025	207L00000X	NA	Other	026	PHYSICIANS	22334	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
216007	Fee-for-Service	1164697199	1164697199	1	1	BRIGHT EXPECTATIONS	3/27/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LAKESIDE DIVISION	7910 LAKESIDE DR	None	RIVERSIDE	CA	92509	7033	33	06065	33.98274803	-117.4545822	Riverside County
216008	Fee-for-Service	1275023491	1275023491	1	1	BRIDGE HOME HEALTH SERVICES	9/9/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INLAND EMPIRE, LLC	2930 E INLAND EMPIRE BLV	STE 120	ONTARIO	CA	91764	4802	36	06071	34.068753	-117.589491	San Bernardino County
216014	Fee-for-Service	1194743054	1194743054	1	2	BLIND & VISUAL IMPAIRED	4/21/2017	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	225 LAUREL AVE	None	PACIFIC GROVE	CA	93950	3651	27	06053	36.61721911	-121.90931	Monterey County
216026	Fee-for-Service	1376625913	1376625913	1	2	BAILONY, MOHAMMED T MD	9/2/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	34406	40	Pediatrics	0	In state provider	None	4074 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.75098505	-117.1009103	San Diego County
216086	Fee-for-Service	1497883359	1497883359	1	1	B&D MORGAN, INC	5/16/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	NEW HORIZONS 'B'	502 N B ST	None	EXETER	CA	93221	1208	54	06107	36.30090064	-119.1388332	Tulare County
216087	Fee-for-Service	1609887678	1609887678	1	1	BAHMANI, PARVANEH MD	3/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81644	45	Nephrology (Renal-Kidney)	0	In state provider	None	9301 WILSHIRE BLVD	STE 405	BEVERLY HILLS	CA	90210	6138	19	06037	34.06707307	-118.3946743	Los Angeles County
216099	Fee-for-Service	1912967324	1912967324	2	1	BLITZER, JONATHAN B MD	12/21/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62021	68	Hematology	0	In state provider	None	2840 LONG BEACH BLVD	STE 130	LONG BEACH	CA	90806	1516	19	06037	33.808743	-118.189341	Los Angeles County
216165	Fee-for-Service	1609063429	1609063429	1	3	BHASKAR, SHYAM MD INC	4/8/2009	207R00000X	NA	Other	026	PHYSICIANS	74116	41	Internal Medicine	0	In state provider	None	231 W NOBLE AVENUE	None	VISALIA	CA	93277	2631	54	06107	36.326133	-119.294091	Tulare County
216171	Fee-for-Service	1851769871	1851769871	1	3	BARRACK, VALERIE LMFT	11/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	537 G STREET	205	EUREKA	CA	95503	1043	12	06023	40.80153993	-124.1647136	Humboldt County
216206	Fee-for-Service	1447659982	1447659982	1	1	BLOUNT, PAUL J LCSW	2/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
216223	Fee-for-Service	1598813586	1598813586	1	1	BRODERSEN, PAMELA K NP	9/2/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9449 E IMPERIAL HWY	None	DOWNEY	CA	90424	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
216232	Fee-for-Service	1144834722	1144834722	1	1	BLUE WAVE HOSPICE INC	12/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2323 WEST LINCOLN AVE	STE 207A	ANAHEIM	CA	92801	5100	30	06059	33.83253604	-117.9642941	Orange County
216265	Fee-for-Service	1497201768	1497201768	1	1	BLM PHARMACY INC	8/1/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12675 LA MIRADA BLVD	STE 100	LA MIRADA	CA	90638	2249	19	06037	33.91589551	-118.0119734	Los Angeles County
216269	Fee-for-Service	1649616855	1649616855	1	1	BRINLEY, BRITTANY DO	7/6/2020	207R00000X	NA	Other	026	PHYSICIANS	17587	41	Internal Medicine	0	In state provider	None	3828 DELMAS	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
216276	Fee-for-Service	1568857712	1568857712	1	1	BEST QUALITY CARE HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	6931 VAN NUYS BLVD	SUITE 314	VAN NUYS	CA	91405	3997	19	06037	34.19649	-118.448787	Los Angeles County
216302	Fee-for-Service	1023254992	1023254992	1	1	BUI, THAO P LMFT	11/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
216307	Fee-for-Service	1275741167	1275741167	1	2	BHIMJI, ALTAF A LCSW	12/12/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	50 SAND CREEK	320	BRENTWOOD	CA	94513	2089	07	06013	37.94657758	-121.6971754	Contra Costa County
216336	Fee-for-Service	1982962320	1982962320	1	1	BLEICHER, DREW MD	4/7/2021	2085R0204X	NA	Other	026	PHYSICIANS	171620	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
216339	Fee-for-Service	1578572590	1578572590	1	1	BHARGAVA, HEMA P MD	8/11/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	156703	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
216382	Fee-for-Service	1487657714	1487657714	1	1	BUCHWALD, SUSAN S MD	1/5/2001	208600000X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
216401	Fee-for-Service	1710492798	1710492798	1	1	BIERMANN, LAURA CNP	11/23/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25880 MCBEAN PKWY	None	SANTA CLARITA	CA	91355	2004	19	06037	34.40360638	-118.5522028	Los Angeles County
216414	Fee-for-Service	1689297640	1689297640	1	2	BLUE ANGEL TRANS LLC	3/25/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DICAL TRANSPORTATION	11082 COLOMA RD	10	RANCHO CORDOVA	CA	95670	2875	34	06067	38.617317	-121.272642	Sacramento County
216416	Fee-for-Service	1457387805	1457387805	1	1	BONILLA-TANDOC, SHEILA M	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69281	03	Allergy	0	In state provider	MD	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
216426	Fee-for-Service	1699827402	1699827402	1	1	BORHANI, REZA S DO	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8433	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
216429	Fee-for-Service	1710022546	1710022546	1	1	BULGARELLI, TIMOTHY D	3/4/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	24811 SAN FERNANDO RD	None	SANTA CLARITA	CA	91321	1516	19	06037	34.37154291	-118.5159868	Los Angeles County
216474	Fee-for-Service	1942601398	1942601398	1	1	BOSSARD, BRIANNA L LCSW	8/10/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	706 13TH ST	None	MODESTO	CA	95354	2414	50	06099	37.63996267	-120.9942148	Stanislaus County
216486	Fee-for-Service	1326069873	1326069873	1	1	BRAUER, STANLEY MD	9/30/1983	207L00000X	NA	Other	026	PHYSICIANS	47127	None	None	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
216492	Fee-for-Service	1184955130	1184955130	1	1	BRUMMELL, JANNAEE S LMFT	1/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
216493	Fee-for-Service	1912970856	1912970856	1	1	BAHK, THOMAS J MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68011	40	Pediatrics	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
216520	Fee-for-Service	1144834722	1144834722	1	1	BLUE WAVE HOSPICE INC	12/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2323 WEST LINCOLN AVE	STE 207A	ANAHEIM	CA	92801	5100	30	06059	33.83253604	-117.9642941	Orange County
216521	Fee-for-Service	1134275068	1134275068	1	1	BELAPURKAR, SONALI MD	2/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97203	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
216528	Fee-for-Service	1750479317	1750479317	1	1	BRAVERMAN, AHUVA PHD	10/28/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1137 SECOND STREET	STE 101	SANTA MONICA	CA	90403	5068	19	06037	34.01807978	-118.5007837	Los Angeles County
216538	Fee-for-Service	1831738475	1831738475	1	1	BERRY, BRIANNA PT	2/27/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1160 E LERDO HWY	STE G	SHAFTER	CA	93263	9417	15	06029	35.49994334	-119.2589787	Kern County
216555	Fee-for-Service	1366795528	1366795528	1	1	BERGER, AMY C MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132893	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216565	Fee-for-Service	1568857712	1568857712	1	1	BEST QUALITY CARE HOSPICE	11/27/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	6931 VAN NUYS BLVD	SUITE 314	VAN NUYS	CA	91405	3997	19	06037	34.19649	-118.448787	Los Angeles County
216594	Fee-for-Service	1841360914	1841360914	1	1	BUSH, QIANA M LCSW	5/17/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
216596	Fee-for-Service	1093858052	1093858052	1	1	BUCHAN, MICHAEL J MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	39297	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
216601	Fee-for-Service	1649266834	1649266834	1	1	BROZINSKY, STEVEN MD	6/30/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	41969	10	Gastroenterology (M.D. only)	0	In state provider	None	752 MEDICAL CENTER CT	STE 301	CHULA VISTA	CA	91911	6661	37	06073	32.61800405	-117.0232585	San Diego County
216607	Fee-for-Service	1356382956	1356382956	1	1	BAXTER, RICHARD B MD	12/11/2002	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53594	30	Radiology	0	In state provider	None	451 SHERMAN AVE	STE 110	PALO ALTO	CA	94306	1844	43	06085	37.42520633	-122.1442605	Santa Clara County
216628	Fee-for-Service	1578572590	1578572590	1	1	BHARGAVA, HEMA P MD	8/11/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	156703	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
216634	Fee-for-Service	1780715169	1780715169	1	1	BRYNE, SUSAN K LMFT	11/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13129 ARTHUR WAY	None	GRASS VALLEY	CA	95949	8138	29	06057	39.08219054	-121.1408216	Nevada County
216659	Fee-for-Service	1326115262	1326115262	1	1	BRAUN, WILLIAM W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29979	01	General Practice	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
216662	Fee-for-Service	1417024258	1417024258	1	1	BAHADORI, MARYAM MD	12/26/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	86394	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
216704	Fee-for-Service	1457387805	1457387805	1	1	BONILLA-TANDOC, SHEILA M	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69281	41	Internal Medicine	0	In state provider	MD	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
216744	Fee-for-Service	1821002627	1821002627	2	1	BLAND, STEPHEN L MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	5590	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 1010	LOS ANGELES	CA	90017	4001	19	06037	34.05270508	-118.2641005	Los Angeles County
216750	Fee-for-Service	1801030622	1801030622	1	1	BROWN, TOSHA N MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	100253	22	Pathology (M.D. only)	0	In state provider	None	14362 E RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08622063	-117.9606346	Los Angeles County
216794	Fee-for-Service	1467983338	1467983338	1	1	BELL, JOSEPH S MD	4/17/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	161165	14	Neurological Surgery	0	In state provider	None	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
216797	Fee-for-Service	1780940106	1780940106	1	1	BROWN, RYANNE A MD	5/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126737	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216820	Fee-for-Service	1922415736	1922415736	1	1	BERMUDEZ, NOURA A LMFT	1/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
216824	Fee-for-Service	1689741597	1689741597	1	1	BLASKO, BARBARA MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61519	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
216851	Fee-for-Service	1841225224	1841225224	1	1	BUI, MARY P DO	2/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8116	41	Internal Medicine	0	In state provider	None	600 N 13TH AVE	None	UPLAND	CA	91786	4905	36	06071	34.10113004	-117.6336234	San Bernardino County
216881	Fee-for-Service	1194863399	1194863399	1	2	BAART BEHAVIORAL HEALTH SERV	3/22/1991	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	15229 AMAR RD	None	LA PUENTE	CA	91744	2066	19	06037	34.03783114	-117.9526334	Los Angeles County
216911	Fee-for-Service	1487908398	1487908398	1	1	BRYSON, JULIA MD INC	1/31/2013	2084N0400X	NA	Neurology	026	PHYSICIANS	106988	25	Physical Medicine and Rehabilitation	0	In state provider	None	1 N CALLE CESAR CHAVEZ	#110	SANTA BARBARA	CA	93103	3664	42	06083	34.41876104	-119.682754	Santa Barbara County
216915	Fee-for-Service	1376997916	1376997916	1	1	BRUCKNER, JULIA L MD	1/7/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	16457	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
216947	Fee-for-Service	1235447491	1235447491	1	3	BOURNE, JEFFREY DO MEDICAL	11/21/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3880 VIA LUCERO	None	SANTA BARBARA	CA	93110	1605	42	06083	34.44207617	-119.7500272	Santa Barbara County
216969	Fee-for-Service	1386703007	1386703007	1	1	BHAVSAR, CHIRAG D MD	6/3/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	88362	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
216997	Fee-for-Service	1356652929	1356652929	1	1	BRISSON, MARYELLEN	2/9/2021	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 TORRANCE	140	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
217005	Fee-for-Service	1942322490	1942322490	1	1	BORAMANAND, NAVARATNA MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	18125 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.69976893	-117.9544379	Orange County
217012	Fee-for-Service	1285145243	1285145243	1	1	BASS, CHLOE E MD	1/31/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160066	None	None	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
217022	Fee-for-Service	1336257138	1336257138	1	1	BARBER, JAMES E MD INC	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86802	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 NEWPORT CENTER DRIVE	#409	NEWPORT BEACH	CA	92660	7697	30	06059	33.6142606	-117.8726808	Orange County
217031	Fee-for-Service	1295893592	1295893592	1	1	BURLINSON, KATRIEN A MD	7/31/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62983	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
217043	Fee-for-Service	1518349588	1518349588	1	1	BELTON, PATRICK J MD	6/6/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	177054	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
217085	Fee-for-Service	1780940106	1780940106	1	1	BROWN, RYANNE A MD	5/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126737	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
217128	Fee-for-Service	1194420067	1194420067	1	1	BONNER, BRITTANY NP	8/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	501 S VINCENT AVE	SUITE 205	WEST COVINA	CA	91790	6712	19	06037	34.0662144	-117.9274205	Los Angeles County
217140	Fee-for-Service	1841225224	1841225224	1	1	BUI, MARY P DO	2/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8116	45	Nephrology (Renal-Kidney)	0	In state provider	None	600 N 13TH AVE	None	UPLAND	CA	91786	4905	36	06071	34.10113004	-117.6336234	San Bernardino County
217141	Fee-for-Service	1689709537	1689709537	1	1	BRUDOS, GINGER K PHD	3/17/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
217179	Fee-for-Service	1902954910	1902954910	1	1	BHARTI, AJAY R MD	2/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85085	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217181	Fee-for-Service	1306131545	1306131545	1	1	BORREGO COMMUNITY HEALTH	9/27/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	8856 ARLINGTON AVE	None	RIVERSIDE	CA	92503	1365	33	06065	33.94647572	-117.4674078	Riverside County
217185	Fee-for-Service	1952695975	1952695975	1	1	BRENNER, KERI OXLEY MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152737	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
217186	Fee-for-Service	1912091646	1912091646	1	1	BULATOV, IGOR V MD	4/28/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71433	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
217205	Fee-for-Service	1487657763	1487657763	1	1	BROOKS D THOMPSON MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1100 S MEDICAL DR	None	MT PLEASANT	UT	84647	2222	00	None	39.53181056	-111.4610021	Sanpete County
217221	Fee-for-Service	1588205553	1588205553	1	1	BROWN, MICHAEL LMFT	11/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
217232	Fee-for-Service	1568481497	1568481497	1	1	BAATH, NAVDEEP S MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88305	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
217310	Fee-for-Service	1295121945	1295121945	1	1	BEAM, ERIC O MD	4/1/2019	208M00000X	NA	Other	026	PHYSICIANS	159628	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217319	Fee-for-Service	1881716256	1881716256	1	1	BALLARD, MORRIS R MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17510	08	Family Practice	0	In state provider	None	2020 COURT ST	STE 109	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
217363	Fee-for-Service	1700357241	1700357241	1	1	BROOM, ALEXUS LMFT	10/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
217378	Fee-for-Service	1568661288	1568661288	1	1	BLACK, CARRIE E MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136371	24	Plastic Surgery	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
217390	Fee-for-Service	1326716077	1326716077	1	1	BEST PLUS HOME HEALTH, INC	11/8/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13058 SHERMAN WAY	None	NORTH HOLLYWOOD	CA	91605	4955	19	06037	34.20117151	-118.417923	Los Angeles County
217405	Fee-for-Service	1003135930	1003135930	1	1	BROSCHARD, LEWIS T JR MD	5/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	22557	01	General Practice	0	In state provider	None	1228 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.2504083	-122.0490637	Solano County
217422	Fee-for-Service	1437115896	1437115896	1	1	BARBARA HIPP M.D.	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 116TH AVE NE	None	BELLEVUE	WA	98004	3829	00	None	47.624247	-122.1856625	King County
217461	Fee-for-Service	1437112141	1437112141	1	1	BARTHOLOMEW, ELIZABETH A NP	9/3/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
217504	Fee-for-Service	1851666473	1851666473	1	1	BAUTISTA, MARITA C MD	10/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123660	41	Internal Medicine	0	In state provider	None	555 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
217510	Fee-for-Service	1497718597	1497718597	1	1	BARRY, MICHAEL DO	9/13/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2145 W 28TH STREET	SUITE B	YUMA	AZ	85364	1219	00	None	32.676309	-114.646419	Yuma County
217527	Fee-for-Service	1972939411	1972939411	1	1	BHAKTA, MEERAL R OD	1/4/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 N FREMONT STREET	None	MANTECA	CA	95336	4725	39	06077	37.799019	-121.209612	San Joaquin County
217528	Fee-for-Service	1598539413	1598539413	1	1	BIRTH COMPANIONS COMMUNITY C	2/8/2024	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
217594	Fee-for-Service	1376863746	1376863746	1	1	BECHIS, SETH K MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139139	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
217612	Fee-for-Service	1285110866	1285110866	1	1	BLANK, TIANA M MD	6/8/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166428	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
217613	Fee-for-Service	1629152376	1629152376	1	1	BROCK, VINCENT D LCSW	7/3/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
217643	Fee-for-Service	1285090167	1285090167	1	1	BROWN, RAVEN M LMFT	10/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
217682	Fee-for-Service	1235447491	1235447491	1	4	BOURNE, JEFFREY DO MEDICAL	11/21/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	290 HEATHER CT.	None	TEMPLETON	CA	93465	9738	40	06079	35.55288	-120.7176565	San Luis Obispo County
217689	Fee-for-Service	1366855512	1366855512	1	1	BTN PHARMACY INC	11/1/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 N ORANGE AVE	SUITE 103	WEST COVINA	CA	91790	2016	19	06037	34.07369406	-117.9431173	Los Angeles County
217698	Fee-for-Service	1326023391	1326023391	1	1	BRIAN MEEKER	7/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	504 N 9TH AVE	None	VINTON	IA	52349	2254	00	None	42.173541	-92.01334455	Benton County
217745	Fee-for-Service	1639118912	1639118912	1	1	BECKES, JOHN D DO	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	6973	41	Internal Medicine	0	In state provider	None	5550 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2307	37	06073	32.74809744	-117.0773303	San Diego County
217756	Fee-for-Service	1124204086	1124204086	1	1	BOYLAN, COLIN LPCC	4/4/2022	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
217767	Fee-for-Service	1023628435	1023628435	1	1	BETANCOURT, SONIA I NP	12/13/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
217794	Fee-for-Service	1497718597	1497718597	1	1	BARRY, MICHAEL DO	9/13/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	2145 W 28TH STREET	SUITE B	YUMA	AZ	85364	1219	00	None	32.676309	-114.646419	Yuma County
217827	Fee-for-Service	1043387061	1043387061	1	1	BUGNOSEN, RAUL G MD	10/16/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61052	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
217835	Fee-for-Service	1013485390	1013485390	1	1	BENEDICT, CATHERINE PHD	12/5/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
217918	Fee-for-Service	1649290750	1649290750	1	1	BLAND, DAVID MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	34161	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
217923	Fee-for-Service	1861449142	1861449142	1	1	BARBER, JOSEPH A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 UNIVERSITY DRIVE	None	HERSHEY	PA	17033	0000	00	None	40.26440258	-76.67394583	Dauphin County
217930	Fee-for-Service	1407004807	1407004807	1	1	BOWNS, CHRISTOPHER S MD	1/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112762	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
217970	Fee-for-Service	1912158635	1912158635	1	1	BLEDSOE, BRYAN DO	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
217990	Fee-for-Service	1821547035	1821547035	1	1	BOWERS, VICTORIA M LMFT	7/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4415 SONOMA HIGHWAY	SUITE G	SANTA ROSA	CA	95409	7100	49	06097	38.45819154	-122.6759063	Sonoma County
218032	Fee-for-Service	1477756823	1477756823	1	1	BHALODIA, RAJESHKUMA M MD	11/29/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	112565	45	Nephrology (Renal-Kidney)	0	In state provider	None	795 EAST SECOND ST	STE 5	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
218057	Fee-for-Service	1154718435	1154718435	1	1	BLESSED CARE HOSPICE INC	6/1/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 205	CANOGA PARK	CA	91303	3209	36	06071	34.1994564	-118.5884133	Los Angeles County
218084	Fee-for-Service	1295797793	1295797793	1	1	BEHR, CHRISTOPHER T MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83964	20	Orthopedic Surgery	0	In state provider	None	4060 4TH AVE	STE 700	SAN DIEGO	CA	92103	2121	37	06073	32.75053673	-117.1616539	San Diego County
218099	Fee-for-Service	1366957334	1366957334	1	1	BEST HOSPICE PROVIDERS INC	1/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	26230 INDUSTRIAL BLVD	STE B	HAYWARD	CA	94545	2922	01	06001	37.6346079	-122.1124137	Alameda County
218108	Fee-for-Service	1134758485	1134758485	1	1	BEDI, RIPIKA DO	6/30/2024	207L00000X	NA	Other	026	PHYSICIANS	22296	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
218116	Fee-for-Service	1124303011	1124303011	1	1	BOTTINI, NUNZIO MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126488	83	Rheumatology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
218127	Fee-for-Service	1043639321	1043639321	1	1	BUTLER, CHRISTI M MD	9/10/2021	208800000X	NA	Other	026	PHYSICIANS	138209	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
218137	Fee-for-Service	1215903455	1215903455	1	1	BLACKMAN, EDWARD I MD	5/31/1984	207ZP0102X	NA	Other	026	PHYSICIANS	49755	22	Pathology (M.D. only)	0	In state provider	None	6245 DE LONGPRE AVE	None	LOS ANGELES	CA	90028	8253	19	06037	34.0962065	-118.325178	Los Angeles County
218162	Fee-for-Service	1932546074	1932546074	1	1	BAKSHI, ANKUR	11/2/2021	208G00000X	NA	General Surgery	026	PHYSICIANS	172633	41	Internal Medicine	0	In state provider	None	1955 W CITRACADO PKWY	SUITE 300	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
218215	Fee-for-Service	1841678182	1841678182	1	1	BAHN, URIAH M CRNA	12/1/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
218224	Fee-for-Service	1184739302	1184739302	1	1	BARSOOK, BARBARA	6/19/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	STE 901	LOS ANGELES	CA	90017	3910	19	06037	34.05270508	-118.2641005	Los Angeles County
218287	Fee-for-Service	1174510309	1174510309	1	1	BRANCH, JOHN DAVID DO	12/8/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5212	08	Family Practice	0	In state provider	None	4646 BROCKTON AVE	STE 202	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
218298	Fee-for-Service	1356581573	1356581573	1	1	BEACH CITIES MIDWIFERY &	5/12/2021	No Taxonomy Provided	NA	None	052	ALTERNATIVE BIRTH CENTERS - SPECIALTY CLINIC	-	-	NOT APPLICABLE	0	In state provider	WOMENS HEALTH CARE	23141 MOULTON PARKWAY	STE 108	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
218299	Fee-for-Service	1841313418	1841313418	1	1	BUCK, GARY L PHD	9/20/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	921 TRANSPORT WAY,	STE. 33	PETALUMA	CA	94954	1464	49	06097	38.2557496	-122.6400016	Sonoma County
218347	Fee-for-Service	1154718435	1154718435	1	1	BLESSED CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 205	CANOGA PARK	CA	91303	3209	36	06071	34.1994564	-118.5884133	Los Angeles County
218372	Fee-for-Service	1750307658	1750307658	1	1	BATRA, NARINDER S MD	6/30/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	48829	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	201 S ALVARADO ST	STE 515	LOS ANGELES	CA	90057	2385	19	06037	34.06417777	-118.2719543	Los Angeles County
218387	Fee-for-Service	1366957334	1366957334	1	1	BEST HOSPICE PROVIDERS INC	1/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	26230 INDUSTRIAL BLVD	STE B	HAYWARD	CA	94545	2922	01	06001	37.6346079	-122.1124137	Alameda County
218413	Fee-for-Service	1184781064	1184781064	1	1	BLISS, JUDITH C MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70467	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
218470	Fee-for-Service	1700952827	1700952827	1	1	BOUTROS, ADEL A MD	1/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	47792	08	Family Practice	0	In state provider	None	24432 MUIRLANDS BLVD.	101	LAKE FOREST	CA	92630	3939	30	06059	33.62755212	-117.7028876	Orange County
218525	Fee-for-Service	1548320435	1548320435	1	1	BENEWAH COMMUNITY HOSP	5/14/2008	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	229 S 7TH ST	None	ST MARIES	ID	83861	1803	00	None	47.31509202	-116.56671	Benewah County
218549	Fee-for-Service	1144454158	1144454158	1	1	BRAMLETT, DESIREE M LMFT	6/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
218561	Fee-for-Service	1760035976	1760035976	1	1	BAL, HARPREET K NP	2/22/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
218568	Fee-for-Service	1134623614	1134623614	1	1	BALL, ALEXANDER J MD	7/14/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	164871	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
218573	Fee-for-Service	1124083266	1124083266	1	1	BENNETT, LINDSEY K MD	12/1/2008	207R00000X	NA	Other	026	PHYSICIANS	103126	07	Dermatology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
218578	Fee-for-Service	1952459828	1952459828	1	1	BASS, EVAN S MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75049	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
218581	Fee-for-Service	1962456210	1962456210	1	1	BRESSLER, DAVID MD	5/27/1998	207R00000X	NA	Other	026	PHYSICIANS	44929	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
218592	Fee-for-Service	1164783908	1164783908	1	1	BRAR, SIMRAN K DO	1/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	13929	67	Endocrinology	0	In state provider	None	830 MAGNOLIA AVE	None	CORONA	CA	92879	3128	33	06065	33.86017131	-117.5520534	Riverside County
218628	Fee-for-Service	1285939553	1285939553	1	1	BERGE, KARINA M NP	5/14/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
218638	Fee-for-Service	1396285482	1396285482	1	1	BARLEV, PAULINA	6/19/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	9451	07	06013	37.94947636	-121.7752571	Contra Costa County
218653	Fee-for-Service	1083722086	1083722086	1	1	BACCI AND GLINN PHYSICAL THE	6/25/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RAPY INC	5533 W HILLSDALE AVE	SUITE 'A'	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
218692	Fee-for-Service	1245521475	1245521475	1	1	BHULLAR, PUNAM K MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125646	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
218716	Fee-for-Service	1619115656	1619115656	1	1	BABANYAN, NARINE LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
218727	Fee-for-Service	1801927884	1801927884	1	1	BRIGHT CARE HOME HEALTH, INC	8/23/2007	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3925 ROSEMEAD BLVD	STE 205A	ROSEMEAD	CA	91770	1986	19	06037	34.07930385	-118.0732531	Los Angeles County
218759	Fee-for-Service	1932115367	1932115367	1	1	BYOCK, IRA R MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39591	01	General Practice	0	In state provider	None	4101 TORRANCE BOULEVARD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
218771	Fee-for-Service	1235474065	1235474065	1	1	BARATELLI, FELICITA E MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132531	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1839	19	06037	34.07671715	-118.3799413	Los Angeles County
218807	Fee-for-Service	1548320435	1548320435	1	1	BENEWAH COMMUNITY HOSP	5/14/2008	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	229 S 7TH ST	None	ST MARIES	ID	83861	1803	00	None	47.31509202	-116.56671	Benewah County
218812	Fee-for-Service	1598836355	1598836355	1	1	BARRIO, VICTORIA R MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91617	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
218849	Fee-for-Service	1457317729	1457317729	1	1	BERNSTEIN, JOSHUA I MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99752	None	None	0	In state provider	None	2100 WEBSTER STREET	STE 405	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
218852	Fee-for-Service	1699331462	1699331462	1	1	BALDIOLI, VIRGINIA FAMILY	11/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING INC	6850 VAN NUYS BLVD	STE 202	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
218857	Fee-for-Service	1891806014	1891806014	1	1	BAZALGETTE, MARK B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46290	02	General Surgery	0	In state provider	None	1300 S ELISEO DR	STE 203	GREENBRAE	CA	94904	2015	21	06041	37.94447529	-122.53657	Marin County
218869	Fee-for-Service	1962456210	1962456210	1	1	BRESSLER, DAVID MD	5/27/1998	207R00000X	NA	Other	026	PHYSICIANS	44929	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
218885	Fee-for-Service	1629187448	1629187448	1	1	BRUNH, FREDERIC W MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43549	77	Infectious Disease	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
218947	Fee-for-Service	1831340470	1831340470	1	1	BLYTHE INTERNAL MEDICINE	3/12/2014	207R00000X	NA	Other	026	PHYSICIANS	49380	41	Internal Medicine	0	In state provider	CLINIC INC	332 W HOBSON WAY	None	BLYTHE	CA	92225	1640	33	06065	33.6101727	-114.600231	Riverside County
218974	Fee-for-Service	1124751300	1124751300	1	1	BROWN, ANN MARIE F NP	10/31/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
219005	Fee-for-Service	1053384719	1053384719	1	1	BOOS, RICHARD J MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63221	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
219024	Fee-for-Service	1063856441	1063856441	1	1	BARTENSTEIN, MAYURIKA B MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133763	40	Pediatrics	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
219060	Fee-for-Service	1689977472	1689977472	1	1	BRIGGS, JESSICA J MD	6/11/2018	207R00000X	NA	Other	026	PHYSICIANS	140756	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
219071	Fee-for-Service	1235335431	1235335431	1	1	BUTLER, ROBERT J MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50130	41	Internal Medicine	0	In state provider	None	1100 CARVER RD	STE 19	MODESTO	CA	95350	4788	50	06099	37.65942392	-121.0219332	Stanislaus County
219099	Fee-for-Service	1598836355	1598836355	1	1	BARRIO, VICTORIA R MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91617	07	Dermatology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
219109	Fee-for-Service	1902070030	1902070030	1	1	BIOCEPT, INC.	3/8/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	9955 MESA RIM ROAD	None	SAN DIEGO	CA	92121	2834	37	06073	32.89931616	-117.1779601	San Diego County
219122	Fee-for-Service	1194989079	1194989079	1	1	BEUTTLER, RICHARD C PHD	1/8/2009	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11900 E ARTESIA BLVD	None	ARTESIA	CA	90701	4034	19	06037	33.87297352	-118.078848	Los Angeles County
219123	Fee-for-Service	1477970697	1477970697	1	1	BOWMAN, WILLIS S MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140103	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
219147	Fee-for-Service	1891992095	1891992095	1	1	BOURGEOIS, ANDREW L MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111526	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 N SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
219168	Fee-for-Service	1639246499	1639246499	1	1	BURKE, RANDALL J MD	1/5/2004	2084P0800X	NA	Psychiatry	026	PHYSICIANS	84293	36	Psychiatry	0	In state provider	None	1062 S K ST	None	TULARE	CA	93274	6421	54	06107	36.19548226	-119.3433058	Tulare County
219171	Fee-for-Service	1629187448	1629187448	1	1	BRUNH, FREDERIC W MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43549	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
219181	Fee-for-Service	1457700767	1457700767	1	1	BRADLEY, DANIEL S MD	3/10/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152476	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
219186	Fee-for-Service	1255506903	1255506903	1	1	BOGINENI, ROHINI D MD	9/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121727	02	General Surgery	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
219204	Fee-for-Service	1760936884	1760936884	1	4	BEVERLYCARE	10/22/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8862 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2658	19	06037	34.0017037	-118.0850301	Los Angeles County
219214	Fee-for-Service	1194713925	1194713925	1	1	BONZANI, TERESA A MD	11/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87853	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
219215	Fee-for-Service	1184648933	1184648933	1	1	BILLESDON, JOHN C MD	10/25/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	22785	10	Gastroenterology (M.D. only)	0	In state provider	None	1100 W GONZALES RD	STE 1	OXNARD	CA	93036	3336	56	06111	34.21910048	-119.1907575	Ventura County
219254	Fee-for-Service	1538525241	1538525241	1	1	BROWNING, JENNIFER L LCSW	12/12/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PKWY	BUILDING C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
219308	Fee-for-Service	1073710976	1073710976	1	1	BAY HORIZON, INC	4/7/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1618 S GRANT ST	None	SAN MATEO	CA	94402	2657	41	06081	37.55911215	-122.3048489	San Mateo County
219328	Fee-for-Service	1831432202	1831432202	1	1	BRAY, JESSICA E LMFT	7/15/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
219335	Fee-for-Service	1497248793	1497248793	1	1	BERKOWITZ, AMANDA LMFT	6/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
219368	Fee-for-Service	1881706687	1881706687	1	1	BIO MEDICAL APPLICATIONS	3/12/2002	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	301 N PRAIRIE AVE	STE 100	INGLEWOOD	CA	90301	4508	19	06037	33.965712	-118.3439965	Los Angeles County
219378	Fee-for-Service	1114066800	1114066800	1	1	BARROZO, BRIAN K MD	2/8/2008	207R00000X	NA	Other	026	PHYSICIANS	88124	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
219380	Fee-for-Service	1598832453	1598832453	1	1	BERKELEY, MARSHA H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44305	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
219413	Fee-for-Service	1487943916	1487943916	1	1	BAGSHAW, HILARY P MD	6/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133849	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
219415	Fee-for-Service	1043291073	1043291073	1	1	BERGMAN, ERIK W MD	5/22/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153284	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
219459	Fee-for-Service	1629187448	1629187448	1	1	BRUNH, FREDERIC W MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43549	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
219480	Fee-for-Service	1154495943	1154495943	1	1	BECKER, ROBERT J DC	2/8/2015	111NR0200X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	580 HARBOR ST	None	MORRO BAY	CA	93442	1904	40	06079	35.36689647	-120.846879	San Luis Obispo County
219492	Fee-for-Service	1760936884	1760936884	1	4	BEVERLYCARE	7/15/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8862 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2658	19	06037	34.0017037	-118.0850301	Los Angeles County
219505	Fee-for-Service	1184648933	1184648933	1	1	BILLESDON, JOHN C MD	10/25/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	22785	41	Internal Medicine	0	In state provider	None	1100 W GONZALES RD	STE 1	OXNARD	CA	93036	3336	56	06111	34.21910048	-119.1907575	Ventura County
219508	Fee-for-Service	1003867565	1003867565	1	1	BARTON HEALTHCARE SYSTEM	12/1/1977	207R00000X	NA	Other	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2170 SOUTH AVE	None	S LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
219519	Fee-for-Service	1487682423	1487682423	1	1	BENJAMIN, ARTHUR MD	9/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55562	18	Ophthalmology	0	In state provider	A PROF MEDICAL CORP	9201 W SUNSET BLVD	STE 709	LOS ANGELES	CA	90069	3708	19	06037	34.09054375	-118.392295	Los Angeles County
219525	Fee-for-Service	1972653376	1972653376	1	1	BARHAM, FRANCIS L MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	6665	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
219538	Fee-for-Service	1669066833	1669066833	1	1	BUI, CHAU M MD	8/28/2024	207ZP0102X	NA	Other	026	PHYSICIANS	181206	22	Pathology (M.D. only)	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
219546	Fee-for-Service	1407974439	1407974439	1	1	BETANCOURT, LOURDES LCSW	11/21/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
219567	Fee-for-Service	1952390593	1952390593	1	1	BRADSHAW, DONNA M MD	1/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	251 MAPLE ST	None	ASHLAND	OR	97520	1516	00	None	42.20650947	-122.7244455	Jackson County
219596	Fee-for-Service	1083798284	1083798284	1	1	BOWENS, KAROL L MD	4/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	54708	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16660 PARAMOUNT BLVD	STE 100	PARAMOUNT	CA	90723	5457	19	06037	33.882723	-118.1599535	Los Angeles County
219623	Fee-for-Service	1265882336	1265882336	1	1	BALLAT, ELIAS S DO	12/10/2019	207R00000X	NA	Other	026	PHYSICIANS	15965	41	Internal Medicine	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
219700	Fee-for-Service	1487943916	1487943916	1	1	BAGSHAW, HILARY P MD	6/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133849	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
219756	Fee-for-Service	1518296706	1518296706	1	1	BABAYEV, MIKHAIL LCSW	3/10/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
219758	Fee-for-Service	1386801058	1386801058	1	1	BORKE, JESSE A MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128982	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
219761	Fee-for-Service	1891023479	1891023479	1	1	BRACAMONTE, CRISTINA	6/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90701	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
219777	Fee-for-Service	1760936884	1760936884	1	4	BEVERLYCARE	7/15/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8862 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2658	19	06037	34.0017037	-118.0850301	Los Angeles County
219796	Fee-for-Service	1003867565	1003867565	1	1	BARTON HEALTHCARE SYSTEM	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2170 SOUTH AVE	None	S LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
219805	Fee-for-Service	1851769871	1851769871	1	2	BARRACK, VALERIE LMFT	9/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2354 ALFRED CIR	None	EUREKA	CA	95503	7213	12	06023	40.73301247	-124.2008145	Humboldt County
219832	Fee-for-Service	1811314271	1811314271	1	1	BARRIENTOS, KYRA D LMFT	9/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4344 LATHAM	110	RIVERSIDE	CA	92501	0400	33	06065	34.00198519	-117.3739252	Riverside County
219874	Fee-for-Service	1376707554	1376707554	1	2	BURGINA, LYUBOV LMFT	3/4/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14903 S NORMANDIE AVE	UNIT 214	GARDENA	CA	90247	2968	19	06037	33.89635356	-118.3004719	Los Angeles County
219875	Fee-for-Service	1225135288	1225135288	1	1	BEKENDAM, PAMELA JOANNE MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55099	None	None	0	In state provider	None	555 N THIRTEENTH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
219883	Fee-for-Service	1083798284	1083798284	1	1	BOWENS, KAROL L MD	4/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	54708	08	Family Practice	0	In state provider	None	16660 PARAMOUNT BLVD	STE 100	PARAMOUNT	CA	90723	5457	19	06037	33.882723	-118.1599535	Los Angeles County
219911	Fee-for-Service	1659780096	1659780096	1	1	BAY VISTA HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	5901 DOWNEY AVE	None	LONG BEACH	CA	90805	4518	19	06037	33.863193	-118.1512385	Los Angeles County
219934	Fee-for-Service	1700348398	1700348398	1	1	BUI, TINA DO	9/6/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	19636	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
219980	Fee-for-Service	1295904100	1295904100	1	2	BIEDA, JOHN C LMFT	4/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS	600	CONCORD	CA	94520	5232	07	06013	37.96879608	-122.0519798	Contra Costa County
219981	Fee-for-Service	1407369887	1407369887	1	1	BELIZAIRE, MADELEINE CNM	11/14/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
220011	Fee-for-Service	1255520425	1255520425	1	1	BYRNE, VALERIE J LMFT	8/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6233 SOQUEL DR	None	APTOS	CA	95003	3184	44	06087	36.99054564	-121.931252	Santa Cruz County
220018	Fee-for-Service	1184065088	1184065088	1	1	BORREGO COMMUNITY HEALTH	1/2/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	11750 CHOLLA DRIVE	SUITE B	DESERT HOT SPRING	CA	92240	3064	33	06065	33.96386115	-116.5144878	Riverside County
220032	Fee-for-Service	1265500797	1265500797	1	1	BERND G. BARTHEL, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2799 W GRAND BLVD	None	DETROIT	MI	48202	2608	00	None	42.36645079	-83.08385497	Wayne County
220050	Fee-for-Service	1023536992	1023536992	1	1	BEHAVIORAL HEALTH SERVICES	9/5/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1334 N AVALON BLVD	None	WILMINGTON	CA	90744	2639	19	06037	33.78988991	-118.2632007	Los Angeles County
220060	Fee-for-Service	1427256957	1427256957	1	3	BEVERLY HILLS ONCOLOGY MEDIC	8/24/2010	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5901 WEST OLYMPIC BLVD	SUITE 420	LOS ANGELES	CA	90036	4667	19	06037	34.05764121	-118.3603115	Los Angeles County
220064	Fee-for-Service	1942392683	1942392683	1	1	BALA, NARINDER S MD INC	7/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37020	40	Pediatrics	0	In state provider	None	3120 TULARE ST	STE 103	FRESNO	CA	93721	1580	10	06019	36.74193828	-119.7786169	Fresno County
220071	Fee-for-Service	1023571239	1023571239	1	1	BARBOUR, RACHEL MD	7/11/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177829	None	None	0	In state provider	None	240 S. LA CIENEGA BLVD	350	BEVERLY HILLS	CA	90211	3324	19	06037	34.06392928	-118.3761548	Los Angeles County
220082	Fee-for-Service	1003854738	1003854738	1	1	BEAIRD, BRENT A MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139605	66	Emergency Medicine (Urgent Care)	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
220089	Fee-for-Service	1356362966	1356362966	2	1	BEARMAN, ROBERT M MD	12/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	25432	22	Pathology (M.D. only)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
220093	Fee-for-Service	1790304111	1790304111	1	1	BARBARO, MICHAEL F MD	6/2/2023	207P00000X	NA	Other	026	PHYSICIANS	186439	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
220103	Fee-for-Service	1932287588	1932287588	1	1	BEUGELMANS, DANIEL B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31883	36	Psychiatry	0	In state provider	None	34 GROVE DR	None	PORTOLA VALLEY	CA	94028	7637	41	06081	37.37677933	-122.2192975	San Mateo County
220107	Fee-for-Service	1871804443	1871804443	1	1	BAGHDADI, JONATHAN D MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131082	77	Infectious Disease	0	In state provider	None	200 MED PLAZA	365 420 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
220130	Fee-for-Service	1366106882	1366106882	1	1	BURROUS, ELIZABETH M NP	9/26/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220136	Fee-for-Service	1326545658	1326545658	1	1	BAJWA, TAJINDER MD	10/28/2022	207R00000X	NA	Other	026	PHYSICIANS	174223	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
220152	Fee-for-Service	1912079740	1912079740	1	1	BRICKNER, LESLEA A MD	11/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	81495	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
220158	Fee-for-Service	1396784088	1396784088	1	1	BERGER, JACK M MD	7/31/1994	207L00000X	NA	Other	026	PHYSICIANS	35647	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
220183	Fee-for-Service	1992159891	1992159891	1	1	BRAZDZIONIS, ANNE V LPCC	5/24/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
220187	Fee-for-Service	1508118993	1508118993	1	1	BAYCHER, ANNA OD	11/6/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4403 S VERMONT AVE	None	LOS ANGELES	CA	90037	2413	19	06037	34.00342736	-118.2915892	Los Angeles County
220235	Fee-for-Service	1396241915	1396241915	1	1	BENIN, SAMANTHA MD	3/12/2024	208M00000X	NA	Other	026	PHYSICIANS	173499	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
220247	Fee-for-Service	1457715963	1457715963	1	1	BALA, ABIRAM MD	9/22/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	150564	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
220290	Fee-for-Service	1700204989	1700204989	1	1	BRANDAL, GARTH MD	4/5/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	139948	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
220294	Fee-for-Service	1568901809	1568901809	1	1	BLUE JAY MANOR, LLC	7/16/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	35 BLUE JAY LANE	None	REDLANDS	CA	92374	1650	36	06071	34.08516493	-117.183213	San Bernardino County
220305	Fee-for-Service	1184065088	1184065088	1	1	BORREGO COMMUNITY HEALTH	1/2/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	11750 CHOLLA DRIVE	SUITE B	DESERT HOT SPRING	CA	92240	3064	33	06065	33.96386115	-116.5144878	Riverside County
220307	Fee-for-Service	1629137245	1629137245	1	1	BAINER, JAMES L MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	37983	18	Ophthalmology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
220320	Fee-for-Service	1679719777	1679719777	1	1	BASU, SUPARNA MD	1/23/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
220332	Fee-for-Service	1598758468	1598758468	1	1	BORNO, SAM MD INC	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	44967	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	30 RIVER PARK PL W	STE 440	FRESNO	CA	93720	1547	10	06019	36.85863998	-119.7892053	Fresno County
220339	Fee-for-Service	1023536992	1023536992	1	1	BEHAVIORAL HEALTH SERVICES	2/9/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1334 N AVALON BLVD	None	WILMINGTON	CA	90744	2639	19	06037	33.78988991	-118.2632007	Los Angeles County
220342	Fee-for-Service	1629597877	1629597877	1	1	BLACK, TRENYE J LPCC	3/28/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
220371	Fee-for-Service	1003854738	1003854738	1	1	BEAIRD, BRENT A MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139605	01	General Practice	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
220396	Fee-for-Service	1255484283	1255484283	1	1	BURNS, JASON W MD	3/2/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18439	None	None	0	In state provider	None	559 ABBOTT ST	None	SALINAS	CA	93901	4325	27	06053	36.66284132	-121.6420108	Monterey County
220427	Fee-for-Service	1447643853	1447643853	1	1	BRIGHT HEART HEALTH, INC.	9/27/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
220429	Fee-for-Service	1962464016	1962464016	1	1	BON SECOURS ST MARYS	10/8/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL OF RICHMOND INC	5801 BREMO ROAD	None	RICHMOND	VA	23226	1907	00	None	37.58431422	-77.51321767	Henrico County
220430	Fee-for-Service	1992088512	1992088512	1	1	BLOCK, ASHLEY LCSW	1/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
220435	Fee-for-Service	1972971901	1972971901	1	1	BRIGHT VISION OPTOMETRY INC	4/7/2017	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2935 CHINO AVE	STE E3	CHINO HILLS	CA	91709	3575	36	06071	34.01060806	-117.7414777	San Bernardino County
220444	Fee-for-Service	1477013878	1477013878	1	1	BRIONES, NAOMI F	9/8/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	190120	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
220470	Fee-for-Service	1952318537	1952318537	1	1	BOCKENSTEDT, JENNELL J OD	5/31/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	48 W ROMIE LANE	None	SALINAS	CA	93901	2317	27	06053	36.66343104	-121.6600006	Monterey County
220489	Fee-for-Service	1164890703	1164890703	1	1	BUSH, EMILY F LCSW	2/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
220490	Fee-for-Service	1215675178	1215675178	1	1	BRETADO, LAURA J CNP	1/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18080 IMPERIAL HWY	None	YORBA LINDA	CA	92886	3436	30	06059	33.89287302	-117.8194305	Orange County
220493	Fee-for-Service	1063524312	1063524312	1	1	BRANTON, SANDRA L PSYD	2/26/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	870 EMERALD BAY ROAD	SUITE 301	SOUTH LAKE TAHOE	CA	96150	6324	09	06017	38.91645023	-120.0084206	El Dorado County
220516	Fee-for-Service	1619117181	1619117181	1	2	BRAR, MANPREET DPM	7/18/2023	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1421 OAKDALE ROAD	None	MODESTO	CA	95355	3356	50	06099	37.664802	-120.9576055	Stanislaus County
220557	Fee-for-Service	1497173207	1497173207	1	1	BATCHU, SINDHURA T MD	9/25/2020	390200000X	NA	Other	026	PHYSICIANS	149222	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
220587	Fee-for-Service	1669940003	1669940003	1	1	BUENA MEDICAL GROUP	12/9/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	631 COOPER RD	None	OXNARD	CA	93030	5427	56	06111	34.20454837	-119.1719737	Ventura County
220602	Fee-for-Service	1659389104	1659389104	1	1	BJORNSON, KRIS M MD	1/29/2015	207L00000X	NA	Other	026	PHYSICIANS	27581	05	Anesthesiology	0	In state provider	None	250 PROSPECT PLACE	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
220625	Fee-for-Service	1023536992	1023536992	1	1	BEHAVIORAL HEALTH SERVICES	9/5/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1334 N AVALON BLVD	None	WILMINGTON	CA	90744	2639	19	06037	33.78988991	-118.2632007	Los Angeles County
220642	Fee-for-Service	1467006718	1467006718	1	1	BALLENTINE, KYLE D LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
220645	Fee-for-Service	1831319516	1831319516	1	1	BAIDOO, EMMANUEL K DO	12/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9954	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
220680	Fee-for-Service	1750332631	1750332631	1	1	BHATT, ASHWIN N MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	49357	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
220685	Fee-for-Service	1851981799	1851981799	1	1	BASH PHYSIATRY INC	4/5/2021	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4390	42	06083	34.42887662	-119.7237878	Santa Barbara County
220690	Fee-for-Service	1255401170	1255401170	1	1	BHARATI BEATRIX BANSAL MD	9/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
220694	Fee-for-Service	1285829531	1285829531	1	1	BHAJAL, SUKHVINDER S MD	1/15/2008	193400000X	NA	Other	026	PHYSICIANS	55117	06	Cardiovascular Disease (M.D. only)	0	In state provider	OF CALIFORNIA INC	5120 W CYPRESS	None	VISALIA	CA	93291	6164	54	06107	36.324405	-119.347326	Tulare County
220697	Fee-for-Service	1538230271	1538230271	1	1	BRENTON MEDA	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13103 E MANSFIELD AVE	None	SPOKANE VLY	WA	99216	1642	00	None	47.67755045	-117.228357	Spokane County
220701	Fee-for-Service	1548252505	1548252505	1	1	BUI, TRIEU T DO	11/8/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6601	01	General Practice	0	In state provider	None	10551 MCFADDEN AVE	STE C	GARDEN GROVE	CA	92843	5329	30	06059	33.73796199	-117.9453037	Orange County
220704	Fee-for-Service	1669821310	1669821310	1	1	BYANOVA, KATERINA L MD	6/7/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168588	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
220705	Fee-for-Service	1013197045	1013197045	1	1	BARCARSE, ERIN A MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100408	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
220707	Fee-for-Service	1255311676	1255311676	1	1	BABAJANIANS, ANDRE MD	2/28/1991	207R00000X	NA	Other	026	PHYSICIANS	47789	41	Internal Medicine	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
220717	Fee-for-Service	1962464016	1962464016	1	1	BON SECOURS ST MARYS	10/8/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL OF RICHMOND INC	5801 BREMO ROAD	None	RICHMOND	VA	23226	1907	00	None	37.58431422	-77.51321767	Henrico County
220718	Fee-for-Service	1457700353	1457700353	1	1	BARAGONA, PAMELA A	6/8/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41769 ENTERPRISE CIR N	STE 104	TEMECULA	CA	92590	5626	33	06065	33.51823541	-117.1701538	Riverside County
220742	Fee-for-Service	1992978399	1992978399	1	1	BRUCE R. CARLTON, M.D., INC.	3/27/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2023 VALE RD	STE 6	SAN PABLO	CA	94806	3890	07	06013	37.95369824	-122.3378493	Contra Costa County
220759	Fee-for-Service	1073704524	1073704524	1	1	BORRERO, MARCOS MD INC	1/27/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3490 PALM AVENUE	None	SAN DIEGO	CA	92154	1664	37	06073	32.58391748	-117.0594012	San Diego County
220776	Fee-for-Service	1962577213	1962577213	2	1	BUTTE THERAPY SYSTEMS	10/24/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1695-A SIERRA AVENUE	None	YUBA CITY	CA	95993	9144	51	06101	39.14041994	-121.6508203	Sutter County
220806	Fee-for-Service	1285702951	1285702951	1	1	BOCHKUR-PREM, BIANA	1/18/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11336 DONA LISA DR	None	STUDIO CITY	CA	91604	4315	19	06037	34.1313147	-118.3775371	Los Angeles County
220813	Fee-for-Service	1831616283	1831616283	1	1	BELLESTAR HOME HEALTH CARE	10/4/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1568 CREEKSIDE DRIVE	STE 203	FOLSOM	CA	95630	3449	34	06067	38.666772	-121.1503545	Sacramento County
220830	Fee-for-Service	1003008772	1003008772	1	1	BRUCE, LOUISE M NP	7/24/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
220860	Fee-for-Service	1417069105	1417069105	1	1	BRUCE, SAMUEL L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29223	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	HUNTINGTON PERINATAL MED	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
220878	Fee-for-Service	1174792030	1174792030	1	1	BARSUN, ALURA L NP	4/16/2008	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
220882	Fee-for-Service	1083152912	1083152912	1	1	BI-BETT	2/17/2017	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1390 SANTA CLARA AVE	BUILDINGS 1-3	CONCORD	CA	94518	1031	07	06013	37.97151733	-122.0264718	Contra Costa County
220916	Fee-for-Service	1992780787	1992780787	1	1	BONEKAT, H WILLIAM DO	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	5566	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
220919	Fee-for-Service	1841268646	1841268646	1	1	BARRIE, STACEY F MD	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61094	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2299 MOWRY AVE	STE 3A	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
220946	Fee-for-Service	1114459997	1114459997	1	1	BALI, RADHIKA MD	8/30/2020	207R00000X	NA	Other	026	PHYSICIANS	165853	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
220964	Fee-for-Service	1205242765	1205242765	1	1	BRESHEARS, LISA D DPM	12/3/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1141 W REDONDO BEACH BLV	STE 302	GARDENA	CA	90247	3583	19	06037	33.89247036	-118.2941482	Los Angeles County
220990	Fee-for-Service	1760417950	1760417950	1	1	BATTAGLIA, MICHAEL J MD	9/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73848	05	Anesthesiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
220993	Fee-for-Service	1255311676	1255311676	1	1	BABAJANIANS, ANDRE MD	2/28/1991	207R00000X	NA	Other	026	PHYSICIANS	47789	83	Rheumatology	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
221000	Fee-for-Service	1679987374	1679987374	1	1	BENJAMIN, JOHN MD	1/7/2020	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
221002	Fee-for-Service	1689064214	1689064214	1	1	BILLOTTE, CHASE L PT	8/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
221030	Fee-for-Service	1558366567	1558366567	1	1	BASIL, SHERWIN A	9/30/2004	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5842 E 2ND ST	None	LONG BEACH	CA	90803	5045	19	06037	33.75626418	-118.1203171	Los Angeles County
221054	Fee-for-Service	1891960167	1891960167	1	1	BHAT, AMBIKA MD	10/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112591	25	Physical Medicine and Rehabilitation	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
221067	Fee-for-Service	1255484200	1255484200	1	1	BURK, LYNN A LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
221109	Fee-for-Service	1013999101	1013999101	1	1	BEISENHERZ, CHRISTOPH K	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	40964	01	General Practice	0	In state provider	None	4327 GOLDEN CENTER DR	None	PLACERVILLE	CA	95667	6260	09	06017	38.70662835	-120.8276613	El Dorado County
221135	Fee-for-Service	1740592112	1740592112	1	1	BOYKOFF, NELLI MD	7/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117929	13	Neurology (M.D. only)	0	In state provider	None	2100 WEBSTER ST	SUITE 404	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
221145	Fee-for-Service	1851305478	1851305478	1	1	BERKMAN, PETER M MD	3/31/1985	207P00000X	NA	Other	026	PHYSICIANS	44450	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4415 LAKEVIEW CANYON RD	None	WESTLAKE VILLAGE	CA	91361	3603	19	06037	34.14720238	-118.8195228	Los Angeles County
221162	Fee-for-Service	1134230386	1134230386	1	1	BOBBA, ANNAPURNA MD	8/30/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158209	15	Obstetrics (D.O. only)	0	In state provider	None	1418 E MAIN ST	210	SANTA MARIA	CA	93454	4836	42	06083	34.95286855	-120.4137315	Santa Barbara County
221164	Fee-for-Service	1659790558	1659790558	1	1	BRAUN, LINDSAY P MD	7/8/2020	2080P0203X	NA	Other	026	PHYSICIANS	143001	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
221172	Fee-for-Service	1730347899	1730347899	1	1	BLAKE PHILLIPS	3/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
221173	Fee-for-Service	1912464017	1912464017	1	1	BOATENG, BETTY N	8/2/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7313 FALLBROOK AVENUE	None	WEST HILLS	CA	91307	2105	19	06037	34.203141	-118.6234595	Los Angeles County
221178	Fee-for-Service	1346811551	1346811551	1	1	BEST SOLUTION HOME HEALTH	12/13/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE	2450 COLORADO AVE	STE 100E/323	SANTA MONICA	CA	90404	3575	19	06037	34.02955722	-118.4724908	Los Angeles County
221241	Fee-for-Service	1831642792	1831642792	1	1	BENAVIDES, AMON LMFT	3/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1010 N CENTRAL AVE	SUITE 310	GLENDALE	CA	91202	2937	19	06037	34.16012317	-118.2571026	Los Angeles County
221286	Fee-for-Service	1700271640	1700271640	1	1	BATSIS, MARIA MD	4/4/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172031	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
221366	Fee-for-Service	1538138243	1538138243	1	1	BEHREND, CLINT E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2770 CORTEZ AVE	None	IDAHO FALLS	ID	83404	7590	00	None	43.47282307	-111.9887831	Bonneville County
221373	Fee-for-Service	1649415456	1649415456	1	1	BE, HING M DO INC	10/20/2008	261QP2300X	NA	Other	026	PHYSICIANS	7045	08	Family Practice	0	In state provider	None	1834 W LINCOLN AVE	# P	ANAHEIM	CA	92801	5425	30	06059	33.83242251	-117.947484	Orange County
221394	Fee-for-Service	1013999101	1013999101	1	1	BEISENHERZ, CHRISTOPH K	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	40964	08	Family Practice	0	In state provider	None	4327 GOLDEN CENTER DR	None	PLACERVILLE	CA	95667	6260	09	06017	38.70662835	-120.8276613	El Dorado County
221461	Fee-for-Service	1770169120	1770169120	1	1	BREEN, ILANA D MD	6/14/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	180602	07	Dermatology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
221462	Fee-for-Service	1609057884	1609057884	1	1	BOUDREAULT, DAVID J MD	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	98186	24	Plastic Surgery	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
221517	Fee-for-Service	1821011248	1821011248	1	1	BEXAR COUNTY HOSP DIST	1/4/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	UNIVERSITY HEALTH SYSTEM	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
221542	Fee-for-Service	1922101237	1922101237	1	1	BAYARD, PAUL J MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74328	08	Family Practice	0	In state provider	None	2417 CENTRAL AVENUE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
221559	Fee-for-Service	1003180050	1003180050	1	1	BROWN, STEWART W MD	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	28389	01	General Practice	0	In state provider	None	2700 N BELLFLOWER BLVD	STE 312	LONG BEACH	CA	90815	1145	19	06037	33.805692	-118.1251805	Los Angeles County
221628	Fee-for-Service	1376728295	1376728295	1	1	BALADA, FRANCESCA PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23121 PLAZA POINTE DR	SUITE 150	LAGUNA HILLS	CA	92653	1468	30	06059	33.6265559	-117.7229842	Orange County
221633	Fee-for-Service	1376565473	1376565473	1	1	BAIRD, ERIC G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
221635	Fee-for-Service	1962963645	1962963645	1	1	BEHAVIORAL HEALTH SERVICES	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4511 WHITTIER BLVD	None	LOS ANGELES	CA	90022	2407	19	06037	34.02325325	-118.1705935	Los Angeles County
221637	Fee-for-Service	1205995917	1205995917	1	1	BRINK, KIMBERLY R CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9333 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
221682	Fee-for-Service	1104991058	1104991058	1	1	BHADURI, SHARMILA LMFT	12/20/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16152 BEACH BLVD	STE 200	HUNTINGTON BEACH	CA	92647	3869	30	06059	33.72889962	-117.9891397	Orange County
221691	Fee-for-Service	1154646131	1154646131	1	1	BHATIA, AJAY K MD	2/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112314	40	Pediatrics	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
221693	Fee-for-Service	1255425146	1255425146	1	1	BRYANT, DIANA RUTH MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	62214	41	Internal Medicine	0	In state provider	None	1777 N BELLFLOWER BLVD	STE 101	LONG BEACH	CA	90815	4019	19	06037	33.78791149	-118.1240221	Los Angeles County
221706	Fee-for-Service	1164691788	1164691788	1	1	BALI, BHAVNA MD	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101957	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
221722	Fee-for-Service	1336429711	1336429711	1	1	BAJWA-DULAI, SONIA T MD	11/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132228	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
221737	Fee-for-Service	1447755392	1447755392	1	1	BURTON, SARAH B PSYD	4/17/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
221757	Fee-for-Service	1811507601	1811507601	1	1	BERMAN, ANNA J LMFT	7/23/2021	103T00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
221758	Fee-for-Service	1679780423	1679780423	1	1	BORIS ZAKS, MD INC	7/9/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	435 N ROXBURY DR	SUITE 408	BEVERLY HILLS	CA	90210	5006	19	06037	34.06777102	-118.4067032	Los Angeles County
221760	Fee-for-Service	1902097231	1902097231	1	1	BURTON, JOSHUA B MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117109	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
221775	Fee-for-Service	1295125516	1295125516	1	1	BANG, VINCENT S T CA	5/16/2016	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	244 S OXFORD AVE	STE 11	LOS ANGELES	CA	90004	5126	19	06037	34.069851	-118.3078535	Los Angeles County
221791	Fee-for-Service	1942522867	1942522867	1	1	BENECK, AMY L	5/13/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
221797	Fee-for-Service	1215385190	1215385190	1	1	BROOKS, NICOLE MD	9/8/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167771	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
221804	Fee-for-Service	1821011248	1821011248	1	1	BEXAR COUNTY HOSP DIST	1/4/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	UNIVERSITY HEALTH SYSTEM	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
221810	Fee-for-Service	1700810298	1700810298	1	1	BARBER, MELISSA E AU	2/1/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
221835	Fee-for-Service	1265434591	1265434591	1	1	BOUZ, NAJIB MD INC	2/14/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	32244	None	None	0	In state provider	None	315 E ALOSTA AVE	STE 201	GLENDORA	CA	91740	6257	19	06037	34.1288686	-117.8608708	Los Angeles County
221838	Fee-for-Service	1952314510	1952314510	2	1	BARNETT, KATRINA MD	4/29/2022	207P00000X	NA	Other	026	PHYSICIANS	95093	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
221853	Fee-for-Service	1942638978	1942638978	1	3	BRIGHTER BEGINNINGS	9/15/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	512 WEST 5TH STREET	None	ANTIOCH	CA	94509	1236	07	06013	38.01478351	-121.813218	Contra Costa County
221895	Fee-for-Service	1780681403	1780681403	1	1	BELL, RANDALL C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7700 FLOYD CURL DR	None	SAN ANTONIO	TX	78229	3902	00	None	29.50734825	-98.57341588	Bexar County
221906	Fee-for-Service	1639257280	1639257280	1	1	BRENMAN, AANA R MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75139	41	Internal Medicine	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
221912	Fee-for-Service	1972578417	1972578417	1	2	BURESH, CHRISTOPHER T MD	3/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
221919	Fee-for-Service	1417020009	1417020009	1	1	BROWN, BRET LMFT	3/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	316 E BRANCH ST	None	ARROYO GRANDE	CA	93420	2706	40	06079	35.12466588	-120.5760857	San Luis Obispo County
221923	Fee-for-Service	1598777658	1598777658	1	1	BRALEY, SCOTT C MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68901	02	General Surgery	0	In state provider	None	5 MEDICAL PLAZA DR	SUITE 120	ROSEVILLE	CA	95661	2866	31	06061	38.76604411	-121.2466761	Placer County
221924	Fee-for-Service	1962963645	1962963645	1	1	BEHAVIORAL HEALTH SERVICES	2/9/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4511 WHITTIER BLVD	None	LOS ANGELES	CA	90022	2407	19	06037	34.02325325	-118.1705935	Los Angeles County
221947	Fee-for-Service	1548663404	1548663404	1	1	BROWN, TIMOTHY T LPCC	6/28/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
221951	Fee-for-Service	1104809110	1104809110	1	2	BORGES, GABRIEL S DO	3/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7049	None	None	0	In state provider	None	2540 CARMICHAEL WAY	None	CARMICHAEL	CA	95608	5314	34	06067	38.611062	-121.327011	Sacramento County
221992	Fee-for-Service	1770013146	1770013146	1	1	BAHRI, GHAZAL N MD	12/2/2020	208M00000X	NA	Other	026	PHYSICIANS	163355	None	None	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
222008	Fee-for-Service	1184858615	1184858615	1	1	BENJAMIN S DANGERFIELD, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
222018	Fee-for-Service	1790313815	1790313815	1	1	BHULLAR, HARMAN MD	8/8/2023	208M00000X	NA	Other	026	PHYSICIANS	19949	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
222033	Fee-for-Service	1902435191	1902435191	1	1	BATRA, SAHIL DO	9/20/2023	390200000X	NA	Other	026	PHYSICIANS	20977	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
222043	Fee-for-Service	1235447491	1235447491	1	1	BOURNE, JEFFREY DO MEDICAL	8/15/2013	207R00000X	NA	Other	026	PHYSICIANS	7050	41	Internal Medicine	0	In state provider	CORPORATION	14900 EL CAMINO REAL	None	ATASCADERO	CA	93422	6417	40	06079	35.42950475	-120.6067977	San Luis Obispo County
222074	Fee-for-Service	1639141716	1639141716	1	1	BLUM, BARRY I MD	2/10/1995	207R00000X	NA	Other	026	PHYSICIANS	34386	41	Internal Medicine	0	In state provider	None	960 E GREEN ST	STE 280	PASADENA	CA	91106	2419	19	06037	34.14451994	-118.1301695	Los Angeles County
222090	Fee-for-Service	1538708839	1538708839	1	1	BARON, LEONE M PT	12/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	43	06085	37.36777579	-122.0276404	Santa Clara County
222126	Fee-for-Service	1497933311	1497933311	1	1	BENDER, MICHAEL A PT	5/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
222134	Fee-for-Service	1922174192	1922174192	1	1	BALLIN, DARRYL J MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51935	41	Internal Medicine	0	In state provider	None	5525 ETIWANDA AVE	None	TARZANA	CA	91356	6140	19	06037	34.17046451	-118.5308463	Los Angeles County
222135	Fee-for-Service	1003331455	1003331455	1	1	BARRETT, BRIAN J PT	5/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
222144	Fee-for-Service	1942638978	1942638978	1	3	BRIGHTER BEGINNINGS	4/15/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	512 WEST 5TH STREET	None	ANTIOCH	CA	94509	1236	07	06013	38.01478351	-121.813218	Contra Costa County
222146	Fee-for-Service	1326290834	1326290834	1	1	BURAK, JENNIFER CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
222154	Fee-for-Service	1215956396	1215956396	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	5410 CYPRESS AVE	102	VISALIA	CA	93277	8343	54	06107	36.326277	-119.3508675	Tulare County
222177	Fee-for-Service	1952344640	1952344640	1	1	BIG SUR MEDICAL CORPORTATION	7/14/2008	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	94411	04	Otology, Laryngology, Rhinology	0	In state provider	None	10760 WARNER AVE	STE 201	FOUNTAIN VALLEY	CA	92708	3845	30	06059	33.71627097	-117.9410205	Orange County
222207	Fee-for-Service	1295813947	1295813947	1	1	BALFOUR, MONICA S MD	9/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81568	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
222211	Fee-for-Service	1962963645	1962963645	1	1	BEHAVIORAL HEALTH SERVICES	7/30/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4511 WHITTIER BLVD	None	LOS ANGELES	CA	90022	2407	19	06037	34.02325325	-118.1705935	Los Angeles County
222231	Fee-for-Service	1538424197	1538424197	1	1	BARRERA, JAZMIN X LMFT	5/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3334 SAN BRUNO AVE	1	SAN FRANCISCO	CA	94134	2014	38	06075	37.71968659	-122.4006242	San Francisco County
222255	Fee-for-Service	1609136597	1609136597	1	1	BOLDEN, KHALIMA A PHD	8/6/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
222305	Fee-for-Service	1942347216	1942347216	1	1	BRAVMAN, JONATHAN T MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
222309	Fee-for-Service	1184638686	1184638686	1	1	BOBBA, VISHNU V R MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40046	40	Pediatrics	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
222341	Fee-for-Service	1528170685	1528170685	1	1	BLANKENBURG, REBECCA	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83218	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
222359	Fee-for-Service	1891146817	1891146817	1	1	BOBO, KIANA L LMFT	8/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
222364	Fee-for-Service	1124161104	1124161104	1	1	BRITSCH, JERRI L MD	5/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1905 MAIN STREET	None	KLAMATH FALLS	OR	97601	2638	00	None	42.22838442	-121.7691707	Klamath County
222367	Fee-for-Service	1780762575	1780762575	1	1	BAER, DAVID M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31951	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
222382	Fee-for-Service	1578179677	1578179677	1	1	BESSETTE, DALLAS M CRNA	10/28/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
222384	Fee-for-Service	1326353434	1326353434	1	1	BLAKEY-ARMSTRONG, AQILA L	9/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
222390	Fee-for-Service	1356672612	1356672612	1	1	BANEK, RAFAL B CRNA	12/20/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
222397	Fee-for-Service	1033523782	1033523782	1	1	BAGHEL, SHEELA MD	11/22/2024	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	171745	13	Neurology (M.D. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
222424	Fee-for-Service	1700147352	1700147352	1	1	BIEWENGA, MELISSA A MD	9/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122243	01	General Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
222431	Fee-for-Service	1942638978	1942638978	1	3	BRIGHTER BEGINNINGS	6/5/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	512 WEST 5TH STREET	None	ANTIOCH	CA	94509	1236	07	06013	38.01478351	-121.813218	Contra Costa County
222435	Fee-for-Service	1114960788	1114960788	1	1	BECKER, KEVIN MD	10/24/2024	207L00000X	NA	Other	026	PHYSICIANS	52913	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
222438	Fee-for-Service	1538242045	1538242045	1	1	BUNNALAI, THIANCHAI MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129732	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
222457	Fee-for-Service	1962498410	1962498410	1	1	BARGOUT, RAED MD	1/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53521	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1300 N VERMONT AVE	STE 409	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
222459	Fee-for-Service	1265120166	1265120166	1	1	BYUNGWOO CHOI MD INC	8/21/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	4000 CALLE TECATE	STE 220	CAMARILLO	CA	93012	5289	56	06111	34.22147843	-119.0178246	Ventura County
222496	Fee-for-Service	1083957187	1083957187	1	1	BHALLA, ISH P MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154252	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
222498	Fee-for-Service	1063945863	1063945863	1	1	BARIL, SANDRA K MD	2/25/2025	2080P0207X	NA	Hematology	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	2825 J STREET	STE 235	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
222513	Fee-for-Service	1629524392	1629524392	1	1	BEKAERT, JILL LMFT	12/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	37815 2ND STREET	None	FREMONT	CA	94536	2926	01	06001	37.57528592	-121.9769296	Alameda County
222518	Fee-for-Service	1689063810	1689063810	1	1	BROEKSTRA, LINDSAY LMFT	1/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
222555	Fee-for-Service	1629530209	1629530209	1	1	BARNES, LEANDRA A MD	3/20/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	180977	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
222572	Fee-for-Service	1730687146	1730687146	1	1	BARNARD, ALEXANDER A LCSW	3/3/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
222588	Fee-for-Service	1275821001	1275821001	1	1	BENAKA HEBBAR, VAISHALI MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129252	40	Pediatrics	0	In state provider	None	200 C STREET	None	PATTERSON	CA	95363	2701	50	06099	37.46733509	-121.1258615	Stanislaus County
222591	Fee-for-Service	1679262547	1679262547	1	1	BURK, MEGAN CNM	5/15/2024	163WM0102X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
222632	Fee-for-Service	1245226232	1245226232	1	1	BRUCKNER, MARK N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50614	40	Pediatrics	0	In state provider	STERLING MEDICAL GROUP	2876 SYCAMORE DR	STE 302	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
222660	Fee-for-Service	1295039360	1295039360	1	1	BHULLAR, MANMINDER S MD	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	123839	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
222686	Fee-for-Service	1396757456	1396757456	1	1	BRAY, HOLLY A	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
222699	Fee-for-Service	1316502495	1316502495	1	1	BROUSSEAU, ANNA A LMFT	6/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24977 WASHINGTON AVENUE	SUITES K & L	MURRIETA	CA	92562	6149	33	06065	33.55150034	-117.2118708	Riverside County
222711	Fee-for-Service	1285811497	1285811497	1	1	BARR, HEATHER M MD	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105662	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
222717	Fee-for-Service	1942638978	1942638978	1	3	BRIGHTER BEGINNINGS	6/5/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	512 WEST 5TH STREET	None	ANTIOCH	CA	94509	1236	07	06013	38.01478351	-121.813218	Contra Costa County
222727	Fee-for-Service	1538242045	1538242045	1	1	BUNNALAI, THIANCHAI MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129732	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
222745	Fee-for-Service	1508941055	1508941055	1	1	BARICAR, FEBIN O MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130202	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
222785	Fee-for-Service	1376526491	1376526491	1	1	BEVERLY, DAVID T IV MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69902	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
222786	Fee-for-Service	1063945863	1063945863	1	1	BARIL, SANDRA K MD	2/25/2025	2080P0207X	NA	Hematology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2825 J STREET	STE 235	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
222809	Fee-for-Service	1649254640	1649254640	1	1	BARNES, CRAIG E MD	4/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
222916	Fee-for-Service	1366478117	1366478117	1	1	BOBO, CHARMAINE MD	2/28/1984	207P00000X	NA	Other	026	PHYSICIANS	45616	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9500 S BROADWAY	None	LOS ANGELES	CA	90003	4053	19	06037	33.949935	-118.2781105	Los Angeles County
222942	Fee-for-Service	1467446138	1467446138	1	1	BARTON, DAVID J MD	4/30/1985	208VP0000X	NA	Other	026	PHYSICIANS	55320	02	General Surgery	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
222954	Fee-for-Service	1831127356	1831127356	1	1	BARNERT, AJ LMFT	9/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18827 EDLEEN DR	None	TARZANA	CA	91356	4810	19	06037	34.1571473	-118.5430855	Los Angeles County
222973	Fee-for-Service	1285652818	1285652818	1	1	BOWERSOX, MICHAEL T MD	8/6/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	53320	08	Family Practice	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
222981	Fee-for-Service	1053448472	1053448472	1	1	BARROW, TEAH L LMFT	3/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
222984	Fee-for-Service	1336176544	1336176544	1	1	BURNHAM,ERIN MD	2/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 E 19TH ST	None	DALLES	OR	97058	0000	00	None	45.58806554	-121.164498	Wasco County
223004	Fee-for-Service	1952932766	1952932766	1	1	BRANDMAN, DAVID MD	10/1/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	174191	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
223035	Fee-for-Service	1205959947	1205959947	1	1	BRAHMAVAR, AMEET S MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
223052	Fee-for-Service	1083069447	1083069447	1	1	BAY AREA COMMUNITY RESOURCES	10/20/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	, INC.	171 CARLOS DRIVE	None	SAN RAFAEL	CA	94903	2005	21	06041	38.01757315	-122.5347337	Marin County
223063	Fee-for-Service	1831263250	1831263250	1	1	BOLLINGER, OROPHENIA T CRNA	3/30/2004	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
223075	Fee-for-Service	1063945863	1063945863	1	1	BARIL, SANDRA K MD	2/25/2025	2080P0207X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	2825 J STREET	STE 235	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
223081	Fee-for-Service	1649219395	1649219395	1	1	BANCROFT, TIMOTHY D MD	6/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87548	40	Pediatrics	0	In state provider	None	3811 VALLEY CENTRE DR	None	SAN DIEGO	CA	92130	3318	37	06073	32.93760492	-117.2320932	San Diego County
223127	Fee-for-Service	1912330648	1912330648	1	1	BABB, MEGAN A DO	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12888	01	General Practice	0	In state provider	None	1700 PRAIRIE CITY ROAD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
223128	Fee-for-Service	1457410037	1457410037	1	1	BATTAGLIA, ALEXANDER S	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80541	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
223129	Fee-for-Service	1558565762	1558565762	1	1	BENJAMIN DAHL M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
223133	Fee-for-Service	1841202280	1841202280	1	1	BREEN, TERRANCE W MD	10/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52003	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
223171	Fee-for-Service	1760936884	1760936884	1	2	BEVERLYCARE	4/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1920 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4009	19	06037	34.01311835	-118.1222242	Los Angeles County
223174	Fee-for-Service	1003471434	1003471434	1	1	BOBEN, BRIAN A MD	9/13/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180813	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
223187	Fee-for-Service	1386806883	1386806883	1	1	BOWMAN, NINA N DO	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10250	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
223212	Fee-for-Service	1811424393	1811424393	1	1	BICKFORD, JESSICA S	3/11/2019	133V00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2605 LOMA VISTA RD	None	VENTURA	CA	93003	1548	56	06111	34.27483633	-119.2613688	Ventura County
223218	Fee-for-Service	1811706310	1811706310	1	1	BRAR, RAJWANT CNP	4/15/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8329 BRIMHALL RD	804	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
223230	Fee-for-Service	1205806940	1205806940	1	1	BOLLIMPALLI, SRINIVAS S	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE,	SUITE 500	PHOENIX	AZ	85012	0000	00	None	33.480666	-112.0729905	Maricopa County
223265	Fee-for-Service	1003274424	1003274424	1	1	BOOLS, TIFFANY R	1/4/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12692 FREMONT ST	None	YUCAIPA	CA	92399	4941	36	06071	34.02342211	-117.0260398	San Bernardino County
223311	Fee-for-Service	1295774909	1295774909	1	1	BLUMENTHAL, JOSEPH MD	11/25/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22670	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1580 VALENCIA ST	STE 701	SAN FRANCISCO	CA	94110	4421	38	06075	37.74746923	-122.4202583	San Francisco County
223345	Fee-for-Service	1659390219	1659390219	1	1	BROECKEL, WILLIAM F MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53319	49	Unknown	0	In state provider	None	700 S MAIN ST	None	YREKA	CA	96097	3354	47	06093	41.72616846	-122.6381326	Siskiyou County
223368	Fee-for-Service	1295844074	1295844074	1	1	BELLOMO, ANTHONY F MD	8/1/1995	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	79283	20	Orthopedic Surgery	0	In state provider	None	13050 HEACOCK ST	None	MORENO VALLEY	CA	92553	3122	33	06065	33.931386	-117.243772	Riverside County
223372	Fee-for-Service	1427549773	1427549773	1	1	BROOKINS, MICOLE NP	9/23/2024	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
223383	Fee-for-Service	1225265101	1225265101	1	1	BRUMMEL, JARED A MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	10794	20	Orthopedic Surgery	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
223395	Fee-for-Service	1245573039	1245573039	1	1	BUONO, KRISTEN MD	9/28/2017	390200000X	NA	Other	026	PHYSICIANS	131712	24	Plastic Surgery	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
223447	Fee-for-Service	1639150568	1639150568	1	1	BRAY, TIMOTHY J MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30821	20	Orthopedic Surgery	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
223461	Fee-for-Service	1760936884	1760936884	1	2	BEVERLYCARE	5/21/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1920 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4009	19	06037	34.01311835	-118.1222242	Los Angeles County
223481	Fee-for-Service	1962098046	1962098046	1	1	BARAY, MICHAEL A CRNA	3/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
223489	Fee-for-Service	1699700971	1699700971	1	1	BRAR, HARBINDER S MD INC	5/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40011	15	Obstetrics (D.O. only)	0	In state provider	None	4000 14TH ST	STE 310	RIVERSIDE	CA	92501	4018	33	06065	33.97771007	-117.3818381	Riverside County
223518	Fee-for-Service	1588744668	1588744668	1	1	BARTON, CYRIL H MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	25414	45	Nephrology (Renal-Kidney)	0	In state provider	None	101 CITY DR S	RM 102	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
223519	Fee-for-Service	1831345297	1831345297	1	1	BELAYNEH, DANIEL K MD	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109923	08	Family Practice	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
223534	Fee-for-Service	1447663182	1447663182	1	1	BENAVIDEZ, DAVID MD	1/25/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	162091	None	None	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 401	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
223550	Fee-for-Service	1003274424	1003274424	1	1	BOOLS, TIFFANY R	1/4/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12692 FREMONT ST	None	YUCAIPA	CA	92399	4941	36	06071	34.02342211	-117.0260398	San Bernardino County
223559	Fee-for-Service	1598326803	1598326803	1	2	BROTHERS MEDICAL TRANSPORTAT	8/24/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ION	2130 ATLANTIC BLVD	None	COMMERCE	CA	90040	1320	19	06037	34.00747213	-118.1610428	Los Angeles County
223568	Fee-for-Service	1457827867	1457827867	1	1	BURGHOLZER, EMILY PT	7/31/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
223600	Fee-for-Service	1164581815	1164581815	1	1	BLEDSTEIN, ALLAN H MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	34363	08	Family Practice	0	In state provider	None	1808 W LINCOLN AVE	STE 101	ANAHEIM	CA	92801	6732	30	06059	33.83242652	-117.946026	Orange County
223623	Fee-for-Service	1134390347	1134390347	1	1	BAIL, DANA LCSW	2/17/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5905 SOQUEL DR	STE 400	SOQUEL	CA	95073	2850	44	06087	36.98881452	-121.9364193	Santa Cruz County
223632	Fee-for-Service	1952599839	1952599839	1	1	BLUM, DIANA P MD	12/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92277	13	Neurology (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
223673	Fee-for-Service	1346275484	1346275484	1	1	BANSAL, SANJAY MD	10/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66178	18	Ophthalmology	0	In state provider	LASERVUE EYE CENTER	3540 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3639	49	06097	38.473938	-122.7258495	Sonoma County
223685	Fee-for-Service	1821632670	1821632670	1	1	BARRIOS, SANDRA L LCSW	10/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
223691	Fee-for-Service	1447348628	1447348628	1	1	BECKER, STEVEN J DO	8/11/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7939	41	Internal Medicine	0	In state provider	THE KATELLA WELLNESS	5122 KATELLA AVE	STE 210	LOS ALAMITOS	CA	90720	6836	30	06059	33.80290311	-118.0433422	Orange County
223696	Fee-for-Service	1134218621	1134218621	1	1	BRATLIE, RACHEL A DO	8/15/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	10155	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
223715	Fee-for-Service	1174027775	1174027775	1	1	BRANDON, JONATHAN MD	4/12/2024	207P00000X	NA	Other	026	PHYSICIANS	189385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
223740	Fee-for-Service	1528110749	1528110749	1	1	BERNSTEIN, ROBERT M MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	45322	30	Radiology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
223744	Fee-for-Service	1215413836	1215413836	1	1	BRHEL, ADAM E PT	1/7/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
223748	Fee-for-Service	1760936884	1760936884	1	2	BEVERLYCARE	4/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1920 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4009	19	06037	34.01311835	-118.1222242	Los Angeles County
223767	Fee-for-Service	1467402974	1467402974	1	1	BROWER, JON R MD	9/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	520 MEDICAL CENTER DR	STE 200	MEDFORD	OR	97504	4314	00	None	42.318801	-122.831728	Jackson County
223792	Fee-for-Service	1174613244	1174613244	1	1	BOON, SHERYL J MD	1/1/1998	2080P0216X	NA	Other	026	PHYSICIANS	61747	01	General Practice	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
223826	Fee-for-Service	1396066635	1396066635	1	1	BABKINA, NATALIA MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121142	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 W LEGION RD	SUITE 203	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
223885	Fee-for-Service	1972794956	1972794956	1	1	BHAT, SHOBHA	10/29/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152182	08	Family Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
223891	Fee-for-Service	1407843949	1407843949	1	1	BENOIT, JAMES L MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	45198	67	Endocrinology	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
223899	Fee-for-Service	1215040522	1215040522	1	1	BUNKER, CLINTON J CRNA	12/16/2020	367500000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
223912	Fee-for-Service	1235118613	1235118613	1	1	BRANDON, FREDERICK R DO	8/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10089	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
223914	Fee-for-Service	1639313299	1639313299	1	1	BHANDARI, SIMRAN K MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106985	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
223922	Fee-for-Service	1356309041	1356309041	1	1	BASSIRI, HALEH G MC	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68704	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223925	Fee-for-Service	1386842938	1386842938	1	1	BROSIOUS, JOHN P MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	24	Plastic Surgery	1	Border provider	None	1707 W CHARLESTON BLVD	STE 190	LAS VEGAS	NV	89102	2352	00	None	36.15879353	-115.1643015	Clark County
223936	Fee-for-Service	1720692031	1720692031	1	1	BELMONT HOSPICE & PALLIATIVE	1/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	460 S CENTRAL AVE	STE B	GLENDALE	CA	91204	1602	19	06037	34.140825	-118.2578225	Los Angeles County
223944	Fee-for-Service	1346652559	1346652559	1	1	BARGHOUTH, URSULA G MD	7/22/2024	207R00000X	NA	Other	026	PHYSICIANS	22795	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
223952	Fee-for-Service	1730126608	1730126608	1	1	BEEMANS BOUTIQUE LLC	10/27/2024	332B00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	355 E 21ST STREET	SUITE J	SAN BERNARDINO	CA	92404	4851	36	06071	34.13404548	-117.2779515	San Bernardino County
223960	Fee-for-Service	1851749253	1851749253	1	1	BUENROSTRO, CHRISTINA NP	9/11/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
224000	Fee-for-Service	1932299039	1932299039	1	1	BROSNAN, BRIAN D MD	11/20/2007	207N00000X	NA	Dermatology	026	PHYSICIANS	87446	07	Dermatology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
224002	Fee-for-Service	1306109020	1306109020	1	1	BAHR, MONICA H LMFT	7/11/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	90490	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	SUITE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
224007	Fee-for-Service	1043525967	1043525967	1	1	BLESSING-MOORE, JOANN MD INC	2/11/2013	207K00000X	NA	Other	026	PHYSICIANS	26617	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 S SAN MATEO DR	STE 311	SAN MATEO	CA	94401	3844	41	06081	37.56590481	-122.325549	San Mateo County
224037	Fee-for-Service	1760936884	1760936884	1	2	BEVERLYCARE	4/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1920 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4009	19	06037	34.01311835	-118.1222242	Los Angeles County
224091	Fee-for-Service	1003921461	1003921461	1	1	BARMAKI, ALI R MD	4/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92599	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
224117	Fee-for-Service	1851362453	1851362453	1	1	BUTTON, MARY ANN OD	12/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	1	Border provider	None	629 MAIN ST	None	KLAMATH FALLS	OR	97601	6007	00	None	42.2250778	-121.7822384	Klamath County
224119	Fee-for-Service	1316949316	1316949316	1	1	BLATTER, DUANE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE & C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.778496	-111.8805615	Salt Lake County
224120	Fee-for-Service	1063524866	1063524866	1	1	BIO MEDICAL APPLICATIONS OF	5/12/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, INC	12711 RAMONA BLVD	STE 111	IRWINDALE	CA	91706	3679	19	06037	34.07844514	-117.9949346	Los Angeles County
224126	Fee-for-Service	1861924458	1861924458	1	1	BRENNEMAN, JEREMY L DO	2/9/2023	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
224138	Fee-for-Service	1942638978	1942638978	1	2	BRIGHTER BEGINNINGS	7/22/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	3505 LONE TREE WAY	SUITE 1	ANTIOCH	CA	94509	6014	07	06013	37.98725411	-121.8065036	Contra Costa County
224142	Fee-for-Service	1922302959	1922302959	1	1	BORSACK, DIANA LMFT	7/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16168 BEACH BLVD	SUITE 215	HUNTINGTON BEACH	CA	92647	3881	30	06059	33.728283	-117.9891305	Orange County
224144	Fee-for-Service	1770645624	1770645624	1	1	BUTLER ACUNA, AUDREA C LMFT	1/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
224179	Fee-for-Service	1659626711	1659626711	1	1	BUDATI, SREE L MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155813	01	General Practice	0	In state provider	None	460 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
224189	Fee-for-Service	1366474645	1366474645	1	1	BABINGTON, KATHLEEN L MD DO	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87982	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
224210	Fee-for-Service	1356309041	1356309041	1	1	BASSIRI, HALEH G MC	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68704	47	Miscellaneous	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
224226	Fee-for-Service	1720692031	1720692031	1	1	BELMONT HOSPICE & PALLIATIVE	1/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	460 S CENTRAL AVE	STE B	GLENDALE	CA	91204	1602	19	06037	34.140825	-118.2578225	Los Angeles County
224237	Fee-for-Service	1619231537	1619231537	1	1	BUI, CHRISTOPHER N MD	6/26/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	127139	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
224261	Fee-for-Service	1750815684	1750815684	1	1	BUB, CHRISTINE D MD	7/8/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	177741	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
224297	Fee-for-Service	1043525967	1043525967	1	1	BLESSING-MOORE, JOANN MD INC	2/11/2013	207K00000X	NA	Other	026	PHYSICIANS	26617	03	Allergy	0	In state provider	None	101 S SAN MATEO DR	STE 311	SAN MATEO	CA	94401	3844	41	06081	37.56590481	-122.325549	San Mateo County
224340	Fee-for-Service	1346407434	1346407434	1	1	BAY AREA ANESTHESIA	1/25/2011	207L00000X	NA	Other	026	PHYSICIANS	86587	05	Anesthesiology	0	In state provider	ASSOCIATES	4512 FEATHER RIVER DR	STE B	STOCKTON	CA	95219	6563	39	06077	37.98245291	-121.3469128	San Joaquin County
224369	Fee-for-Service	1255185062	1255185062	1	1	BOBILA, JUSTIN M NP	7/23/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15434 W SAGE ST	None	VICTORVILLE	CA	92395	3965	36	06071	34.51210263	-117.3272335	San Bernardino County
224372	Fee-for-Service	1831113281	1831113281	1	1	BLUM, VICKY S LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	621 CHAPALA ST	STE A	SANTA BARBARA	CA	93101	7010	42	06083	34.41720602	-119.6986863	Santa Barbara County
224387	Fee-for-Service	1720192685	1720192685	1	1	BJARNASON, RONALD V	12/14/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5161	01	General Practice	0	In state provider	None	8397 LANDER AVE	None	HILMAR	CA	95324	8324	24	06047	37.4101079	-120.8500956	Merced County
224395	Fee-for-Service	1457546582	1457546582	1	1	BANGARU, BABU S MD	11/6/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	167646	40	Pediatrics	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
224397	Fee-for-Service	1649688821	1649688821	1	1	BLUE SPIRIT HOSPICE INC	3/15/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1433 W MERCED AVE	UNIT 220	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
224410	Fee-for-Service	1790724490	1790724490	1	1	BERMAN, JOEL A	1/1/1979	208600000X	NA	General Surgery	026	PHYSICIANS	24685	None	None	0	In state provider	None	11100 WARNER AVE	STE 108	FOUNTAIN VALLEY	CA	92708	7595	30	06059	33.716291	-117.9355051	Orange County
224467	Fee-for-Service	1760565154	1760565154	1	1	BARNETT, MICHAEL S MD	12/14/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	35769	-	NOT APPLICABLE	0	In state provider	None	220 N LOCUST ST	None	VISALIA	CA	93291	4946	54	06107	36.331803	-119.293335	Tulare County
224474	Fee-for-Service	1992879597	1992879597	1	1	BARYLIUK, LINDA L MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63220	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
224476	Fee-for-Service	1467849901	1467849901	1	1	BANERJEE, SUDEEP MD	10/4/2023	208C00000X	NA	General Surgery	026	PHYSICIANS	149773	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
224497	Fee-for-Service	1356309041	1356309041	1	1	BASSIRI, HALEH G MC	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68704	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
224519	Fee-for-Service	1841836459	1841836459	1	1	BIENESTAR COMMUNITY CLINIC	3/9/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1619 CECIL AVE	STE A	DELANO	CA	93215	1515	15	06029	35.77593953	-119.235546	Kern County
224559	Fee-for-Service	1255780771	1255780771	1	1	BELANGER, MANJIT K LMFT	3/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
224568	Fee-for-Service	1750310231	1750310231	1	1	BERGMAN, MICHELE D MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77659	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
224572	Fee-for-Service	1306887666	1306887666	1	1	BRIAN E SHIOZAWA MD	3/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11800 S STATE ST	None	DRAPER	UT	84020	9740	00	None	40.5369877	-111.8914787	Salt Lake County
224612	Fee-for-Service	1487825691	1487825691	1	1	BALBOA, JODY A	6/3/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2547 SAN JACINTO	UNIT 18	SAN JACINTO	CA	92583	5317	33	06065	33.75961983	-116.9586481	Riverside County
224658	Fee-for-Service	1962796581	1962796581	1	1	BONITO, AMBER E CA	1/29/2019	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	564 BROADWAY AVE	None	EL CAJON	CA	92021	5423	37	06073	32.8077483	-116.9557722	San Diego County
224683	Fee-for-Service	1457546582	1457546582	1	1	BANGARU, BABU S MD	11/6/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	167646	10	Gastroenterology (M.D. only)	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
224688	Fee-for-Service	1649688821	1649688821	1	1	BLUE SPIRIT HOSPICE INC	3/15/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1433 W MERCED AVE	UNIT 220	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
224696	Fee-for-Service	1164481180	1164481180	1	1	BZ MEDICAL CORPORATION	12/18/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2160 W GRANT LINE RD	STE 110	TRACY	CA	95377	7331	39	06077	37.75399922	-121.455877	San Joaquin County
224708	Fee-for-Service	1346291762	1346291762	1	1	BRADLEY CLOSE M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
224712	Fee-for-Service	1679899033	1679899033	1	1	BAGHDASSARIAN, ANI B MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121527	41	Internal Medicine	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
224722	Fee-for-Service	1821061334	1821061334	1	1	BUSH, THOMAS M MD	11/30/1987	207RR0500X	NA	Other	026	PHYSICIANS	51800	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
224731	Fee-for-Service	1982931853	1982931853	1	1	BAKSHANDEH, ARTA DO	5/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10961	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
224771	Fee-for-Service	1114075165	1114075165	1	1	BISCAY, RICHARD C MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	27259	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
224789	Fee-for-Service	1326150129	1326150129	1	1	BIO-MEDICAL APPLICATIONS	10/31/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	11031 VIA FRONTERA	STE C	SAN DIEGO	CA	92127	1709	37	06073	33.01220224	-117.0925383	San Diego County
224821	Fee-for-Service	1851820567	1851820567	1	1	BHATHELA, NEIL DO	12/7/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	19037	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
224860	Fee-for-Service	1083835474	1083835474	1	1	BALLON, JACOB S MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96636	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
224870	Fee-for-Service	1801896683	1801896683	1	1	BOUNDARY COMMUNITY HOSPITAL	2/11/2011	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6640 KANIKSU ST	None	BONNERS FERRY	ID	83805	7532	00	None	48.70254244	-116.3206603	Boundary County
224902	Fee-for-Service	1134800238	1134800238	1	1	BARDWELLS PINES MANOR LLC	8/15/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5336 BARDWELL AVENUE	None	RIVERSIDE	CA	92506	1517	33	06065	33.95469497	-117.3618507	Riverside County
224918	Fee-for-Service	1720199342	1720199342	1	1	BAIG, KHALID A MD	3/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49356	08	Family Practice	0	In state provider	None	632 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
224922	Fee-for-Service	1760493407	1760493407	1	1	BARGA, PATRICK M	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2030 SUTTER PL	STE 1300	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
224929	Fee-for-Service	1649439563	1649439563	1	1	BENKE, CHRISTEN M DO	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	9693	08	Family Practice	0	In state provider	None	12395 EL CAMINO REAL	STE 120	SAN DIEGO	CA	92130	3083	37	06073	32.94324259	-117.2396525	San Diego County
224988	Fee-for-Service	1750457404	1750457404	1	1	BRONSTEIN, MARK A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44667	18	Ophthalmology	0	In state provider	None	11180 WARNER AVE	STE 163	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.71632048	-117.9334575	Orange County
224994	Fee-for-Service	1306914510	1306914510	1	1	BORDEN, MARIANNE M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72974	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
224998	Fee-for-Service	1952402141	1952402141	1	1	BRAR, BANU	4/7/2025	2084P0804X	NA	Psychiatry	026	PHYSICIANS	94879	36	Psychiatry	0	In state provider	None	3425 COFFEE RD	2A	MODESTO	CA	95355	1582	50	06099	37.687914	-120.9761055	Stanislaus County
225010	Fee-for-Service	1821061334	1821061334	1	1	BUSH, THOMAS M MD	11/30/1987	207RR0500X	NA	Other	026	PHYSICIANS	51800	83	Rheumatology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
225016	Fee-for-Service	1225097025	1225097025	1	1	BEVERLY HEALTH & BIRTH	5/14/1996	174400000X	NA	Other	052	ALTERNATIVE BIRTH CENTERS - SPECIALTY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER	4620 BEVERLY BLVD	None	LOS ANGELES	CA	90004	3102	19	06037	34.07622211	-118.3099548	Los Angeles County
225023	Fee-for-Service	1588970024	1588970024	1	1	BHARATI, PANKAJ MD	2/2/2022	208M00000X	NA	Other	026	PHYSICIANS	123662	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
225027	Fee-for-Service	1407936826	1407936826	1	1	BARGER, PHILIP M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID	CAMPUS BOX 8015	ST LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
225038	Fee-for-Service	1881866507	1881866507	1	1	BROWN, JASON P MD	9/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86856	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
225057	Fee-for-Service	1104941608	1104941608	1	1	BRENT, BRANDY M	1/17/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
225106	Fee-for-Service	1528126190	1528126190	1	1	BONITA CARDIOVASCULAR MEDI	6/2/1996	193200000X	NA	Other	026	PHYSICIANS	30915	33	Thoracic Surgery	0	In state provider	CAL GROUP IN	3916 PALM DR	None	BONITA	CA	91902	2518	37	06073	32.66151012	-117.022468	San Diego County
225147	Fee-for-Service	1346615838	1346615838	1	1	BUTERBAUGH, KRISTY L CSW	4/27/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	65477	-	NOT APPLICABLE	0	In state provider	None	1341 N ESCONDIDO BLVD	None	ESCONDIDO	CA	92026	2507	37	06073	33.14046993	-117.0924096	San Diego County
225159	Fee-for-Service	1942462155	1942462155	1	1	BRAGG, WILLIAM E MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111527	20	Orthopedic Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
225160	Fee-for-Service	1801896683	1801896683	1	1	BOUNDARY COMMUNITY HOSPITAL	2/11/2011	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6640 KANIKSU ST	None	BONNERS FERRY	ID	83805	7532	00	None	48.70254244	-116.3206603	Boundary County
225221	Fee-for-Service	1477960276	1477960276	1	2	BECKER PEDIATRIC MEDICAL COR	1/18/2021	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	P.	24679 MONROE AVE	SUITE D102-103	MURRIETA	CA	92562	2528	33	06065	33.56669315	-117.2017028	Riverside County
225266	Fee-for-Service	1386140275	1386140275	1	1	BERRYHILL, ALLISON C DO	7/29/2022	363LP0222X	NA	Nurse Practitioner	026	PHYSICIANS	19123	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
225289	Fee-for-Service	1104095678	1104095678	1	1	BULLEOVA, SLAVKA MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	63207	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
225309	Fee-for-Service	1881820934	1881820934	1	1	BOZORGNIA, LEILA MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107098	40	Pediatrics	0	In state provider	None	8781 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2401	19	06037	34.22960628	-118.4502708	Los Angeles County
225331	Fee-for-Service	1699113852	1699113852	1	1	BLAUM, JUSTIN DO	2/27/2025	207P00000X	NA	Other	026	PHYSICIANS	23342	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2770 MEDICAL CENTER	None	MISSION VIEJO	CA	92391	6426	30	06059	33.56015385	-117.6660444	Orange County
225338	Fee-for-Service	1285061390	1285061390	1	1	BERGERON, PATRICK R	9/11/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4650 PALM AVE	None	SAN DIEGO	CA	92154	8404	37	06073	32.5839467	-117.0337851	San Diego County
225351	Fee-for-Service	1174842876	1174842876	1	1	BARCENAS-REYES, DIANA A LMFT	7/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
225395	Fee-for-Service	1528126190	1528126190	1	1	BONITA CARDIOVASCULAR MEDI	6/2/1996	193200000X	NA	Other	026	PHYSICIANS	30915	66	Emergency Medicine (Urgent Care)	0	In state provider	CAL GROUP IN	3916 PALM DR	None	BONITA	CA	91902	2518	37	06073	32.66151012	-117.022468	San Diego County
225404	Fee-for-Service	1790913465	1790913465	1	1	BAKER, MIRYAH C MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108666	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
225450	Fee-for-Service	1023410040	1023410040	1	1	BAHL, SARIKA PHD	12/8/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
225468	Fee-for-Service	1477639540	1477639540	1	1	BIRD, MARILYN REID	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	595 MILLICH DR	STE 105	CAMPBELL	CA	95008	0550	43	06085	37.29553879	-121.9595389	Santa Clara County
225499	Fee-for-Service	1417653171	1417653171	1	1	BIRTHWORKERS OF COLOR COLLEC	2/27/2023	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
225515	Fee-for-Service	1609332618	1609332618	1	1	BARTLETT, MARIA	12/30/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	135553	-	NOT APPLICABLE	0	In state provider	None	320 E PALMDALE BLVD	None	PALMDALE	CA	93550	4598	19	06037	34.57983613	-118.1240079	Los Angeles County
225544	Fee-for-Service	1578823407	1578823407	1	1	BRUNSWICK, ANDREW S MD	11/6/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	160659	14	Neurological Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
225584	Fee-for-Service	1336481712	1336481712	1	1	BURTON, MONICA M LMFT	4/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
225591	Fee-for-Service	1235525163	1235525163	1	1	BONDA, DAVID J MD	11/9/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	191826	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
225608	Fee-for-Service	1073513610	1073513610	1	1	BROWN, JAMES F DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4865 ALBERSON CT	None	SAN DIEGO	CA	92130	2701	37	06073	32.94995002	-117.2124404	San Diego County
225626	Fee-for-Service	1205133188	1205133188	1	1	BROTHERTON, BRIAN MD	11/24/2024	207R00000X	NA	Other	026	PHYSICIANS	115778	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
225681	Fee-for-Service	1528126190	1528126190	1	1	BONITA CARDIOVASCULAR MEDI	6/2/1996	193200000X	NA	Other	026	PHYSICIANS	30915	06	Cardiovascular Disease (M.D. only)	0	In state provider	CAL GROUP IN	3916 PALM DR	None	BONITA	CA	91902	2518	37	06073	32.66151012	-117.022468	San Diego County
225695	Fee-for-Service	1114615697	1114615697	1	1	BROTHER CARE LLC	5/16/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8291 UTICA AVE	STE 208	RANCHO CUCAMONGA	CA	91730	7614	36	06071	34.10254043	-117.5711583	San Bernardino County
225698	Fee-for-Service	1104568526	1104568526	1	1	BEHAVIORAL HEALTH SERVICES,	10/3/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	R AT MLK CAMPUS	12021 SOUTH WILMINGTON A	BUILDING 18, SUITE 101	LOS ANGELES	CA	90059	3046	19	06037	33.922863	-118.2431655	Los Angeles County
225706	Fee-for-Service	1164657771	1164657771	1	1	BOCTOR, BAHER N MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	110451	05	Anesthesiology	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
225709	Fee-for-Service	1659877876	1659877876	1	1	BUGGELN, JENNIFER LCSW	1/29/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2880 ATLANTIC AVE	SUITE 170	LONG BEACH	CA	90806	1715	19	06037	33.809382	-118.185001	Los Angeles County
225734	Fee-for-Service	1801274139	1801274139	1	1	BICKART, KEVIN C MD	6/9/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	148941	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
225741	Fee-for-Service	1104943083	1104943083	1	1	BERENSON, JAMES R MD INC	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42018	78	Neoplastic Diseases/Oncology	0	In state provider	None	9201 W SUNSET BLVD	SUITE 310	WEST HOLLYWOOD	CA	90069	3704	19	06037	34.09054375	-118.392295	Los Angeles County
225773	Fee-for-Service	1902998503	1902998503	1	1	BADIEE, SHIVA MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97492	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
225804	Fee-for-Service	1174770382	1174770382	1	1	BOZORGCHAMI, HORMOZD MD	7/3/2009	390200000X	NA	Other	026	PHYSICIANS	105812	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
225830	Fee-for-Service	1013195817	1013195817	1	1	BELLANTE, TRISH LMFT	2/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
225865	Fee-for-Service	1912260340	1912260340	1	1	BAGHDANIAN, ARMONDE A MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147585	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
225872	Fee-for-Service	1568634509	1568634509	1	1	BURK, BRANDON MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110173	30	Radiology	0	In state provider	None	11370 ANDERSON STREET	STE 1700	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
225895	Fee-for-Service	1932330180	1932330180	1	1	BAKHADIROV, KHAMIDULLA MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135878	13	Neurology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
225921	Fee-for-Service	1518983113	1518983113	1	1	BAYLINK, DAVID J MD	5/31/1983	207R00000X	NA	Other	026	PHYSICIANS	46488	67	Endocrinology	0	In state provider	None	11370 ANDERSON ST	STE 3700	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
225969	Fee-for-Service	1871519827	1871519827	1	1	BENOIT, DAVID A	5/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	95 MONTGOMERY DR	STE 202	SANTA ROSA	CA	95404	9803	49	06097	38.442357	-122.704641	Sonoma County
225977	Fee-for-Service	1467494203	1467494203	1	1	BOONE, MICHAEL I MD	8/1/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	83015	18	Ophthalmology	0	In state provider	None	1827 S COURT ST	STE D	VISALIA	CA	93277	5469	54	06107	36.314424	-119.2922235	Tulare County
225982	Fee-for-Service	1033157979	1033157979	1	1	BURROWS, OLIVER M MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	43321	08	Family Practice	0	In state provider	None	440 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3361	19	06037	34.13599629	-117.8714999	Los Angeles County
225987	Fee-for-Service	1407886799	1407886799	2	1	BINDUSAGAR, REDDY H MD	3/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	48170	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	579 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06956759	-119.0299875	Tulare County
226002	Fee-for-Service	1669790838	1669790838	1	1	BHASIN, NITIN MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109234	45	Nephrology (Renal-Kidney)	0	In state provider	None	1335 CYPRESS STREET	SUITE 205	SAN DIMAS	CA	91773	3538	19	06037	34.09583252	-117.834134	Los Angeles County
226031	Fee-for-Service	1104943083	1104943083	1	1	BERENSON, JAMES R MD INC	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42018	68	Hematology	0	In state provider	None	9201 W SUNSET BLVD	SUITE 310	WEST HOLLYWOOD	CA	90069	3704	19	06037	34.09054375	-118.392295	Los Angeles County
226033	Fee-for-Service	1285782219	1285782219	1	1	BIRKBECK-GARCIA, ANNE M	11/14/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	89900	40	Pediatrics	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
226090	Fee-for-Service	1750950499	1750950499	1	4	BARTON MEDICAL FOUNDATION	12/10/2024	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2175 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7024	09	06017	38.91234551	-119.9972565	El Dorado County
226129	Fee-for-Service	1396885570	1396885570	1	1	BAHARI-NEJAD, PEJMAN DO	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7938	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
226135	Fee-for-Service	1013131671	1013131671	1	1	B&M, INC	2/28/2000	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FLEETWOOD ICF/DD-H	2796 FLEETWOOD DR	None	SAN BRUNO	CA	94066	2627	41	06081	37.62586772	-122.4469201	San Mateo County
226147	Fee-for-Service	1518164540	1518164540	1	1	BRANDMAN, DANIELLE MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99342	10	Gastroenterology (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
226197	Fee-for-Service	1790733533	1790733533	1	1	BEIN, MARSHALL E MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	23526	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
226226	Fee-for-Service	1255991105	1255991105	1	1	BRILLIANT HEALTH HOME CARE	1/19/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	730 S CENTRAL AVENUE	UNIT 205	GLENDALE	CA	91204	4340	19	06037	34.136991	-118.2578235	Los Angeles County
226245	Fee-for-Service	1700824927	1700824927	1	1	BROWN, PAUL DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 S BALLENGER HWY	None	FLINT	MI	48532	3638	00	None	43.01432039	-83.73359605	Genesee County
226250	Fee-for-Service	1255307021	1255307021	1	1	BERG, BRUCE L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51649	36	Psychiatry	0	In state provider	None	835 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6724	34	06067	38.56428	-121.4190675	Sacramento County
226274	Fee-for-Service	1902007891	1902007891	1	1	BRUMMITT, FRANK J	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
226280	Fee-for-Service	1205499506	1205499506	1	1	BERNABA, MARIO	10/7/2024	207R00000X	NA	Other	026	PHYSICIANS	177582	41	Internal Medicine	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
226289	Fee-for-Service	1669790838	1669790838	1	1	BHASIN, NITIN MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109234	41	Internal Medicine	0	In state provider	None	1335 CYPRESS STREET	SUITE 205	SAN DIMAS	CA	91773	3538	19	06037	34.09583252	-117.834134	Los Angeles County
226294	Fee-for-Service	1346286325	1346286325	1	1	BENEZE, NATHAN E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3003 HIGHWAY 95	STE G73	BULLHEAD CITY	AZ	86442	7860	00	None	35.075763	-114.593787	Mohave County
226299	Fee-for-Service	1720208861	1720208861	1	1	BELEK, KYLE A MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	99786	24	Plastic Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
226314	Fee-for-Service	1033592795	1033592795	1	1	BOZKANAT, KUBRA M MD	9/23/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
226334	Fee-for-Service	1366766180	1366766180	1	1	BEVERLY RADIOLOGY MEDICAL	5/25/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	201 S BUENA VISTA BLVD	SUITE 315	BURBANK	CA	91505	4571	19	06037	34.15978726	-118.3289164	Los Angeles County
226340	Fee-for-Service	1164839528	1164839528	1	3	BODAPATI, NAGA VENKATA MD	1/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154649	36	Psychiatry	0	In state provider	None	4664 AMERICAN AVE	STE B	BAKERSFIELD	CA	93309	4017	15	06029	35.34068389	-119.0546534	Kern County
226352	Fee-for-Service	1972619518	1972619518	1	1	BIVINS, HERBERT G MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	40063	None	None	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
226359	Fee-for-Service	1841324662	1841324662	1	1	BILLINGS, CAITLIN E LCSW	6/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3021 CITRUS CIR	240	WALNUT CREEK	CA	94598	2692	07	06013	37.92845517	-122.0144911	Contra Costa County
226361	Fee-for-Service	1407071566	1407071566	1	1	BURSTINER, DEBRA F	2/8/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	867 BEVERLY WAY	None	ARCATA	CA	95521	6561	12	06023	40.86336343	-124.0658916	Humboldt County
226373	Fee-for-Service	1326138165	1326138165	1	1	BLAND, RICHARD D MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	22317	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
226375	Fee-for-Service	1417962994	1417962994	1	1	BOUGH, EDWARD W MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58752	33	Thoracic Surgery	0	In state provider	None	2660 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4315	43	06085	37.36653288	-122.0778348	Santa Clara County
226402	Fee-for-Service	1124295134	1124295134	1	1	BOLING, MICHAEL J MD	5/5/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53128	None	None	0	In state provider	None	801 N HARBOR BLVD	None	ANAHEIM	CA	92805	1810	30	06059	33.84310811	-117.92254	Orange County
226421	Fee-for-Service	1801109871	1801109871	1	1	BAI, CHESTER K MD	5/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120741	30	Radiology	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
226455	Fee-for-Service	1962546713	1962546713	1	1	BARTOK, WILLIAM R MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29940	07	Dermatology	0	In state provider	None	26302 LA PAZ RD	STE 214	MISSION VIEJO	CA	92691	5328	30	06059	33.60034452	-117.671202	Orange County
226543	Fee-for-Service	1760064463	1760064463	1	1	BORNN, TIFFANY R PHD	11/27/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
226566	Fee-for-Service	1447346663	1447346663	1	1	BRAGGS, BELINDA L MD	2/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73432	08	Family Practice	0	In state provider	None	605 NEW YORK RANCH RD	None	JACKSON	CA	95642	9328	03	06005	38.36077733	-120.7651246	Amador County
226567	Fee-for-Service	1205499506	1205499506	1	1	BERNABA, MARIO	10/7/2024	207R00000X	NA	Other	026	PHYSICIANS	177582	45	Nephrology (Renal-Kidney)	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
226569	Fee-for-Service	1265517932	1265517932	1	1	BUI, VINH T MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44779	20	Orthopedic Surgery	0	In state provider	None	150 N JACKSON AVE	STE 104	SAN JOSE	CA	95116	1908	43	06085	37.36190683	-121.8468659	Santa Clara County
226664	Fee-for-Service	1417962994	1417962994	1	1	BOUGH, EDWARD W MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58752	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2660 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4315	43	06085	37.36653288	-122.0778348	Santa Clara County
226686	Fee-for-Service	1619951548	1619951548	1	1	BERNSTEIN, ROBERT M MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76402	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
226688	Fee-for-Service	1831100163	1831100163	1	1	BADKE, CHRISTINE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55052	41	Internal Medicine	0	In state provider	None	601 S MAIN ST	None	SALINAS	CA	93901	3201	27	06053	36.6691565	-121.6553715	Monterey County
226692	Fee-for-Service	1669542213	1669542213	1	1	BRODY, ROSA E MD	1/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51839	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
226699	Fee-for-Service	1720633597	1720633597	1	1	BONNY MASTERS MD INC	8/10/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	675 24TH	None	SANTA CRUZ	CA	95062	4205	44	06087	36.96479042	-121.979556	Santa Cruz County
226736	Fee-for-Service	1588748503	1588748503	1	1	BUCKNER,CHARLES B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 528	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
226753	Fee-for-Service	1538343462	1538343462	1	1	BAUER, JOSEF A MD	4/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98468	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
226762	Fee-for-Service	1306391487	1306391487	1	1	BILGER, ANNELISE M LMFT	2/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
226791	Fee-for-Service	1013095645	1013095645	1	1	BADDOUR, EDWARD J MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63628	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
226798	Fee-for-Service	1407941404	1407941404	1	1	BUSHMAN, GERALD A MD	2/22/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50541	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
226824	Fee-for-Service	1043289796	1043289796	1	1	BOKHARI, FREEHA F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	390 FOUNDERS WAY	None	FORKS	WA	98331	9062	00	None	47.94641266	-124.393799	Clallam County
226865	Fee-for-Service	1124024153	1124024153	1	1	BAUER, ELIZABETH B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4405 E 26TH ST	None	SIOUX FALLS	SD	57103	4187	00	None	43.528572	-96.6732075	Minnehaha County
227024	Fee-for-Service	1790718740	1790718740	1	1	BATEMAN, SCOTT F MD	4/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30557	08	Family Practice	0	In state provider	None	234118 CIVIC CENTER WAY	None	MALIBU	CA	90265	4802	19	06037	34.0352362	-118.6944715	Los Angeles County
227025	Fee-for-Service	1093730251	1093730251	1	1	BARBA, DAVID MD	7/31/1987	207T00000X	NA	General Surgery	026	PHYSICIANS	42092	14	Neurological Surgery	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
227056	Fee-for-Service	1801830609	1801830609	1	1	BOLIVAR, DAVID A MD	8/23/1995	207P00000X	NA	Other	026	PHYSICIANS	33373	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
227072	Fee-for-Service	1437237096	1437237096	1	1	BUNYAVIROCH, ARNOLD MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68903	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
227092	Fee-for-Service	1801973474	1801973474	1	1	BURDICK, ADAM P MD	2/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118186	14	Neurological Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
227118	Fee-for-Service	1497166029	1497166029	1	1	BARAJAS, GRISELDA LMFT	7/25/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	105040	-	NOT APPLICABLE	0	In state provider	None	1275 B ST	None	MERCED	CA	95341	6345	24	06047	37.29119757	-120.4710848	Merced County
227129	Fee-for-Service	1255338448	1255338448	1	1	BEDIKIAN, SEVAG A DC	8/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4719 TORRANCE BLVD	None	TORRANCE	CA	90503	4173	19	06037	33.83759548	-118.364301	Los Angeles County
227169	Fee-for-Service	1538169578	1538169578	1	1	BITTNER, DONALD E MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70407	20	Orthopedic Surgery	0	In state provider	None	400 W CENTRAL AVE	STE 100	BREA	CA	92821	3007	30	06059	33.93194888	-117.9029987	Orange County
227188	Fee-for-Service	1861569022	1861569022	1	1	BRAR, GURBINDER	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53763	None	None	0	In state provider	None	6235 N FRESNO ST	STE 106	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
227203	Fee-for-Service	1467542217	1467542217	1	1	BOULE, JENNIFER N MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84290	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
227235	Fee-for-Service	1275908386	1275908386	1	1	BHATT, ELIZABETH LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	112418	-	NOT APPLICABLE	0	In state provider	None	370 S CRENSHAW BLVD	STE E100	TORRANCE	CA	90503	1727	19	06037	33.84549	-118.3287415	Los Angeles County
227284	Fee-for-Service	1649852807	1649852807	1	1	BREWER, MARGARET A LMFT	6/24/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 N MARKET	STE 950	SAN JOSE	CA	95113	1112	43	06085	37.33791617	-121.8939388	Santa Clara County
227301	Fee-for-Service	1902241821	1902241821	1	1	BRADLEY, ELLEN R MD	6/2/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	131788	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
227328	Fee-for-Service	1306349196	1306349196	1	1	BELLMAN, POLINA MD	9/26/2024	390200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
227339	Fee-for-Service	1558486084	1558486084	1	1	BANTOLO, MICHAEL P	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
227343	Fee-for-Service	1801830609	1801830609	1	1	BOLIVAR, DAVID A MD	8/23/1995	207P00000X	NA	Other	026	PHYSICIANS	33373	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
227386	Fee-for-Service	1922846591	1922846591	1	1	BELL, NICOLE A	10/9/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
227411	Fee-for-Service	1447200498	1447200498	1	1	BASKIN, MARK A MD	10/31/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	30252	18	Ophthalmology	0	In state provider	None	16550 VENTURA BLVD	STE 406	ENCINO	CA	91436	5028	19	06037	34.15778374	-118.4942662	Los Angeles County
227415	Fee-for-Service	1316263387	1316263387	1	1	BALKMAN, JASON D MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135797	30	Radiology	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
227437	Fee-for-Service	1093719056	1093719056	1	1	BROWN, MICHAEL A MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79875	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
227439	Fee-for-Service	1558978270	1558978270	1	1	BEST HOSPICE CARE INC	9/28/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3731 CAHUENGA BLVD	STE H	STUDIO CITY	CA	91604	3504	19	06037	34.13561311	-118.3618333	Los Angeles County
227447	Fee-for-Service	1295936961	1295936961	1	1	BOSWELL, JOHN S MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100542	07	Dermatology	0	In state provider	None	2828 FRESNO ST	#203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
227451	Fee-for-Service	1982746749	1982746749	1	1	BIMBELA, ALFREDO NP	4/21/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
227538	Fee-for-Service	1386688851	1386688851	1	1	BERGER, ROBERT MD	9/9/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161385	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92255	4267	33	06065	33.838623	-116.542737	Riverside County
227550	Fee-for-Service	1629032578	1629032578	1	1	BOLKIKI MEDICAL SUPPLIES	2/20/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AND EQUIPMENT, INC	2690 N MARKS AVE	STE 108	FRESNO	CA	93722	5286	10	06019	36.77735075	-119.8452827	Fresno County
227610	Fee-for-Service	1003992850	1003992850	1	1	BABU, VEER R MD	9/10/2019	207R00000X	NA	Other	026	PHYSICIANS	52956	41	Internal Medicine	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
227612	Fee-for-Service	1306349196	1306349196	1	1	BELLMAN, POLINA MD	9/26/2024	390200000X	NA	Other	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
227616	Fee-for-Service	1679034375	1679034375	1	1	BAHRANI, MILAD DO	8/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19837	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
227617	Fee-for-Service	1578736724	1578736724	1	1	BELASCO, KEVIN T DO	6/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12076	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	STE 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
227619	Fee-for-Service	1346564119	1346564119	1	1	BUCK, ADAM M MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119186	41	Internal Medicine	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
227629	Fee-for-Service	1689636730	1689636730	1	1	BURBANK EMERG MED GRP INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	19	06037	34.158213	-118.328112	Los Angeles County
227638	Fee-for-Service	1134348832	1134348832	1	1	BROWN, VICTORIA L LMFT	1/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING	730 2ND ST	#15313	SANTA ROSA	CA	95401	9540	49	06097	38.440062	-122.7102525	Sonoma County
227644	Fee-for-Service	1457735300	1457735300	1	1	BUNNELL, MITCHELL	10/5/2023	208M00000X	NA	Other	026	PHYSICIANS	15041	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
227700	Fee-for-Service	1295919157	1295919157	1	1	BERGER, JOHN A MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	16367	01	General Practice	0	In state provider	None	205 WALNUT AVE	None	SAN DIEGO	CA	92103	4935	37	06073	32.74143711	-117.1628376	San Diego County
227714	Fee-for-Service	1679000657	1679000657	1	1	BETAT, DANIEL MD	9/1/2020	207R00000X	NA	Other	026	PHYSICIANS	157747	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
227718	Fee-for-Service	1467785766	1467785766	1	1	BONILLA PARADA, KARLA E	4/11/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	629 E 4TH APT 8	None	LONG BEACH	CA	90802	2690	19	06037	33.77176628	-118.1842718	Los Angeles County
227725	Fee-for-Service	1558978270	1558978270	1	1	BEST HOSPICE CARE INC	9/28/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3731 CAHUENGA BLVD	STE H	STUDIO CITY	CA	91604	3504	19	06037	34.13561311	-118.3618333	Los Angeles County
227735	Fee-for-Service	1295936961	1295936961	1	1	BOSWELL, JOHN S MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100542	41	Internal Medicine	0	In state provider	None	2828 FRESNO ST	#203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
227767	Fee-for-Service	1093829327	1093829327	1	1	BEAN, GARY E MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	53663	66	Emergency Medicine (Urgent Care)	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
227778	Fee-for-Service	1720452790	1720452790	1	1	BRIGHT WAY CARE HOSPICE, INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2650 JONES WAY	SUITE 21	SIMI VALLEY	CA	93065	1203	56	06111	34.28861251	-118.745991	Ventura County
227791	Fee-for-Service	1780763235	1780763235	1	1	BAVELAS, VICKY Y MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	85535	01	General Practice	0	In state provider	None	2020 GENESEE AVENUE	None	SAN DIEGO	CA	92101	2327	37	06073	32.7921973	-117.1571251	San Diego County
227799	Fee-for-Service	1992978399	1992978399	1	2	BRUCE R. CARLTON, M.D., INC.	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	22448	07	Dermatology	0	In state provider	None	292 ALAMO DR	STE 2	VACAVILLE	CA	95688	4243	48	06095	38.35454015	-122.0091474	Solano County
227829	Fee-for-Service	1972971281	1972971281	1	1	BROME, ALLYSON B DO	8/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21069	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
227831	Fee-for-Service	1508052333	1508052333	1	1	BURGOYNE, CHADLER R MD	2/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	99619	20	Orthopedic Surgery	0	In state provider	None	5176 HILL ROAD EAST	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
227840	Fee-for-Service	1982710869	1982710869	1	1	BRATTON, CHARLES F MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149909	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
227842	Fee-for-Service	1942638978	1942638978	1	1	BRIGHTER BEGINNINGS	12/1/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	07	06013	37.93503193	-122.3422799	Contra Costa County
227867	Fee-for-Service	1275510422	1275510422	1	1	BANIGO, MAY L	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	66185	05	Anesthesiology	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
227877	Fee-for-Service	1487288387	1487288387	1	1	BABARIA, SWETA R LMFT	6/4/2021	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
227882	Fee-for-Service	1427125319	1427125319	1	1	BURNS, KENNETH D MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51141	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
227897	Fee-for-Service	1003992850	1003992850	1	1	BABU, VEER R MD	9/10/2019	207R00000X	NA	Other	026	PHYSICIANS	52956	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
227899	Fee-for-Service	1225180458	1225180458	1	1	BOWMAN, STACEY A MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88985	40	Pediatrics	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
227911	Fee-for-Service	1669570495	1669570495	1	1	BADRI, MOHSEN DO	2/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	9095	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
227987	Fee-for-Service	1295919157	1295919157	1	1	BERGER, JOHN A MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	16367	08	Family Practice	0	In state provider	None	205 WALNUT AVE	None	SAN DIEGO	CA	92103	4935	37	06073	32.74143711	-117.1628376	San Diego County
227999	Fee-for-Service	1467785766	1467785766	1	1	BONILLA PARADA, KARLA E	4/11/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	629 E 4TH APT 8	None	LONG BEACH	CA	90802	2690	19	06037	33.77176628	-118.1842718	Los Angeles County
228009	Fee-for-Service	1114253101	1114253101	1	1	BRIXIE, ROSEMARY A NP	4/16/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6120 N VINELAND	None	NORTH HOLLYWOOD	CA	91606	4914	19	06037	34.1819583	-118.3702737	Los Angeles County
228013	Fee-for-Service	1801144738	1801144738	1	1	BORG, MEREDITH W CRNA	11/14/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
228035	Fee-for-Service	1639240674	1639240674	1	1	BROSNAN, EDWARD J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	21309	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
228039	Fee-for-Service	1053598060	1053598060	1	1	BONDURANT, JOSHUA J DO	5/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10238	05	Anesthesiology	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
228043	Fee-for-Service	1366580540	1366580540	1	1	BAART BEHAVIORAL HEALTH SERV	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	539 N VAN NESS AVE	None	FRESNO	CA	93728	3419	10	06019	36.751158	-119.7989285	Fresno County
228056	Fee-for-Service	1093829327	1093829327	1	1	BEAN, GARY E MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	53663	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
228065	Fee-for-Service	1720452790	1720452790	1	1	BRIGHT WAY CARE HOSPICE, INC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2650 JONES WAY	SUITE 21	SIMI VALLEY	CA	93065	1203	56	06111	34.28861251	-118.745991	Ventura County
228072	Fee-for-Service	1184091290	1184091290	1	1	BACKS, JULIA C NP	8/22/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
228129	Fee-for-Service	1942638978	1942638978	1	1	BRIGHTER BEGINNINGS	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	07	06013	37.93503193	-122.3422799	Contra Costa County
228161	Fee-for-Service	1578643656	1578643656	1	1	BERA, RIMAL B MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64160	36	Psychiatry	0	In state provider	None	3 TERRAZA	None	IRVINE	CA	92614	8111	30	06059	33.67995532	-117.825817	Orange County
228169	Fee-for-Service	1427125319	1427125319	1	1	BURNS, KENNETH D MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51141	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
228256	Fee-for-Service	1912121401	1912121401	1	1	BAUGNON, MICHAEL J PHD	10/19/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
228283	Fee-for-Service	1427034065	1427034065	1	1	BALLARD, DUSTIN W MD	6/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
228308	Fee-for-Service	1336596907	1336596907	1	1	BAY AREA INTERNAL MEDICINE,	11/9/2017	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	PROFESSIONAL MEDICAL COR	350 HAWTHORNE AVENUE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
228333	Fee-for-Service	1336672559	1336672559	1	1	BEPO, LURIT L MD	3/11/2021	207R00000X	NA	Other	026	PHYSICIANS	161520	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
228356	Fee-for-Service	1194346254	1194346254	1	1	BEST IN THE WEST HOSPICE INC	2/24/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19231 VICTORY BLVD	SUITE 556	RESEDA	CA	91335	6383	19	06037	34.18659852	-118.552221	Los Angeles County
228391	Fee-for-Service	1760610943	1760610943	1	1	BEHL, ESHA DO	2/11/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18543	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
228417	Fee-for-Service	1942638978	1942638978	1	1	BRIGHTER BEGINNINGS	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	07	06013	37.93503193	-122.3422799	Contra Costa County
228428	Fee-for-Service	1184702854	1184702854	1	1	BENSON, JOHN C DPM	5/18/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
228447	Fee-for-Service	1487973376	1487973376	1	1	BAIG, KHALID M D INC	12/21/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49356	08	Family Practice	0	In state provider	None	632 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
228450	Fee-for-Service	1467756023	1467756023	1	1	BINKOWSKI, ALLISON M MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114604	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
228451	Fee-for-Service	1659946747	1659946747	1	1	BIAGTAN, CZARINA MARIEL REGL	6/9/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	OS OT	7737 MEANY AVE	B5-7	BAKERSFIELD	CA	93308	5266	15	06029	35.39423549	-119.0882835	Kern County
228474	Fee-for-Service	1619023793	1619023793	1	1	BHATEJA, MEERA MD	12/1/1998	207R00000X	NA	Other	026	PHYSICIANS	54011	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
228503	Fee-for-Service	1144515099	1144515099	1	1	BHAVSAR, RAJIV ISHWARLAL MD	9/8/2015	207R00000X	NA	Other	026	PHYSICIANS	50717	41	Internal Medicine	0	In state provider	AMC	1321 N HARBOR BLVD	STE 302	FULLERTON	CA	92835	4124	30	06059	33.88346929	-117.9251709	Orange County
228567	Fee-for-Service	1598712069	1598712069	1	1	BHIMANI, MEENESH A MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77402	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
228586	Fee-for-Service	1346412426	1346412426	1	1	BRIMMO, OLUBUSOLA A MD	4/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130240	01	General Practice	0	In state provider	None	819 S VERMONT AVE	None	LOS ANGELES	CA	90005	1522	19	06037	34.05713422	-118.2917118	Los Angeles County
228587	Fee-for-Service	1770765729	1770765729	1	1	BRANDMAN, SCOTT MD	2/9/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	120747	None	None	0	In state provider	None	1825 CIVIC CENTER DR	STE 1	SANTA CLARA	CA	95050	7302	43	06085	37.35595381	-121.9573173	Santa Clara County
228606	Fee-for-Service	1760942437	1760942437	1	1	BONANNO, PHILIP MD	8/1/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	185592	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
228608	Fee-for-Service	1265827174	1265827174	1	1	BALL, SETH	8/29/2024	207PP0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
228644	Fee-for-Service	1194346254	1194346254	1	1	BEST IN THE WEST HOSPICE INC	2/24/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19231 VICTORY BLVD	SUITE 556	RESEDA	CA	91335	6383	19	06037	34.18659852	-118.552221	Los Angeles County
228666	Fee-for-Service	1831146679	1831146679	1	1	BEVERLY, SHEREEN L MD	9/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	68251	None	None	0	In state provider	INC	4455 W 117TH ST	STE 506	HAWTHORNE	CA	90250	2293	19	06037	33.92825048	-118.3539285	Los Angeles County
228708	Fee-for-Service	1942638978	1942638978	1	1	BRIGHTER BEGINNINGS	9/15/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	07	06013	37.93503193	-122.3422799	Contra Costa County
228718	Fee-for-Service	1427412816	1427412816	1	1	BRONDFIELD, MAX N MD	8/23/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	153389	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
228783	Fee-for-Service	1750301230	1750301230	1	1	BLURTON, DOMINIC J	6/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77780	None	None	0	In state provider	None	3080 BRISTOL STREET	SUITE 600	COSTA MESA	CA	92626	7341	30	06059	33.68480996	-117.8854767	Orange County
228790	Fee-for-Service	1760933873	1760933873	1	1	BIDDLE, CARINA LMFT	1/22/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19712 MACARTHUR BLVD	110	IRVINE	CA	92612	2407	30	06059	33.65788122	-117.8626278	Orange County
228808	Fee-for-Service	1205037629	1205037629	1	1	BERSOT, THOMAS MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26303	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
228823	Fee-for-Service	1326544925	1326544925	1	1	BRADDOCK DIALYSIS LLC	6/24/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11239 S WESTERN AVE	None	LOS ANGELES	CA	90047	4848	19	06037	33.9315238	-118.3091617	Los Angeles County
228826	Fee-for-Service	1235447491	1235447491	1	2	BOURNE, JEFFREY DO MEDICAL	11/21/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3033 AUGUSTA	None	SAN LUIS OBISPO	CA	93401	5820	40	06079	35.26715802	-120.6407349	San Luis Obispo County
228835	Fee-for-Service	1891873543	1891873543	1	1	BUXTON, SARAH E MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	65922	40	Pediatrics	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
228846	Fee-for-Service	1699798025	1699798025	1	1	BRADEN PARTNERS, LP	3/15/2013	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	MED-MART/ PAC PULM SVC	605 HINDRY AVE	None	INGLEWOOD	CA	90301	3003	19	06037	33.955479	-118.373617	Los Angeles County
228853	Fee-for-Service	1437321866	1437321866	1	1	BANGALOREVATSANSRI, LAKSHMI	4/11/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	131376	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1299 WATER LILY WAY	SUITE 90	SAN JOSE	CA	95129	2868	43	06085	37.30340127	-122.0331737	Santa Clara County
228858	Fee-for-Service	1477564193	1477564193	1	1	BAKER, MOLLY M MD	4/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64894	08	Family Practice	0	In state provider	None	520 COTTONWOOD ST	STE 4	WOODLAND	CA	95695	3603	57	06113	38.675016	-121.7933365	Yolo County
228877	Fee-for-Service	1538262043	1538262043	1	1	BURCHARD, ESTEBAN G MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65084	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
228879	Fee-for-Service	1295277473	1295277473	1	1	BOTTOMS, GRAHAM N LMFT	12/10/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52741	-	NOT APPLICABLE	0	In state provider	None	2560 PULGAS AVENUE	None	EAST PALO ALTO	CA	94303	1323	41	06081	37.47530197	-122.1318685	San Mateo County
228881	Fee-for-Service	1881637999	1881637999	1	1	BODNER, SARA M MD	5/28/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50574	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
228890	Fee-for-Service	1851367213	1851367213	1	1	BETTICH, MARC E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1407 W 4TH ST	None	RED WING	MN	55066	2108	00	None	44.56065239	-92.5480666	Goodhue County
228899	Fee-for-Service	1770585887	1770585887	1	1	BREYDEN, EILEEN S MD	2/28/1995	207RR0500X	NA	Other	026	PHYSICIANS	69655	41	Internal Medicine	0	In state provider	None	607 S GLENOAKS BLVD	None	BURBANK	CA	91502	1424	19	06037	34.17950025	-118.3013539	Los Angeles County
228900	Fee-for-Service	1326230095	1326230095	1	1	BERTOZZI, JOHN MD	12/30/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
228921	Fee-for-Service	1346353679	1346353679	1	1	BANNING HEALTH CENTER	9/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3055 W RAMSEY ST	None	BANNING	CA	92220	3781	33	06065	33.92577647	-116.910234	Riverside County
228927	Fee-for-Service	1184318834	1184318834	1	1	BAYNES, JASON LMFT	6/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3010 I ST	None	SACRAMENTO	CA	95816	4420	34	06067	38.573793	-121.4657685	Sacramento County
228944	Fee-for-Service	1134365943	1134365943	1	1	BENT, ALISHA C PHD	5/11/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
228965	Fee-for-Service	1205166758	1205166758	1	1	BONTOGON, NORMAN D CRNA	1/12/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
228969	Fee-for-Service	1801942719	1801942719	1	1	BEAUFORD, JAMES PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
229023	Fee-for-Service	1114277787	1114277787	1	1	BORQUEZ, ALEJANDRO A MD	7/28/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	138091	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
229030	Fee-for-Service	1710397294	1710397294	1	1	BESHORE, JORDAN L DO	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14377	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
229040	Fee-for-Service	1144397035	1144397035	1	1	BIZHANG, RAMIN MD	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84640	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
229055	Fee-for-Service	1528431970	1528431970	1	1	BAUTISTA, ARLENE PALLANAN	1/19/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	344 W CHENNAULT AVE	None	CLOVIS	CA	93611	0216	10	06019	36.84297948	-119.7186705	Fresno County
229071	Fee-for-Service	1891061123	1891061123	1	1	BUMGARNER, ABEL M MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149258	36	Psychiatry	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
229078	Fee-for-Service	1407237118	1407237118	1	1	BASSI, SUNNY NP	5/21/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95002585	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
229128	Fee-for-Service	1558466763	1558466763	1	1	BARSEGNIA, ARSEN	5/17/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ARSENIO MED SUPPLY	1259 S GLENDALE AVE	STE B	GLENDALE	CA	91205	3280	19	06037	34.13003451	-118.2525595	Los Angeles County
229134	Fee-for-Service	1306283890	1306283890	1	1	BRYANT, TIMOTHY D MD	4/1/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	142403	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
229140	Fee-for-Service	1548533904	1548533904	1	1	BUBASH, GARY F LMFT	1/22/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94894	-	NOT APPLICABLE	0	In state provider	None	2595 DEPOT ROAD	None	HAYWARD	CA	94545	2341	01	06001	37.63872323	-122.1145864	Alameda County
229165	Fee-for-Service	1538262043	1538262043	1	1	BURCHARD, ESTEBAN G MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65084	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
229186	Fee-for-Service	1770585887	1770585887	1	1	BREYDEN, EILEEN S MD	2/28/1995	207RR0500X	NA	Other	026	PHYSICIANS	69655	83	Rheumatology	0	In state provider	None	607 S GLENOAKS BLVD	None	BURBANK	CA	91502	1424	19	06037	34.17950025	-118.3013539	Los Angeles County
229207	Fee-for-Service	1225870553	1225870553	1	1	BUTE, ERIN	8/9/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	667 LIGHTHOUSE AVE	201	PACIFIC GROVE	CA	93950	2644	27	06053	36.62205802	-121.9200608	Monterey County
229210	Fee-for-Service	1346353679	1346353679	1	1	BANNING HEALTH CENTER	9/1/1997	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3055 W RAMSEY ST	None	BANNING	CA	92220	3781	33	06065	33.92577647	-116.910234	Riverside County
229249	Fee-for-Service	1659716959	1659716959	1	1	BASERI, BABAK MD	3/25/2019	390200000X	NA	Other	026	PHYSICIANS	160360	None	None	0	In state provider	None	25405 HANCOCK AVE	SUITE 203	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
229263	Fee-for-Service	1972515864	1972515864	1	1	BRASHER WARREN MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COOK CHILDREN'S PHYSICIA	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
229284	Fee-for-Service	1073802062	1073802062	1	1	BURNETT, GREGORY P MD	12/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2865 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
229302	Fee-for-Service	1023006434	1023006434	1	1	BAYHEALTH MEDICAL CENTER, IN	9/14/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	C.	100 WELLNESS WAY	None	MILFORD	DE	19963	4364	00	None	38.886948	-75.391857	Sussex County
229310	Fee-for-Service	1750638102	1750638102	1	1	BISHOP, LAURA E DO	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12898	41	Internal Medicine	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
229320	Fee-for-Service	1497166029	1497166029	1	2	BARAJAS, GRISELDA LMFT	4/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
229344	Fee-for-Service	1528431970	1528431970	1	1	BAUTISTA, ARLENE PALLANAN	1/19/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	344 W CHENNAULT AVE	None	CLOVIS	CA	93611	0216	10	06019	36.84297948	-119.7186705	Fresno County
229365	Fee-for-Service	1336817287	1336817287	1	1	BURNS, LISA N NP	1/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
229431	Fee-for-Service	1316429517	1316429517	1	1	BAMIDELE, BABATUNDE CRNA	12/27/2022	163WC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
229492	Fee-for-Service	1831727700	1831727700	1	1	BANAYAT, AUGUSTO NP	7/21/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
229499	Fee-for-Service	1346353679	1346353679	1	1	BANNING HEALTH CENTER	9/1/1997	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3055 W RAMSEY ST	None	BANNING	CA	92220	3781	33	06065	33.92577647	-116.910234	Riverside County
229500	Fee-for-Service	1417110479	1417110479	1	1	BARANOV, CLAIRE C	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
229503	Fee-for-Service	1023158060	1023158060	1	1	BDIL, GENNADY G	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	FAIRFAX OPTICAL LAB	453 N FAIRFAX AVE	None	LOS ANGELES	CA	90036	1716	19	06037	34.079733	-118.361508	Los Angeles County
229524	Fee-for-Service	1134793136	1134793136	1	1	BARRETT, HANNA M DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21041	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
229535	Fee-for-Service	1760888010	1760888010	1	1	BUECHLER, DAVID M	12/27/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
229564	Fee-for-Service	1538742838	1538742838	1	1	BROWNING, ANGEL M	5/11/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	38117 LIDO DR	None	PALMDALE	CA	93552	3206	19	06037	34.57489634	-118.0377889	Los Angeles County
229575	Fee-for-Service	1164639225	1164639225	1	1	BLANCAFLOR, MARIELOU B NP	8/3/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND ST W	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
229588	Fee-for-Service	1023006434	1023006434	1	1	BAYHEALTH MEDICAL CENTER, IN	9/14/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	C.	100 WELLNESS WAY	None	MILFORD	DE	19963	4364	00	None	38.886948	-75.391857	Sussex County
229601	Fee-for-Service	1982863536	1982863536	1	1	BAIRAMIAN, JACK J MD	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	110103	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
229623	Fee-for-Service	1831308469	1831308469	1	1	BROOKS, JACQUELINE LMFT	11/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
229657	Fee-for-Service	1568531960	1568531960	1	1	BUTLER, JULIUS C.	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	59219	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5301 F ST	STE 110	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
229668	Fee-for-Service	1477528099	1477528099	1	1	BALES, DENNIS R OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2040 VIBORG RD	STE 240	SOLVANG	CA	93463	3203	42	06083	34.6024706	-120.1275138	Santa Barbara County
229707	Fee-for-Service	1558488700	1558488700	1	1	BUTTERI, MATTHEW J MD	9/10/2008	207R00000X	NA	Other	026	PHYSICIANS	90898	38	Geriatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
229713	Fee-for-Service	1184182032	1184182032	1	1	BALISI, MICHELLE LMFT	10/18/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5252 BALBOA AVE	STE 801	SAN DIEGO	CA	92117	6970	37	06073	32.81892468	-117.1833243	San Diego County
229721	Fee-for-Service	1366602229	1366602229	1	1	BHULLAR, JASJOT K MD	7/1/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
229724	Fee-for-Service	1295816502	1295816502	1	1	BROWN, VANESSA K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 CEDAR ST	None	OROFINO	ID	83544	9029	00	None	46.48694067	-116.2595042	Clearwater County
229735	Fee-for-Service	1548266877	1548266877	1	1	BACKER,LAURA K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
229738	Fee-for-Service	1407819394	1407819394	1	1	BRUNSWICK, CATHERINE E	5/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
229743	Fee-for-Service	1982708921	1982708921	1	1	BHATIA, NARENDER N MD	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	33956	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
229759	Fee-for-Service	1205014297	1205014297	1	1	BICK-FORRESTER, JUSTIN MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102073	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
229786	Fee-for-Service	1346353679	1346353679	1	1	BANNING HEALTH CENTER	9/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3055 W RAMSEY ST	None	BANNING	CA	92220	3781	33	06065	33.92577647	-116.910234	Riverside County
229791	Fee-for-Service	1184890782	1184890782	1	1	BRACE, ELION	5/1/2014	207R00000X	NA	Other	026	PHYSICIANS	105638	None	None	0	In state provider	None	890 EASTLAKE PKWY	STE 301	CHULA VISTA	CA	91914	4522	37	06073	32.65223126	-116.9677279	San Diego County
229794	Fee-for-Service	1194730994	1194730994	1	1	BHOGAL, RABINDER S MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40574	10	Gastroenterology (M.D. only)	0	In state provider	None	5959 TRUXTUN AVE	STE 200	BAKERSFIELD	CA	93309	0437	15	06029	35.36306164	-119.0711264	Kern County
229795	Fee-for-Service	1285271668	1285271668	1	1	BAIG, AMBER L PSYD	10/27/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4835 VAN NUYS BLVD	1-200	SHERMAN OAKS	CA	91403	2139	19	06037	34.1587068	-118.4487394	Los Angeles County
229831	Fee-for-Service	1548202526	1548202526	1	1	BLOOM, CHARLES DO	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
229842	Fee-for-Service	1386637833	1386637833	1	1	BORCHARDT, ROGER L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1160 E 3900 S	STE 2000	SALT LAKE CTY	UT	84124	1236	00	None	40.68703647	-111.85785	Salt Lake County
229850	Fee-for-Service	1538742838	1538742838	1	1	BROWNING, ANGEL M	5/11/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	38117 LIDO DR	None	PALMDALE	CA	93552	3206	19	06037	34.57489634	-118.0377889	Los Angeles County
229873	Fee-for-Service	1952325318	1952325318	1	1	BALL, SCOTT T MD	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75221	20	Orthopedic Surgery	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
229891	Fee-for-Service	1376766311	1376766311	1	1	BILBREY, CHRISTINE L MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138335	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
229893	Fee-for-Service	1902995707	1902995707	1	1	BALARAMAN, SUMANTHI DO MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9084	36	Psychiatry	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
229913	Fee-for-Service	1699744524	1699744524	1	1	BUHAY-MAGLUNOG, MARIA S	12/18/2008	207RR0500X	NA	Other	026	PHYSICIANS	42390	83	Rheumatology	0	In state provider	None	1250 S SUNSET AVE	STE 201	WEST COVINA	CA	91790	3963	19	06037	34.0610671	-117.9463685	Los Angeles County
229968	Fee-for-Service	1629682463	1629682463	1	1	BADZE, ISHMAEL	10/30/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14560 1/4 DICKENS ST.	None	SHERMAN OAKS	CA	91403	3766	19	06037	34.15026639	-118.4509373	Los Angeles County
229990	Fee-for-Service	1841222023	1841222023	1	1	BRENNER, MICHAEL B MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	63953	18	Ophthalmology	0	In state provider	None	3950 LONG BEACH BLVD	STE 200	LONG BEACH	CA	90807	5412	19	06037	33.830559	-118.1893225	Los Angeles County
230004	Fee-for-Service	1346242005	1346242005	1	1	BOLIVAR, DAVID A MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68161	02	General Surgery	0	In state provider	None	292 POSADA LN	STE C	TEMPLETON	CA	93465	4054	40	06079	35.5531447	-120.7214979	San Luis Obispo County
230010	Fee-for-Service	1366602229	1366602229	1	1	BHULLAR, JASJOT K MD	7/1/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
230081	Fee-for-Service	1194730994	1194730994	1	1	BHOGAL, RABINDER S MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40574	41	Internal Medicine	0	In state provider	None	5959 TRUXTUN AVE	STE 200	BAKERSFIELD	CA	93309	0437	15	06029	35.36306164	-119.0711264	Kern County
230143	Fee-for-Service	1154525004	1154525004	1	1	BAUM, PAUL D MD	2/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72596	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	BLDG 30, RM 3320	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
230178	Fee-for-Service	1942257373	1942257373	1	1	BUSH, MELISSA C MD	4/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65240	None	None	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
230182	Fee-for-Service	1699192286	1699192286	1	1	BRODOVSKY, JEFFREY M DO	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16385	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
230201	Fee-for-Service	1699744524	1699744524	1	1	BUHAY-MAGLUNOG, MARIA S	12/18/2008	207RR0500X	NA	Other	026	PHYSICIANS	42390	41	Internal Medicine	0	In state provider	None	1250 S SUNSET AVE	STE 201	WEST COVINA	CA	91790	3963	19	06037	34.0610671	-117.9463685	Los Angeles County
230208	Fee-for-Service	1023495397	1023495397	1	1	BLATT, CHERYL E	8/17/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
230216	Fee-for-Service	1427256957	1427256957	1	2	BEVERLY HILLS ONCOLOGY MEDIC	8/24/2010	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5363 BALBOA BLVD	SUITE 345	ENCINO	CA	91316	2805	19	06037	34.169058	-118.5011265	Los Angeles County
230239	Fee-for-Service	1144248766	1144248766	1	1	BETTELHEIM, ERIC A OD	5/1/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	409 E ARROW HWY	None	GLENDORA	CA	91740	5607	19	06037	34.1067993	-117.8564247	Los Angeles County
230244	Fee-for-Service	1720520182	1720520182	1	1	BEYAOJU, ANDREA NP	7/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
230251	Fee-for-Service	1801194287	1801194287	1	1	BENDER, DEANNE KL, LMFT	4/21/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53535	-	NOT APPLICABLE	0	In state provider	None	11643 GLENOAKS BLVD	None	PACOIMA	CA	91331	1050	19	06037	34.28133474	-118.4198166	Los Angeles County
230260	Fee-for-Service	1629682463	1629682463	1	1	BADZE, ISHMAEL	10/30/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14560 1/4 DICKENS ST.	None	SHERMAN OAKS	CA	91403	3766	19	06037	34.15026639	-118.4509373	Los Angeles County
230266	Fee-for-Service	1588828081	1588828081	1	1	BEHZADIZADEH, ANAHID J NP	12/12/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
230268	Fee-for-Service	1548782717	1548782717	1	1	BISHOP, ROBERT MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
230286	Fee-for-Service	1235755208	1235755208	1	1	BENTLEY, KAITLYN LMFT	3/18/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28465 OLD TOWN FRONT ST	None	TEMECULA	CA	92590	1822	33	06065	33.49566437	-117.1516462	Riverside County
230292	Fee-for-Service	1346242005	1346242005	1	1	BOLIVAR, DAVID A MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68161	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	292 POSADA LN	STE C	TEMPLETON	CA	93465	4054	40	06079	35.5531447	-120.7214979	San Luis Obispo County
230320	Fee-for-Service	1942931878	1942931878	1	1	BRIDGEWATER, REBECCA LMFT	1/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
230336	Fee-for-Service	1285084772	1285084772	1	1	BAUER, SONJA K PT	8/29/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
230352	Fee-for-Service	1356570915	1356570915	1	1	BERMAN, STEPHANIE B MD	3/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107266	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
230406	Fee-for-Service	1538172143	1538172143	1	1	BEHL, DEEPTI MD	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110167	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
230412	Fee-for-Service	1477809580	1477809580	1	1	BRIGHT PEDIATRICS &	9/10/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	89633	40	Pediatrics	0	In state provider	ECHOCARDIOGRAPHY INC	1922 S COURT ST	None	VISALIA	CA	93277	5426	54	06107	36.313461	-119.291112	Tulare County
230432	Fee-for-Service	1922354083	1922354083	1	1	BRODE, ERICA C MD	9/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130047	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
230446	Fee-for-Service	1174775449	1174775449	1	1	BALLINGER, JENNIFER L MD	1/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111025	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
230466	Fee-for-Service	1760838981	1760838981	1	1	BAIDWAN, DAMANDEEP K MD	8/14/2019	390200000X	NA	Other	026	PHYSICIANS	158001	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
230467	Fee-for-Service	1619393394	1619393394	1	1	BRUNNER, RICHARD D CP	7/31/2014	174400000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7551 TIMBERLAKE WAY	#110	SACRAMENTO	CA	95823	5421	34	06067	38.466225	-121.415958	Sacramento County
230481	Fee-for-Service	1689821704	1689821704	1	1	BAKER, DUSTYN C MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116987	None	None	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
230545	Fee-for-Service	1124408422	1124408422	1	1	BRIMBERRY, LAURA NP	2/6/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
230566	Fee-for-Service	1922307479	1922307479	1	1	BOYADJIAN, AVETIS A MD	5/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126900	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
230571	Fee-for-Service	1235175894	1235175894	1	1	BENAVIDES, ISABEL MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	68376	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3800 JANES ROAD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
230583	Fee-for-Service	1609029453	1609029453	1	1	BRIGGS, DANIELLE N NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230597	Fee-for-Service	1699340810	1699340810	1	1	BROWN, HEATHER L PT	9/23/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
230606	Fee-for-Service	1528262284	1528262284	1	1	BURNETTE, AMBER M MD	10/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97788	03	Allergy	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
230667	Fee-for-Service	1558981381	1558981381	1	1	BLESSING COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	3972 N WATERMAN AVENUE	SUITE 104	SAN BERNARDINO	CA	92404	1767	36	06071	34.164153	-117.2787275	San Bernardino County
230692	Fee-for-Service	1538172143	1538172143	1	1	BEHL, DEEPTI MD	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110167	68	Hematology	0	In state provider	None	1020 29TH STREET	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
230713	Fee-for-Service	1558740241	1558740241	1	1	BRIGHT HEALTH PHYSICIAINS OF	10/2/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PIH	15725 W WHITTIER BLVD	STE 300, 350	WHITTIER	CA	90603	2338	19	06037	33.94435533	-117.9931159	Los Angeles County
230714	Fee-for-Service	1518795764	1518795764	1	1	BUSIASHVILI, ERIC P PT	10/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16573 VENTURA BLVD	5	ENCINO	CA	91436	2022	19	06037	34.1578643	-118.4944187	Los Angeles County
230783	Fee-for-Service	1073634523	1073634523	1	1	BOBAK, SARA M MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116671	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
230791	Fee-for-Service	1033485115	1033485115	1	1	BITAR, ABDALLAH Y MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123971	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
230797	Fee-for-Service	1427096478	1427096478	1	1	BALI, AMBIKA MD	4/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51761	10	Gastroenterology (M.D. only)	0	In state provider	None	1801 W ROMNEYA DR	STE 505	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
230815	Fee-for-Service	1497139661	1497139661	1	1	BUENROSTRO, MARCENA LCSW	7/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
230821	Fee-for-Service	1669619144	1669619144	1	1	BOWLES, ALAN R CRNA	10/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
230830	Fee-for-Service	1578864203	1578864203	1	1	BACH, PATRICIA L PSYD	7/1/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
230832	Fee-for-Service	1144650789	1144650789	1	1	BRIDGES PROFESSIONAL	5/23/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	TREATMENT SERVICES INC	3600 POWER INN RD	SUITES A,B,C	SACRAMENTO	CA	95826	3826	34	06067	38.541726	-121.4096355	Sacramento County
230839	Fee-for-Service	1629276944	1629276944	1	1	BEPPU, ALDO F	8/10/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
230871	Fee-for-Service	1134297260	1134297260	2	1	BAIG & ADMANI A PARTNERSHIP	4/7/2014	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	565 MAIN STREET	None	BRAWLEY	CA	92227	2423	13	06025	32.97865752	-115.532307	Imperial County
230902	Fee-for-Service	1164848701	1164848701	1	1	BAUER, MAYA W MD	11/3/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154007	40	Pediatrics	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
230945	Fee-for-Service	1194261891	1194261891	1	1	BAUTISTA, DAVID LMFT	8/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
230954	Fee-for-Service	1083343156	1083343156	1	1	BRAB, KATHARINA M MD	4/7/2025	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
230956	Fee-for-Service	1558981381	1558981381	1	1	BLESSING COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	3972 N WATERMAN AVENUE	SUITE 104	SAN BERNARDINO	CA	92404	1767	36	06071	34.164153	-117.2787275	San Bernardino County
230979	Fee-for-Service	1538172143	1538172143	1	1	BEHL, DEEPTI MD	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110167	78	Neoplastic Diseases/Oncology	0	In state provider	None	1020 29TH STREET	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
231005	Fee-for-Service	1639194681	1639194681	1	1	BARON, PEDRO W MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50369	02	General Surgery	0	In state provider	None	11234 ANDERSON ST	STE 1405	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
231020	Fee-for-Service	1871662817	1871662817	1	1	BELL, DOUGLAS G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DEACONESS BILLINGS CLN	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
231025	Fee-for-Service	1063660462	1063660462	1	1	BAKER, CARA B MD	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111286	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	SUITE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
231049	Fee-for-Service	1669070397	1669070397	1	1	BELSHIRE PARAISO LLC	1/14/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	17807 BELSHIRE AVE	None	ARTESIA	CA	90701	4234	19	06037	33.86898531	-118.0707755	Los Angeles County
231069	Fee-for-Service	1689945776	1689945776	1	1	BANSAL, ERIC J MD	7/15/2019	390200000X	NA	Other	026	PHYSICIANS	122292	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1701 CESAR E CHAVEZ AVE	SUITE 125	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
231074	Fee-for-Service	1316010556	1316010556	2	1	BARRETT, CHARLES	11/29/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	20767	None	None	0	In state provider	None	505 W OLIVE AVE	STE 210	SUNNYVALE	CA	94086	7621	43	06085	37.37181771	-122.0378399	Santa Clara County
231084	Fee-for-Service	1427096478	1427096478	1	1	BALI, AMBIKA MD	4/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51761	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 505	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
231085	Fee-for-Service	1013909811	1013909811	1	1	BERRY, SHANNON M MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70193	41	Internal Medicine	0	In state provider	None	295 POSADA LN	STE C	TEMPLETON	CA	93465	4055	40	06079	35.55315971	-120.7214435	San Luis Obispo County
231103	Fee-for-Service	1275995953	1275995953	1	1	BAKR, OMAR MD	8/22/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	152366	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
231119	Fee-for-Service	1154682987	1154682987	1	1	BAKERSFIELD COMMUNITY	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	1811 OAK STREET	SUITE 160	BAKERSFIELD	CA	93301	3064	15	06029	35.37534422	-119.0386865	Kern County
231135	Fee-for-Service	1265815880	1265815880	1	1	BALU, VIDYAMOHAN MD	8/2/2019	207R00000X	NA	Other	026	PHYSICIANS	152595	41	Internal Medicine	0	In state provider	None	341 E MAIN ST	STE 100	SAN JACINTO	CA	92583	4205	33	06065	33.78391437	-116.9562698	Riverside County
231140	Fee-for-Service	1740296037	1740296037	1	1	BERKEBILE,MARY S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84605	0000	00	None	40.248072	-111.6673905	Utah County
231145	Fee-for-Service	1134411879	1134411879	1	1	BIRHANIE, MELAKU T MD	9/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122966	None	None	0	In state provider	None	4002 VISTA WY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
231161	Fee-for-Service	1922525542	1922525542	1	1	BENAVIDEZ, JOANNA R PHD	4/25/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3633 CAMINO DEL RIO S	102	SAN DIEGO	CA	92108	4011	37	06073	32.77798059	-117.1163142	San Diego County
231172	Fee-for-Service	1720426786	1720426786	1	1	BOLER, AMBER MD	9/30/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	134627	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	765 MEDICAL CENTER CT	STE 211	CHULA VISTA	CA	91911	6656	37	06073	32.619069	-117.020835	San Diego County
231186	Fee-for-Service	1982879870	1982879870	1	1	BARRON, PENNY S	9/11/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1760 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13015449	-122.2521178	Solano County
231243	Fee-for-Service	1558981381	1558981381	1	1	BLESSING COMMUNITY HEALTH	2/27/2025	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	3972 N WATERMAN AVENUE	SUITE 104	SAN BERNARDINO	CA	92404	1767	36	06071	34.164153	-117.2787275	San Bernardino County
231277	Fee-for-Service	1134184708	1134184708	1	1	BALASUBRAMANIAM, KUMARAVELU	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44716	41	Internal Medicine	0	In state provider	None	2006 N RIVERSIDE AVE	STE B	RIALTO	CA	92377	4697	36	06071	34.13670866	-117.3704994	San Bernardino County
231297	Fee-for-Service	1518963024	1518963024	1	1	BORHAN, ALI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND ST	STE 601	PHOENIX	AZ	85012	2395	00	None	33.486606	-112.071654	Maricopa County
231317	Fee-for-Service	1124058193	1124058193	1	1	BRODY, ALLAN J MD	1/5/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78180	66	Emergency Medicine (Urgent Care)	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
231374	Fee-for-Service	1578751087	1578751087	1	1	BATES, NORMA I CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1900 E 4TH ST	None	SANTA ANA	CA	92705	3910	30	06059	33.74805463	-117.8400671	Orange County
231406	Fee-for-Service	1154682987	1154682987	1	1	BAKERSFIELD COMMUNITY	8/23/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	1811 OAK STREET	SUITE 160	BAKERSFIELD	CA	93301	3064	15	06029	35.37534422	-119.0386865	Kern County
231429	Fee-for-Service	1952781791	1952781791	1	1	BLISS HOME HEALTH CARE INC	9/28/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2520 HONOLULU AVE	SUITE 180	MONTROSE	CA	91020	1853	19	06037	34.20751518	-118.2337088	Los Angeles County
231437	Fee-for-Service	1568070365	1568070365	1	1	BASS, OLIVIA OD	5/26/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
231485	Fee-for-Service	1538659768	1538659768	1	1	BRIDGE HOME HEALTH EAST BAY	11/3/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	3021 CITRUS CIRCLE	STE 270	WALNUT CREEK	CA	94598	2675	07	06013	37.92845517	-122.0144911	Contra Costa County
231489	Fee-for-Service	1457489924	1457489924	1	1	BUTTE COUNTY CCS	10/26/2006	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	OROVILLE MTU	2900 WYANDOTTE AVE	None	OROVILLE	CA	95966	6539	04	06007	39.50049778	-121.5405336	Butte County
231492	Fee-for-Service	1700844248	1700844248	1	1	BIPPART, PETER E MD	12/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88121	09	Gynecology (D.O. only)	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
231502	Fee-for-Service	1720334790	1720334790	1	1	BROWN, ALYSON N LCSW	11/26/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
231530	Fee-for-Service	1558981381	1558981381	1	1	BLESSING COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	3972 N WATERMAN AVENUE	SUITE 104	SAN BERNARDINO	CA	92404	1767	36	06071	34.164153	-117.2787275	San Bernardino County
231534	Fee-for-Service	1770926636	1770926636	1	1	BLOOME, JESSICA MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133732	41	Internal Medicine	0	In state provider	None	995 POTRERO AVENUE	ROOM WD80	SAN FRANCISCO	CA	94110	3518	38	06075	37.75729541	-122.4066641	San Francisco County
231593	Fee-for-Service	1043971641	1043971641	1	1	BROOKS, TAMRA CCC-SLP	2/5/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7550 ALTURA PL	None	OAKLAND	CA	94605	3108	01	06001	37.77604948	-122.1575596	Alameda County
231620	Fee-for-Service	1669886222	1669886222	1	1	BRUSCA, REBECCAH M MD	8/10/2020	208M00000X	NA	Other	026	PHYSICIANS	168526	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
231639	Fee-for-Service	1194827816	1194827816	1	1	BENICH, JONATHAN A	8/25/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1385 TAVERN RD	None	ALPINE	CA	91901	3833	37	06073	32.83576956	-116.7758893	San Diego County
231670	Fee-for-Service	1245295450	1245295450	1	1	BICKLER, PHILIP	2/18/1992	207L00000X	NA	Other	026	PHYSICIANS	64031	05	Anesthesiology	0	In state provider	None	533 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
231692	Fee-for-Service	1811329824	1811329824	1	1	BREWER, KYLE R OD	6/10/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
231712	Fee-for-Service	1356535835	1356535835	1	1	BAKER, PATRICIA L LMFT	5/21/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	124482	-	NOT APPLICABLE	0	In state provider	None	900 LAUREL AVE	None	SAN MATEO	CA	94401	4211	41	06081	37.56069077	-122.3192645	San Mateo County
231731	Fee-for-Service	1811074768	1811074768	1	1	BRANSON, CHERYL L MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69906	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
231764	Fee-for-Service	1790886117	1790886117	1	1	BUTTE COUNTY HLTH DEPT	12/1/1977	251K00000X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	78 TABLE MOUNTAIN BLVD	None	OROVILLE	CA	95965	3578	04	06007	39.52092343	-121.5541342	Butte County
231778	Fee-for-Service	1861712663	1861712663	1	1	BLANCHARD, MALCOLM D MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133200	41	Internal Medicine	0	In state provider	None	818 W ALONDRA BLVD	None	COMPTON	CA	90220	3500	19	06037	33.88834265	-118.2377666	Los Angeles County
231781	Fee-for-Service	1700844248	1700844248	1	1	BIPPART, PETER E MD	12/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88121	15	Obstetrics (D.O. only)	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
231827	Fee-for-Service	1164832069	1164832069	1	1	BHANDARI, VINDEEP DO	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15240	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
231856	Fee-for-Service	1548239882	1548239882	1	1	BROWN, NANCY L CRNA	5/5/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6601 WHITE FEATHER	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
231890	Fee-for-Service	1801546072	1801546072	1	1	BECHT, RYAN M MD	2/20/2025	207P00000X	NA	Other	026	PHYSICIANS	189602	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
231919	Fee-for-Service	1740500115	1740500115	1	1	BECHIS, MARY Z MD	11/13/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	140520	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2600 VIA DE LA VALLE	SUITE 200	DEL MAR	CA	92014	1192	37	06073	32.98053969	-117.2508471	San Diego County
231929	Fee-for-Service	1851760508	1851760508	1	1	BAIK, JONATHAN PT	11/16/2018	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11205 KNOTT AVE	SUITE E	CYPRESS	CA	90630	5489	30	06059	33.8006025	-118.0111199	Orange County
231930	Fee-for-Service	1952629149	1952629149	1	1	BRAVO, THOMAS P MD	1/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135297	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
231967	Fee-for-Service	1013102664	1013102664	1	1	BURANAHIRUN, CATHLIYN E PSYD	6/29/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
231981	Fee-for-Service	1942391339	1942391339	1	1	BLACK, NATALIA M MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51397	41	Internal Medicine	0	In state provider	None	804 HARBOR BLVD	None	WEST SACRAMENTO	CA	95691	2202	57	06113	38.57921959	-121.5490927	Yolo County
231995	Fee-for-Service	1275741167	1275741167	1	1	BHIMJI, ALTAF A LCSW	1/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	518 EL CERRITO	None	EL CERRITO	CA	94530	4006	07	06013	37.89865085	-122.300278	Contra Costa County
232004	Fee-for-Service	1235385246	1235385246	1	1	BAYNE, CHRISTOPHER O MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132653	None	None	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
232018	Fee-for-Service	1659459873	1659459873	1	1	BROWN, STEVEN M MD	10/29/2018	207R00000X	NA	Other	026	PHYSICIANS	49127	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
232025	Fee-for-Service	1073506861	1073506861	2	1	BUI, LAI T MD	3/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	48262	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
232048	Fee-for-Service	1063560969	1063560969	1	1	BATTISTA, LEAH R MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73262	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
232061	Fee-for-Service	1427142587	1427142587	1	1	BUI, VU L MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95416	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
232080	Fee-for-Service	1740280445	1740280445	1	1	BEHAVIORAL HEALTH MED	5/1/1998	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	GRP OF BEVERLY HILLS INC	435 N BEDFORD DR	STE 112	BEVERLY HILLS	CA	90210	4330	19	06037	34.06851281	-118.4056736	Los Angeles County
232093	Fee-for-Service	1407840895	1407840895	1	1	BOSWORTH, JEFFREY A MD	7/1/1993	207R00000X	NA	Other	026	PHYSICIANS	77006	08	Family Practice	0	In state provider	None	3731 SISKIYOU ST	None	REDDING	CA	96001	2959	45	06089	40.56769586	-122.4190178	Shasta County
232102	Fee-for-Service	1629040605	1629040605	1	1	BOMBARD, ALLAN T MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76627	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92193	9001	37	06073	32.7537975	-117.1658298	San Diego County
232110	Fee-for-Service	1568416485	1568416485	2	1	BEBARTA, VIKHYAT S MD	11/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
232133	Fee-for-Service	1407139272	1407139272	1	1	BUDDE, AUDRA L DO	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11421	01	General Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
232148	Fee-for-Service	1336291665	1336291665	1	1	BORTZ, DAVID L MD FACP	7/27/2022	207R00000X	NA	Other	026	PHYSICIANS	45505	None	None	0	In state provider	None	9850 GENESEE AVE	SUITE 570	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
232159	Fee-for-Service	1013969161	1013969161	1	1	BOTWIN, ALLISON J MD	3/30/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	45202	-	NOT APPLICABLE	0	In state provider	None	44-359 PALM ST	None	INDIO	CA	92201	3116	33	06065	33.72380849	-116.227381	Riverside County
232162	Fee-for-Service	1124124953	1124124953	1	1	BIOTAB LLC	5/9/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	11701 BORMAN DR	#107	SAINT LOUIS	MO	63146	4264	00	None	38.69598085	-90.43086629	St. Louis County
232169	Fee-for-Service	1801982889	1801982889	1	1	BOLOGNINI, NICHOLAS DPM	8/31/1982	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
232179	Fee-for-Service	1801546072	1801546072	1	1	BECHT, RYAN M MD	2/20/2025	207P00000X	NA	Other	026	PHYSICIANS	189602	70	Clinic (mixed specialty)	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
232205	Fee-for-Service	1295720613	1295720613	1	1	BANUELOS, ALFONSO F MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	45949	38	Geriatrics	0	In state provider	BLDG H-12	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
232227	Fee-for-Service	1861946451	1861946451	1	1	BRICKER, HEATHER CCC-SLP	9/20/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3518 JEFFERSON AVE	None	REDWOOD CITY	CA	94062	3136	41	06081	37.46715891	-122.2492205	San Mateo County
232235	Fee-for-Service	1033260039	1033260039	1	1	BEAR VALLEY UNIFIED SD	12/18/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	42271 MOONRIDGE RD	None	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24287708	-116.8810938	San Bernardino County
232238	Fee-for-Service	1457763088	1457763088	1	1	BERI, NEIL MD	8/22/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	140127	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
232244	Fee-for-Service	1154746592	1154746592	1	1	BOYD, JEFFREY S LMFT	1/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10832 LAUREL	STE 102	RANCHO CUCAMONGA	CA	91730	3865	36	06071	34.10486789	-117.5684863	San Bernardino County
232264	Fee-for-Service	1184638223	1184638223	1	1	BARTOLOME, THERESA A MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81251	08	Family Practice	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
232267	Fee-for-Service	1174571517	1174571517	1	1	BIBBY, CHARLES K JR MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
232318	Fee-for-Service	1225397086	1225397086	1	1	BURBANK VILLAGE COMPOUNDING	11/9/2012	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	337 E MAGNOLIA BLVD	None	BURBANK	CA	91502	1132	19	06037	34.18477403	-118.3099272	Los Angeles County
232320	Fee-for-Service	1639498488	1639498488	1	1	BAKAL, JAMIE A DPM	7/1/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3800 J ST	SUITE 200	SACRAMENTO	CA	95816	5551	34	06067	38.569869	-121.455729	Sacramento County
232331	Fee-for-Service	1710046388	1710046388	1	1	BLUM, RHODA K MD	12/1/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60250	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
232358	Fee-for-Service	1013084011	1013084011	1	1	BARRON, ARNOLD MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	20459	18	Ophthalmology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
232380	Fee-for-Service	1790281673	1790281673	1	1	BRADLEY, FLORA E MD	11/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174540	None	None	0	In state provider	None	726 N MEDICAL CTR DR E	STE 209	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
232404	Fee-for-Service	1881645794	1881645794	1	1	BESSEN, STEVEN C MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
232421	Fee-for-Service	1104026962	1104026962	1	1	BRASFIELD, ATHENA R OD	9/19/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	52565 HARRISON ST	STE 105	COACHELLA	CA	92236	1534	33	06065	33.71023983	-116.1827622	Riverside County
232450	Fee-for-Service	1558131607	1558131607	1	1	BOZKURT, GEYMI NP	3/5/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95028623	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
232473	Fee-for-Service	1598312852	1598312852	1	1	BEHAN, RENEE LMFT	8/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
232493	Fee-for-Service	1295720613	1295720613	1	1	BANUELOS, ALFONSO F MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	45949	41	Internal Medicine	0	In state provider	BLDG H-12	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
232496	Fee-for-Service	1295982494	1295982494	1	1	BECK, TRISHA J MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105200	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
232509	Fee-for-Service	1528038346	1528038346	1	1	BIELAWSKI, ANTHONY M MD	1/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119182	66	Emergency Medicine (Urgent Care)	0	In state provider	None	41870 GARSTIN ROAD	None	BIG BEAR LAKE	CA	92315	9999	36	06071	34.24602097	-116.8885243	San Bernardino County
232524	Fee-for-Service	1396380770	1396380770	1	1	BRENNAN, SHANDA M LCSW	7/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
232527	Fee-for-Service	1689910010	1689910010	1	1	BRUZAS, JESSICA PSYD	5/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
232535	Fee-for-Service	1952402109	1952402109	1	1	BRYANT, GARFIELD D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85663	02	General Surgery	0	In state provider	None	13847 E 14TH ST	STE 110	SAN LEANDRO	CA	94578	2625	01	06001	37.71457844	-122.1418551	Alameda County
232548	Fee-for-Service	1427256957	1427256957	1	1	BEVERLY HILLS ONCOLOGY MEDIC	8/24/2010	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
232573	Fee-for-Service	1013083120	1013083120	1	1	BOTELLO, ALVARO G NP	2/13/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1022 LONG BEACH BLVD	None	LONG BEACH	CA	90813	4508	19	06037	33.77941497	-118.189231	Los Angeles County
232576	Fee-for-Service	1558456046	1558456046	1	1	BONDELL, JAMES A PHD	11/10/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2477 CONGRESS STREET	None	SAN DIEGO	CA	92110	2820	37	06073	32.75171522	-117.1952311	San Diego County
232615	Fee-for-Service	1952784258	1952784258	1	1	BANTON, CHRISTA A LMFT	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10918 HESPERIA RD	STE B	HESPERIA	CA	92345	2151	36	06071	34.44933232	-117.2964082	San Bernardino County
232630	Fee-for-Service	1922062579	1922062579	1	1	BALOCH, ANWER MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50137	68	Hematology	0	In state provider	None	200 N G ST	None	PORTERVILLE	CA	93257	3410	54	06107	36.06927488	-119.0225379	Tulare County
232647	Fee-for-Service	1578141743	1578141743	1	1	BOWEN, ANNA MD	9/4/2024	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	192103	08	Family Practice	0	In state provider	None	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
232649	Fee-for-Service	1568697159	1568697159	1	1	BUNCHIEN, ARIN	4/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118815	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5593	04	06007	39.75705992	-121.572292	Butte County
232650	Fee-for-Service	1780796581	1780796581	1	1	BIO-MEDICAL APPS OF CA INC	3/2/2010	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	19836 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2678	19	06037	34.17230866	-118.5651601	Los Angeles County
232665	Fee-for-Service	1043494818	1043494818	1	1	BOYTIM, MICHAEL J CRNA	8/30/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
232672	Fee-for-Service	1457537318	1457537318	1	1	BERMAN, COURTNEY S MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101200	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
232712	Fee-for-Service	1447781968	1447781968	1	1	BOCTOR, NOELLE MD	5/5/2020	207R00000X	NA	Other	026	PHYSICIANS	157686	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
232717	Fee-for-Service	1821232356	1821232356	1	1	BRADY, CAROLYN H	5/23/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
232740	Fee-for-Service	1003867565	1003867565	1	6	BARTON HEALTHCARE SYSTEM	9/12/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2170B S AVE	FIRST FLOOR	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	34.55796246	-118.0889836	Los Angeles County
232741	Fee-for-Service	1659660686	1659660686	1	1	BURG, GREGORY	3/17/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
232796	Fee-for-Service	1669679080	1669679080	1	1	BOROUGH, HANS W LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93524	6219	19	06037	34.66467	-118.1567445	Los Angeles County
232801	Fee-for-Service	1275858409	1275858409	1	1	BUI-DUY, MAI-KHANH MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119506	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
232808	Fee-for-Service	1609014489	1609014489	1	1	BACON, WILLIAM R MD	2/2/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173340	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
232816	Fee-for-Service	1255800025	1255800025	1	1	BELL, AMY LMFT INC	6/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 W E STREET	None	ENCINITAS	CA	92024	0027	37	06073	33.04461485	-117.2943356	San Diego County
232837	Fee-for-Service	1326533753	1326533753	1	1	BHATTA, SABITA MD	12/14/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	173377	None	None	0	In state provider	None	401 SCHOOL AVE	None	VISALIA	CA	93291	5032	54	06107	36.332757	-119.288682	Tulare County
232838	Fee-for-Service	1427256957	1427256957	1	1	BEVERLY HILLS ONCOLOGY MEDIC	8/24/2010	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
232845	Fee-for-Service	1467871897	1467871897	1	1	BIVENS, MOLLIE C OT	1/13/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	805 AEROVISTA	101	SAN LUIS OBISPO	CA	93401	7919	40	06079	35.24101691	-120.643055	San Luis Obispo County
232847	Fee-for-Service	1427444769	1427444769	1	1	BAUTISTA, GEOANNA MARIE S MD	6/8/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	155189	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
232868	Fee-for-Service	1902999642	1902999642	1	1	BRICENO, ELMA V LCSW	4/2/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	751 W LEGION RD	STE 201	BRAWLEY	CA	92227	7750	13	06025	32.95996012	-115.5538196	Imperial County
232875	Fee-for-Service	1265703300	1265703300	1	1	BIRNSTEIN, ELLIOTT A MD	10/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122533	10	Gastroenterology (M.D. only)	0	In state provider	None	2403 CASTILLO ST	STE 201	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
232895	Fee-for-Service	1710922141	1710922141	1	1	BEITEL,BRIAN MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65151	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
232909	Fee-for-Service	1003867565	1003867565	1	5	BARTON HEALTHCARE SYSTEM	9/12/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2170B S AVE	FIRST FLOOR	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	34.55796246	-118.0889836	Los Angeles County
232913	Fee-for-Service	1922062579	1922062579	1	1	BALOCH, ANWER MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50137	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 N G ST	None	PORTERVILLE	CA	93257	3410	54	06107	36.06927488	-119.0225379	Tulare County
232925	Fee-for-Service	1174597231	1174597231	1	1	BRAHME, SEVIL K MD	2/28/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50152	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
232955	Fee-for-Service	1396784500	1396784500	2	1	BANSAL, ANUJ MD	11/9/2018	207R00000X	NA	Other	026	PHYSICIANS	148154	41	Internal Medicine	0	In state provider	None	1230 JEFFERSON ST	None	DELANO	CA	93215	2204	15	06029	35.77274103	-119.2450573	Kern County
232963	Fee-for-Service	1063571685	1063571685	1	1	BESHARA, MICHELLE MD	6/30/1995	208600000X	NA	General Surgery	026	PHYSICIANS	79824	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
232986	Fee-for-Service	1487706586	1487706586	1	1	BODYWORKS PHYSIOTHERAPY CLIN	9/13/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	IC	333 N PALM CANYON DR	SUITE # 114	PALM SPRINGS	CA	92262	5658	33	06065	33.827652	-116.5468485	Riverside County
233026	Fee-for-Service	1962580712	1962580712	1	1	BACKER, HOWARD D MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31950	01	General Practice	0	In state provider	None	10024 PINE AVE	None	TRUCKEE	CA	96161	4833	29	06057	39.3259221	-120.2015419	Nevada County
233029	Fee-for-Service	1659660686	1659660686	1	1	BURG, GREGORY	3/17/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
233038	Fee-for-Service	1104812643	1104812643	1	1	BYUN, EUGENE MD	3/6/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82180	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
233041	Fee-for-Service	1700964863	1700964863	1	1	BURNS, THOMAS A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42067	08	Family Practice	0	In state provider	None	PO BOX 547	None	YOSEMITE NTPK	CA	95389	0547	22	06043	0	0	None
233047	Fee-for-Service	1538131222	1538131222	1	1	BELSHER, ROBERT J MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	87108	08	Family Practice	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
233124	Fee-for-Service	1427256957	1427256957	1	1	BEVERLY HILLS ONCOLOGY MEDIC	8/24/2010	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
233128	Fee-for-Service	1669564225	1669564225	1	1	BERKELEY, ROSS P MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
233132	Fee-for-Service	1083659296	1083659296	1	1	BARAYAN, SAHAR S MD	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60604	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
233136	Fee-for-Service	1205927837	1205927837	1	1	BALDWIN, DALTON D MD	10/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75384	02	General Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
233165	Fee-for-Service	1740492230	1740492230	1	1	BISCHOFF, MELISSA N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
233166	Fee-for-Service	1265703300	1265703300	1	1	BIRNSTEIN, ELLIOTT A MD	10/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122533	41	Internal Medicine	0	In state provider	None	2403 CASTILLO ST	STE 201	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
233190	Fee-for-Service	1417330697	1417330697	1	1	BEHAN, CARA LMFT	2/14/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	924 ANACAPA ST	SUITE G	SANTA BARBARA	CA	93101	7107	42	06083	34.42221248	-119.7001388	Santa Barbara County
233211	Fee-for-Service	1134578107	1134578107	1	1	BERRENSON, ERIC C LMFT	12/12/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15650 DEVONSHIRE ST	STE 212	GRANADA HILLS	CA	91344	7245	19	06037	34.2573035	-118.473615	Los Angeles County
233246	Fee-for-Service	1366682742	1366682742	1	1	BAKH, NOEL MD	3/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106758	41	Internal Medicine	0	In state provider	None	38485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9581	33	06065	33.59408721	-117.2367937	Riverside County
233262	Fee-for-Service	1457715443	1457715443	1	1	BODOLAN, ADINA A MD	7/1/2021	207ZP0102X	NA	Other	026	PHYSICIANS	173236	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
233280	Fee-for-Service	1437165354	1437165354	1	1	BLAKE, BOB E MD	6/1/1994	207P00000X	NA	Other	026	PHYSICIANS	31964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
233315	Fee-for-Service	1669565990	1669565990	1	1	BRUMM, VIRDETTE L PHD	3/3/1998	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
233365	Fee-for-Service	1942610118	1942610118	1	1	BENPERLAS, JOSEPH A MD	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144042	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
233387	Fee-for-Service	1245569623	1245569623	1	1	BONHAM, MICHAEL J MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103191	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
233401	Fee-for-Service	1962415224	1962415224	1	1	BERGER, MAINA MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	43473	08	Family Practice	0	In state provider	SUITE 209	7901 SANTA MONICA BLVD	None	LOS ANGELES	CA	90046	5177	19	06037	34.09089561	-118.3615405	Los Angeles County
233424	Fee-for-Service	1205927837	1205927837	1	1	BALDWIN, DALTON D MD	10/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75384	34	Urology and Urological Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
233444	Fee-for-Service	1417280421	1417280421	1	1	BANKS, JAMILA J LMFT	4/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
233451	Fee-for-Service	1326137464	1326137464	1	1	BUDGE, WILLIAM ROGER MD	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	30458	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	165 ROWLAND WAY	STE 201	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
233452	Fee-for-Service	1013076777	1013076777	1	1	BERRY MATTHEW S MD	6/30/1987	207P00000X	NA	Other	026	PHYSICIANS	60766	01	General Practice	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
233476	Fee-for-Service	1427038975	1427038975	1	1	BURMAN, NATALIE J DO	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8117	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
233477	Fee-for-Service	1881641595	1881641595	1	1	BUSTAMANTE, JAVIER MD	7/17/2012	174400000X	NA	Other	026	PHYSICIANS	40966	40	Pediatrics	0	In state provider	None	300 OLD RIVER RD	STE 105	BAKERSFIELD	CA	93311	9506	15	06029	35.352648	-119.1122505	Kern County
233489	Fee-for-Service	1316132442	1316132442	1	1	BOUCHIER, TODD A MD	5/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106595	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3163	50	06099	37.62692973	-121.0131742	Stanislaus County
233506	Fee-for-Service	1215529003	1215529003	1	1	BILSBOROUGH, ELISHA CRNA	3/11/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
233526	Fee-for-Service	1912249004	1912249004	1	1	BUKOWSKI, KYLE C MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133994	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
233546	Fee-for-Service	1972024644	1972024644	1	1	BENAVIDES ORDONEZ, ANDREA D	8/25/2021	207R00000X	NA	Other	026	PHYSICIANS	170365	None	None	0	In state provider	MD	925 S. EUCLID ST.	None	ANAHEIM	CA	92802	1522	30	06059	33.81918207	-117.9415353	Orange County
233566	Fee-for-Service	1457784019	1457784019	1	2	BERNEY, ALLISON R MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126897	40	Pediatrics	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
233587	Fee-for-Service	1982873352	1982873352	1	1	BAHAMAS SURGERY CENTER LLC	9/25/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2400 BAHAMAS DR	STE 100	BAKERSFIELD	CA	93309	0745	15	06029	35.37485948	-119.0454927	Kern County
233606	Fee-for-Service	1972561280	1972561280	1	1	BESSER, EDUARDO MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79263	01	General Practice	0	In state provider	None	6347 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	4101	19	06037	33.9821769	-118.2252706	Los Angeles County
233617	Fee-for-Service	1194143933	1194143933	1	1	BASTIAENS, JESSE A MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137683	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
233631	Fee-for-Service	1710374814	1710374814	1	1	BOKMAN, CHRISTINE L MD	7/2/2019	207WX0200X	NA	Ophthalmology	026	PHYSICIANS	149172	18	Ophthalmology	0	In state provider	None	1513 SOUTH GRAND AVE	STE 200	LOS ANGELES	CA	90015	3021	19	06037	34.03596303	-118.266212	Los Angeles County
233641	Fee-for-Service	1710150867	1710150867	1	1	BROWN MUNOZ, CHRISTIE L MD	4/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108855	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
233689	Fee-for-Service	1962415224	1962415224	1	1	BERGER, MAINA MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	43473	01	General Practice	0	In state provider	SUITE 209	7901 SANTA MONICA BLVD	None	LOS ANGELES	CA	90046	5177	19	06037	34.09089561	-118.3615405	Los Angeles County
233724	Fee-for-Service	1881680171	1881680171	1	1	BARTLETT, WILLIAM H MD	11/5/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	85502	18	Ophthalmology	0	In state provider	None	380 TESCONI CT	None	SANTA ROSA	CA	95401	4653	49	06097	38.447631	-122.7345885	Sonoma County
233739	Fee-for-Service	1679569115	1679569115	2	1	BRIDLE HOME LLC	11/26/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3336 BRIDLE DR	None	HAYWARD	CA	94541	5706	01	06001	37.67026144	-122.0444668	Alameda County
233756	Fee-for-Service	1851450423	1851450423	1	1	BEESON, CHARLES C MD	8/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70706	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
233779	Fee-for-Service	1295189181	1295189181	1	1	BADASHOVA, KSENYA K MD	5/3/2022	207P00000X	NA	Other	026	PHYSICIANS	173626	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
233813	Fee-for-Service	1932153970	1932153970	1	1	BAZAK, ILAN DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1121 N FAIRFAX AVE	None	LOS ANGELES	CA	90046	5306	19	06037	34.091451	-118.3615195	Los Angeles County
233829	Fee-for-Service	1548091077	1548091077	1	1	BEE HAVEN PSYCHOLOGICAL & BE	11/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HAVIORAL HEALTH WELLNESS	12140 ARTESIA BLVD	STE 111	ARTESIA	CA	90701	4054	19	06037	33.87301048	-118.073313	Los Angeles County
233881	Fee-for-Service	1114996345	1114996345	1	1	BAKERSFIELD PATHOLOGY	6/1/2002	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	MEDICAL GROUP	2615 EYE ST	None	BAKERSFIELD	CA	93301	1900	15	06029	35.38291587	-119.0199632	Kern County
233893	Fee-for-Service	1235662255	1235662255	1	1	BAKHAJ, KIARASH DPM	9/10/2021	390200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1711 W TEMPLE ST	3306	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
233896	Fee-for-Service	1609571470	1609571470	1	1	BRIZENDINE, MORGAN LMFT	9/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 PASEO CAMARILLO	155	CAMARILLO	CA	93010	6050	56	06111	34.22097448	-119.054079	Ventura County
233899	Fee-for-Service	1548615909	1548615909	1	1	BIALCZAK, RADOSLAW MD	6/1/2018	207P00000X	NA	Other	026	PHYSICIANS	144105	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
233907	Fee-for-Service	1265464721	1265464721	1	1	BLASBERG, DENNIS J MD	6/30/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	31966	30	Radiology	0	In state provider	None	709 18TH ST	None	MODESTO	CA	95354	1210	50	06099	37.64364413	-120.9896383	Stanislaus County
233918	Fee-for-Service	1477655769	1477655769	1	1	BURINGRUD, CHERYL PT	11/15/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
233925	Fee-for-Service	1568859205	1568859205	1	1	BANDARU, RAJAVARDHAN MD	1/21/2019	207R00000X	NA	Other	026	PHYSICIANS	154314	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
233933	Fee-for-Service	1720051493	1720051493	1	1	BEJAR, RAFAEL MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121394	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
233973	Fee-for-Service	1780405647	1780405647	1	1	BARDINI, AMBER BIRTH DOULA	1/9/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
233989	Fee-for-Service	1962426510	1962426510	1	1	BELANOFF, JEFFREY R MD	5/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69781	08	Family Practice	0	In state provider	None	128 S HICKORY ST	None	ESCONDIDO	CA	92025	3354	37	06073	33.12361045	-117.0753881	San Diego County
234022	Fee-for-Service	1366492498	1366492498	1	1	BURNISON, CHRISTIANE MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48425	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	STE C2000	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
234028	Fee-for-Service	1871728691	1871728691	1	1	BHATIA, SHAILAJA S MD	5/17/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155250	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
234046	Fee-for-Service	1972704385	1972704385	1	1	BARCZAK, JEFFREY T DO	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	12066	05	Anesthesiology	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
234047	Fee-for-Service	1548229297	1548229297	1	2	BREISCH, STUART T MD	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88386	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
234052	Fee-for-Service	1770735326	1770735326	1	1	BAUER, KEVIN D MD	9/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110953	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
234069	Fee-for-Service	1730765447	1730765447	1	1	BAKER, HANAN A MD	5/3/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
234072	Fee-for-Service	1972631786	1972631786	1	1	BUSTILLO, GERARDO MD	2/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51357	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
234087	Fee-for-Service	1871739979	1871739979	1	1	BOTROS, ARMEA MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	111709	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVENUE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
234115	Fee-for-Service	1285183269	1285183269	1	1	BABAKHANIANS, ARTHUR	3/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145193	None	None	0	In state provider	None	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
234120	Fee-for-Service	1700027372	1700027372	1	1	BEHAR, CHEYENNE R NP	12/14/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
234156	Fee-for-Service	1467626663	1467626663	1	1	BARNES, SUSAN C NP	3/22/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	536445	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
234165	Fee-for-Service	1801999404	1801999404	1	1	BUTTAN, VINAY K MD INC	9/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	33656	41	Internal Medicine	0	In state provider	None	166 N VILLA ST	None	PORTERVILLE	CA	93257	3218	54	06107	36.06885992	-119.0306664	Tulare County
234222	Fee-for-Service	1720051493	1720051493	1	1	BEJAR, RAFAEL MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121394	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
234225	Fee-for-Service	1609348002	1609348002	1	1	BARTLETT, BRENT A PT	10/14/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1935 W AVENUE L	None	LANCASTER	CA	93534	8827	19	06037	34.66045164	-118.1643147	Los Angeles County
234230	Fee-for-Service	1104879436	1104879436	1	1	BARATZ, DAVID M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
234261	Fee-for-Service	1891766333	1891766333	2	1	BARBER, MARCUS A MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	49156	40	Pediatrics	0	In state provider	None	16465 SIERRA LAKES PKWY	STE 275	FONTANA	CA	92336	1263	36	06071	34.13805177	-117.4457839	San Bernardino County
234306	Fee-for-Service	1710191325	1710191325	1	1	BYRNE, NICHOLAS P MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	86857	90	Pathology-Forensic	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
234309	Fee-for-Service	1366492498	1366492498	1	1	BURNISON, CHRISTIANE MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48425	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	STE C2000	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
234340	Fee-for-Service	1447362462	1447362462	1	1	BRAHAM, ARLENE F MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66379	08	Family Practice	0	In state provider	None	14075 HESPERIA RD	STE 201-203	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
234342	Fee-for-Service	1265820088	1265820088	1	1	BUENVIAJE, DONALDSON A PT	4/22/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
234391	Fee-for-Service	1154423648	1154423648	1	1	BLACKWOOD, ROBERT S MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
234406	Fee-for-Service	1659362408	1659362408	1	1	BENJAMIN FREDRIC MARTIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BERKELEY ST	None	UNIONTOWN	PA	15401	5514	00	None	39.9022144	-79.73784796	Fayette County
234424	Fee-for-Service	1780843185	1780843185	1	1	BERTONI, DANIELLE M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105375	02	General Surgery	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
234425	Fee-for-Service	1760559462	1760559462	1	4	BAY AREA PEDIATRIC	4/28/1998	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	29 BAYWOOD AVE	STE 1	SAN MATEO	CA	94402	1516	41	06081	37.56478204	-122.3289243	San Mateo County
234430	Fee-for-Service	1821550609	1821550609	1	1	BYRNE, STEPHANIE R MD	7/9/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177273	None	None	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
234436	Fee-for-Service	1609861558	1609861558	1	1	BOSWELL, PAMELA D DO	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	6606	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
234445	Fee-for-Service	1609859321	1609859321	1	1	BARKIN, ROGER M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
234528	Fee-for-Service	1760097935	1760097935	1	1	BRIGHT FUTURE HOME CARE	7/1/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	6735 VAN NUYS BLVD	STE 303	VAN NUYS	CA	91405	4645	19	06037	34.193133	-118.4487775	Los Angeles County
234531	Fee-for-Service	1669700753	1669700753	1	1	BENCH, SHAWN R MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108975	02	General Surgery	0	In state provider	None	7910 FROST STREET	SUITE 450	SAN DIEGO	CA	92123	2765	37	06073	32.80027449	-117.153846	San Diego County
234541	Fee-for-Service	1245360130	1245360130	1	1	BEHAVIORAL HEALTH SERVICES	11/3/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	2501 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3317	19	06037	33.91648148	-118.3206645	Los Angeles County
234569	Fee-for-Service	1528107521	1528107521	1	1	BARROW, VICTORIA L MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	63629	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
234575	Fee-for-Service	1164442620	1164442620	1	1	BRAKIN, MARIO I MD	9/22/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
234591	Fee-for-Service	1780764472	1780764472	1	1	BROOKS, LAWRENCE R MD	1/31/1990	207R00000X	NA	Other	026	PHYSICIANS	57144	41	Internal Medicine	0	In state provider	None	1136 W 6TH ST	None	LOS ANGELES	CA	90017	1805	19	06037	34.05460669	-118.2635005	Los Angeles County
234605	Fee-for-Service	1306956461	1306956461	1	1	BOYCHUK, RODNEY B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
234611	Fee-for-Service	1790473064	1790473064	1	1	BANNING SNF HEALTHCARE LLC	6/15/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3476 W WILSON ST	None	BANNING	CA	92220	3420	33	06065	33.93247151	-116.914941	Riverside County
234618	Fee-for-Service	1831120146	1831120146	1	1	BOAZ, TRAVIS MD	6/18/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
234645	Fee-for-Service	1902150931	1902150931	1	1	BAILEY, ALEXANDER J MD	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142948	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
234650	Fee-for-Service	1619924032	1619924032	1	1	BENZIAN, STEPHEN R MD	3/31/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22463	30	Radiology	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
234679	Fee-for-Service	1790886117	1790886117	1	2	BUTTE COUNTY HLTH DEPT	7/27/2009	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	OF PUBLIC HEALTH CLINICS	695 OLEANDER AVE	None	CHICO	CA	95926	3924	04	06007	39.73502442	-121.841522	Butte County
234764	Fee-for-Service	1124550470	1124550470	1	1	BRUNO, WILLIAM J MD	9/9/2020	207P00000X	NA	Other	026	PHYSICIANS	158372	None	None	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3219	19	06037	34.09906108	-117.8343639	Los Angeles County
234792	Fee-for-Service	1417981267	1417981267	1	1	BAZMI, ALALEH MD	12/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83355	41	Internal Medicine	0	In state provider	None	2201 MOUNT VERNON AVE	STE 211	BAKERSFIELD	CA	93306	3312	15	06029	35.38781796	-118.9673567	Kern County
234797	Fee-for-Service	1578911145	1578911145	1	2	BAART BEHAVIORAL HEALTH SERV	7/1/2017	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	89 EAST MILL AVE	None	PORTERVILLE	CA	93257	3808	54	06107	36.06877628	-119.014426	Tulare County
234821	Fee-for-Service	1780070649	1780070649	1	1	BARSEGIAN, ARPINE MD	5/6/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161632	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
234822	Fee-for-Service	1356817886	1356817886	1	1	BICYCLE HEALTH PROVIDER GROU	11/4/2023	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	P INC.	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
234838	Fee-for-Service	1437156221	1437156221	1	1	BETHUNE, DAVID SCOTT	9/10/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	50004	None	None	0	In state provider	None	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97165921	-121.2895813	San Joaquin County
234863	Fee-for-Service	1164442620	1164442620	1	1	BRAKIN, MARIO I MD	9/22/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
234865	Fee-for-Service	1285954941	1285954941	1	1	BABAN, KANDAN F DO	2/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	10598	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
234878	Fee-for-Service	1952573388	1952573388	1	1	BUI, YEN K MD	4/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102797	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
234879	Fee-for-Service	1437564051	1437564051	2	1	BOHANON, ERRIE D LCSW	1/15/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	131 HUNTINGTON DR	None	VACAVILLE	CA	95687	5009	48	06095	38.34704248	-121.9553452	Solano County
234880	Fee-for-Service	1912393224	1912393224	1	1	BACA, AMY MD	7/25/2018	390200000X	NA	Other	026	PHYSICIANS	146447	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
234908	Fee-for-Service	1336533256	1336533256	1	1	BUCKLE, GEOFFREY C MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146446	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
234938	Fee-for-Service	1720104227	1720104227	1	1	BABAK KOSARI, DPM INC.	8/29/2003	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	17075 DEVONSHIRE ST	304	NORTHRIDGE	CA	91325	1600	19	06037	34.25755945	-118.50471	Los Angeles County
235013	Fee-for-Service	1477808285	1477808285	1	1	BOEDER, SCHAFER C MD	6/16/2017	207RE0101X	NA	Endocrinology	026	PHYSICIANS	129134	67	Endocrinology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
235045	Fee-for-Service	1932135886	1932135886	1	1	BERRY, DAVID L MD	8/31/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33887	30	Radiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
235052	Fee-for-Service	1134199847	1134199847	1	1	BECK, STEVEN P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE,	SUITE 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
235054	Fee-for-Service	1841751518	1841751518	1	1	BHATTI, ARMAN S MD	3/4/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	184706	36	Psychiatry	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 401	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
235063	Fee-for-Service	1730420845	1730420845	1	2	BOND, NICHOLAUS H LMFT	7/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
235064	Fee-for-Service	1548250772	1548250772	1	1	BARLOW, ERIC R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 PLEASANT ST	None	DES MOINES	IA	50309	1406	00	None	41.58886035	-93.63191864	Polk County
235083	Fee-for-Service	1639158744	1639158744	1	1	BENJAMIN THOMPSON	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 MAHALANI ST	None	WAILUKU	HI	96793	2526	00	None	20.88554026	-156.4902142	Maui County
235090	Fee-for-Service	1245262104	1245262104	2	1	BRAVO, FERNANDO B	5/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72360	41	Internal Medicine	0	In state provider	None	2619 F ST	None	BAKERSFIELD	CA	93301	1815	15	06029	35.38353323	-119.0235023	Kern County
235111	Fee-for-Service	1356817886	1356817886	1	1	BICYCLE HEALTH PROVIDER GROU	7/3/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P INC.	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
235131	Fee-for-Service	1033772546	1033772546	1	1	BAILEY, JOSIANNE MD	7/6/2022	207R00000X	NA	Other	026	PHYSICIANS	180134	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
235134	Fee-for-Service	1457892622	1457892622	1	1	BASSI, MANPREET MD	9/26/2023	207P00000X	NA	Other	026	PHYSICIANS	182651	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
235156	Fee-for-Service	1376789131	1376789131	1	1	BARNES, LAUREN A MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105852	41	Internal Medicine	0	In state provider	None	450 E SPRING ST	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
235220	Fee-for-Service	1679056493	1679056493	1	1	BEAUMIER, CATHERINE K. MD	9/27/2018	2086S0120X	NA	General Surgery	026	PHYSICIANS	155930	85	Surgery-Pediatric	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
235224	Fee-for-Service	1164768511	1164768511	1	1	BRIGHT SKY HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	502 CAJON ST	STE A	REDLANDS	CA	92373	8715	36	06071	34.04873385	-117.1775922	San Bernardino County
235229	Fee-for-Service	1124265632	1124265632	1	1	BRIDWELL, EMILY LCSW	4/24/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
235233	Fee-for-Service	1487725446	1487725446	1	1	BHAGAT, RAJESH MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33008	26	Psychiatry (child)	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
235273	Fee-for-Service	1396487070	1396487070	1	1	BLISSFUL CANYON HOMECARE LLC	5/26/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1770 CENTURY AVE	None	RIVERSIDE	CA	92506	3755	33	06065	33.93651755	-117.3506698	Riverside County
235275	Fee-for-Service	1457348872	1457348872	1	1	BAUMAN, PHILIP O MD	5/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77400	40	Pediatrics	0	In state provider	None	4120 PRESCOTT RD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
235289	Fee-for-Service	1942281712	1942281712	1	1	BEAL, SHANNON H MD	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97355	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
235305	Fee-for-Service	1558352948	1558352948	1	1	BERTAGNOLLI, REONO MD	4/14/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	106069	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
235330	Fee-for-Service	1972139848	1972139848	1	1	BROOKHART, CAROLYN MD	10/16/2023	390200000X	NA	Other	026	PHYSICIANS	183672	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
235335	Fee-for-Service	1336285568	1336285568	1	1	BRUGNANO, JACLIN G LMFT	8/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	578 RIO LINDO AVE	STE 3	CHICO	CA	95926	1800	04	06007	39.75476878	-121.8485796	Butte County
235365	Fee-for-Service	1265756860	1265756860	1	1	BADDAY, EWA I MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130454	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
235395	Fee-for-Service	1023043916	1023043916	1	1	BROOKS, CATHERINE	6/1/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
235398	Fee-for-Service	1356817886	1356817886	1	1	BICYCLE HEALTH PROVIDER GROU	2/19/2025	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P INC.	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
235413	Fee-for-Service	1306817317	1306817317	1	1	BRION, SONJA K MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68705	40	Pediatrics	0	In state provider	None	285 N EL CAMINO REAL	STE 114	ENCINITAS	CA	92024	5384	37	06073	33.05317488	-117.2611779	San Diego County
235423	Fee-for-Service	1356589634	1356589634	1	1	BLANCHE, CARLOS MD A MEDICAL	4/13/2015	174400000X	NA	Other	026	PHYSICIANS	39859	33	Thoracic Surgery	0	In state provider	CORPORATION	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
235429	Fee-for-Service	1255835799	1255835799	1	1	BOSE, RUPAN MD	7/2/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	164222	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235438	Fee-for-Service	1386756864	1386756864	1	1	BEAR, THOMAS F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	437 PORTAGE TRL	None	CUYAHOGA FLS	OH	44221	3227	00	None	41.13778356	-81.48889898	Summit County
235447	Fee-for-Service	1376789131	1376789131	1	1	BARNES, LAUREN A MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105852	08	Family Practice	0	In state provider	None	450 E SPRING ST	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
235450	Fee-for-Service	1932616315	1932616315	1	1	BACHNER, MICHAEL B PT	10/16/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 S MERCEY SPRINGS RD	STE I	LOS BANOS	CA	93635	4928	24	06047	37.054854	-120.835392	Merced County
235455	Fee-for-Service	1568563591	1568563591	1	1	BRUCE A DANIEL, MD	4/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	150 W 100 N	None	VERNAL	UT	84078	2036	00	None	40.45713947	-109.531368	Uintah County
235488	Fee-for-Service	1881817112	1881817112	1	1	BERKOWITZ, BERNICE LMFT	3/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
235511	Fee-for-Service	1164768511	1164768511	1	1	BRIGHT SKY HOSPICE CARE INC	11/25/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	502 CAJON ST	STE A	REDLANDS	CA	92373	8715	36	06071	34.04873385	-117.1775922	San Bernardino County
235519	Fee-for-Service	1467836221	1467836221	1	1	BERNHARDT, TRACI M	11/21/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
235522	Fee-for-Service	1598082711	1598082711	1	1	BARNHARD, SARAH E MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119834	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
235532	Fee-for-Service	1356587711	1356587711	1	1	BOORA, KAMALJEET MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102646	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	SUITE 160	SACRAMENTO	CA	95834	2309	34	06067	38.647737	-121.510467	Sacramento County
235534	Fee-for-Service	1770803983	1770803983	1	1	BALAKRISHNAN, SUDHEER MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142797	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
235561	Fee-for-Service	1275876294	1275876294	1	1	BOTELLO, ZAIDA M MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135801	01	General Practice	0	In state provider	None	678 3RD AVE	None	CHULA VISTA	CA	91910	5736	37	06073	32.62870793	-117.0750108	San Diego County
235579	Fee-for-Service	1255302766	1255302766	1	1	BULLHEAD CITY HOSP CORP	7/1/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	WESTERN ARIZONA REG MED	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
235591	Fee-for-Service	1184069155	1184069155	1	1	BECK, STEVEN J MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129333	01	General Practice	0	In state provider	None	2 WEST FERN	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
235601	Fee-for-Service	1649003773	1649003773	1	1	BLANKE, BROOKE CCC-SLP	9/5/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
235607	Fee-for-Service	1588830863	1588830863	1	1	BORENSTEIN, PENNY E MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	88337	01	General Practice	0	In state provider	None	2191 JOHNSON AVENUE	None	SAN LUIS OBISPO	CA	93401	4534	40	06079	35.27456614	-120.6466115	San Luis Obispo County
235611	Fee-for-Service	1083276273	1083276273	1	1	BINAVI, HOWNAZ Z NP	2/24/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
235635	Fee-for-Service	1235798919	1235798919	1	1	BRENT R DRISKILL MD INC	10/4/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	4033 3RD AVE STE 104	None	SAN DIEGO	CA	92103	2136	37	06073	32.75053781	-117.1627168	San Diego County
235654	Fee-for-Service	1346260627	1346260627	1	1	BROOKS-KAYAL, AMY R MD	2/1/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	170839	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
235659	Fee-for-Service	1437207388	1437207388	1	1	BRAGG, ROBERT J	10/18/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
235685	Fee-for-Service	1356817886	1356817886	1	1	BICYCLE HEALTH PROVIDER GROU	7/19/2023	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	P INC.	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
235692	Fee-for-Service	1477523710	1477523710	1	1	BLAIR, DONALD R. MD	10/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
235693	Fee-for-Service	1164051819	1164051819	1	1	BOATENG, EMMANUEL MD	8/15/2023	207R00000X	NA	Other	026	PHYSICIANS	188541	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
235701	Fee-for-Service	1053832923	1053832923	1	1	BRAS AND HONEY LINGERIE	8/2/2019	193400000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	LIMITED	4242 CAMINO DEL RIO N	STE 9	SAN DIEGO	CA	92108	2612	37	06073	32.77939608	-117.1042096	San Diego County
235716	Fee-for-Service	1255835799	1255835799	1	1	BOSE, RUPAN MD	7/2/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	164222	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235726	Fee-for-Service	1548223480	1548223480	1	1	BAISAC, JOSEPHINE R MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51148	45	Nephrology (Renal-Kidney)	0	In state provider	None	1315 10TH ST	STE 200	MODESTO	CA	95354	0721	50	06099	37.64387411	-121.0043926	Stanislaus County
235729	Fee-for-Service	1871871681	1871871681	1	1	BAJWA, TANVEER S MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129058	41	Internal Medicine	0	In state provider	None	525 WEST ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
235753	Fee-for-Service	1336169408	1336169408	1	1	BORGER, SIMON P LCSW	12/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
235773	Fee-for-Service	1477260545	1477260545	1	1	BYERS, ATIJA CD	5/5/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
235801	Fee-for-Service	1730167073	1730167073	1	1	BARAGA,JOSEPH J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	69 WEST EXCHANGE STREET	None	ST PAUL	MN	55102	0000	00	None	44.94809812	-93.09980256	Ramsey County
235813	Fee-for-Service	1518077726	1518077726	1	1	BLUMENFELD, YAIR J MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94480	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235867	Fee-for-Service	1255302766	1255302766	1	1	BULLHEAD CITY HOSP CORP	7/1/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	WESTERN ARIZONA REG MED	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
235883	Fee-for-Service	1548463383	1548463383	1	1	BURNS, HEATHER L LCSW	9/3/2010	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	501 KEARNEY STREET	None	EL CERRITO	CA	94530	3327	07	06013	37.90264358	-122.3024948	Contra Costa County
235895	Fee-for-Service	1588830863	1588830863	1	1	BORENSTEIN, PENNY E MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	88337	40	Pediatrics	0	In state provider	None	2191 JOHNSON AVENUE	None	SAN LUIS OBISPO	CA	93401	4534	40	06079	35.27456614	-120.6466115	San Luis Obispo County
235920	Fee-for-Service	1083137251	1083137251	1	1	BONATO, ALEXANDER E MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	500 SW RAMSEY	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
235932	Fee-for-Service	1881140846	1881140846	1	1	BROWN, KAREN D CNM	7/1/2017	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1224 E WARDLOW ROAD	None	LONG BEACH	CA	92881	7262	19	06037	33.8189015	-118.1756925	Los Angeles County
235938	Fee-for-Service	1447334412	1447334412	1	1	BEERS, ROSEANNE MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	58255	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
235958	Fee-for-Service	1760632947	1760632947	1	1	BAGHERI, ALI MD	2/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	123272	20	Orthopedic Surgery	0	In state provider	None	9333 GENESEE AVE	STE 350	SAN DIEGO	CA	92121	2103	37	06073	32.875668	-117.2139225	San Diego County
235973	Fee-for-Service	1134157308	1134157308	1	1	BEART, ROBERT W MD	3/29/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76196	01	General Practice	0	In state provider	None	1441 EASTLAKE AVE	STE 7418	LOS ANGELES	CA	90089	0178	19	06037	34.06169385	-118.2044698	Los Angeles County
235983	Fee-for-Service	1710415435	1710415435	1	1	BAILEY, MARIEL MD	8/25/2024	207R00000X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
235984	Fee-for-Service	1225310071	1225310071	1	1	BARAKOS, JOHN A JR LMFT	6/10/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 HARRISON STREET	None	OAKLAND	CA	94612	3811	01	06001	37.81349235	-122.2609539	Alameda County
235993	Fee-for-Service	1083069850	1083069850	1	1	BRIDGE VISION LICENSED CLINI	9/30/2018	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER INC.	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
235995	Fee-for-Service	1184168650	1184168650	1	1	BLISSFUL HOME HEALTH	6/23/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	18645 SHERMAN WAY	SUITE 205	RESEDA	CA	91335	8618	19	06037	34.20120553	-118.54026	Los Angeles County
236005	Fee-for-Service	1275576993	1275576993	1	1	BARNES, DAVID K MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88383	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
236018	Fee-for-Service	1669520516	1669520516	1	1	BARCHILON, JOHN MD	1/16/2008	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	49727	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
236019	Fee-for-Service	1164258778	1164258778	1	1	BERGER, VERONICA LCSW	10/8/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
236030	Fee-for-Service	1104064872	1104064872	1	1	BOLA, PARVINDER K MD	9/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114734	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 HOSPITAL DRIVE	SUITE 220	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
236069	Fee-for-Service	1902441371	1902441371	1	1	BLUE CROSS HOSPICE	10/13/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	STE 305	NORTH HOLLYWOOD	CA	91602	1875	19	06037	34.15389329	-118.3679999	Los Angeles County
236078	Fee-for-Service	1780434068	1780434068	1	1	BALASURIYA ARACHCHI, DULSHAN	5/17/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	I	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
236079	Fee-for-Service	1295020089	1295020089	1	1	BARNHILL, JOSHUA C MD	8/24/2022	207L00000X	NA	Other	026	PHYSICIANS	171227	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
236082	Fee-for-Service	1598836892	1598836892	1	2	BEST HEALTH CARE	4/18/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP INC	3392 MOTOR AVE	None	LOS ANGELES	CA	90034	3712	19	06037	34.02780514	-118.4095758	Los Angeles County
236095	Fee-for-Service	1770147464	1770147464	1	1	BHAKTA, HARSHAL MD	7/21/2023	207L00000X	NA	Other	026	PHYSICIANS	179573	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
236102	Fee-for-Service	1336178573	1336178573	1	1	BEN-AVI, LUCINDA	10/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42573	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
236104	Fee-for-Service	1376295527	1376295527	1	1	BUI, JACQUELINE CNP	3/25/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19121 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2307	30	06059	33.685155	-117.988868	Orange County
236109	Fee-for-Service	1043286040	1043286040	1	1	BRITT, MICHELLE T MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74497	18	Ophthalmology	0	In state provider	None	12550B AMARGOSA RD	None	VICTORVILLE	CA	92392	5476	36	06071	34.4784513	-117.3404727	San Bernardino County
236124	Fee-for-Service	1568652139	1568652139	1	1	BAKER, GAIL LMFT	8/19/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
236133	Fee-for-Service	1942393400	1942393400	1	1	BIELMAN, MYLINDA L DO	8/24/2006	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	7688	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25405 HANCOCK AVE	STE 108	MURRIETA	CA	92562	5982	33	06065	33.5580833	-117.1850127	Riverside County
236152	Fee-for-Service	1629277249	1629277249	1	1	BERNSTEIN, PETER S MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
236169	Fee-for-Service	1619326188	1619326188	1	1	BALLSTAEDT, LEVI T DO	8/4/2020	207P00000X	NA	Other	026	PHYSICIANS	18417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	4685	55	06109	37.97749352	-120.3700335	Tuolumne County
236181	Fee-for-Service	1487180832	1487180832	1	1	BARSUKOVA, YULIYA MD	9/1/2020	208M00000X	NA	Other	026	PHYSICIANS	164110	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
236200	Fee-for-Service	1922008598	1922008598	1	1	BAO, GANG MD	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83170	41	Internal Medicine	0	In state provider	None	5555 RESERVOIR DR	STE 201	SAN DIEGO	CA	92120	5191	37	06073	32.77628471	-117.0563688	San Diego County
236231	Fee-for-Service	1841479144	1841479144	1	1	BARBRE, TEENA H LMFT	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	42336	-	NOT APPLICABLE	0	In state provider	None	1200 N MAIN ST	STE 100B, 301, 500	SANTA ANA	CA	92701	3630	30	06059	33.755175	-117.8676195	Orange County
236233	Fee-for-Service	1801112172	1801112172	1	1	BAUMGARTEN, MORRIS MD INC	1/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43156	20	Orthopedic Surgery	0	In state provider	None	931 BUENA VISTA STREET	SUITE 505	DUARTE	CA	91010	1727	19	06037	34.141635	-117.9775755	Los Angeles County
236234	Fee-for-Service	1710930052	1710930052	1	1	BERNHARD, GERSON C MD	2/8/2015	207RR0500X	NA	Other	026	PHYSICIANS	3717	83	Rheumatology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
236246	Fee-for-Service	1649614827	1649614827	1	1	BALL-ZONDERVAN, MONICA J MD	2/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	133126	08	Family Practice	0	In state provider	None	27800 MEDICAL CENTER RD	STE 461	MISSION VIEJO	CA	92691	6424	30	06059	33.55952733	-117.6645199	Orange County
236261	Fee-for-Service	1134157308	1134157308	1	1	BEART, ROBERT W MD	3/29/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76196	28	Proctology (colon and rectal)	0	In state provider	None	1441 EASTLAKE AVE	STE 7418	LOS ANGELES	CA	90089	0178	19	06037	34.06169385	-118.2044698	Los Angeles County
236264	Fee-for-Service	1083069850	1083069850	1	1	BRIDGE VISION LICENSED CLINI	1/16/2022	251S00000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER INC.	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
236266	Fee-for-Service	1851362875	1851362875	1	1	BARATTA, ISABEL M MD	12/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52701	40	Pediatrics	0	In state provider	None	685 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.62788873	-117.0746104	San Diego County
236275	Fee-for-Service	1255481057	1255481057	1	1	BABER, SALMA A MD	10/17/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	45380	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2323 16TH ST	STE 305	BAKERSFIELD	CA	93301	3453	15	06029	35.37238027	-119.0288508	Kern County
236296	Fee-for-Service	1750345112	1750345112	1	1	BROWN, DOUGLAS E MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	36005	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9844 GENESEE AVE	STE 400	LA JOLLA	CA	92037	1209	37	06073	32.883714	-117.2266425	San Diego County
236313	Fee-for-Service	1023194560	1023194560	1	1	BURROWS, TERENCE J CRNA	10/4/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
236337	Fee-for-Service	1932972510	1932972510	1	1	BOBADILLA, SOPHIA PT	11/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	224 N RIVERSIDE AVE	SUITE A	RIALTO	CA	92376	5968	36	06071	34.10345211	-117.3705328	San Bernardino County
236347	Fee-for-Service	1750487823	1750487823	1	1	BRADLEY HISER	3/8/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	705 QUAIL CREEK DR	None	AMARILLO	TX	79124	1608	00	None	35.2098974	-101.9110914	Potter County
236357	Fee-for-Service	1902441371	1902441371	1	1	BLUE CROSS HOSPICE	10/13/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	STE 305	NORTH HOLLYWOOD	CA	91602	1875	19	06037	34.15389329	-118.3679999	Los Angeles County
236368	Fee-for-Service	1598836892	1598836892	1	2	BEST HEALTH CARE	4/18/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	MEDICAL GROUP INC	3392 MOTOR AVE	None	LOS ANGELES	CA	90034	3712	19	06037	34.02780514	-118.4095758	Los Angeles County
236378	Fee-for-Service	1336130988	1336130988	1	1	BENSON, DANIEL R MD	7/4/1971	No Taxonomy Provided	NA	None	026	PHYSICIANS	17561	None	None	0	In state provider	None	223 FARGO WAY	None	FOLSOM	CA	95630	2961	34	06067	38.681244	-121.158918	Sacramento County
236392	Fee-for-Service	1457541369	1457541369	1	1	BURNIKEL, DAVID J MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138043	None	None	0	In state provider	None	5555 RESERVOIR DRIVE	SUITE 104	SAN DIEGO	CA	92120	5198	37	06073	32.77628471	-117.0563688	San Diego County
236445	Fee-for-Service	1922384239	1922384239	1	1	BHARADWA, KIRAN MD	1/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131540	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
236462	Fee-for-Service	1235576794	1235576794	1	1	BENNETT, TYRA LMFT	8/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
236473	Fee-for-Service	1699472183	1699472183	1	1	BRAINIAC MEDICAL CORPORATION	5/2/2023	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1007 E COOLEY DR	STE 111	COLTON	CA	92324	3901	36	06071	34.05461152	-117.310599	San Bernardino County
236490	Fee-for-Service	1922008598	1922008598	1	1	BAO, GANG MD	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83170	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5555 RESERVOIR DR	STE 201	SAN DIEGO	CA	92120	5191	37	06073	32.77628471	-117.0563688	San Diego County
236499	Fee-for-Service	1407484173	1407484173	1	1	BOTEJUE, MAHESH MD	10/5/2022	390200000X	NA	Other	026	PHYSICIANS	178150	None	None	0	In state provider	None	19929 GREENLEY RD	None	SONORA	CA	95370	5996	55	06109	37.9837971	-120.366851	Tuolumne County
236520	Fee-for-Service	1447602446	1447602446	1	1	BHATTACHARYA, SREYASI MD	8/21/2019	207R00000X	NA	Other	026	PHYSICIANS	160177	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
236527	Fee-for-Service	1831120450	1831120450	1	1	BHARAT KHANDHERIA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S COULTER ST	None	AMARILLO	TX	79106	1786	00	None	35.200422	-101.924559	Potter County
236538	Fee-for-Service	1154314516	1154314516	1	1	BODILY, DAN W MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86055	05	Anesthesiology	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
236553	Fee-for-Service	1083069850	1083069850	1	1	BRIDGE VISION LICENSED CLINI	9/30/2018	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER INC.	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
236579	Fee-for-Service	1467551994	1467551994	1	1	BYRNE, BRIAN A MD	3/21/2006	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39837	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ASSOCI WM'S HLTHCARE INC	36450 INLAND VALLEY DR	STE 102	WILDOMAR	CA	92595	9598	33	06065	33.591168	-117.2367715	Riverside County
236611	Fee-for-Service	1881789840	1881789840	1	1	BANICO, MARIA A MD	3/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75222	08	Family Practice	0	In state provider	None	710 N. EUCLID ST	STE 214	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
236613	Fee-for-Service	1568717213	1568717213	1	1	BANH, MARTA A OD	11/21/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
236626	Fee-for-Service	1801808795	1801808795	1	1	BURZYNSKI, MARGARET M MD	4/28/1999	207L00000X	NA	Other	026	PHYSICIANS	55272	05	Anesthesiology	0	In state provider	None	5469 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1152	37	06073	32.83298834	-117.1388725	San Diego County
236663	Fee-for-Service	1548646417	1548646417	1	1	BASIR, MARIAM DO	12/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	16561	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
236682	Fee-for-Service	1518626977	1518626977	1	1	BENTON, TATIANA	7/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
236722	Fee-for-Service	1083024186	1083024186	1	1	BARTON, KATHERINE D LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7293 DUMOSA AVE	STE 8	YUCCA VALLEY	CA	92284	3700	36	06071	34.12094334	-116.4177385	San Bernardino County
236729	Fee-for-Service	1659446540	1659446540	1	1	BRODETSKY, KELLY EIR	12/1/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MENDOCINO VILLAGE PHARM	10501 LANSING ST	None	MENDOCINO	CA	95460	0904	23	06045	39.30727341	-123.7987965	Mendocino County
236736	Fee-for-Service	1699974469	1699974469	1	1	BATTISTICH, SARAH M MD	11/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105663	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4799	12	06023	40.78355148	-124.1420294	Humboldt County
236752	Fee-for-Service	1861751083	1861751083	1	1	BHANVADIA, AMIT B MD	6/19/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	159586	10	Gastroenterology (M.D. only)	0	In state provider	None	408 S BEACH BLVD	STE 211	ANAHEIM	CA	92804	1853	30	06059	33.82709101	-117.9932293	Orange County
236760	Fee-for-Service	1699472183	1699472183	1	1	BRAINIAC MEDICAL CORPORATION	12/28/2023	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1007 E COOLEY DR	STE 111	COLTON	CA	92324	3901	36	06071	34.05461152	-117.310599	San Bernardino County
236775	Fee-for-Service	1871856369	1871856369	1	1	BRUCHANSKI-GALLAGHER,	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121637	41	Internal Medicine	0	In state provider	NATALIA MD	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
236778	Fee-for-Service	1508032103	1508032103	1	1	BRUCE GARDNER M.D.	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	0000	00	None	46.807308	-100.782459	Burleigh County
236814	Fee-for-Service	1215413414	1215413414	1	1	BLESSED HOME HEALTH CARE INC	3/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4900 CALIFORNIA AVE	TWR B-2ND FLOOR	BAKERSFEILD	CA	93309	7024	15	06029	35.36440586	-119.0562732	Kern County
236818	Fee-for-Service	1063618858	1063618858	1	1	BROCKARDT, CHAD J MD	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105664	20	Orthopedic Surgery	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
236820	Fee-for-Service	1083324248	1083324248	1	1	BUTTS, LA TOYA M CNP	1/25/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
236822	Fee-for-Service	1073930038	1073930038	1	1	BANY, TENILLE MD	6/24/2022	207L00000X	NA	Other	026	PHYSICIANS	142947	None	None	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
236849	Fee-for-Service	1346443918	1346443918	1	1	BELTRAN, VINITHA R	12/24/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12815 HEACOCK ST	None	MORENO VALLEY	CA	92553	3116	33	06065	33.934842	-117.2438195	Riverside County
236882	Fee-for-Service	1740245281	1740245281	1	1	BECK, NAMA MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38311	45	Nephrology (Renal-Kidney)	0	In state provider	None	999 N TUSTIN AVE	STE 15	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
236890	Fee-for-Service	1477001154	1477001154	1	1	BARLOW, JACOB LCSW	12/2/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
236914	Fee-for-Service	1699849489	1699849489	1	1	BAJWA, RAVINDER S MD	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85528	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
236918	Fee-for-Service	1902831878	1902831878	1	1	BELL, WILLIAM LMFT	6/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	328 N SAN MATEO DRIVE	SUITE C	SAN MATEO	CA	94401	0241	41	06081	37.57154218	-122.331759	San Mateo County
236932	Fee-for-Service	1033383625	1033383625	1	1	BATCHU, KSHONIJA MD	4/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102336	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
237002	Fee-for-Service	1073907986	1073907986	1	1	BARTLEY, CHRISTOPHER MD	11/5/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	145689	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
237003	Fee-for-Service	1306994116	1306994116	1	1	BUCKWALTER, NAOMI R MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39582	22	Pathology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
237011	Fee-for-Service	1821269069	1821269069	1	1	BIO-MEDICAL APPLICATIONS	12/7/2009	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	6737 N WILLOW AVE	#C	FRESNO	CA	93710	5954	10	06019	36.83465951	-119.7305415	Fresno County
237019	Fee-for-Service	1619061553	1619061553	1	1	BEHRMAN, CAROL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71131	05	Anesthesiology	0	In state provider	None	2323 DE LA VINA ST	STE 102	SANTA BARBARA	CA	93105	3878	42	06083	34.43202913	-119.7212339	Santa Barbara County
237049	Fee-for-Service	1699472183	1699472183	1	1	BRAINIAC MEDICAL CORPORATION	5/2/2023	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1007 E COOLEY DR	STE 111	COLTON	CA	92324	3901	36	06071	34.05461152	-117.310599	San Bernardino County
237123	Fee-for-Service	1376625913	1376625913	1	1	BAILONY, MOHAMMED T MD	3/31/1981	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	34406	47	Miscellaneous	0	In state provider	None	655 EUCLID AVENUE	#205	NATIONAL CITY	CA	91950	2967	37	06073	32.68353398	-117.082625	San Diego County
237153	Fee-for-Service	1609147453	1609147453	1	1	BAE, ESTHER H DO	8/15/2018	208600000X	NA	General Surgery	026	PHYSICIANS	12710	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
237170	Fee-for-Service	1740245281	1740245281	1	1	BECK, NAMA MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38311	41	Internal Medicine	0	In state provider	None	999 N TUSTIN AVE	STE 15	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
237186	Fee-for-Service	1770568537	1770568537	1	1	BLACKER, DAWN M PHD	9/25/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
237192	Fee-for-Service	1750508537	1750508537	1	1	BARNES, THOMAS J PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3636 FOURTH AVE	STE 304	SAN DIEGO	CA	92103	4294	37	06073	32.74395987	-117.1616056	San Diego County
237205	Fee-for-Service	1710043310	1710043310	1	1	BROWN, JULIE CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
237221	Fee-for-Service	1417375262	1417375262	1	1	BONSALL, STEVEN D MD	7/27/2018	207L00000X	NA	Other	026	PHYSICIANS	141565	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
237230	Fee-for-Service	1144921305	1144921305	1	1	BLUE HORSE SENIOR SHUTTLE LL	5/24/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	C	6213 STAR SAPPHIRE DR	None	BAKERSFIELD	CA	93313	5301	15	06029	35.29097883	-119.0721402	Kern County
237240	Fee-for-Service	1093977100	1093977100	1	2	BOWN, MARJORIE L LCSW	8/13/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 W HOSPITALITY LN	STE 208A	SAN BERNARDINO	CA	92408	3245	36	06071	34.06586109	-117.2884682	San Bernardino County
237267	Fee-for-Service	1013980481	1013980481	1	1	BORGE, DAVID J MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	68939	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
237308	Fee-for-Service	1992384994	1992384994	1	1	BEARDSLEY, RIO MD	4/21/2025	207P00000X	NA	Other	026	PHYSICIANS	191800	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
237309	Fee-for-Service	1821104811	1821104811	1	1	BOLES, SCOTT A PHD	11/25/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	900 N CUYAMACA ST	STE 206	EL CAJON	CA	92020	1865	37	06073	32.807718	-116.979659	San Diego County
237321	Fee-for-Service	1073830964	1073830964	1	1	BHATARAKAMOL, VEENA K DO	11/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12126	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
237351	Fee-for-Service	1598726507	1598726507	1	1	BENNETT, MICHELLE MD	4/4/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56367	40	Pediatrics	0	In state provider	None	2071 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
237353	Fee-for-Service	1992016323	1992016323	1	1	BAILEY, CAITLIN H MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107343	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
237370	Fee-for-Service	1851309272	1851309272	1	1	BRASCH, JOHN F MD INC	2/8/2015	208800000X	NA	Other	026	PHYSICIANS	30172	34	Urology and Urological Surgery	0	In state provider	None	6360 WILSHIRE BLVD	STE 205	LOS ANGELES	CA	90048	5601	19	06037	34.06363617	-118.3676811	Los Angeles County
237398	Fee-for-Service	1902013691	1902013691	1	1	BHATT, JITEN B	7/6/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
237423	Fee-for-Service	1184734840	1184734840	1	1	BEL AIR MARKET INC.	2/10/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4005 MANZANITA AVE	None	CARMICHAEL	CA	95608	1770	34	06067	38.637936	-121.330494	Sacramento County
237445	Fee-for-Service	1922176080	1922176080	1	1	BRYANT, JANIE L MD	5/8/2008	207R00000X	NA	Other	026	PHYSICIANS	83532	41	Internal Medicine	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
237465	Fee-for-Service	1275744195	1275744195	1	1	BENJAMIN M. CHANG, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
237467	Fee-for-Service	1750709168	1750709168	1	1	BHATIA, HARPREET S MD	7/13/2022	390200000X	NA	Other	026	PHYSICIANS	155303	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
237538	Fee-for-Service	1669612826	1669612826	1	1	BARAJAS, LUCIA LCSW	5/16/2020	364SP0809X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
237552	Fee-for-Service	1013980481	1013980481	1	1	BORGE, DAVID J MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	68939	01	General Practice	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
237580	Fee-for-Service	1366505059	1366505059	1	1	BALAGTAS, PRUDENCIO DO	2/2/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	9691	None	None	0	In state provider	None	2801 K ST	SUITE 410	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
237597	Fee-for-Service	1063757011	1063757011	2	1	BERNOUS, BEHZAD PSYD	11/21/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1451 QUAIL ST	STE 102	NEWPORT BEACH	CA	92660	2747	30	06059	33.66105363	-117.8688433	Orange County
237637	Fee-for-Service	1578982633	1578982633	1	1	BLUE PACIFIC HOSPICE CARE	4/6/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	2920 W OLIVE AVE	SUITE 216	BURBANK	CA	91505	4548	19	06037	34.15744117	-118.3334122	Los Angeles County
237658	Fee-for-Service	1194856427	1194856427	1	1	BALOURDAS, GREGORY M MD	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51351	20	Orthopedic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
237682	Fee-for-Service	1548548795	1548548795	1	1	BIGHORN HEARING AID CENTER	9/15/2011	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	INC	39000 BOB HOPE	PROBST 202	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
237729	Fee-for-Service	1619377447	1619377447	1	1	BUCKLEY, MAUREEN D NP	10/14/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
237750	Fee-for-Service	1336577527	1336577527	1	1	BISTA, PRAKRITI MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139923	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
237794	Fee-for-Service	1245406800	1245406800	1	1	BUDD, ROSANA M NP	10/6/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15051	-	NOT APPLICABLE	0	In state provider	None	907 W LANCASTER BLVD	None	LANCASTER	CA	93534	2305	19	06037	34.69735779	-118.1471724	Los Angeles County
237806	Fee-for-Service	1912043985	1912043985	1	1	BIO-MEDICAL APPS OF CA INC	3/21/2008	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	23681 VIA LINDA	STE E	MISSION VIEJO	CA	92691	2807	30	06059	33.6194942	-117.6748835	Orange County
237810	Fee-for-Service	1841835162	1841835162	1	1	BOGNER, REBECCA	3/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
237855	Fee-for-Service	1528119237	1528119237	1	1	BARRON, RITA CNM	11/25/2024	207V00000X	NA	Obstetrics & Gynecology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
237863	Fee-for-Service	1891296760	1891296760	1	1	BENS, MARYANN K PSYD	4/13/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
237869	Fee-for-Service	1295467769	1295467769	1	1	BOSS, SAVANAH J	6/30/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14540 E KAMM AVE	None	KINGSBURG	CA	93631	9202	10	06019	36.53236683	-119.5295006	Fresno County
237873	Fee-for-Service	1689664484	1689664484	1	1	BARNES, EDWARD V MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82407	45	Nephrology (Renal-Kidney)	0	In state provider	None	795 E. SECOND	SUITE 5	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
237875	Fee-for-Service	1235755208	1235755208	1	2	BENTLEY, KAITLYN LMFT	10/11/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41197 GOLDEN GATE CIR	207	MURRIETA	CA	92562	1422	33	06065	33.53652808	-117.1759195	Riverside County
237882	Fee-for-Service	1316972235	1316972235	1	1	BOSTROM, KRISTINA I MD	1/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52816	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
237924	Fee-for-Service	1578982633	1578982633	1	1	BLUE PACIFIC HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	2920 W OLIVE AVE	SUITE 216	BURBANK	CA	91505	4548	19	06037	34.15744117	-118.3334122	Los Angeles County
237925	Fee-for-Service	1457644296	1457644296	1	1	BENYAMINI, POUYA MD	3/1/2017	208600000X	NA	General Surgery	026	PHYSICIANS	122804	02	General Surgery	0	In state provider	None	8631 W 3RD ST	STE 235E	LOS ANGELES	CA	90048	5915	19	06037	34.07361928	-118.3803143	Los Angeles County
238032	Fee-for-Service	1689435471	1689435471	1	1	BLUESCRIPT PHARMACY INC	4/2/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7233 CORBIN AVE	None	WINNETKA	CA	91306	3006	19	06037	34.2023073	-118.5623208	Los Angeles County
238033	Fee-for-Service	1205891066	1205891066	1	1	BASTIAN, BORIS MD	11/16/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77085	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
238044	Fee-for-Service	1174705891	1174705891	1	1	BAYBERRY INC	6/3/1983	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	400 AGUIRRE WAY	None	NAPA	CA	94559	3551	28	06055	38.2961188	-122.2711298	Napa County
238108	Fee-for-Service	1851825889	1851825889	1	1	BETTER LIFE HOME HEALTH CARE	12/22/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC.	600 W BROADWAY	SUITE 260	GLENDALE	CA	91204	1039	19	06037	34.14678282	-118.2666498	Los Angeles County
238114	Fee-for-Service	1548250848	1548250848	1	1	BRASS, STEVEN D MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53710	13	Neurology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
238121	Fee-for-Service	1184610305	1184610305	1	1	BASARAN, JOANN L MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72488	08	Family Practice	0	In state provider	None	313 KENDAL ST	None	VACAVILLE	CA	95688	3960	48	06095	38.35754372	-121.9893443	Solano County
238158	Fee-for-Service	1295467769	1295467769	1	1	BOSS, SAVANAH J	6/30/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14540 E KAMM AVE	None	KINGSBURG	CA	93631	9202	10	06019	36.53236683	-119.5295006	Fresno County
238184	Fee-for-Service	1891882536	1891882536	1	1	BANERIAN, KIRK G MD	8/30/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50529	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
238220	Fee-for-Service	1538127717	1538127717	1	1	BARNETT, CHRISTOPHER F MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99520	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3503	19	06037	34.06550726	-118.3775199	Los Angeles County
238230	Fee-for-Service	1083678726	1083678726	1	1	BRONK, MARTIN I MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42455	02	General Surgery	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
238234	Fee-for-Service	1720078041	1720078041	1	1	BAY MEDICAL CENTER	6/10/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	615 N BONITA AVE	None	PANAMA CITY	FL	32401	3623	00	None	30.159756	-85.6487745	Bay County
238247	Fee-for-Service	1689836280	1689836280	1	1	BROWER, MEREDITH A MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110818	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
238283	Fee-for-Service	1902923428	1902923428	1	1	BACKMAN, KENNETH N MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	29437	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
238315	Fee-for-Service	1306331608	1306331608	1	1	BODE, SARAH MD	1/27/2025	261QX0100X	NA	Other	026	PHYSICIANS	175388	39	Preventive (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
238320	Fee-for-Service	1205891066	1205891066	1	1	BASTIAN, BORIS MD	11/16/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77085	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
238328	Fee-for-Service	1891861563	1891861563	1	1	BURGHAM, JENNIFER L MD	3/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77379	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
238360	Fee-for-Service	1104023720	1104023720	1	1	BARBIETO, MONIQUE T MD	4/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100244	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
238368	Fee-for-Service	1215322748	1215322748	1	1	BARBERA, NICOLE L DO	11/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	15385	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
238435	Fee-for-Service	1982256012	1982256012	1	1	BURR, AMANDA J OT	2/14/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
238492	Fee-for-Service	1568826170	1568826170	1	1	BAKER, COURTNEY C MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	167766	09	Gynecology (D.O. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
238524	Fee-for-Service	1720078041	1720078041	1	1	BAY MEDICAL CENTER	6/10/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	615 N BONITA AVE	None	PANAMA CITY	FL	32401	3623	00	None	30.159756	-85.6487745	Bay County
238530	Fee-for-Service	1417249111	1417249111	1	1	BECKER, ALLISON P OD	6/19/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
238547	Fee-for-Service	1174088173	1174088173	1	1	BALFOUR, KATHYRINE NP	1/16/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	500 OLD RIVER RD	110	BAKERSFIELD	CA	93311	9504	15	06029	35.35127492	-119.1142991	Kern County
238548	Fee-for-Service	1528008125	1528008125	1	1	BENEDICT, MATTHEW D MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89186	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
238608	Fee-for-Service	1205891066	1205891066	1	1	BASTIAN, BORIS MD	11/16/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77085	07	Dermatology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
238611	Fee-for-Service	1154848000	1154848000	1	1	BARRON, AMY J LMFT	8/13/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
238622	Fee-for-Service	1013908425	1013908425	1	2	BAY AREA THERAPEUTIC	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	RADIOLOGY & ONCOLOGY	115 LA CASA VIA	STE 102	WALNUT CREEK	CA	94598	3022	07	06013	37.91251201	-122.0424904	Contra Costa County
238634	Fee-for-Service	1629430814	1629430814	1	1	BROWN, ANDREW J MD	5/22/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154289	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	200	LA MESA	CA	91942	3134	37	06073	32.78442148	-117.0073814	San Diego County
238646	Fee-for-Service	1750859310	1750859310	1	1	BIRKINSHAW, LAUREN J NP	1/13/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
238647	Fee-for-Service	1073284451	1073284451	1	1	BRACAMONTES, ANGELINA	5/29/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1244 UNIVERSITY	None	SAN DIEGO	CA	92103	3312	37	06073	32.74858435	-117.15183	San Diego County
238657	Fee-for-Service	1477891679	1477891679	1	1	BAVERY, KARINA LMFT	2/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
238662	Fee-for-Service	1659381861	1659381861	1	1	BERTRAM, MATTHEW G MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98622	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANNAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
238666	Fee-for-Service	1629022314	1629022314	1	1	BUSUTTIL, ASHLEY MD	4/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90390	None	None	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	95004	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
238685	Fee-for-Service	1528367166	1528367166	1	1	BEELETSEGA YENENEH	4/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
238692	Fee-for-Service	1619950342	1619950342	1	1	BOYADJIAN, SHOVEK MD	8/2/1995	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	54443	01	General Practice	0	In state provider	None	14860 ROSCOE BLVD	STE 205	PANORAMA CITY	CA	91402	4693	19	06037	34.2214515	-118.4573205	Los Angeles County
238723	Fee-for-Service	1043551609	1043551609	1	1	BAILEY, AMY K NP	10/11/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	890 SUNSET DR	B2	HOLLISTER	CA	95023	5651	35	06069	36.83514342	-121.3877091	San Benito County
238730	Fee-for-Service	1760797484	1760797484	1	1	BRIBEAUX, MICHAEL A LMFT	8/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
238741	Fee-for-Service	1457392219	1457392219	1	1	BENOZA, ELLA S MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65998	30	Radiology	0	In state provider	None	123 DISALVO AVE	#A	SAN JOSE	CA	95128	0000	43	06085	37.32628785	-121.9371289	Santa Clara County
238748	Fee-for-Service	1437623253	1437623253	1	1	BORJA-RODRIGUEZ, TANIA J CNP	11/17/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
238754	Fee-for-Service	1376009530	1376009530	1	1	BURTS PHARMACY MOORPARK	5/20/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	865 PATRIOT DR	STE. 103	MOORPARK	CA	93021	3407	56	06111	34.27758343	-118.8663357	Ventura County
238773	Fee-for-Service	1164506663	1164506663	1	1	BROWN, STACEY L NP	5/12/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
238774	Fee-for-Service	1417308537	1417308537	1	1	BOYLE, JILL M LMFT	10/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	46971	-	NOT APPLICABLE	0	In state provider	None	4141 PACIFIC HIGHWAY	None	SAN DIEGO	CA	92110	2030	37	06073	32.7444541	-117.1921543	San Diego County
238781	Fee-for-Service	1568826170	1568826170	1	1	BAKER, COURTNEY C MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	167766	15	Obstetrics (D.O. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
238798	Fee-for-Service	1477588705	1477588705	1	1	B00NE, RODNEY P PHD	4/1/1998	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
238820	Fee-for-Service	1124090303	1124090303	1	1	BHOJRAJ, SANJAY D MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112163	41	Internal Medicine	0	In state provider	None	36320 INLAND VALLEY DR	#301	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
238872	Fee-for-Service	1992014062	1992014062	1	1	BRIO ENTERPRISE INCORPORATED	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14712 PIPELINE AVE	STE C	CHINO HILLS	CA	91709	1298	36	06071	33.985728	-117.715258	San Bernardino County
238888	Fee-for-Service	1215219712	1215219712	1	1	BOLANOS, FRANKLIN LCSW	2/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 S SAN VICENTE BLVD	STE 101	LOS ANGELES	CA	90048	4653	19	06037	34.06576461	-118.3728518	Los Angeles County
238893	Fee-for-Service	1700945144	1700945144	1	1	BAKSHANDEH, KIUMARS MD	1/1/1979	208800000X	NA	Other	026	PHYSICIANS	31570	34	Urology and Urological Surgery	0	In state provider	None	9730 WILSHIRE BLVD	STE 115	BEVERLY HILLS	CA	90212	2003	19	06037	34.06705051	-118.4074425	Los Angeles County
238895	Fee-for-Service	1104872605	1104872605	1	2	BREAST IMAGING RADIOLOGISTS,	4/1/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	A MEDICAL GROUP INC	2810 LONG BEACH BLVD	None	LONG BEACH	CA	90806	1558	19	06037	33.808185	-118.187163	Los Angeles County
238908	Fee-for-Service	1013908425	1013908425	1	2	BAY AREA THERAPEUTIC	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	RADIOLOGY & ONCOLOGY	115 LA CASA VIA	STE 102	WALNUT CREEK	CA	94598	3022	07	06013	37.91251201	-122.0424904	Contra Costa County
238910	Fee-for-Service	1497991988	1497991988	1	1	BONGIOVANNI, MICHAEL S	9/30/1995	174400000X	NA	Other	026	PHYSICIANS	59386	20	Orthopedic Surgery	0	In state provider	MD INC	4065 FOURTH AVE	STE 630	SAN DIEGO	CA	92103	2121	37	06073	32.75131076	-117.1615568	San Diego County
238911	Fee-for-Service	1043222193	1043222193	1	1	BRADSHAW, JOYCE G MD	9/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	84124	40	Pediatrics	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
238913	Fee-for-Service	1760428221	1760428221	1	1	BOCOBO, GEORGE G MD	11/12/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	42	Nuclear Medicine	0	In state provider	None	438 LAS TUNAS	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
238977	Fee-for-Service	1477521193	1477521193	1	1	BECKETT, TIMOTHY MD	8/17/2023	207L00000X	NA	Other	026	PHYSICIANS	138537	None	None	0	In state provider	None	975 SOUTH FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
239063	Fee-for-Service	1679772404	1679772404	1	1	BOCO, APRIL JOY B MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120123	40	Pediatrics	0	In state provider	None	1900 DRESDEN DR	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
239068	Fee-for-Service	1457642977	1457642977	1	1	BURNET HOSPICE CARE INC	9/17/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18000 STUDEBAKER RD	SUITE 110	CERRITOS	CA	90703	2679	19	06037	33.86863289	-118.0988933	Los Angeles County
239069	Fee-for-Service	1811126774	1811126774	1	1	BAKHTIANI, RAJESH K MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121881	38	Geriatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
239086	Fee-for-Service	1124333497	1124333497	1	1	BARNES DENTAL SURGERY CENTER	4/2/2012	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	2626 S. MOONEY BLVD	SUITE C	VISALIA	CA	93277	6203	54	06107	36.307071	-119.313504	Tulare County
239094	Fee-for-Service	1578001673	1578001673	1	1	BELKNAP, LAURA E LMFT	8/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
239099	Fee-for-Service	1639676273	1639676273	1	1	BELTRAN DE LA PAZ, TANIA G L	2/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
239106	Fee-for-Service	1124090303	1124090303	1	1	BHOJRAJ, SANJAY D MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112163	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	36320 INLAND VALLEY DR	#301	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
239110	Fee-for-Service	1609810357	1609810357	1	1	BHATIA, KAVITHA R MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90588	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
239133	Fee-for-Service	1669906541	1669906541	1	1	BURKE, SEAN M MD	1/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
239134	Fee-for-Service	1477900850	1477900850	1	2	BASHIRI, SEYEDEH MARYAM MD	5/28/2021	390200000X	NA	Other	026	PHYSICIANS	166072	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
239147	Fee-for-Service	1780635490	1780635490	1	1	BODES,STEPHANIE MD	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
239160	Fee-for-Service	1992014062	1992014062	1	1	BRIO ENTERPRISE INCORPORATED	10/18/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14712 PIPELINE AVE	STE C	CHINO HILLS	CA	91709	1298	36	06071	33.985728	-117.715258	San Bernardino County
239184	Fee-for-Service	1225016561	1225016561	1	1	BAY AREA HOSPITAL DISTRICT	12/6/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1775 THOMPSON RD	None	COOS BAY	OR	97420	2198	00	None	43.383456	-124.2330435	Coos County
239201	Fee-for-Service	1760428221	1760428221	1	1	BOCOBO, GEORGE G MD	11/12/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	438 LAS TUNAS	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
239209	Fee-for-Service	1801967450	1801967450	1	1	BAKER, PETER C MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
239218	Fee-for-Service	1922334895	1922334895	1	1	BISHOP, ADAM J	6/1/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
239246	Fee-for-Service	1114563996	1114563996	1	1	BRUASKI, LAUREN V LMFT	8/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3130 5TH AVE	8	SAN DIEGO	CA	92103	5839	37	06073	32.73813729	-117.1603812	San Diego County
239281	Fee-for-Service	1760782817	1760782817	1	2	BEAN, LISA M MD	8/20/2021	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	125372	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
239303	Fee-for-Service	1134531403	1134531403	1	1	BEN FARAS, HANANE MD	6/1/2021	207R00000X	NA	Other	026	PHYSICIANS	167523	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
239339	Fee-for-Service	1033800560	1033800560	1	1	BAUTISTA, MONIQUE LCSW	5/26/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	6101 CHERRY AVE	205	FONTANA	CA	92336	5362	36	06071	34.14241631	-117.4883609	San Bernardino County
239356	Fee-for-Service	1457642977	1457642977	1	1	BURNET HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18000 STUDEBAKER RD	SUITE 110	CERRITOS	CA	90703	2679	19	06037	33.86863289	-118.0988933	Los Angeles County
239358	Fee-for-Service	1679637029	1679637029	1	1	BLANEY, JOHN	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
239378	Fee-for-Service	1639103906	1639103906	1	1	BUSUTTIL, RONALD W MD	1/1/1979	204F00000X	NA	General Surgery	026	PHYSICIANS	22460	02	General Surgery	0	In state provider	UCLA MED CTR	SURG DEPT RM 62-182E	None	LOS ANGELES	CA	90024	0000	19	06037	33.96250627	-118.4532133	Los Angeles County
239386	Fee-for-Service	1972764660	1972764660	1	1	BARNETT, KEITH J LCSW	10/15/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22425 SUNBRIGHT AVE	None	RED BLUFF	CA	96080	9237	52	06103	40.11839058	-122.2038466	Tehama County
239392	Fee-for-Service	1922452341	1922452341	1	1	BARSHOW, SUZANNE M MD	6/16/2022	207K00000X	NA	Other	026	PHYSICIANS	178697	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
239409	Fee-for-Service	1134650286	1134650286	1	1	BURNES, AUTUMN MD	11/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158129	None	None	0	In state provider	None	3883 AIRWAY DR	202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
239410	Fee-for-Service	1124262506	1124262506	1	1	BROXHAM, ERIC J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111301	22	Pathology (M.D. only)	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
239446	Fee-for-Service	1285721092	1285721092	1	2	BOYER, RANDALL W MD	4/6/2017	208600000X	NA	General Surgery	026	PHYSICIANS	23260	02	General Surgery	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
239454	Fee-for-Service	1174689665	1174689665	1	1	BETH ISRAEL MED CENTER	9/1/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	FIRST AVE AT 16TH ST	None	NEW YORK	NY	10003	0000	00	None	40.732668	-73.98162	New York County
239468	Fee-for-Service	1760533426	1760533426	1	1	BEN B SHENASSA MD INC	1/4/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2750 W BROADWAY	None	EAGLE ROCK	CA	90041	1050	19	06037	34.14318932	-118.2251055	Los Angeles County
239474	Fee-for-Service	1225016561	1225016561	1	1	BAY AREA HOSPITAL DISTRICT	12/6/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1775 THOMPSON RD	None	COOS BAY	OR	97420	2198	00	None	43.383456	-124.2330435	Coos County
239481	Fee-for-Service	1801957568	1801957568	1	1	BALDWIN, SHERI L PT	5/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	900 MAIN ST	None	CAMBRIA	CA	93428	2820	40	06079	35.56580276	-121.0979727	San Luis Obispo County
239492	Fee-for-Service	1972625069	1972625069	1	1	BASSUK, PABLO J MD	7/1/2007	208M00000X	NA	Other	026	PHYSICIANS	99057	08	Family Practice	0	In state provider	None	801 S CHEVY CHASE DR	STE 230	GLENDALE	CA	91205	4436	19	06037	34.136757	-118.2396195	Los Angeles County
239495	Fee-for-Service	1801967450	1801967450	1	1	BAKER, PETER C MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84861	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
239624	Fee-for-Service	1306195748	1306195748	1	1	BEHAVIORAL HEALTH SERVICES	3/22/2016	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	341 AND 351 EAST 6TH ST	None	LONG BEACH	CA	90802	1402	19	06037	33.77418318	-118.1880771	Los Angeles County
239637	Fee-for-Service	1841789104	1841789104	2	2	BIOPLUS SPECIALTY PHARMACY S	8/17/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ERVICES, LLC	13925 YALE AVE	SUITE 145	IRVINE	CA	92620	2668	30	06059	33.70497316	-117.772376	Orange County
239644	Fee-for-Service	1609814235	1609814235	1	1	BRANDISH, ATOUSA MD	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81432	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
239680	Fee-for-Service	1578838298	1578838298	1	1	BYER, JENNIFER E J MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119671	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DRIVE	SUITE G06	SANTA ROSA	CA	95405	4558	49	06097	38.44332	-122.6985255	Sonoma County
239696	Fee-for-Service	1104099431	1104099431	1	1	BREIG, NICHOLAS A MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123444	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
239698	Fee-for-Service	1043683170	1043683170	2	1	BRISTOL HOSPICE INLAND	2/19/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	EMPIRE LLC	6296 RIVER CREST DR	STE L	RIVERSIDE	CA	92507	0738	33	06065	33.93737876	-117.2927235	Riverside County
239710	Fee-for-Service	1629019708	1629019708	1	1	BONILLA, LUIS ALFREDO	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44911	01	General Practice	0	In state provider	None	1580 VALENCIA ST	STE 803B	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
239725	Fee-for-Service	1639336076	1639336076	1	1	BROMFIELD, CHRISTIAN S MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106524	20	Orthopedic Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
239736	Fee-for-Service	1184718488	1184718488	2	1	BERNSTEIN, ROBERT F MD	12/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	37476	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	555 E TACHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
239739	Fee-for-Service	1568081693	1568081693	1	1	BOYER, TRISTAN R MD	9/15/2023	208M00000X	NA	Other	026	PHYSICIANS	186045	None	None	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
239742	Fee-for-Service	1124394135	1124394135	1	1	BHAGAVATH, ANITA MD	7/1/2019	207LC0200X	NA	Other	026	PHYSICIANS	158946	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
239746	Fee-for-Service	1174689665	1174689665	1	1	BETH ISRAEL MED CENTER	9/1/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	FIRST AVE AT 16TH ST	None	NEW YORK	NY	10003	0000	00	None	40.732668	-73.98162	New York County
239783	Fee-for-Service	1013384965	1013384965	1	1	BELL, COLIN M CRNA	12/14/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
239788	Fee-for-Service	1649461518	1649461518	1	1	BRYANT R MCCALL M.D.	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
239789	Fee-for-Service	1700246964	1700246964	1	1	BUFFUM, TARA M OT	12/3/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
239878	Fee-for-Service	1508812363	1508812363	1	1	BUNIN, NELSON MD	2/26/1995	207R00000X	NA	Other	026	PHYSICIANS	31521	41	Internal Medicine	0	In state provider	None	5915 B HOLLIS ST	None	EMERYVILLE	CA	94608	2066	01	06001	37.84148798	-122.2898215	Alameda County
239928	Fee-for-Service	1528574225	1528574225	1	1	BAUER, GRACE C CRNA	2/1/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
239931	Fee-for-Service	1699861518	1699861518	1	1	BUTLER, DAVID M MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90360	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
239948	Fee-for-Service	1811647514	1811647514	1	1	BELL, FLETCHER M MD	3/18/2025	207R00000X	NA	Other	026	PHYSICIANS	189346	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
239953	Fee-for-Service	1396933156	1396933156	1	3	BEVERLY RADIOLOGY MEDICAL GR	8/20/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GING	23115 SHERMAN PLACE	None	WEST HILLS	CA	91307	2006	19	06037	34.2010023	-118.6303441	Los Angeles County
239970	Fee-for-Service	1992806152	1992806152	1	1	BERNARDINO, RICARDO M MD	8/1/1998	207R00000X	NA	Other	026	PHYSICIANS	52712	41	Internal Medicine	0	In state provider	None	714 MAIN ST	None	DELANO	CA	93215	2953	15	06029	35.76576485	-119.2448585	Kern County
239984	Fee-for-Service	1043683170	1043683170	2	1	BRISTOL HOSPICE INLAND	2/19/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	EMPIRE LLC	6296 RIVER CREST DR	STE L	RIVERSIDE	CA	92507	0738	33	06065	33.93737876	-117.2927235	Riverside County
239987	Fee-for-Service	1659763373	1659763373	1	1	BHATNAGAR, ROSHNI MD	6/3/2022	207R00000X	NA	Other	026	PHYSICIANS	178704	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
240005	Fee-for-Service	1366442386	1366442386	1	1	BROWN, CAROL L NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8001 VENTURA CANYON AVE	None	PANORAMA CITY	CA	91402	6312	19	06037	34.21619623	-118.4287605	Los Angeles County
240029	Fee-for-Service	1942711486	1942711486	1	1	BRASSARD, ALAIN J J MD	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152008	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
240079	Fee-for-Service	1093203887	1093203887	1	1	BEIENE, ZODINA MD	1/8/2025	207LC0200X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
240081	Fee-for-Service	1417336850	1417336850	1	1	BROWN, ITALO M MD	8/3/2019	207P00000X	NA	Other	026	PHYSICIANS	163900	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
240104	Fee-for-Service	1063558757	1063558757	1	1	BHATTACHARYA, MALLAR MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98985	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
240114	Fee-for-Service	1861839151	1861839151	1	1	BUENROSTRO, JOSE I MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142442	01	General Practice	0	In state provider	None	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
240121	Fee-for-Service	1962418533	1962418533	1	1	BARBER, VICTORIA L MD	7/1/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	72492	20	Orthopedic Surgery	0	In state provider	None	1800 SULLIVAN AVE	RM 307	DALY CITY	CA	94015	2223	41	06081	37.68077723	-122.4728941	San Mateo County
240137	Fee-for-Service	1114017928	1114017928	1	1	BURD, AARON W RNP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MT CARMEL WAY	None	PITTSBURG	KS	66762	7587	00	None	37.38064104	-94.68386502	Crawford County
240171	Fee-for-Service	1346677085	1346677085	1	1	BLANCO, MARLENE B	8/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSO	#300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
240175	Fee-for-Service	1215980347	1215980347	1	1	BURDON, TOM A MD	5/31/1991	208G00000X	NA	General Surgery	026	PHYSICIANS	50167	None	None	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
240187	Fee-for-Service	1780856997	1780856997	1	1	BURKETT, DALE A MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
240193	Fee-for-Service	1366886392	1366886392	1	1	BRADLEY, CHRYSTAL A MD	7/14/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	124830	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
240211	Fee-for-Service	1780690040	1780690040	1	1	BASHAR HAMAD M.D.	11/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1100 HOUBOLT RD	None	JOLIET	IL	60431	9063	00	None	41.50197098	-88.16879273	Will County
240234	Fee-for-Service	1558795757	1558795757	1	1	BUCKLEY, CANDACE J DPM	8/13/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	11332 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3854	36	06071	34.04709935	-117.2436936	San Bernardino County
240246	Fee-for-Service	1619310604	1619310604	1	1	BERNTHAL, JULIE T MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137334	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
240287	Fee-for-Service	1104844174	1104844174	1	1	BEHL, RAJESH MD	8/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96509	78	Neoplastic Diseases/Oncology	0	In state provider	None	3010 COLBY ST	STE 221	BERKELEY	CA	94705	2056	01	06001	37.85492078	-122.2576101	Alameda County
240300	Fee-for-Service	1942687074	1942687074	1	1	BURGA-HOGAN, GUILLERMO E NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
240307	Fee-for-Service	1154385599	1154385599	1	1	BONG, PAUL MD	6/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	62660	36	Psychiatry	0	In state provider	None	2215 TRUXTUN AVE	SUITE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
240388	Fee-for-Service	1356322879	1356322879	1	1	BECK, PAUL A MD	9/30/1987	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	56068	20	Orthopedic Surgery	0	In state provider	None	725 W LA VETA AVE	STE 260	ORANGE	CA	92868	4439	30	06059	33.78063949	-117.8603285	Orange County
240399	Fee-for-Service	1114360245	1114360245	1	1	BULOCK, NATALIE W DO	8/14/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13791	09	Gynecology (D.O. only)	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
240432	Fee-for-Service	1508842014	1508842014	1	1	BOGANEY, ANTHONY C MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55608	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
240471	Fee-for-Service	1730114752	1730114752	1	1	BERKMAN, SAMUEL A MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	23110	41	Internal Medicine	0	In state provider	None	9400 BRIGHTON WAY	STE 201	BEVERLY HILLS	CA	90210	4709	19	06037	34.07043476	-118.4011952	Los Angeles County
240483	Fee-for-Service	1326393141	1326393141	1	1	BARMAN, RAJDIP MD	1/31/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	187246	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
240486	Fee-for-Service	1982778973	1982778973	1	1	BRUNE, BRANDY	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
240489	Fee-for-Service	1972918563	1972918563	1	1	BONO, KATE P LCSW	9/18/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 HOPE ST	STE 350	SOUTH PASADENA	CA	91030	2628	19	06037	34.11679363	-118.150088	Los Angeles County
240493	Fee-for-Service	1497114805	1497114805	1	1	BUGAS, ADDIE J MD	10/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145745	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
240495	Fee-for-Service	1952547044	1952547044	1	1	BLANKINSHIP, GEORGE L III MD	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112787	25	Physical Medicine and Rehabilitation	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
240503	Fee-for-Service	1255831046	1255831046	1	1	BALANCE ACUPUNCTURE, INC.	9/20/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1401 S BROOKHURST RD	SUITE 107	FULLERTON	CA	92833	4471	30	06059	33.85761255	-117.9593114	Orange County
240528	Fee-for-Service	1659507788	1659507788	1	1	BIRHAN, AMINU M MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94185	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
240544	Fee-for-Service	1023192028	1023192028	1	1	BOYCE, ANTHONY K DO	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	6806	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
240550	Fee-for-Service	1679718753	1679718753	1	1	BENJAMIN J REMINGTON M D INC	12/10/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	4016 DALE RD	None	MODESTO	CA	95356	9268	50	06099	37.69723812	-121.049967	Stanislaus County
240563	Fee-for-Service	1386954154	1386954154	1	1	BAKTANIAN, ALBERT MD INC	11/13/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41358	18	Ophthalmology	0	In state provider	APMC	1030 S GLENDALE AVE	SUITE 505	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
240573	Fee-for-Service	1457425860	1457425860	1	1	BEDNARSKI, NICHOLAS E MD	11/30/1992	207R00000X	NA	Other	026	PHYSICIANS	33058	41	Internal Medicine	0	In state provider	None	1200 W GONZALES RD	STE 300	OXNARD	CA	93036	3075	56	06111	34.21910561	-119.1919869	Ventura County
240617	Fee-for-Service	1720814353	1720814353	1	1	BAILON SALAS, KAREN DOULA	5/19/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	13	06025	0	0	None
240630	Fee-for-Service	1073356465	1073356465	1	1	BENDER, EDWARD W MD	7/8/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
240680	Fee-for-Service	1699959973	1699959973	1	1	BONFOCO, EMANUELA M MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101432	None	None	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
240688	Fee-for-Service	1770736456	1770736456	1	1	BONNI, ARAM MD	11/24/2008	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	66385	34	Urology and Urological Surgery	0	In state provider	None	904 E MAIN ST	None	BARSTOW	CA	92311	2406	36	06071	34.89860768	-117.0148631	San Bernardino County
240720	Fee-for-Service	1013308329	1013308329	1	1	BUB, ANGELA M LCSW	5/11/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
240771	Fee-for-Service	1477524239	1477524239	1	1	BELVILLE, JAMES K MD	8/9/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	42711	None	None	0	In state provider	None	44139 MONTEREY AVE	A	PALM DESERT	CA	92260	8700	33	06065	33.728004	-116.3912775	Riverside County
240804	Fee-for-Service	1932283009	1932283009	1	1	BLOOM, KAREN B MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62416	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
240863	Fee-for-Service	1003578006	1003578006	1	1	BONILLA, EDWARD X OT	10/19/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
240878	Fee-for-Service	1649439084	1649439084	1	1	BARNES, ERIN M MD	11/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102913	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	#230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
240910	Fee-for-Service	1316197510	1316197510	1	1	BECKWITH, ELIKA LMFT	9/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	349 E BULLARD AVE	STE 102	FRESNO	CA	93710	5298	10	06019	36.82285854	-119.7825885	Fresno County
240914	Fee-for-Service	1497016315	1497016315	1	1	BATOU, AUGEN B DO	5/7/2018	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
240976	Fee-for-Service	1770736456	1770736456	1	1	BONNI, ARAM MD	11/24/2008	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	66385	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	904 E MAIN ST	None	BARSTOW	CA	92311	2406	36	06071	34.89860768	-117.0148631	San Bernardino County
240995	Fee-for-Service	1588664817	1588664817	1	1	BREGER, BARBARA CM	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	21132	None	None	0	In state provider	None	435 N BEDFORD DR	None	BEVERLY HILLS	CA	90210	4321	19	06037	34.06851281	-118.4056736	Los Angeles County
241001	Fee-for-Service	1134358211	1134358211	1	1	BARNETT, MISTY L LCSW	8/22/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2628 VICTOR AVE	STE. C	REDDING	CA	96002	1454	45	06089	40.56894199	-122.3392301	Shasta County
241033	Fee-for-Service	1619076536	1619076536	1	1	BEKO, MARYANN ERIKA	5/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85947	41	Internal Medicine	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
241039	Fee-for-Service	1528403110	1528403110	1	1	BYRON, ALEXANDRA S OT	5/13/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
241043	Fee-for-Service	1295703775	1295703775	1	1	BRIMMER, JENNA J MD	9/29/2014	207R00000X	NA	Other	026	PHYSICIANS	81625	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
241046	Fee-for-Service	1285384636	1285384636	1	1	BROUSSARD MARRIAGE & FAMILY	1/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	THERAPY INC	41661 ENTERPRISE CIR N	STE 111	TEMECULA	CA	92590	5629	33	06065	33.51978342	-117.1690916	Riverside County
241118	Fee-for-Service	1043414204	1043414204	1	1	BAGUL, NITIN D MD	10/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	115458	36	Psychiatry	0	In state provider	None	201 HARTNELL AVE	None	REDDING	CA	96002	1843	45	06089	40.56739956	-122.3690135	Shasta County
241122	Fee-for-Service	1699915363	1699915363	1	1	BASSI, CHRISTINE LCSW	2/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
241173	Fee-for-Service	1972662633	1972662633	1	1	BAKER, CYNTHIA N MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45710	84	Surgery-Head and Neck	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
241209	Fee-for-Service	1487627212	1487627212	1	1	BARNES, HAROLD C MD	7/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64256	41	Internal Medicine	0	In state provider	None	81880 DR CARREON BLVD	STE B201	INDIO	CA	92201	5585	33	06065	33.70742953	-116.23572	Riverside County
241227	Fee-for-Service	1912047556	1912047556	1	1	BRANDT GROUP HOMES INC	4/3/2000	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7357 WOODRUFF WAY	None	CITRUS HEIGHTS	CA	95621	1349	34	06067	38.717793	-121.296978	Sacramento County
241239	Fee-for-Service	1205885902	1205885902	1	1	BRODER, KEVIN W MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82409	24	Plastic Surgery	0	In state provider	None	8899 UNIVERSITY CENTER L	STE 350	SAN DIEGO	CA	92122	1010	37	06073	32.8702653	-117.2280462	San Diego County
241252	Fee-for-Service	1073140638	1073140638	1	1	BAUM, EVAN J MD	6/2/2023	207R00000X	NA	Other	026	PHYSICIANS	185801	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
241286	Fee-for-Service	1023515566	1023515566	1	1	BURNS, ROSHAN M MD	6/27/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164117	None	None	0	In state provider	None	2500 HOSPITAL DRIVE	SUITE 4A	MOUNTAIN VIEW	CA	94040	4110	43	06085	37.36908	-122.081819	Santa Clara County
241301	Fee-for-Service	1629384219	1629384219	1	1	BARKHORDARIAN, SIAMAK MD INC	9/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94148	02	General Surgery	0	In state provider	None	8631 W 3RD ST	STE 540-E	LOS ANGELES	CA	90048	6140	19	06037	34.07361928	-118.3803143	Los Angeles County
241310	Fee-for-Service	1083984827	1083984827	1	1	BANH, JENNY V MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119559	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
241332	Fee-for-Service	1710173992	1710173992	1	1	BARTEL, BRIDGETTE	1/10/2022	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
241380	Fee-for-Service	1164484721	1164484721	1	1	BOARDMAN, JOHN W MD	4/29/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	51441	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
241392	Fee-for-Service	1376858829	1376858829	1	1	BUI, CHRISTOPHER T MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119877	25	Physical Medicine and Rehabilitation	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
241403	Fee-for-Service	1245098029	1245098029	1	1	BABOUJIAN ACUPUNCTURE INC	5/17/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	411 N CENTRAL AVE	SUITE 350	GLENDALE	CA	91203	2081	19	06037	34.15248444	-118.2579448	Los Angeles County
241432	Fee-for-Service	1760610497	1760610497	1	1	BULAHAN, SOFIA R NP	8/26/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
241460	Fee-for-Service	1972662633	1972662633	1	1	BAKER, CYNTHIA N MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45710	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
241463	Fee-for-Service	1457359978	1457359978	1	1	BAGHERI, SHAHIN MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77192	83	Rheumatology	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 420	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
241468	Fee-for-Service	1235620543	1235620543	1	1	BHATT, HELI M MD	12/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174137	None	None	0	In state provider	None	4190 CHICAGO AVE	None	RIVERSIDE	CA	92507	5348	33	06065	33.97217008	-117.3484877	Riverside County
241478	Fee-for-Service	1801902200	1801902200	1	1	BAKSHI, NANDINI MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49041	41	Internal Medicine	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
241488	Fee-for-Service	1437410131	1437410131	1	1	BALASUBRAMANIAN, DIVYA DO	12/17/2023	207P00000X	NA	Other	026	PHYSICIANS	20237	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
241508	Fee-for-Service	1033453006	1033453006	1	2	BARNES, BRANDY LCSW	9/30/2020	1041S0200X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CES	11801 PIERCE STREET	STE 200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
241514	Fee-for-Service	1437272705	1437272705	1	1	BRYAN COFFING	1/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14300 ORCHARD PKWY	None	WESTMINSTER	CO	80023	9206	00	None	39.95561619	-104.9936945	Adams County
241518	Fee-for-Service	1083318091	1083318091	1	1	BONILLA, JANEEN L LMFT	10/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
241621	Fee-for-Service	1417159161	1417159161	1	1	BOSTIC, NICOLE I MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55464	40	Pediatrics	0	In state provider	None	341 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
241627	Fee-for-Service	1245432145	1245432145	1	1	BAGI, PREET K MD	8/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126118	10	Gastroenterology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
241641	Fee-for-Service	1790889350	1790889350	1	1	BASCH, MICHAEL S MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	62314	41	Internal Medicine	0	In state provider	TALIA MEDICAL GROUP	41593 WINCHESTER RD	STE 101	TEMECULA	CA	92590	4858	33	06065	33.52030169	-117.1659061	Riverside County
241645	Fee-for-Service	1447413331	1447413331	1	1	BAWEJA, PARAMDEEP MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2640	00	None	39.08455286	-94.57578107	Jackson County
241663	Fee-for-Service	1356418115	1356418115	1	1	BUSBY, ANDREW J MD	10/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81781	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
241682	Fee-for-Service	1063634913	1063634913	1	1	BENDROFF, ANN D	9/10/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
241693	Fee-for-Service	1508001165	1508001165	1	1	BRUSHWYLER, ELIZABETH D PT	2/5/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 MARCONI AVE	None	SACRAMENTO	CA	95821	5309	34	06067	38.618109	-121.380255	Sacramento County
241705	Fee-for-Service	1205039815	1205039815	1	1	BUENAFLOR, JAY KENNETH P	6/27/2007	193400000X	NA	Other	026	PHYSICIANS	82945	None	None	0	In state provider	MD AMC	608 G ST	STE 1-A	BRAWLEY	CA	92227	2568	13	06025	32.97749255	-115.5318435	Imperial County
241717	Fee-for-Service	1497792832	1497792832	1	1	BADURA, RICHARD J MD	4/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	12040 NO EAST 128TH ST	None	KIRKLAND	WA	98034	3013	00	None	47.71493427	-122.1792761	King County
241734	Fee-for-Service	1457469470	1457469470	1	1	BOYCE,SHIMAMOTO T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	347 N KUAKINI ST	None	HONOLULU	HI	96825	0370	00	None	21.32247447	-157.8564644	Honolulu County
241768	Fee-for-Service	1801902200	1801902200	1	1	BAKSHI, NANDINI MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49041	13	Neurology (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
241771	Fee-for-Service	1427128453	1427128453	1	1	BERLETTI, CHARLES MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	32986	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
241790	Fee-for-Service	1023349883	1023349883	1	2	BORREGO COMM HLTH FOUNDATION	4/14/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	950 CIVIC CENTER DR	None	VISTA	CA	92083	5208	37	06073	33.19303885	-117.2348616	San Diego County
241807	Fee-for-Service	1265730808	1265730808	1	1	BROWN, CLIFFORD O MD INC	9/20/2012	193400000X	NA	Other	026	PHYSICIANS	84823	18	Ophthalmology	0	In state provider	None	82013 DR CARREON BLVD	STE H	INDIO	CA	92201	5832	33	06065	33.70738152	-116.233002	Riverside County
241825	Fee-for-Service	1487016044	1487016044	1	1	BIRD, JASON P	3/17/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
241839	Fee-for-Service	1710110929	1710110929	1	1	BUTLER, TAKAMI	3/1/1995	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 E 8TH ST	None	DAVIS	CA	95616	2502	57	06113	38.55331005	-121.7285704	Yolo County
241856	Fee-for-Service	1548231608	1548231608	1	1	BARNNY JEPP, LLC	5/10/2004	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1400 S GRAND AVE	STE 105	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
241863	Fee-for-Service	1073063186	1073063186	1	1	BARNES-HINKSON, NICOLE LCSW	12/9/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2301 E 28TH STREET	SUITE 309	LONG BEACH	CA	90755	2181	19	06037	33.80807423	-118.1639744	Los Angeles County
241873	Fee-for-Service	1093726879	1093726879	1	1	BRENT, BRUCE N MD	8/23/1981	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44202	None	None	0	In state provider	None	2351 CLAY ST	# 309	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
241878	Fee-for-Service	1477597474	1477597474	1	1	BARRETT, ROBERT T MD	12/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	41169	02	General Surgery	0	In state provider	None	7890 MAGNOLIA AVE	None	FAIR OAKS	CA	95628	7336	34	06067	38.636397	-121.27365	Sacramento County
241880	Fee-for-Service	1871014829	1871014829	1	1	BARCLAY, JONATHAN R MD	5/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159070	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
241919	Fee-for-Service	1073646329	1073646329	1	1	BEAM, PAYAL G LCSW	2/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
241949	Fee-for-Service	1437660321	1437660321	1	1	BERNARD, JESSIE A CNP	12/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
242004	Fee-for-Service	1851732366	1851732366	1	1	BOYCE, WILLIAM T MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42213	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
242016	Fee-for-Service	1851552509	1851552509	1	1	BORRAYO, MERCEDES LMFT	1/24/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
242035	Fee-for-Service	1528444262	1528444262	1	1	BEANN, LAURA LCSW	6/23/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 PETALUMA AVE.	SUITE 2D	SEBASTOPOL	CA	95472	0000	49	06097	38.40200716	-122.8229065	Sonoma County
242047	Fee-for-Service	1396933156	1396933156	1	1	BEVERLY RADIOLOGY MEDICAL GR	3/24/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16130 VENTURA BLVD	#100	ENCINO	CA	91436	2517	19	06037	34.1565054	-118.4849516	Los Angeles County
242051	Fee-for-Service	1679060255	1679060255	1	1	BORSAN, COSMIN MD DO	10/10/2021	390200000X	NA	Other	026	PHYSICIANS	17643	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
242076	Fee-for-Service	1023349883	1023349883	1	2	BORREGO COMM HLTH FOUNDATION	4/14/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	950 CIVIC CENTER DR	None	VISTA	CA	92083	5208	37	06073	33.19303885	-117.2348616	San Diego County
242095	Fee-for-Service	1770042889	1770042889	1	1	BROWN, SAMANTHA K MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	179983	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
242118	Fee-for-Service	1417948274	1417948274	1	1	BHAT, MOHAN R	10/8/2018	207R00000X	NA	Other	026	PHYSICIANS	152410	41	Internal Medicine	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
242132	Fee-for-Service	1821234196	1821234196	1	1	BIGGER, ALAINA A LCSW	11/28/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
242167	Fee-for-Service	1063936219	1063936219	1	1	BRENZA, SARA J NP	8/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	500 W THOMAS ROAD	SUITE 500	PHOENIX	AZ	85013	4220	00	None	33.481485	-112.080816	Maricopa County
242181	Fee-for-Service	1740669969	1740669969	1	1	BIO MEDICAL APPLICATIONS OF	10/18/2016	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1223 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	2931	19	06037	33.78970725	-118.2983104	Los Angeles County
242212	Fee-for-Service	1295734614	1295734614	1	1	BAHADINI, BAHAREH MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64997	41	Internal Medicine	0	In state provider	None	1041 E YORBA LINDA BLVD	STE 5	PLACENTIA	CA	92870	3736	30	06059	33.88848865	-117.8451029	Orange County
242227	Fee-for-Service	1538473251	1538473251	1	1	BROWN, AMY H PSYD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
242253	Fee-for-Service	1871777573	1871777573	1	1	BEDI, TEJA MD	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94053	78	Neoplastic Diseases/Oncology	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
242259	Fee-for-Service	1629629563	1629629563	1	1	BOIRE, JANETTE L LMFT	1/4/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118719	-	NOT APPLICABLE	0	In state provider	None	8739 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4507	19	06037	34.08687562	-118.3813577	Los Angeles County
242270	Fee-for-Service	1427211531	1427211531	1	1	BUSCHAUER, MIKKI L LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4760 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
242278	Fee-for-Service	1023137403	1023137403	1	1	BAGIU, KRISTIN NP	8/29/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
242345	Fee-for-Service	1689209322	1689209322	1	1	BAUMGARDNER, BENJAMIN PT	7/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
242355	Fee-for-Service	1346492055	1346492055	1	1	BESHAY, ISAAC N MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89039	None	None	0	In state provider	None	2200 HARBOR BLVD	STE B 210	COSTA MESA	CA	92627	2501	30	06059	33.654546	-117.919074	Orange County
242394	Fee-for-Service	1629693858	1629693858	1	1	BERGAL, JACK DO	9/6/2023	208M00000X	NA	Other	026	PHYSICIANS	20526	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
242429	Fee-for-Service	1255747598	1255747598	1	1	BECHARA DIAZ, ANA MARIA MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148149	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
242442	Fee-for-Service	1174601702	1174601702	1	1	BUCKHOLZ, GARY T MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82836	08	Family Practice	0	In state provider	None	4311 THIRD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
242451	Fee-for-Service	1760465041	1760465041	1	1	BOWLES,MATTHEW E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PARKVIEW MEDICAL CENTER	400 W 16TH STREET	None	PEUBLO	CO	81003	0000	00	None	38.28171999	-104.6119963	Pueblo
242516	Fee-for-Service	1770522203	1770522203	1	1	BRODERICK, DAVID MD	12/31/1985	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	42099	20	Orthopedic Surgery	0	In state provider	None	107 SCRIPPS DR	STE 200	SACRAMENTO	CA	95825	6300	34	06067	38.571732	-121.4084475	Sacramento County
242524	Fee-for-Service	1861665051	1861665051	1	1	BIGGS, KRISTEN LYNN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
242533	Fee-for-Service	1003932351	1003932351	1	1	BATES, JAMILAH N LCSW	12/30/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
242537	Fee-for-Service	1093722126	1093722126	1	1	BERENSON, MARK S MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88385	08	Family Practice	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
242540	Fee-for-Service	1871777573	1871777573	1	1	BEDI, TEJA MD	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94053	68	Hematology	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
242552	Fee-for-Service	1376556944	1376556944	1	1	BRENNAN, TIMOTHY J MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78406	08	Family Practice	0	In state provider	None	950 CIRCLE DR	STE A	SALINAS	CA	93905	2150	27	06053	36.67966512	-121.6271512	Monterey County
242604	Fee-for-Service	1710310586	1710310586	1	1	BHUKHAN, PREETI B OD	2/9/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
242610	Fee-for-Service	1184741795	1184741795	1	1	BCD BAK INC	2/26/2004	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	DBA DARLYN'S DARLINGS	4801 TRUXTUN AVE	# 200	BAKERSFIELD	CA	93309	0605	15	06029	35.3708764	-119.0554467	Kern County
242622	Fee-for-Service	1235293127	1235293127	1	1	BALDONADO, JESUS P MD	7/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68306	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	1201 JEFFERSON ST	None	DELANO	CA	93215	2203	15	06029	35.77204969	-119.2449995	Kern County
242721	Fee-for-Service	1760687388	1760687388	1	1	BRYANT MARK WHITING M.D.	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
242764	Fee-for-Service	1962501635	1962501635	1	1	BARRA, MOHAMMAD A MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	30194	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	930 SUNNYSLOPE RD	# 1	HOLLISTER	CA	95023	5615	35	06069	36.83909681	-121.3851338	San Benito County
242770	Fee-for-Service	1528239175	1528239175	1	1	BACCHUS, TRACY L	10/11/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
242794	Fee-for-Service	1811931306	1811931306	1	1	BRAULT, ANDREA M MD	2/11/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73405	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
242800	Fee-for-Service	1013967215	1013967215	1	1	BRINK, DANIEL J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53326	08	Family Practice	0	In state provider	None	1590 POOLE BLVD	None	YUBA CITY	CA	95993	2607	51	06101	39.14468476	-121.6436714	Sutter County
242816	Fee-for-Service	1578120739	1578120739	1	1	BOUZ, DANNY C DO	8/20/2023	207L00000X	NA	Other	026	PHYSICIANS	20047	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
242818	Fee-for-Service	1740731413	1740731413	1	1	BHOOT, HEETEN V MD	1/30/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	15217	45	Nephrology (Renal-Kidney)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
242838	Fee-for-Service	1376556944	1376556944	1	1	BRENNAN, TIMOTHY J MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78406	01	General Practice	0	In state provider	None	950 CIRCLE DR	STE A	SALINAS	CA	93905	2150	27	06053	36.67966512	-121.6271512	Monterey County
242862	Fee-for-Service	1780421198	1780421198	1	1	BESERRA, LAUREN	2/20/2025	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
242880	Fee-for-Service	1598019085	1598019085	1	1	BAY IMAGING CONSULTANTS	6/30/2015	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
242920	Fee-for-Service	1245813724	1245813724	1	1	BRADLEY, MICHAEL CPO	11/21/2024	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	10481 GRANT LINE RD	SUITE 175	ELK GROVE	CA	95624	9702	34	06067	38.376495	-121.358943	Sacramento County
242926	Fee-for-Service	1619106119	1619106119	1	1	BAILEY, CRAIG A MD	3/4/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	158468	-	NOT APPLICABLE	0	In state provider	None	11682 ATLANTIC AVE	None	LYNWOOD	CA	90262	3832	19	06037	33.91730723	-118.1889829	Los Angeles County
242952	Fee-for-Service	1366118549	1366118549	1	1	BELLAMY, KEESHA CRNA	10/21/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
242956	Fee-for-Service	1619191749	1619191749	1	1	BROWN, KAREN M MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111710	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
242979	Fee-for-Service	1528070844	1528070844	1	1	BALAKRISHNAN, KARTHIK MD	12/12/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	165904	04	Otology, Laryngology, Rhinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
243031	Fee-for-Service	1487217816	1487217816	1	1	BLANKERS, MATTHEW LCSW	1/31/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	386 W. LINE ST	None	BISHOP	CA	93514	1100	14	06027	37.36135856	-118.3979892	Inyo County
243034	Fee-for-Service	1184009771	1184009771	1	1	BERGMAN, KEVIN P PT	12/10/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1519 W YOSEMITE AVE	None	MANTECA	CA	95337	5159	39	06077	37.79738017	-121.2413628	San Joaquin County
243106	Fee-for-Service	1215021720	1215021720	1	1	BAUTISTA, GRACE S MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	45534	41	Internal Medicine	0	In state provider	None	675 S ARROYO PKWY	None	PASADENA	CA	91105	3263	19	06037	34.13385453	-118.1474229	Los Angeles County
243139	Fee-for-Service	1982662193	1982662193	1	1	BARBADILLO, FERDINAND MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	49307	40	Pediatrics	0	In state provider	None	502 EUCLID AVE	STE 201	NATIONAL CITY	CA	91950	2949	37	06073	32.68505421	-117.0832793	San Diego County
243155	Fee-for-Service	1629336573	1629336573	1	1	BARKER, CHAD H MD	1/31/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	107824	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
243167	Fee-for-Service	1972297703	1972297703	1	1	BOOMER, JOANN LYNN	6/20/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8782 CORDIAL ROAD	None	EL CAJON	CA	92021	2136	37	06073	32.83888723	-116.8878307	San Diego County
243172	Fee-for-Service	1275519175	1275519175	1	1	BUI, HANH M	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79185	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
243188	Fee-for-Service	1144897018	1144897018	1	1	BIONICS ORTHOTICS AND PROSTH	3/10/2022	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ETICS	3737 MORAGA AVE	STE B107	SAN DIEGO	CA	92117	5300	37	06073	32.8086683	-117.2109991	San Diego County
243251	Fee-for-Service	1477602449	1477602449	1	1	BARNARD, WILLIAM M MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	40925	13	Neurology (M.D. only)	0	In state provider	None	3840 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
243272	Fee-for-Service	1326260522	1326260522	1	1	BORENSTEIN, JEFF E MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75307	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
243335	Fee-for-Service	1912539065	1912539065	1	1	BRIGHT BLUE HOSPICE INC	10/29/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1907 W BURBANK BLVD	SUITE B	BURBANK	CA	91506	1316	19	06037	34.18084539	-118.3318883	Los Angeles County
243355	Fee-for-Service	1710044318	1710044318	1	1	BRADDOCK, CLARENCE H MD	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	55945	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
243361	Fee-for-Service	1174557508	1174557508	1	1	BEVAN, JULIE C DO	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71095	41	Internal Medicine	0	In state provider	None	15025 INNOVATION DR	# 54433	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
243368	Fee-for-Service	1053547075	1053547075	1	1	BERNABA, BOB N MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103834	22	Pathology (M.D. only)	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
243384	Fee-for-Service	1215179767	1215179767	1	1	BORSODY, MARK K MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54987	13	Neurology (M.D. only)	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
243394	Fee-for-Service	1215021720	1215021720	1	1	BAUTISTA, GRACE S MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	45534	77	Infectious Disease	0	In state provider	None	675 S ARROYO PKWY	None	PASADENA	CA	91105	3263	19	06037	34.13385453	-118.1474229	Los Angeles County
243454	Fee-for-Service	1972297703	1972297703	1	1	BOOMER, JOANN LYNN	6/20/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8782 CORDIAL ROAD	None	EL CAJON	CA	92021	2136	37	06073	32.83888723	-116.8878307	San Diego County
243476	Fee-for-Service	1043315740	1043315740	1	1	BENNITT, ELIZA G MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	87850	41	Internal Medicine	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
243503	Fee-for-Service	1689914939	1689914939	1	1	BIO-MEDICAL APPLICATIONS OF	11/14/2013	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	3201 MALL VIEW ROAD	None	BAKERSFIELD	CA	93306	3061	15	06029	35.39430514	-118.95731	Kern County
243520	Fee-for-Service	1083602155	1083602155	1	1	BHARADWAJ, JAYARAM S MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54428	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 203	ANAHEIM	CA	92801	1824	30	06059	33.8506615	-117.946413	Orange County
243540	Fee-for-Service	1477602449	1477602449	1	1	BARNARD, WILLIAM M MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	40925	36	Psychiatry	0	In state provider	None	3840 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
243561	Fee-for-Service	1023196805	1023196805	1	1	BASINA, MARINA MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72355	47	Miscellaneous	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
243566	Fee-for-Service	1336858869	1336858869	1	1	BLOSSOM WELLNESS SPA INC	9/15/2023	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10642 SANTA MONICA BLVD	209	LOS ANGELES	CA	90025	4525	19	06037	34.05272707	-118.4306058	Los Angeles County
243576	Fee-for-Service	1598703480	1598703480	1	1	BUDDIGA, PRAVEEN MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90273	03	Allergy	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
243586	Fee-for-Service	1932476975	1932476975	1	1	BAEK, MICHAEL D DO	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12528	10	Gastroenterology (M.D. only)	0	In state provider	None	7117 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
243621	Fee-for-Service	1912539065	1912539065	1	1	BRIGHT BLUE HOSPICE INC	10/29/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1907 W BURBANK BLVD	SUITE B	BURBANK	CA	91506	1316	19	06037	34.18084539	-118.3318883	Los Angeles County
243638	Fee-for-Service	1629217229	1629217229	3	1	BOOM INVESTMENTS INC	6/9/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6850 REGIONAL ST	STE 110B	DUBLIN	CA	94568	2930	01	06001	37.70205259	-121.933262	Alameda County
243640	Fee-for-Service	1821836586	1821836586	1	1	BUCKNELL, KATHRYN R NP	9/26/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
243661	Fee-for-Service	1841297868	1841297868	1	2	BAUTISTA, J LUIS MD	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1350 O ST	STE 303	FRESNO	CA	93721	1828	10	06019	36.74132042	-119.7891324	Fresno County
243730	Fee-for-Service	1225059595	1225059595	1	1	BESS, LESLIE H LCSW	6/5/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 EAST STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
243735	Fee-for-Service	1780682021	1780682021	2	1	B SPRING VALLEY, LLC	5/1/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BRIGHTON PLACE SPRG VLY	9009 CAMPO RD	None	SPRING VALLEY	CA	91977	1112	37	06073	32.75178455	-117.0031081	San Diego County
243744	Fee-for-Service	1093044794	1093044794	1	1	BANKO, LESAN MD INC	8/10/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	104321	41	Internal Medicine	0	In state provider	None	12984 HESPERIA RD	100	VICTORVILLE	CA	92395	5819	36	06071	34.48716133	-117.2903452	San Bernardino County
243787	Fee-for-Service	1902979644	1902979644	1	1	BRADLEY, THOMAS P MD	9/19/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	75220	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 WILSON RD	None	MONTEREY	CA	93940	7834	27	06053	36.57377882	-121.8093374	Monterey County
243806	Fee-for-Service	1083602155	1083602155	1	1	BHARADWAJ, JAYARAM S MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54428	78	Neoplastic Diseases/Oncology	0	In state provider	None	1801 W ROMNEYA DR	STE 203	ANAHEIM	CA	92801	1824	30	06059	33.8506615	-117.946413	Orange County
243839	Fee-for-Service	1356460711	1356460711	1	1	BUTLER-HALL, IAN N MD	5/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93055	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE 108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
243846	Fee-for-Service	1306279252	1306279252	1	1	BENNETT, GERALD F PT	5/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
243852	Fee-for-Service	1336858869	1336858869	1	1	BLOSSOM WELLNESS SPA INC	9/15/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10642 SANTA MONICA BLVD	209	LOS ANGELES	CA	90025	4525	19	06037	34.05272707	-118.4306058	Los Angeles County
243876	Fee-for-Service	1932691318	1932691318	1	1	BATANA, JAGADEESH MD	4/4/2024	207R00000X	NA	Other	026	PHYSICIANS	192280	None	None	0	In state provider	None	1415 ROSS AVENUE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
243877	Fee-for-Service	1871754986	1871754986	1	1	BATTLE, TAMARA J MD	12/2/2008	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	85796	40	Pediatrics	0	In state provider	None	1235 OSOS ST	STE 100	SAN LUIS OBISPO	CA	93401	3619	40	06079	35.27979518	-120.6596361	San Luis Obispo County
243907	Fee-for-Service	1811906654	1811906654	1	1	BOYD, JAMES E MD	11/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75335	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
243912	Fee-for-Service	1083896955	1083896955	1	1	BEDAYAT, BABAK MD	9/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115929	25	Physical Medicine and Rehabilitation	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
243922	Fee-for-Service	1720067598	1720067598	1	1	BOREN, ERIC J MD	8/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77407	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
243923	Fee-for-Service	1598789489	1598789489	1	1	BUTLER, DAVID F MD	2/21/2024	2085R0001X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1020 NUT TREE RD	190	VACAVILLE	CA	95687	4100	48	06095	38.35512	-121.94973	Solano County
243928	Fee-for-Service	1710417209	1710417209	1	2	BARKHO, SULAIMAN J MD	9/28/2022	207R00000X	NA	Other	026	PHYSICIANS	177936	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
243963	Fee-for-Service	1558480178	1558480178	1	1	BENTON, REBECCA L MD	3/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54063	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
243986	Fee-for-Service	1407344609	1407344609	1	1	BROCCARD, SACHA MD	10/15/2024	208600000X	NA	General Surgery	026	PHYSICIANS	187906	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
244000	Fee-for-Service	1932130481	1932130481	1	2	BOROVSKY, VICTORIA M MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	82605	-	NOT APPLICABLE	0	In state provider	None	2116-2118 S CENTRAL AVE	None	LOS ANGELES	CA	90011	1237	19	06037	34.02194237	-118.2528116	Los Angeles County
244011	Fee-for-Service	1902851744	1902851744	1	1	BAYATI, NASSER MD	3/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83515	41	Internal Medicine	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
244034	Fee-for-Service	1114905023	1114905023	1	1	BOYER, ERIC A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY MEDICAL SPCLST	3033 S PARKER RD, #800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
244038	Fee-for-Service	1346934064	1346934064	1	1	BATTENBURG, CHAD CNP	1/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
244061	Fee-for-Service	1417028630	1417028630	1	1	BAIG, AFSHAN N MD	8/14/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49428	40	Pediatrics	0	In state provider	None	900 MAIN ST	None	BRAWLEY	CA	92227	2630	13	06025	32.9785797	-115.5285802	Imperial County
244077	Fee-for-Service	1902979644	1902979644	1	1	BRADLEY, THOMAS P MD	9/19/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	75220	68	Hematology	0	In state provider	None	101 WILSON RD	None	MONTEREY	CA	93940	7834	27	06053	36.57377882	-121.8093374	Monterey County
244092	Fee-for-Service	1710035415	1710035415	1	1	BREWER, LAUREL S LMFT	6/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 21ST ST	SUITE 101	BAKERSFIELD	CA	93301	0000	15	06029	35.37823652	-119.0379645	Kern County
244103	Fee-for-Service	1093846628	1093846628	1	1	BAY AREA ANESTHESIA MEDICAL	5/12/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2222 LAFAYETTE ST	None	SANTA CLARA	CA	95050	2904	43	06085	37.36191641	-121.9487686	Santa Clara County
244129	Fee-for-Service	1104189315	1104189315	1	1	BRYAN, BRITTANY A MD	7/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120597	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
244178	Fee-for-Service	1780041335	1780041335	1	1	BADAL, ASHOUR LMFT	10/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
244184	Fee-for-Service	1386296408	1386296408	1	1	BLESSED HEARTS HOME HEALTH	11/10/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	3105 FITE CIRCLE	105	SACRAMENTO	CA	95827	1814	34	06067	38.573109	-121.3238925	Sacramento County
244197	Fee-for-Service	1932365079	1932365079	1	1	BOWMAN, VI Q MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98322	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
244231	Fee-for-Service	1356742217	1356742217	1	1	BECHLER, PAMELA CRNA	9/29/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
244249	Fee-for-Service	1952326498	1952326498	1	1	BORGARDT, PHILIP A MD	7/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55468	41	Internal Medicine	0	In state provider	None	685 MORRO AVE	None	MORRO BAY	CA	93442	2266	40	06079	35.364564	-120.8511755	San Luis Obispo County
244250	Fee-for-Service	1629156443	1629156443	1	1	BOORSTEIN, PETER P MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64203	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
244268	Fee-for-Service	1700928041	1700928041	2	1	BRINKENHOFF, MICHAEL MD	10/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	34522	18	Ophthalmology	0	In state provider	None	231 N DOS CAMINOS AVE	None	VENTURA	CA	93003	1660	56	06111	34.2761449	-119.2559609	Ventura County
244270	Fee-for-Service	1750126082	1750126082	1	1	BRANDNER, GABRIELLE K OT	9/26/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
244296	Fee-for-Service	1174596621	1174596621	1	1	BREWSTER, HOLLISTER P MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	13124	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
244300	Fee-for-Service	1538160601	1538160601	1	1	BEAN, JR., ALBERT L. MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1265 UNION AVE	None	MEMPHIS	TN	38104	3415	00	None	35.13704372	-90.01875401	Shelby County
244318	Fee-for-Service	1376778290	1376778290	1	1	BARDOLE, DONALD N MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43154	08	Family Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
244328	Fee-for-Service	1528362126	1528362126	1	1	BUJA ENTERPRISE, INC	9/14/2011	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4021 ORANGE AVE	None	CYPRESS	CA	90630	2715	30	06059	33.8241363	-118.062928	Orange County
244349	Fee-for-Service	1013025667	1013025667	1	1	BICHLIEN NGUYEN MD INC	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	64758	78	Neoplastic Diseases/Oncology	0	In state provider	None	9900 TALBERT AVENUE	STE 103	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
244365	Fee-for-Service	1902979644	1902979644	1	1	BRADLEY, THOMAS P MD	9/19/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	75220	41	Internal Medicine	0	In state provider	None	101 WILSON RD	None	MONTEREY	CA	93940	7834	27	06053	36.57377882	-121.8093374	Monterey County
244373	Fee-for-Service	1629078571	1629078571	1	1	BART L COX, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
244403	Fee-for-Service	1427190727	1427190727	1	1	BLUME, DOUGLAS N MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	96641	30	Radiology	0	In state provider	None	25455 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5963	33	06065	33.55689911	-117.1863428	Riverside County
244417	Fee-for-Service	1194731604	1194731604	1	1	BROTHERTON, JOY MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86768	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
244466	Fee-for-Service	1194809186	1194809186	1	1	BANE, BRIAN J MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64895	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
244467	Fee-for-Service	1780927103	1780927103	1	1	BIRD, KRISTEN N MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154689	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
244468	Fee-for-Service	1407059587	1407059587	1	1	BOGHOSSIAN, VAN MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103421	02	General Surgery	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
244477	Fee-for-Service	1578794061	1578794061	1	1	BREA-OLINDA SCHOOL DIST	8/25/2009	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1 CIVIC CENTER CIRCLE	LEVEL II	BREA	CA	92822	5792	30	06059	33.91746698	-117.8890845	Orange County
244487	Fee-for-Service	1205045192	1205045192	1	1	BERK, DAVID R MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103865	07	Dermatology	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
244527	Fee-for-Service	1164951307	1164951307	1	1	BHARMAL, MURTAZA I MD	7/5/2024	207R00000X	NA	Other	026	PHYSICIANS	169539	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
244602	Fee-for-Service	1164819207	1164819207	1	1	BLUMSTEIN, GIDEON MD	10/28/2022	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	149225	None	None	0	In state provider	None	4640 ADMIRALTY WAY	9TH FL	MARINA DEL REY	CA	90292	6630	19	06037	33.98120707	-118.4409729	Los Angeles County
244614	Fee-for-Service	1235558578	1235558578	1	1	BHULLAR, HARJOT MD	12/30/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148918	36	Psychiatry	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
244654	Fee-for-Service	1780765289	1780765289	1	1	BASS, ERIC J OD	5/20/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	130 S MAIN ST	STE F	ORANGE	CA	92868	2869	30	06059	33.787512	-117.8673275	Orange County
244661	Fee-for-Service	1457506347	1457506347	1	1	BOTTS, JONATHAN D MD	12/20/2018	174400000X	NA	Other	026	PHYSICIANS	117042	20	Orthopedic Surgery	0	In state provider	None	4955 VAN NUYS BLVD	STE 615	SHERMAN OAKS	CA	91403	1839	19	06037	34.160805	-118.4487295	Los Angeles County
244679	Fee-for-Service	1447469176	1447469176	1	1	BAHARI, ABBAS MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121722	14	Neurological Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
244745	Fee-for-Service	1609848316	1609848316	1	1	BREWSTER, DOUGLAS F MD	11/30/1991	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	67825	66	Emergency Medicine (Urgent Care)	0	In state provider	None	725 S SAN FERNANDO BLVD	None	BURBANK	CA	91502	1445	19	06037	34.17597706	-118.3020251	Los Angeles County
244802	Fee-for-Service	1386158087	1386158087	1	1	BERNARDINO, ADAM M PT	2/26/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
244856	Fee-for-Service	1669672382	1669672382	1	2	BETTY LYNN LEBRUN	12/4/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2455 JEFFERSON BLVD	STE 100	WEST SACRAMENTO	CA	95691	5313	57	06113	38.55304251	-121.5367185	Yolo County
244890	Fee-for-Service	1124289293	1124289293	1	1	BARNES, MELYNDA A MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108882	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2350 BUHNE STREET	SUITE C	EUREKA	CA	95501	3205	12	06023	40.78592523	-124.1422103	Humboldt County
244927	Fee-for-Service	1649382441	1649382441	1	1	BIO MEDICAL APPLICATIONS	5/29/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	242 E HARVARD BLVD	None	SANTA PAULA	CA	93060	3372	56	06111	34.34728904	-119.068761	Ventura County
244991	Fee-for-Service	1023019965	1023019965	1	1	BOSTON, EUGENE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5022	01	General Practice	0	In state provider	None	2720 N HARBOR BLVD	STE 100	FULLERTON	CA	92835	2625	30	06059	33.90126238	-117.9292154	Orange County
245074	Fee-for-Service	1902121940	1902121940	1	1	BERNADETTE L BRENNECKE	3/14/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SED CLINICAL SOCIAL WORK	4574 LIVE OAK CANYON RD	None	LA VERNE	CA	91750	2312	19	06037	34.128486	-117.7449615	Los Angeles County
245081	Fee-for-Service	1013908425	1013908425	1	1	BAY AREA THERAPEUTIC	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	RADIOLOGY & ONCOLOGY	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
245096	Fee-for-Service	1649550062	1649550062	1	1	BECK, ELLEN L MD	11/23/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61838	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
245108	Fee-for-Service	1235664244	1235664244	1	1	BHARATH, SUMAN P MD	7/12/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	172816	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
245118	Fee-for-Service	1023208261	1023208261	1	1	BERNAL, WILLIAM E MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	95664	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
245132	Fee-for-Service	1265681258	1265681258	1	1	BRAZIUNAS, ARETAS MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1155 MILL STREET	NICU	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
245138	Fee-for-Service	1982655809	1982655809	1	1	BATISTE, STANLEY M MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52667	30	Radiology	0	In state provider	None	6305 COYLE AVENUE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
245154	Fee-for-Service	1609911916	1609911916	1	1	BROWN, KATHLEEN M NP	8/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245159	Fee-for-Service	1730420845	1730420845	1	1	BOND, NICHOLAUS H LMFT	6/22/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93804	-	NOT APPLICABLE	0	In state provider	None	1455 E 3RD ST	None	SAN BERNARDINO	CA	92408	0218	36	06071	34.10449624	-117.2555619	San Bernardino County
245198	Fee-for-Service	1215038930	1215038930	1	1	BARON, SCOTT B MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42165	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
245202	Fee-for-Service	1154490563	1154490563	1	1	BOLICH, JAMES J PT	5/21/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7033 N FRESNO ST STE 202	None	FRESNO	CA	93720	2976	10	06019	36.838044	-119.7813175	Fresno County
245276	Fee-for-Service	1023019965	1023019965	1	1	BOSTON, EUGENE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5022	08	Family Practice	0	In state provider	None	2720 N HARBOR BLVD	STE 100	FULLERTON	CA	92835	2625	30	06059	33.90126238	-117.9292154	Orange County
245329	Fee-for-Service	1346341575	1346341575	1	1	BANAFSHE, PAYMON MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8510	41	Internal Medicine	0	In state provider	None	8610 S SEPULVEDA BLVD	STE 102	LOS ANGELES	CA	90045	4009	19	06037	33.959448	-118.396202	Los Angeles County
245333	Fee-for-Service	1265006043	1265006043	1	1	BEKKAM, SOWMYA MD	3/31/2025	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
245336	Fee-for-Service	1023349883	1023349883	1	1	BORREGO COMM HLTH FOUNDATION	7/18/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1121 E WASHINGTON AVE	None	ESCONDIDO	CA	92025	2214	37	06073	33.13236227	-117.0691443	San Diego County
245346	Fee-for-Service	1164592556	1164592556	1	1	BURSTIN, CHARLES J MD	2/1/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	20389	-	NOT APPLICABLE	0	In state provider	None	8330 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	1615	19	06037	34.2217725	-118.3873405	Los Angeles County
245349	Fee-for-Service	1265872154	1265872154	1	1	BHALERAO, NEIL P MD	3/16/2022	207R00000X	NA	Other	026	PHYSICIANS	145495	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
245360	Fee-for-Service	1902121940	1902121940	1	1	BERNADETTE L BRENNECKE	3/14/2023	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SED CLINICAL SOCIAL WORK	4574 LIVE OAK CANYON RD	None	LA VERNE	CA	91750	2312	19	06037	34.128486	-117.7449615	Los Angeles County
245371	Fee-for-Service	1013908425	1013908425	1	1	BAY AREA THERAPEUTIC	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	RADIOLOGY & ONCOLOGY	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
245405	Fee-for-Service	1023208261	1023208261	1	1	BERNAL, WILLIAM E MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	95664	83	Rheumatology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
245406	Fee-for-Service	1013958545	1013958545	1	1	BORROWDALE, ROBERT J MD	7/29/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	56910	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	517 N MAIN ST	SUITE 213	SANTA ANA	CA	92701	6703	30	06059	33.74951945	-117.8675809	Orange County
245410	Fee-for-Service	1043478456	1043478456	1	1	BUNTIN, GERALD S MD	5/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121358	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DRIVE	SUITE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
245427	Fee-for-Service	1033254982	1033254982	1	1	BADAL, JOHN J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
245441	Fee-for-Service	1811079809	1811079809	1	1	BURRELL, TRACEY PHD	6/9/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
245445	Fee-for-Service	1093259426	1093259426	1	1	BEATRICE, CHERYL A LMFT	2/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	325 E. HILLCREST DRIVE	STE. #115	THOUSAND OAKS	CA	91360	7782	56	06111	34.1812975	-118.8718187	Ventura County
245449	Fee-for-Service	1710980289	1710980289	1	1	BLAIR, NANETTE W MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54986	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93902	2420	27	06053	36.65983988	-121.6458041	Monterey County
245463	Fee-for-Service	1255939476	1255939476	1	1	BROWN, HEATHER LCSW	7/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 UNIVERSITY AVE	STE 140	SACRAMENTO	CA	95825	6775	34	06067	38.568276	-121.4199405	Sacramento County
245500	Fee-for-Service	1487117941	1487117941	1	1	BENESCH, TARA D MD	6/15/2022	207P00000X	NA	Other	026	PHYSICIANS	178049	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
245524	Fee-for-Service	1487602702	1487602702	1	1	BAGINSKI, LEON J MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64918	None	None	0	In state provider	None	27800 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6410	30	06059	33.55952733	-117.6645199	Orange County
245562	Fee-for-Service	1245201201	1245201201	1	1	BALLAGH, SUSAN A MD	12/31/1991	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62297	None	None	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
245567	Fee-for-Service	1851438410	1851438410	1	2	BAART BEHAVIORAL HEALTH SERV	3/4/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3103 E. CARTWRIGHT AVE	None	FRESNO	CA	93725	9385	10	06019	36.67617437	-119.7344474	Fresno County
245609	Fee-for-Service	1053508861	1053508861	1	1	BURNETTE, PAUL F	4/1/1995	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3155 KEARNEY ST	#130	FREMONT	CA	94538	2268	01	06001	37.5490951	-121.974815	Alameda County
245626	Fee-for-Service	1023349883	1023349883	1	1	BORREGO COMM HLTH FOUNDATION	7/18/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1121 E WASHINGTON AVE	None	ESCONDIDO	CA	92025	2214	37	06073	33.13236227	-117.0691443	San Diego County
245655	Fee-for-Service	1891809257	1891809257	1	1	BRIED, JAMES M MD	1/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	62595	20	Orthopedic Surgery	0	In state provider	ORTHOPEDIC SURG ASSOC	15525 POMERADO RD	APT 1	POWAY	CA	92064	2435	37	06073	32.99479918	-117.0579468	San Diego County
245660	Fee-for-Service	1992751895	1992751895	1	1	BEGAZ, TOMER J MD	2/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55228	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
245664	Fee-for-Service	1164588216	1164588216	1	1	BROWN, GEORGIA L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
245675	Fee-for-Service	1699126953	1699126953	1	1	BEAVER, DEBORAH J LMFT	7/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30011 IVY GLENN DR	STE 216	LAGUNA NIGUEL	CA	92677	5018	30	06059	33.52732273	-117.715146	Orange County
245685	Fee-for-Service	1013213917	1013213917	1	1	BROWN, KYLE B	1/22/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
245702	Fee-for-Service	1972681070	1972681070	1	1	BOBROFF, EUGENE MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71431	20	Orthopedic Surgery	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
245703	Fee-for-Service	1699091876	1699091876	1	1	BAILEY, CALEB J MD	6/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117623	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 E CHURCH STREET	EM DEPT	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
245717	Fee-for-Service	1679671358	1679671358	1	1	BURKHART, LAUREN MD	10/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68707	40	Pediatrics	0	In state provider	None	1001 E GRAND AVE	None	ESCONDIDO	CA	92025	4604	37	06073	33.12634291	-117.0682058	San Diego County
245722	Fee-for-Service	1578870812	1578870812	1	1	BURKE, JULIA C DO	2/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	10754	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	45 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7925859	Santa Cruz County
245735	Fee-for-Service	1891469979	1891469979	1	2	BASELINE ENTERPRISE-RYCROFT	7/14/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7131 MATHIS COURT	None	CITRUS HEIGHTS	CA	95610	3933	34	06067	38.695851	-121.272759	Sacramento County
245777	Fee-for-Service	1902379985	1902379985	1	1	BANUELOS CALHOUN, RUBY LCSW	1/9/2024	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	253 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1606	19	06037	34.02108125	-117.8103432	Los Angeles County
245787	Fee-for-Service	1851370902	1851370902	1	1	BORBA, SUSAN E MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63558	40	Pediatrics	0	In state provider	None	3305 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58238894	-124.1358909	Humboldt County
245822	Fee-for-Service	1043612914	1043612914	1	1	BELANGER, ROBERT Z LMFT	7/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4010 BARRANCA PARKWAY	STE 252	IRVINE	CA	92604	1716	30	06059	33.68346716	-117.8075649	Orange County
245832	Fee-for-Service	1417035049	1417035049	1	1	BURGESS, NORA L MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41490	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
245844	Fee-for-Service	1750321956	1750321956	1	1	BERGER, MITCHELL Z MD	3/2/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	128562	None	None	0	In state provider	None	8135 S PAINTER AVENUE	SUITE 103	WHITTIER	CA	90602	3171	19	06037	33.965829	-118.032738	Los Angeles County
245883	Fee-for-Service	1578708376	1578708376	1	1	BAIRD-HICKS, MAILE S LMFT	11/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4444 W RIVERSIDE DR	STE 105	BURBANK	CA	91505	4048	19	06037	34.15216892	-118.348791	Los Angeles County
245886	Fee-for-Service	1801329115	1801329115	1	1	BARRERAS, ROSALIE T	12/31/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5960 RILEY ST	None	SAN DIEGO	CA	92110	1420	37	06073	32.76795793	-117.1861186	San Diego County
245909	Fee-for-Service	1548683402	1548683402	1	1	BECERRA, JACQUELYN C CRNA	10/26/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
245914	Fee-for-Service	1023349883	1023349883	1	1	BORREGO COMM HLTH FOUNDATION	7/18/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1121 E WASHINGTON AVE	None	ESCONDIDO	CA	92025	2214	37	06073	33.13236227	-117.0691443	San Diego County
245922	Fee-for-Service	1487763611	1487763611	1	1	BASSO, LAWRENCE V MD	5/28/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20774	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
245937	Fee-for-Service	1821401787	1821401787	1	1	BOGHOSIAN, BRANDIE PSYD	5/12/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30200 AGOURA RD	SUITE 190	AGOURA HILLS	CA	91301	5434	19	06037	34.14513267	-118.7821377	Los Angeles County
245961	Fee-for-Service	1750706263	1750706263	1	1	BALLEZA, SASHA NP	1/12/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3605 VISTA WAY	BLDG B	OCEANSIDE	CA	92056	4565	37	06073	33.1818929	-117.3104591	San Diego County
246000	Fee-for-Service	1982154118	1982154118	1	1	BOLIVAR ESCOBAR, MELISSA LC	4/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
246017	Fee-for-Service	1972047686	1972047686	1	1	BARRY M KERMAN MD INC	2/6/2017	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	21675 REDWOOD ROAD	None	CASTRO VALLEY	CA	94546	6431	01	06001	37.6896228	-122.0737778	Alameda County
246053	Fee-for-Service	1851160444	1851160444	1	1	BEACH WELLNESS CHIROPRACTIC	9/3/2024	193400000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2211 E LINCOLN AVE	None	ANAHEIM	CA	92806	4108	30	06059	33.83945699	-117.8858858	Orange County
246072	Fee-for-Service	1700974698	1700974698	1	1	BUDA, DANIEL C DO	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14394	01	General Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
246079	Fee-for-Service	1528133998	1528133998	1	1	BOWDEN, WILLIAM D MD	4/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	4661	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	421 MARCH AVE	SUITE B	HEALDSBURG	CA	95448	3367	49	06097	38.6259495	-122.865813	Sonoma County
246095	Fee-for-Service	1225145097	1225145097	1	1	BERGER, CRAIG L MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	0000	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
246096	Fee-for-Service	1346626108	1346626108	1	1	BUTLER, ANGEL	6/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
246119	Fee-for-Service	1073087680	1073087680	1	1	BURN AND RECONSTRUCTIVE CENT	3/10/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	1	Border provider	ERS OF NEVADA, LLC	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
246127	Fee-for-Service	1760841274	1760841274	1	1	BRADY, EMMA W	4/5/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
246173	Fee-for-Service	1881006070	1881006070	1	1	BULL, JULIANNE M LMFT	11/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 HOPE ST	STE 350	SOUTH PASADENA	CA	91030	2628	19	06037	34.11679363	-118.150088	Los Angeles County
246174	Fee-for-Service	1801329115	1801329115	1	1	BARRERAS, ROSALIE T	12/31/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5960 RILEY ST	None	SAN DIEGO	CA	92110	1420	37	06073	32.76795793	-117.1861186	San Diego County
246191	Fee-for-Service	1275683963	1275683963	1	1	BOMMARITO, MICHAEL T OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
246202	Fee-for-Service	1023349883	1023349883	1	1	BORREGO COMM HLTH FOUNDATION	12/10/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1121 E WASHINGTON AVE	None	ESCONDIDO	CA	92025	2214	37	06073	33.13236227	-117.0691443	San Diego County
246216	Fee-for-Service	1184291783	1184291783	1	1	BOSE, DEEPIKA PHD	12/11/2023	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
246222	Fee-for-Service	1942208699	1942208699	1	1	BRESLAU, JONATHAN MD	5/24/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81244	None	None	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
246243	Fee-for-Service	1598073819	1598073819	1	1	BARNES, ELVA V LMFT	6/4/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	73929 LARREA ST	SUITE 1B	PALM DESERT	CA	92260	4305	33	06065	33.71878454	-116.375094	Riverside County
246256	Fee-for-Service	1992724009	1992724009	1	1	BRONSTEIN, YURI MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54631	13	Neurology (M.D. only)	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
246263	Fee-for-Service	1760559462	1760559462	1	1	BAY AREA PEDIATRIC	4/28/1998	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	1500 SOUTHGATE AVE	STE 104	DALY CITY	CA	94015	2205	41	06081	37.67558248	-122.4750825	San Mateo County
246281	Fee-for-Service	1124305065	1124305065	1	1	BAYLOR MEDICAL CENTER	6/18/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5252 W UNIVERSITY DR	None	MCKINNEY	TX	75071	7822	00	None	33.221412	-96.682545	Collin County
246285	Fee-for-Service	1902812464	1902812464	3	1	BROWNWYN ELIZABETH HAMILTON	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
246292	Fee-for-Service	1760878847	1760878847	1	1	BANSAL, PRIYA MD	8/16/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172093	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
246293	Fee-for-Service	1336363019	1336363019	1	1	BAEZ, REINA A MFT	1/5/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	329 A 14TH STREET	None	OAKLAND	CA	94612	3906	01	06001	37.80316357	-122.2683469	Alameda County
246319	Fee-for-Service	1174682777	1174682777	1	1	BROBERG, TODD G MD	7/1/1998	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	79418	84	Surgery-Head and Neck	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
246352	Fee-for-Service	1215041835	1215041835	1	1	BABB, MICHAEL J MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	64731	04	Otology, Laryngology, Rhinology	0	In state provider	None	2888 EUREKA WAY	STE 100	REDDING	CA	96001	0210	45	06089	40.58556034	-122.4159705	Shasta County
246356	Fee-for-Service	1972666980	1972666980	1	1	BARR, STEVEN A MD	7/14/1987	207R00000X	NA	Other	026	PHYSICIANS	48546	41	Internal Medicine	0	In state provider	None	3061 MILLICENT WAY	None	PASADENA	CA	91107	4406	19	06037	34.14122896	-118.0872032	Los Angeles County
246362	Fee-for-Service	1699836940	1699836940	1	1	BOSICK, AMY	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
246365	Fee-for-Service	1912360132	1912360132	1	1	BELETE, HEWAN MD	9/2/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
246403	Fee-for-Service	1073087680	1073087680	1	1	BURN AND RECONSTRUCTIVE CENT	3/10/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	1	Border provider	ERS OF NEVADA, LLC	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
246417	Fee-for-Service	1689778839	1689778839	1	1	BHOGAL, MADHU R MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40573	40	Pediatrics	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
246418	Fee-for-Service	1831254853	1831254853	1	1	BISSELL, JENNIFER J LCSW	12/19/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	465 34TH STREET	SUITE B	OAKLAND	CA	94609	2815	01	06001	37.82207411	-122.2647332	Alameda County
246429	Fee-for-Service	1780077750	1780077750	1	1	BACH, BROOKLYN NP	2/25/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
246433	Fee-for-Service	1811121080	1811121080	1	1	BHANDARI, SALIL K MD	10/15/2020	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
246450	Fee-for-Service	1164488946	1164488946	1	1	BOWERSOX, JON C MD	5/6/2011	2086S0129X	NA	General Surgery	026	PHYSICIANS	72140	02	General Surgery	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
246455	Fee-for-Service	1902197254	1902197254	1	1	BOZOGHLANIAN, MARI MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125647	30	Radiology	0	In state provider	None	10833 LE CONTE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
246465	Fee-for-Service	1598058323	1598058323	1	1	BORAD, AMRUTI D DO	5/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12599	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
246470	Fee-for-Service	1619141371	1619141371	1	1	BRENT, MARLENE T LCSW	10/15/2008	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1792 TRIBUTE ROAD	STE 350	SACRAMENTO	CA	95815	4322	34	06067	38.598219	-121.445964	Sacramento County
246498	Fee-for-Service	1033630819	1033630819	1	1	BENE, NICHOLAS C MD	7/2/2024	208200000X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
246531	Fee-for-Service	1629489554	1629489554	1	1	BOPARAI, NAMRITA MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148581	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
246533	Fee-for-Service	1245506294	1245506294	1	2	BIRAGO, AKUA ACHIAA	4/25/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	15982 SAND HILLS CT	None	MORENO VALLEY	CA	92555	9101	33	06065	33.88865582	-117.187053	Riverside County
246537	Fee-for-Service	1437577749	1437577749	1	1	BEBAWY OPTOMETRY INC	12/1/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	418 AUTO CENTER DR	None	CLAREMONT	CA	91711	5458	19	06037	34.08060405	-117.7197492	Los Angeles County
246564	Fee-for-Service	1205064326	1205064326	1	1	BENNITT, JENNIFER MD	6/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108554	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	SACRAMENTO	CA	90095	7001	34	06067	34.06527974	-118.4462792	Los Angeles County
246570	Fee-for-Service	1124305065	1124305065	1	1	BAYLOR MEDICAL CENTER	6/18/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5252 W UNIVERSITY DR	None	MCKINNEY	TX	75071	7822	00	None	33.221412	-96.682545	Collin County
246581	Fee-for-Service	1710236724	1710236724	1	1	BRADFORD, KHALIDA L LCSW	5/31/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
246638	Fee-for-Service	1740207414	1740207414	1	1	BRUCE KLOSTERMAN MD	8/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
246641	Fee-for-Service	1427210160	1427210160	1	1	BAEZ, JUAN C MD	9/16/2019	2085P0229X	NA	Other	026	PHYSICIANS	150446	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
246658	Fee-for-Service	1265520589	1265520589	1	1	BLASIER, ROBERT D MD	8/5/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	56524	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
246661	Fee-for-Service	1437502499	1437502499	1	1	BAZARGAN, MONA DO	9/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18488	09	Gynecology (D.O. only)	0	In state provider	None	220 PALISADE DRIVE	SUITE 203	SANTA MARIA	CA	93454	8902	42	06083	34.95143521	-120.412098	Santa Barbara County
246663	Fee-for-Service	1265927289	1265927289	1	1	BRASLAVSKY, MICHELLE R DO	6/20/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	17982	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
246692	Fee-for-Service	1073087680	1073087680	1	1	BURN AND RECONSTRUCTIVE CENT	3/10/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	1	Border provider	ERS OF NEVADA, LLC	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
246698	Fee-for-Service	1013091008	1013091008	1	1	BALAZS, KRISZTINA J MD	3/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84212	40	Pediatrics	0	In state provider	None	1200 SONOMA AVE	STE A3	SANTA ROSA	CA	95405	6664	49	06097	38.440854	-122.6985165	Sonoma County
246700	Fee-for-Service	1790913960	1790913960	1	1	BERRY, ASHLEY L PSYD	12/7/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 ASHTON AVE	None	MENLO PARK	CA	94025	6501	41	06081	37.43205327	-122.2036961	San Mateo County
246705	Fee-for-Service	1689778839	1689778839	1	1	BHOGAL, MADHU R MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40573	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
246712	Fee-for-Service	1760618839	1760618839	1	1	BISSON, RICHARD J LMFT	9/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27393 YNEZ RD	STE 264	TEMECULA	CA	92591	4610	33	06065	33.50698549	-117.1502918	Riverside County
246739	Fee-for-Service	1164488946	1164488946	1	1	BOWERSOX, JON C MD	5/6/2011	2086S0129X	NA	General Surgery	026	PHYSICIANS	72140	89	Surgery-Traumatic	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
246763	Fee-for-Service	1245366301	1245366301	1	1	BOLTE, ALEXAN LPCC	10/21/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
246768	Fee-for-Service	1396936480	1396936480	1	1	BEKKERMAN, YELENA MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100144	41	Internal Medicine	0	In state provider	None	4311 THIRD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
246788	Fee-for-Service	1083626931	1083626931	1	1	BOWERS, ELYN V MD	8/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101060	07	Dermatology	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
246796	Fee-for-Service	1790100519	1790100519	1	1	BILHARTZ, TERI MEDICAL	8/25/2014	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	12229	09	Gynecology (D.O. only)	0	In state provider	CORPORATION	480 REDWOOD ST	SUITE 14	VALLEJO	CA	94590	2958	48	06095	38.12315545	-122.2597619	Solano County
246824	Fee-for-Service	1245506294	1245506294	1	2	BIRAGO, AKUA ACHIAA	3/26/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	15982 SAND HILLS CT	None	MORENO VALLEY	CA	92555	9101	33	06065	33.88865582	-117.187053	Riverside County
246826	Fee-for-Service	1750378030	1750378030	1	1	BARNETT, STEVEN L MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61908	01	General Practice	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
246831	Fee-for-Service	1194773168	1194773168	1	1	BHASKAR, BILL MD INC	7/31/1989	174400000X	NA	Other	026	PHYSICIANS	29781	41	Internal Medicine	0	In state provider	None	18102 IRVINE BLVD	STE 105	TUSTIN	CA	92780	3423	30	06059	33.74819092	-117.816792	Orange County
246841	Fee-for-Service	1487211728	1487211728	1	1	BIO-MEDICAL APPLICATIONS OF	5/11/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	14001 OSBORNE ST	None	ARLETA	CA	91331	6026	19	06037	34.23350187	-118.4379072	Los Angeles County
246843	Fee-for-Service	1962414011	1962414011	1	1	BLAZUN, JUDITH M MD	2/28/1996	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	63152	01	General Practice	0	In state provider	None	1020 29TH ST	STE 600	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
246907	Fee-for-Service	1881641967	1881641967	1	1	BAGG, MICHAEL D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7420 REMCON CIR	None	EL PASO	TX	79912	3508	00	None	31.83546136	-106.5625255	El Paso County
246930	Fee-for-Service	1427210160	1427210160	1	1	BAEZ, JUAN C MD	9/16/2019	2085P0229X	NA	Other	026	PHYSICIANS	150446	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
246938	Fee-for-Service	1487703856	1487703856	1	1	BACIGALUPA, PIER F LCSW	6/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	414 GOUGH	3	SAN FRANCISCO	CA	94102	4474	38	06075	37.7772453	-122.4230146	San Francisco County
246951	Fee-for-Service	1437502499	1437502499	1	1	BAZARGAN, MONA DO	9/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18488	15	Obstetrics (D.O. only)	0	In state provider	None	220 PALISADE DRIVE	SUITE 203	SANTA MARIA	CA	93454	8902	42	06083	34.95143521	-120.412098	Santa Barbara County
246974	Fee-for-Service	1538364161	1538364161	1	1	BROOKES, JANICE E LCSW	6/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
246984	Fee-for-Service	1922378751	1922378751	1	1	BENSON, JENNIFER LMFT	12/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
247053	Fee-for-Service	1548963127	1548963127	1	1	BALEEN LLC	9/29/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5318 MANZANITA AVENUE	None	CARMICHAEL	CA	95608	0512	34	06067	38.663964	-121.3269615	Sacramento County
247105	Fee-for-Service	1013058122	1013058122	1	1	BAUMANN, DIRK STEPHEN MD	10/1/1996	208600000X	NA	General Surgery	026	PHYSICIANS	81185	02	General Surgery	0	In state provider	None	50 S SAN MATEO DR	STE 360	SAN MATEO	CA	94401	3833	41	06081	37.56634141	-122.3261145	San Mateo County
247132	Fee-for-Service	1811959620	1811959620	1	1	BENEDETTI, PHILIP F MD	5/24/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
247159	Fee-for-Service	1225484678	1225484678	1	1	BALAJI, ARVIND MD	9/29/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	182373	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
247176	Fee-for-Service	1609120948	1609120948	1	1	BURNEY, JEFFREY K CRNA	11/7/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
247183	Fee-for-Service	1154390425	1154390425	1	1	BUI, STEVE Q MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77823	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 211	GARDEN GROVE	CA	92843	1916	30	06059	33.77450141	-117.9123364	Orange County
247185	Fee-for-Service	1053573642	1053573642	1	2	BOGOJE, KASEY M LMFT	4/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
247208	Fee-for-Service	1942469663	1942469663	1	1	BENHAIM, SHARONA MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124866	14	Neurological Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
247222	Fee-for-Service	1477998565	1477998565	1	1	BOWERS, TOBY J DO	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
247226	Fee-for-Service	1053482034	1053482034	1	1	BAIK, HOWARD K MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65077	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
247238	Fee-for-Service	1225074156	1225074156	1	1	BONDAREFF, WILLIAM MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	44324	36	Psychiatry	0	In state provider	None	1640 MARENGO ST	STE 510	LOS ANGELES	CA	90033	1038	19	06037	34.05946374	-118.213356	Los Angeles County
247251	Fee-for-Service	1689747198	1689747198	1	1	BRECHT-DOSCHER, AIMEE R	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68902	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD INC	3901 LAS POSAS RD	STE 100	CAMARILLO	CA	93010	1506	56	06111	34.2415821	-119.0183756	Ventura County
247255	Fee-for-Service	1487147377	1487147377	1	1	BOWERS, IAN D DMD MSD	6/7/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	20924	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
247265	Fee-for-Service	1457381014	1457381014	1	1	BENZ, CHRISTOPHER C MD	12/31/1983	207RX0202X	NA	Oncology	026	PHYSICIANS	25446	68	Hematology	0	In state provider	None	1381 9TH AVE	None	SAN FRANCISCO	CA	94122	2308	38	06075	37.76252699	-122.4662342	San Francisco County
247269	Fee-for-Service	1700225042	1700225042	1	1	BRADSHAW, SAMUEL L MD	9/13/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161202	08	Family Practice	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14847323	-122.2180997	Tehama County
247303	Fee-for-Service	1932635620	1932635620	1	1	BIELSKI, CODY J MD	11/23/2020	390200000X	NA	Other	026	PHYSICIANS	162857	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
247332	Fee-for-Service	1558600445	1558600445	1	1	BRISCOE, RYAN LPCC	12/24/2024	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4550 CALIFORNIA AVE	SUITE 670	BAKERSFIELD	CA	93309	7012	15	06029	35.367903	-119.0537145	Kern County
247333	Fee-for-Service	1144623869	1144623869	1	1	BRIDGEFORD, MARIE PSYD	5/11/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
247376	Fee-for-Service	1760460695	1760460695	1	1	BUGELLI, NICOLA C MD	9/17/2009	207R00000X	NA	Other	026	PHYSICIANS	67439	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
247397	Fee-for-Service	1154439743	1154439743	1	1	BONABI, NAGADEH G	6/30/1989	174400000X	NA	Other	026	PHYSICIANS	46355	41	Internal Medicine	0	In state provider	None	17075 DEVONSHIRE ST	STE 104	NORTHRIDGE	CA	91325	5406	19	06037	34.25755945	-118.50471	Los Angeles County
247422	Fee-for-Service	1184981409	1184981409	1	1	BEVERLY RADIOLOGY MEDICAL	10/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	15651 IMPERIAL HWY	#103	LA MIRADA	CA	90638	1600	19	06037	33.91736136	-117.9972197	Los Angeles County
247435	Fee-for-Service	1861986747	1861986747	1	1	BORIN, DANIELLE MD	11/13/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164869	40	Pediatrics	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
247469	Fee-for-Service	1841367380	1841367380	1	1	BLANKE, KENT J DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1408 CROWN DRIVE	None	KIRKSVILLE	MO	63501	0000	00	None	40.20598968	-92.57392879	Adair County
247471	Fee-for-Service	1154390425	1154390425	1	1	BUI, STEVE Q MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77823	45	Nephrology (Renal-Kidney)	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 211	GARDEN GROVE	CA	92843	1916	30	06059	33.77450141	-117.9123364	Orange County
247475	Fee-for-Service	1326373218	1326373218	1	1	BARRUS, ADAM MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122912	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
247556	Fee-for-Service	1134327224	1134327224	1	1	BASSETT. HILLARY A MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102202	None	None	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
247578	Fee-for-Service	1407296064	1407296064	1	1	BIRELEY, BRANDON E DO	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16540	02	General Surgery	0	In state provider	None	3307 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239431	-124.1358906	Humboldt County
247582	Fee-for-Service	1316025935	1316025935	1	1	BARRON, DANICA N MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74493	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
247583	Fee-for-Service	1093062382	1093062382	1	1	BOBMAN, MATTHEW J	1/30/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4151 FOOTHILL RD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
247602	Fee-for-Service	1114026127	1114026127	1	1	BUCKWAY, CAROLINE MD	12/1/1997	2080P0205X	NA	Endocrinology	026	PHYSICIANS	60707	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
247632	Fee-for-Service	1205236106	1205236106	1	1	BUI, LAMSON T PSYD	2/25/2020	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
247642	Fee-for-Service	1700111226	1700111226	1	1	BASU, SANJAY MD	5/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115459	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.76344756	-122.4581992	San Francisco County
247649	Fee-for-Service	1033296983	1033296983	1	1	BLUMSTEIN, SYLVIE L MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	75859	None	None	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
247656	Fee-for-Service	1215369319	1215369319	1	1	BAINS, RAMANDEEP MD	7/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127178	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
247679	Fee-for-Service	1194955930	1194955930	1	1	BRANT, SARAH M MD	11/1/2019	208600000X	NA	General Surgery	026	PHYSICIANS	163294	02	General Surgery	0	In state provider	None	2526 SISTER MARY COLUMBA	1ST FLOOR	RED BLUFF	CA	96080	4327	52	06103	40.14934389	-122.2195713	Tehama County
247682	Fee-for-Service	1811049893	1811049893	1	1	BRITTO, JOHN A MD	1/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40543	24	Plastic Surgery	0	In state provider	None	7957 S PAINTER AVE	STE 202	WHITTIER	CA	90602	2434	19	06037	33.96837047	-118.0327433	Los Angeles County
247701	Fee-for-Service	1528687738	1528687738	1	1	BRADY, DANIEL DO	10/30/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20902	None	None	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
247723	Fee-for-Service	1578567822	1578567822	1	1	BLOOM, GITTE S MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72269	40	Pediatrics	0	In state provider	None	12660 RIVERSIDE DR	STE 320	NORTH HOLLYWOOD	CA	91607	3431	19	06037	34.1575795	-118.409499	Los Angeles County
247777	Fee-for-Service	1376672196	1376672196	1	1	BOWER, SUSAN A LCSW	4/6/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 STANDIFORD AVE	None	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
247782	Fee-for-Service	1487296364	1487296364	1	1	BROTHERHOOD PHARMACY INC	11/18/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1040 S MOUNT VERNON AVE	E	COLTON	CA	92324	4228	36	06071	34.05117715	-117.3090557	San Bernardino County
247788	Fee-for-Service	1851468680	1851468680	1	1	BRETTLER, JEFFREY W.	10/19/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61590	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
247793	Fee-for-Service	1578721841	1578721841	1	1	BANGA, AMIT MD	7/26/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	177767	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
247838	Fee-for-Service	1083194732	1083194732	1	1	BRODSTON, SHIRLEY H CNP	12/16/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1720 S BASCOM AVE	None	CAMPBELL	CA	95008	0608	43	06085	37.292472	-121.9315815	Santa Clara County
247868	Fee-for-Service	1821655333	1821655333	1	1	BATCHELDER, ASHLEY S CNP	3/22/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
247877	Fee-for-Service	1285721092	1285721092	1	1	BOYER, RANDALL W MD	1/1/1979	208600000X	NA	General Surgery	026	PHYSICIANS	23260	02	General Surgery	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
247892	Fee-for-Service	1275736266	1275736266	1	1	BUTCHER, MARIAN L MD	9/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114201	22	Pathology (M.D. only)	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
247896	Fee-for-Service	1891709689	1891709689	1	1	BLASCHKO, WILLIAM J MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42865	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1116 E LATHAM AVE	None	HEMET	CA	92543	0000	33	06065	33.74938485	-116.9604355	Riverside County
247973	Fee-for-Service	1558664284	1558664284	1	1	BEDNARZ, DANIELLA LMFT	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	89378	-	NOT APPLICABLE	0	In state provider	None	1911 WILLIAMS DRIVE	SUITE 140	OXNARD	CA	93036	2612	56	06111	34.219566	-119.1539365	Ventura County
247974	Fee-for-Service	1942412291	1942412291	1	1	BIRNBAUM, RON A MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83358	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
247976	Fee-for-Service	1962757450	1962757450	1	1	BAIDWAN, AVIJIT S MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137736	41	Internal Medicine	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
248004	Fee-for-Service	1518288042	1518288042	1	1	BUSCH, JUSTIN R MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118006	05	Anesthesiology	0	In state provider	None	ONE HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
248065	Fee-for-Service	1285732701	1285732701	1	1	BAJWA, RANJIT S MD	9/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87760	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
248078	Fee-for-Service	1851468680	1851468680	1	1	BRETTLER, JEFFREY W.	10/19/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61590	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
248097	Fee-for-Service	1174671978	1174671978	1	1	BAUTISTA, LINO O MD	11/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	67114	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
248116	Fee-for-Service	1770992265	1770992265	1	1	BARROSO, VIOLETA E MD	5/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	140005	08	Family Practice	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
248118	Fee-for-Service	1619379922	1619379922	1	1	BARBARIA, GILLIAN J	9/22/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	116 S LASSEN STREET	None	WILLOWS	CA	95988	3009	11	06021	39.52027795	-122.1995617	Glenn County
248158	Fee-for-Service	1114446135	1114446135	1	1	BRIJESH KADAM MD INC.	2/23/2021	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	520 W I ST.	None	LOS BANOS	CA	93635	3419	24	06047	37.06346603	-120.8593647	Merced County
248168	Fee-for-Service	1306574090	1306574090	1	1	BULAN-BARTOLOME, JANICE NP	4/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
248181	Fee-for-Service	1265572572	1265572572	1	1	BASSETT, WILLIAM W MD	10/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109040	34	Urology and Urological Surgery	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
248229	Fee-for-Service	1669993598	1669993598	1	1	BOSCH, AGNES M MD	7/14/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173006	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
248249	Fee-for-Service	1689855561	1689855561	1	1	BAJRACHARYA, ADARSHA S MD	7/25/2023	207R00000X	NA	Other	026	PHYSICIANS	186903	None	None	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4111	19	06037	33.94909549	-118.3481595	Los Angeles County
248252	Fee-for-Service	1891953915	1891953915	1	1	BAIRD, TISHA MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103957	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
248263	Fee-for-Service	1730248717	1730248717	1	1	BERONCAL, DONALDO P	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
248293	Fee-for-Service	1689608879	1689608879	1	1	BTT ENTERPRISES	3/1/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SADDLEBACK VALLEY PHARM	23961 CALLEDELAMAGDALENA	None	LAGUNA HILLS	CA	92653	0000	30	06059	33.60904202	-117.7106597	Orange County
248310	Fee-for-Service	1871541664	1871541664	1	1	BENSON, CONSTANCE A MD	9/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87372	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
248338	Fee-for-Service	1730370859	1730370859	1	1	BENKWITZ, CLAUDIA MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112095	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
248388	Fee-for-Service	1750371571	1750371571	1	1	BUNCKE MEDICAL CLINIC INC	11/9/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
248428	Fee-for-Service	1245471051	1245471051	1	1	BAUER, COLIN E MD	5/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111400	05	Anesthesiology	0	In state provider	None	700 IRWIN STREET	#102	SAN RAFAEL	CA	94901	3339	21	06041	37.97040772	-122.52069	Marin County
248443	Fee-for-Service	1558511469	1558511469	1	1	BOOTH, DANA A MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131313	33	Thoracic Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC:5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
248462	Fee-for-Service	1245479963	1245479963	1	1	BLACK, STEPHANIE ANNE PT	3/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2838 OSWELL ST	None	BAKERSFIELD	CA	93306	2704	15	06029	35.39923633	-118.9499418	Kern County
248525	Fee-for-Service	1518059880	1518059880	1	1	BODDY, MARK G MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89220	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
248527	Fee-for-Service	1649527664	1649527664	1	1	BENSON, ERIC G NP	6/16/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	50	06099	37.662489	-120.957588	Stanislaus County
248643	Fee-for-Service	1376048918	1376048918	1	1	BOYLE, SVETLANA A NP	7/5/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
248654	Fee-for-Service	1336253632	1336253632	1	1	BRADLEY MULLEN M.D.	1/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14502 W MEEKER BLVD	None	SUN CITY WEST	AZ	85375	5282	00	None	33.660657	-112.3736175	Maricopa County
248657	Fee-for-Service	1275877599	1275877599	1	1	BHAVSAR, JESSICA PA-C	7/24/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	57708	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
248675	Fee-for-Service	1992071211	1992071211	1	1	BAUER, BRENTON S MD	3/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127180	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
248702	Fee-for-Service	1437382470	1437382470	1	1	BHANDARI, TARUN MD	2/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130160	26	Psychiatry (child)	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
248708	Fee-for-Service	1780691576	1780691576	1	1	BOENTE, KATHRYN T MD	11/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
248713	Fee-for-Service	1922251271	1922251271	1	1	BARNETT, MAYA Y LMFT	4/21/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11840 MAGNOLIA	STE C	RIVERSIDE	CA	92503	7112	33	06065	33.89540021	-117.4902651	Riverside County
248793	Fee-for-Service	1962507657	1962507657	1	1	BAETGE, GREGORY MD	9/30/1995	207ZP0105X	NA	Other	026	PHYSICIANS	78899	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
248837	Fee-for-Service	1518498492	1518498492	1	1	BACKUS, SAMUEL B MD	8/3/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	161310	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
248838	Fee-for-Service	1154413599	1154413599	1	1	BREWER, MARC L MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79756	40	Pediatrics	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
248868	Fee-for-Service	1851749907	1851749907	1	1	BOWZ, EDWARD P LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH RD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
248876	Fee-for-Service	1861761785	1861761785	1	1	BIOVENTUS LLC	10/11/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1900 CHARLES BRYAN RD	SUITE 275	CORDOVA	TN	38016	5285	00	None	35.17667148	-89.82836113	Shelby County
248896	Fee-for-Service	1619378411	1619378411	1	1	BEKOE-SAKYI, MAVIS CNP	12/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
248904	Fee-for-Service	1568418572	1568418572	1	1	BEDANREK, PAVLA MD	3/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55291	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
248913	Fee-for-Service	1326272071	1326272071	1	1	BAL, IQGAL S MD	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42270	41	Internal Medicine	0	In state provider	None	380 N RESERVATION RD	None	PORTERVILLE	CA	93257	9673	54	06107	36.02996779	-118.7882551	Tulare County
248919	Fee-for-Service	1356461321	1356461321	1	1	BABAYAN, DIANA OD	11/6/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14240 SAN PABLO AVE	None	SAN PABLO	CA	94806	3328	07	06013	37.96332885	-122.345488	Contra Costa County
248940	Fee-for-Service	1750771168	1750771168	1	1	BLAKE, HEATHER J CRNA	4/1/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
248957	Fee-for-Service	1578305165	1578305165	1	1	BRAND, KASAMA CNP	10/30/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3231 WARING COURT	SUITE K	OCEANSIDE	CA	92056	4510	37	06073	33.18776771	-117.2893136	San Diego County
249000	Fee-for-Service	1316200967	1316200967	1	1	BASSO-WILLIAMS, MICHAEL DO	7/26/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13055	20	Orthopedic Surgery	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
249017	Fee-for-Service	1548497282	1548497282	1	1	BAIR, JACOB A DO	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12779	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
249031	Fee-for-Service	1558601708	1558601708	1	1	BORETZ, MICHAEL LCSW	2/7/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
249054	Fee-for-Service	1609824556	1609824556	1	1	BRONK, JAMES BARRY MD	10/31/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50612	30	Radiology	0	In state provider	None	290 ALAMO DR	None	VACAVILLE	CA	95688	4245	48	06095	38.35455773	-122.0091599	Solano County
249056	Fee-for-Service	1497803480	1497803480	1	1	BURGOS, JULIE C DO	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7455	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249083	Fee-for-Service	1962507657	1962507657	1	1	BAETGE, GREGORY MD	9/30/1995	207ZP0105X	NA	Other	026	PHYSICIANS	78899	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
249117	Fee-for-Service	1477786747	1477786747	1	1	BIER, ADAM D MD	1/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103190	20	Orthopedic Surgery	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
249129	Fee-for-Service	1720636400	1720636400	1	1	BRUCKER, MICHAEL C PT	9/17/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16008 KAMANA RD.,	SUITE 200	APPLE VALLEY	CA	92307	0000	36	06071	34.54191149	-117.2725046	San Bernardino County
249145	Fee-for-Service	1497234041	1497234041	1	1	BERTHOUD, DORIAN LMFT	3/11/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
249153	Fee-for-Service	1164638573	1164638573	1	1	BIRD, GARRETT R MD	8/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97356	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2200 CLOVIS AVE	None	CLOVIS	CA	93612	3915	10	06019	36.80635198	-119.7004625	Fresno County
249160	Fee-for-Service	1366435687	1366435687	1	1	BALES, LAUREN D MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86701	None	None	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
249164	Fee-for-Service	1437163904	1437163904	1	1	BETHENCOURT, DANIEL M MD	3/31/1984	208G00000X	NA	General Surgery	026	PHYSICIANS	41588	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
249178	Fee-for-Service	1811259310	1811259310	1	1	BUCKINGHAM, CLARE S MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143225	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
249198	Fee-for-Service	1326272071	1326272071	1	1	BAL, IQGAL S MD	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42270	77	Infectious Disease	0	In state provider	None	380 N RESERVATION RD	None	PORTERVILLE	CA	93257	9673	54	06107	36.02996779	-118.7882551	Tulare County
249203	Fee-for-Service	1306200746	1306200746	1	1	BORJA, ERWIN OT	6/15/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
249205	Fee-for-Service	1851449375	1851449375	1	1	BELZER, HAIM PHD	9/26/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4550 KEARNY VILLA RD.	# 109	SAN DIEGO	CA	92123	1578	37	06073	32.82271596	-117.1441359	San Diego County
249281	Fee-for-Service	1053519280	1053519280	1	1	BHARNE, ANJALI A MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94639	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1749	19	06037	34.069509	-118.383743	Los Angeles County
249282	Fee-for-Service	1578928669	1578928669	1	1	BERKOWITZ, CARLA B MD	6/30/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187413	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
249308	Fee-for-Service	1215905831	1215905831	1	1	BACKMAN,JOHN R MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	29156	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
249312	Fee-for-Service	1447587654	1447587654	1	1	BRINDA, ERIKA Y LMFT	10/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
249329	Fee-for-Service	1578613543	1578613543	1	1	BOOTHPUR, RAGHAVENDER R MD	1/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117765	45	Nephrology (Renal-Kidney)	0	In state provider	None	1525 PLUMAS CT	STE C	YUBA CITY	CA	95991	2971	51	06101	39.15274768	-121.6184473	Sutter County
249355	Fee-for-Service	1366766180	1366766180	1	2	BEVERLY RADIOLOGY MEDICAL	3/2/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP III	2601 W ALAMEDA AVE	SUITE 101	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
249398	Fee-for-Service	1831756105	1831756105	1	1	BERGER, COLBY DPM	7/2/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9850 GENESEE AVE	SUITE 510	LA JOLLA	CA	92037	1213	37	06073	32.882913	-117.226341	San Diego County
249399	Fee-for-Service	1780762526	1780762526	1	1	BALDINI, DAVID M MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66739	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
249408	Fee-for-Service	1386969715	1386969715	1	1	BAUMER, FIONA M MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135183	79	Neurology-Child	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
249478	Fee-for-Service	1821330796	1821330796	1	1	BORTZ, PASCAL G MD	1/22/2021	208600000X	NA	General Surgery	026	PHYSICIANS	139519	None	None	0	In state provider	None	9850 GENESEE AVE	SUITE 570	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
249485	Fee-for-Service	1437234192	1437234192	1	1	BERMAN, RONALD L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27323	01	General Practice	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
249488	Fee-for-Service	1679790778	1679790778	1	1	BEN SHWACHMAN M.D. A PROFESS	10/22/2019	208VP0014X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	IONAL CORPORATION	315 N 3RD AVE	SUITE 200	COVINA	CA	91723	1905	19	06037	34.08873786	-117.8923869	Los Angeles County
249562	Fee-for-Service	1093890758	1093890758	1	1	BAKER, THOMAS E MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37311	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
249597	Fee-for-Service	1215905831	1215905831	1	1	BACKMAN,JOHN R MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	29156	66	Emergency Medicine (Urgent Care)	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
249633	Fee-for-Service	1568452928	1568452928	1	1	BRAL, KAMBIZ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75 BARDAY CIRCLE	STE 205	ROCHESTER HLS	MI	48307	4547	00	None	0	0	None
249643	Fee-for-Service	1891788949	1891788949	1	1	BATTS, KENNETH P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2345 RICE ST	STE 160	SAINT PAUL	MN	55113	3769	00	None	45.011619	-93.106068	Ramsey County
249650	Fee-for-Service	1063744753	1063744753	1	1	BUONCRISTIANI, TINA M NP	6/23/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
249658	Fee-for-Service	1013009778	1013009778	1	1	BELZER, MARVIN ERIC MD	7/31/1987	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	61403	01	General Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
249669	Fee-for-Service	1639101736	1639101736	1	1	BOTTUM, GREGORY E PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1643 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
249683	Fee-for-Service	1932367059	1932367059	1	1	BOGETZ, JORI F MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109018	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
249699	Fee-for-Service	1558664284	1558664284	1	2	BEDNARZ, DANIELLA LMFT	9/28/2020	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10646 ZELZAH AVE	STE 207	GRANADA HILLS	CA	91344	5960	19	06037	34.26341579	-118.5233607	Los Angeles County
249758	Fee-for-Service	1972608016	1972608016	1	1	BARR, RONALD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33956	07	Dermatology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
249775	Fee-for-Service	1437337367	1437337367	1	1	BAIN-DIXON, JENNIFER L	6/3/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 E TAHQUITZ CANYON	WAY BLDG B STE 120	PALM SPRINGS	CA	92262	0116	33	06065	33.8230345	-116.5331835	Riverside County
249786	Fee-for-Service	1487877866	1487877866	1	1	BRUSKY, HEATHER E DO	5/7/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9543	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
249825	Fee-for-Service	1487843280	1487843280	1	1	BENJAMIN, ARTHUR MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55562	18	Ophthalmology	0	In state provider	A PROF MEDICAL CORP	9201 W SUNSET BLVD	STE 709	LOS ANGELES	CA	90069	3708	19	06037	34.09054375	-118.392295	Los Angeles County
249855	Fee-for-Service	1487118931	1487118931	1	1	BUTLER, MICHELLE M CRNA	7/31/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
249863	Fee-for-Service	1023520467	1023520467	1	1	BALTHAZOR, PATRICIA N CCC-SL	12/5/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
249879	Fee-for-Service	1366874844	1366874844	1	1	BIRCH, KRISTINA D LPCC	6/2/2020	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21 N EL CIRCULO AVE	None	PATTERSON	CA	95363	2535	50	06099	37.47121868	-121.1322863	Stanislaus County
249885	Fee-for-Service	1215905831	1215905831	1	1	BACKMAN,JOHN R MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	29156	41	Internal Medicine	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
249907	Fee-for-Service	1518041201	1518041201	1	1	BARRETT, KEVIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SAN JACINTO METHODIST HS	4401 GARTH RD	None	BAYTOWN	TX	77521	0000	00	None	29.76910842	-94.97759843	Harris County
249925	Fee-for-Service	1174905251	1174905251	1	1	BAISZ, AMBER C MD	9/16/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154207	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
249971	Fee-for-Service	1932102456	1932102456	1	1	BANSAL, JAGAN N MD	5/20/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	34128	41	Internal Medicine	0	In state provider	None	5540 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4120	19	06037	34.10855455	-118.1948437	Los Angeles County
249994	Fee-for-Service	1184736985	1184736985	1	1	BIO MEDICAL APPLICATIONS	5/15/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	2679B SAVIERS RD	None	OXNARD	CA	93033	5323	56	06111	34.17479235	-119.1777057	Ventura County
250009	Fee-for-Service	1134353832	1134353832	1	1	BULLON, MAYRA A LMFT	8/9/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23822 VALENCIA BLVD	STE 203	VALENCIA	CA	91355	5344	19	06037	34.41372708	-118.5513626	Los Angeles County
250061	Fee-for-Service	1285962068	1285962068	1	1	BLOCK, PENELOPE B MD	7/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120595	30	Radiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
250079	Fee-for-Service	1154734432	1154734432	1	1	BELARDO, DANIELLE MD	5/15/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	170845	None	None	0	In state provider	None	251 TURNPIKE	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
250103	Fee-for-Service	1992901789	1992901789	1	1	BROWNE, LORNA P MD	12/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
250123	Fee-for-Service	1952312621	1952312621	1	1	BORRERO, MARCOS MD	4/25/2009	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	38907	08	Family Practice	0	In state provider	None	3490 PALM AVE	None	SAN DIEGO	CA	92154	1664	37	06073	32.58391748	-117.0594012	San Diego County
250150	Fee-for-Service	1871955476	1871955476	1	1	BEST, JOHN MD	6/12/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	168313	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
250186	Fee-for-Service	1720218340	1720218340	1	1	BIJAY RISAL	1/21/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8585 PICARDY AVE	None	BATON ROUGE	LA	70809	3748	00	None	30.39345	-91.094409	East Baton Rouge Parish
250187	Fee-for-Service	1538271333	1538271333	1	1	BIO MEDICAL APPLICATIONS	7/16/1999	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	3470 LA SIERRA AVE	None	RIVERSIDE	CA	92503	5223	33	06065	33.89888164	-117.4725216	Riverside County
250189	Fee-for-Service	1063590784	1063590784	1	1	BERG, CECELIA MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50647	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
250194	Fee-for-Service	1619931011	1619931011	1	1	BLOOM, DAVID S MD	12/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	8236	10	Gastroenterology (M.D. only)	0	In state provider	None	1350 S ELISEO DR	STE 3130	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
250218	Fee-for-Service	1104100692	1104100692	1	1	BAILEYOLSON, MARA F NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
250245	Fee-for-Service	1851405724	1851405724	1	1	BAYLE, KAREN MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68362	08	Family Practice	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
250258	Fee-for-Service	1043208903	1043208903	1	1	BEEKVAN, R JACQUES EDWI	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY OF IOWA HOSPI	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
250260	Fee-for-Service	1932102456	1932102456	1	1	BANSAL, JAGAN N MD	5/20/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	34128	38	Geriatrics	0	In state provider	None	5540 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4120	19	06037	34.10855455	-118.1948437	Los Angeles County
250283	Fee-for-Service	1174240766	1174240766	1	1	BOWDRING, MOLLY A PHD	12/1/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250339	Fee-for-Service	1104349091	1104349091	1	1	BRANDON, ADRIANNA LMFT	11/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
250365	Fee-for-Service	1457014979	1457014979	1	1	BROWN, MEGHAN E LCSW	1/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
250388	Fee-for-Service	1326661182	1326661182	1	1	BENEFICIAL HOSPICE AND	4/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	7002 MOODY STREET	STE 205B	LA PALMA	CA	90623	1182	30	06059	33.85795025	-118.0461804	Orange County
250389	Fee-for-Service	1407052921	1407052921	1	1	BRANDON JAY WARRICK	8/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
250411	Fee-for-Service	1013118801	1013118801	1	1	BIVENS, JOSEPH K MD	3/5/2018	208200000X	NA	General Surgery	026	PHYSICIANS	60000	24	Plastic Surgery	0	In state provider	None	207 W. LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
250422	Fee-for-Service	1235208638	1235208638	1	1	BURDENY, DEREK A MD	9/6/2007	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52921	30	Radiology	0	In state provider	None	1260 S ELISEO DR	STE 101	GREENBRAE	CA	94904	2009	21	06041	37.94400039	-122.5357557	Marin County
250473	Fee-for-Service	1649812280	1649812280	1	1	BISHOP, JOCELYN M CCC-SLP	2/3/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
250508	Fee-for-Service	1790737310	1790737310	1	1	BRADLEY ROBERT CRAIG, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 JASMINE ST	None	OMAK	WA	98841	9578	00	None	48.3963912	-119.5454377	Okanogan County
250531	Fee-for-Service	1851405724	1851405724	1	1	BAYLE, KAREN MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68362	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
250541	Fee-for-Service	1477940161	1477940161	1	1	BITAR, JIN SUN L MD	5/11/2021	390200000X	NA	Other	026	PHYSICIANS	150397	None	None	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
250545	Fee-for-Service	1932102456	1932102456	1	1	BANSAL, JAGAN N MD	5/20/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	34128	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5540 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4120	19	06037	34.10855455	-118.1948437	Los Angeles County
250601	Fee-for-Service	1215993399	1215993399	1	1	BASKEVITCH, GEORGE MD	1/31/1983	207P00000X	NA	Other	026	PHYSICIANS	50126	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
250605	Fee-for-Service	1861951352	1861951352	1	1	BAQUIR, EMILIANO D NP	5/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
250617	Fee-for-Service	1649739285	1649739285	1	1	BOWDEN, DANIELLE LMFT	9/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6276 N 1ST ST	103	FRESNO	CA	93710	5400	10	06019	36.82794977	-119.7721574	Fresno County
250662	Fee-for-Service	1699802793	1699802793	1	1	BRANSON, JULIE C LMFT	5/6/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2910 H STREET	SUITES 106,109,112,205	EUREKA	CA	95501	4408	12	06023	40.78177748	-124.1613638	Humboldt County
250677	Fee-for-Service	1326661182	1326661182	1	1	BENEFICIAL HOSPICE AND	4/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	7002 MOODY STREET	STE 205B	LA PALMA	CA	90623	1182	30	06059	33.85795025	-118.0461804	Orange County
250678	Fee-for-Service	1215278536	1215278536	1	1	BECCARELLI, DEBORAH S NP	2/2/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 CRAVEN RD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
250714	Fee-for-Service	1891173068	1891173068	1	1	BIG SUR ANESTHESIA GROUP PC	5/28/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	81812 DOCTOR CARREON BLV	STE F	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
250785	Fee-for-Service	1801235544	1801235544	1	1	BOYD, LAURA L MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148961	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	9713	50	06099	37.70451024	-121.0709696	Stanislaus County
250802	Fee-for-Service	1528422136	1528422136	1	1	BRIGGS, AMY L MD	4/29/2020	207P00000X	NA	Other	026	PHYSICIANS	150532	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
250851	Fee-for-Service	1174244586	1174244586	1	1	BUI, JOSEPH OD	5/31/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5770 1ST ST	None	FRESNO	CA	93710	6204	10	06019	36.822231	-119.7721825	Fresno County
250878	Fee-for-Service	1225057839	1225057839	1	1	BELLARS, RICHARD H MD	10/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70606	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
250886	Fee-for-Service	1841452612	1841452612	1	1	BRUCKMAN, KARL C MD	8/8/2019	204E00000X	NA	Dental Provider	026	PHYSICIANS	163334	24	Plastic Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
250927	Fee-for-Service	1295795151	1295795151	1	1	BENEDUCE, CHRISTOPHER MD	6/9/2020	207L00000X	NA	Other	026	PHYSICIANS	70465	05	Anesthesiology	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
250948	Fee-for-Service	1295743045	1295743045	1	2	BULLOCK, ANDREW C DO	2/22/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	6842	25	Physical Medicine and Rehabilitation	0	In state provider	None	1855 FIRST AVE	STE 200	SAN DIEGO	CA	92101	2650	37	06073	32.7247631	-117.1638834	San Diego County
250957	Fee-for-Service	1003828161	1003828161	1	1	BROOKS, REBECCA S	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
250965	Fee-for-Service	1821278078	1821278078	1	1	BLUM, BRENDA L LCSW	2/14/2013	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	113 N CHURCH ST	STE 418	VISALIA	CA	93291	6316	54	06107	36.330561	-119.2913325	Tulare County
250992	Fee-for-Service	1891469979	1891469979	1	1	BASELINE ENTERPRISE-RYCROFT	8/23/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ENTERPRISE	1840 KERN MOUNTAIN WAY	None	ANTIOCH	CA	94531	7498	07	06013	37.9610953	-121.7928532	Contra Costa County
251013	Fee-for-Service	1588794986	1588794986	1	1	BRASLOW, LAWRENCE MD	5/12/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42773	36	Psychiatry	0	In state provider	None	624 W 9TH ST	103	SAN PEDRO	CA	90731	3158	19	06037	33.73607853	-118.290789	Los Angeles County
251017	Fee-for-Service	1245937325	1245937325	1	1	BILLIONTOONE, INC.	5/14/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1035 OBRIEN DR	None	MENLO PARK	CA	94025	1408	41	06081	37.475145	-122.1501555	San Mateo County
251034	Fee-for-Service	1457551558	1457551558	1	1	BETTER DAY ADHC	5/8/2012	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	723 D ST	None	MARYSVILLE	CA	95901	5318	58	06115	39.1432295	-121.5893663	Yuba County
251082	Fee-for-Service	1932553385	1932553385	1	1	BBH WBMC LLC	12/4/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3400 HIGHWAY 76 EAST	None	JASPER	AL	35501	8956	00	None	0	0	None
251095	Fee-for-Service	1205679446	1205679446	1	1	BOOTHBY, ALEXIS LCSW	10/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
251096	Fee-for-Service	1609040336	1609040336	1	1	BHAREL, CHETAN MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107190	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1328 TWENTY SECOND ST	None	SANTA MONICA	CA	90404	2091	19	06037	34.03122319	-118.4797185	Los Angeles County
251115	Fee-for-Service	1255594909	1255594909	1	1	BERNHARDT, BRIAN E MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129760	05	Anesthesiology	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
251116	Fee-for-Service	1396948170	1396948170	2	1	BAUMBACH, JENNIFER L MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55999	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
251126	Fee-for-Service	1326126160	1326126160	1	1	BANERJEE, SUBHENDRA N MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	63470	02	General Surgery	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
251159	Fee-for-Service	1962423889	1962423889	1	1	BI-VALLEY MEDICAL CLINIC, IN	6/1/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
251177	Fee-for-Service	1295784130	1295784130	1	1	BOYATT, KELLY E MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80960	08	Family Practice	0	In state provider	None	28780 SINGLE OAK DR	SUITE 160	TEMECULA	CA	92590	4080	33	06065	33.49890392	-117.1612965	Riverside County
251188	Fee-for-Service	1063594778	1063594778	1	1	BUCKENBERGER, ROBERT K	3/23/1994	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1642 E HERNDON AVE	STE 103	FRESNO	CA	93720	3377	10	06019	36.83755648	-119.7576495	Fresno County
251202	Fee-for-Service	1538540331	1538540331	1	1	BROSCH, CORY L LMFT	11/25/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49739	-	NOT APPLICABLE	0	In state provider	None	1207 E FRUIT ST	None	SANTA ANA	CA	92701	4206	30	06059	33.75238847	-117.8539245	Orange County
251219	Fee-for-Service	1124451505	1124451505	1	1	BADRAN, KARAM MD	4/23/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	140494	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251227	Fee-for-Service	1447348891	1447348891	1	1	BECK, FRED J MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70405	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
251243	Fee-for-Service	1689165276	1689165276	1	1	BOROFKA, KRISTIAN DO	9/22/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17605	None	None	0	In state provider	None	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	34	06067	38.494602	-121.513743	Sacramento County
251259	Fee-for-Service	1962456707	1962456707	1	1	BROWN, KATHERINE MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73433	40	Pediatrics	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
251313	Fee-for-Service	1346803046	1346803046	1	1	BAIG, ANUM IQBAL	10/18/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180719	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
251323	Fee-for-Service	1912099441	1912099441	1	1	BAUTISTA, RAYMUNDO S MD	4/30/2010	207R00000X	NA	Other	026	PHYSICIANS	52874	41	Internal Medicine	0	In state provider	PROF CORP	118 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3364	19	06037	34.1359527	-117.8664233	Los Angeles County
251369	Fee-for-Service	1063467538	1063467538	1	1	BLUE, BRENT MD	7/1/1982	207P00000X	NA	Other	026	PHYSICIANS	31472	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	19 SAN RAFAEL AVE	None	SAN ANSELMO	CA	94960	2119	21	06041	37.97650843	-122.565042	Marin County
251371	Fee-for-Service	1932553385	1932553385	1	1	BBH WBMC LLC	12/4/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3400 HIGHWAY 76 EAST	None	JASPER	AL	35501	8956	00	None	0	0	None
251416	Fee-for-Service	1710537394	1710537394	1	1	BOIKO, OKSANA	2/4/2025	225XM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
251448	Fee-for-Service	1962423889	1962423889	1	1	BI-VALLEY MEDICAL CLINIC, IN	10/11/1995	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
251493	Fee-for-Service	1235294182	1235294182	1	1	BRACAMONTE,ERIKA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
251502	Fee-for-Service	1033172101	1033172101	1	1	BILENKO, ARKADY MD	10/1/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	69239	36	Psychiatry	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
251530	Fee-for-Service	1659957736	1659957736	1	1	BEROOKHIM, BRIAN	3/1/2024	207R00000X	NA	Other	026	PHYSICIANS	188818	41	Internal Medicine	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
251533	Fee-for-Service	1861542680	1861542680	1	1	BLACKBURN, BRIAN G MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66000	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251558	Fee-for-Service	1790305217	1790305217	1	1	BRADY, RACHELLE L LMFT	11/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
251561	Fee-for-Service	1831519164	1831519164	1	1	BETTINI, ANNA C MD	5/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140206	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251571	Fee-for-Service	1972967362	1972967362	1	1	BLUMBERG, GARRETT MD	10/27/2020	207P00000X	NA	Other	026	PHYSICIANS	168876	66	Emergency Medicine (Urgent Care)	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
251576	Fee-for-Service	1497104889	1497104889	1	1	BENJAMIN, LAWRENCE N MD	2/14/2022	207R00000X	NA	Other	026	PHYSICIANS	160900	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
251581	Fee-for-Service	1033508718	1033508718	1	1	BELNAP, BRIAN D DO A MEDICAL	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10439	01	General Practice	0	In state provider	CORPORATION	4405 MANCHESTER AVE	101	ENCINITAS	CA	92024	4940	37	06073	33.03600429	-117.2392006	San Diego County
251594	Fee-for-Service	1164686127	1164686127	1	1	BRUSETT, LAURA B MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114524	08	Family Practice	0	In state provider	None	2510 AIRPARK DRIVE	SUITE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
251601	Fee-for-Service	1841352838	1841352838	1	1	BAUMGARTEN, ERIC D CRNA	3/16/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251604	Fee-for-Service	1013931104	1013931104	1	1	BLACK, HELENA L MD INC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49132	08	Family Practice	0	In state provider	None	150 PIONEER LN	None	BISHOP	CA	93514	2556	14	06027	37.36193834	-118.4073304	Inyo County
251611	Fee-for-Service	1912099441	1912099441	1	1	BAUTISTA, RAYMUNDO S MD	4/30/2010	207R00000X	NA	Other	026	PHYSICIANS	52874	45	Nephrology (Renal-Kidney)	0	In state provider	PROF CORP	118 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3364	19	06037	34.1359527	-117.8664233	Los Angeles County
251625	Fee-for-Service	1396761631	1396761631	1	1	BROOME, DALE R MD	12/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86348	None	None	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
251656	Fee-for-Service	1902269087	1902269087	1	1	BIRD, LIAT E MD	4/7/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153651	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
251657	Fee-for-Service	1063467538	1063467538	1	1	BLUE, BRENT MD	7/1/1982	207P00000X	NA	Other	026	PHYSICIANS	31472	08	Family Practice	0	In state provider	None	19 SAN RAFAEL AVE	None	SAN ANSELMO	CA	94960	2119	21	06041	37.97650843	-122.565042	Marin County
251683	Fee-for-Service	1316093842	1316093842	1	1	BOUDEVIN, YVONNE LCSW	6/6/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39755 MURRIETA HOT SPRI	STE D160	MURRIETA	CA	92563	7288	33	06065	33.55575954	-117.1627899	Riverside County
251692	Fee-for-Service	1477576254	1477576254	1	1	BINNINGS, KAREN L LMFT	9/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	127 ANITA ST	None	SANTA CRUZ	CA	95060	4718	44	06087	36.96682723	-122.0428222	Santa Cruz County
251734	Fee-for-Service	1831658160	1831658160	1	1	BRIAN, RILEY J MD	3/10/2023	208600000X	NA	General Surgery	026	PHYSICIANS	179863	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
251735	Fee-for-Service	1306185848	1306185848	1	1	BANDA, CLAUDETTE M CNM	11/1/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
251773	Fee-for-Service	1669570073	1669570073	1	1	BARTER, ERIC D DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1064 WOODLAND AVE	STE F	MODESTO	CA	95351	1549	50	06099	37.65317951	-121.023729	Stanislaus County
251792	Fee-for-Service	1538748520	1538748520	1	1	BADA, FEHINTOLU G CNP	3/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	38780 TRADE CENTER DR	SUITE 1C	PALMDALE	CA	93551	3641	19	06037	34.58685376	-118.1430494	Los Angeles County
251803	Fee-for-Service	1225013527	1225013527	1	1	BLECKER, UWE MD	4/22/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
251822	Fee-for-Service	1861542680	1861542680	1	1	BLACKBURN, BRIAN G MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66000	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251825	Fee-for-Service	1164784195	1164784195	1	1	BAKHTA, YEKATERINA A MD FACO	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120309	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
251840	Fee-for-Service	1053600676	1053600676	1	1	BISINGER, ALEXA D MD	3/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124193	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
251842	Fee-for-Service	1003819459	1003819459	1	1	BOERNER, MARK J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 W MAIN ST	STE 200	BOISE	ID	83702	7308	00	None	43.61158663	-116.1956209	Ada County
251843	Fee-for-Service	1619669884	1619669884	1	1	BUEGE, GINA LMFT	8/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
251861	Fee-for-Service	1447335773	1447335773	1	1	BOYD, CHRISTINE R MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73013	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
251867	Fee-for-Service	1164686127	1164686127	1	1	BRUSETT, LAURA B MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114524	01	General Practice	0	In state provider	None	2510 AIRPARK DRIVE	SUITE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
251871	Fee-for-Service	1033508718	1033508718	1	1	BELNAP, BRIAN D DO A MEDICAL	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10439	25	Physical Medicine and Rehabilitation	0	In state provider	CORPORATION	4405 MANCHESTER AVE	101	ENCINITAS	CA	92024	4940	37	06073	33.03600429	-117.2392006	San Diego County
251886	Fee-for-Service	1033453006	1033453006	1	1	BARNES, BRANDY LCSW	1/14/2020	1041S0200X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
251893	Fee-for-Service	1013931104	1013931104	1	1	BLACK, HELENA L MD INC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49132	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 PIONEER LN	None	BISHOP	CA	93514	2556	14	06027	37.36193834	-118.4073304	Inyo County
251919	Fee-for-Service	1134549462	1134549462	1	1	BHATT, PARAAG R MD	6/11/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159894	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251944	Fee-for-Service	1508220542	1508220542	1	1	BAN, VIN SHEN MD	6/26/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	187161	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251945	Fee-for-Service	1740470673	1740470673	1	1	BRZENSKI, ALYSSA B MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107193	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
252004	Fee-for-Service	1477631844	1477631844	1	1	BLOOM, MATTHEW B MD	6/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77610	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
252008	Fee-for-Service	1104849355	1104849355	1	1	BRUN, FRANCISCO A MD	4/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53250	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2351 CLAY STREET	STE 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
252029	Fee-for-Service	1275913089	1275913089	1	1	BITO-ONON, JADE DO	3/11/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15082	08	Family Practice	0	In state provider	None	27212 CALAROGA AVENUE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
252046	Fee-for-Service	1902024367	1902024367	1	1	BOLLYKY, PAUL L MD	5/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56109	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	MC:5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
252063	Fee-for-Service	1760559462	1760559462	1	2	BAY AREA PEDIATRIC	4/28/1998	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	2100 CARLMONT DR	STE 2	BELMONT	CA	94002	3465	41	06081	37.5100845	-122.2935176	San Mateo County
252092	Fee-for-Service	1982839809	1982839809	1	1	BUCCI, BRUNO MD INC	6/15/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63690	08	Family Practice	0	In state provider	None	620 SOUTH MAIN STREET	None	SANTA ANA	CA	92701	5716	30	06059	33.73988621	-117.8677331	Orange County
252133	Fee-for-Service	1578672234	1578672234	1	1	BAGDASSAR, SHAKEH OD	9/30/1993	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EYE TO EYE OPTOMETRY	1101 N PACIFIC AVE	STE 105	GLENDALE	CA	91202	4314	19	06037	34.16078708	-118.2644824	Los Angeles County
252151	Fee-for-Service	1447335773	1447335773	1	1	BOYD, CHRISTINE R MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73013	01	General Practice	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
252181	Fee-for-Service	1013931104	1013931104	1	1	BLACK, HELENA L MD INC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49132	38	Geriatrics	0	In state provider	None	150 PIONEER LN	None	BISHOP	CA	93514	2556	14	06027	37.36193834	-118.4073304	Inyo County
252215	Fee-for-Service	1952345142	1952345142	1	1	BECK, ROBERT G DO	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7614	None	None	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
252217	Fee-for-Service	1023107794	1023107794	1	1	BHARDWAJ, VIRINDER K MD	4/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50673	34	Urology and Urological Surgery	0	In state provider	None	6001 TRUXTON AVENUE	STE 220	BAKERSFIELD	CA	93309	0679	15	06029	35.36252236	-119.072932	Kern County
252231	Fee-for-Service	1497243208	1497243208	1	1	BALLARD, APRIL A MD	8/15/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164716	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
252242	Fee-for-Service	1700651817	1700651817	1	1	BROWN, HEATHER L CRNA	4/3/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
252244	Fee-for-Service	1316955206	1316955206	1	1	BUJOR, ALEXANDRA O MD	4/6/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87447	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
252289	Fee-for-Service	1083632327	1083632327	1	1	BRADKIN,DAVID E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MARICOPA MEDICAL CENTER	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
252296	Fee-for-Service	1104849355	1104849355	1	1	BRUN, FRANCISCO A MD	4/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53250	41	Internal Medicine	0	In state provider	None	2351 CLAY STREET	STE 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
252310	Fee-for-Service	1104075035	1104075035	1	1	BELVADI, YASHASWI MD	8/24/2023	207RC0200X	NA	Other	026	PHYSICIANS	187627	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
252327	Fee-for-Service	1770668428	1770668428	1	1	BRITTAN, MARK S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
252341	Fee-for-Service	1972211399	1972211399	1	1	BUCHMAN, DAYNA PT	5/31/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3215 CALIFORNIA STREET	4	STOCKTON	CA	95204	3433	39	06077	37.98127088	-121.2934355	San Joaquin County
252344	Fee-for-Service	1043300874	1043300874	1	1	BROWN, WILLIE L JR MD	6/7/1988	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40710	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2828 FRESNO ST	STE 201	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
252395	Fee-for-Service	1093336158	1093336158	1	1	BOWER, KENDALL L CCC-SLP	3/26/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
252396	Fee-for-Service	1619346129	1619346129	1	1	BAKER, CHRISTINA E PSYD	4/6/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
252397	Fee-for-Service	1720557499	1720557499	1	1	BEOHOUROU, ROBBIN K LMFT	11/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 W 190TH ST	455A	GARDENA	CA	90248	4320	19	06037	33.85835623	-118.2987754	Los Angeles County
252417	Fee-for-Service	1477714525	1477714525	1	1	BOMSZTYK, ELAN D MD	8/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	SUITE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
252470	Fee-for-Service	1871605675	1871605675	1	1	BIO MEDICAL APPLICATIONS	3/2/2010	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	451 S BRAND BLVD	STE 100	SAN FERNANDO	CA	91340	3641	19	06037	34.28002673	-118.4422478	Los Angeles County
252538	Fee-for-Service	1710308697	1710308697	1	1	BROWN, KRISTEN N CRNA	2/6/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
252540	Fee-for-Service	1518088103	1518088103	1	1	BJORNSON, LYNDA M PHD	5/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12443 LEWIS ST	STE 101	GARDEN GROVE	CA	92840	4650	30	06059	33.78204	-117.8974875	Orange County
252596	Fee-for-Service	1467583963	1467583963	1	1	BUELER, JOHN JR	12/29/1994	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	580 FOREST SHADE	#4	CRESTLINE	CA	92325	0000	36	06071	34.24265206	-117.2780226	San Bernardino County
252597	Fee-for-Service	1720002330	1720002330	2	1	BRADEN PARTNERS L P	6/20/2017	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4140 BANGS AVE	STE A	MODESTO	CA	95356	8710	50	06099	37.70445977	-121.0718049	Stanislaus County
252605	Fee-for-Service	1457612624	1457612624	2	1	BOYD, ELYSIA	6/15/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	675 NORTH JAYE STREET	None	PORTERVILLE	CA	93257	2163	54	06107	36.07805415	-119.0263824	Tulare County
252646	Fee-for-Service	1316232945	1316232945	1	1	BOURLAND, JASON L MD	5/24/2019	207P00000X	NA	Other	026	PHYSICIANS	158261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
252648	Fee-for-Service	1174728612	1174728612	1	1	BITAR, FAHED G MD	8/1/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	84775	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	301 W HUNTINGTON DR	STE 301	ARCADIA	CA	91007	1531	19	06037	34.13481053	-118.0425638	Los Angeles County
252663	Fee-for-Service	1871627521	1871627521	1	1	BARNETT, TIFFANY R MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	6490 S MCCARRAN BLVD	# B13	RENO	NV	89509	6120	00	None	39.47672552	-119.796471	Washoe County
252666	Fee-for-Service	1396009916	1396009916	1	1	BHAT, JOY L MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141680	25	Physical Medicine and Rehabilitation	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
252667	Fee-for-Service	1700978616	1700978616	1	1	BASI, SUKHJIT K MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	84820	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
252707	Fee-for-Service	1598836892	1598836892	1	1	BEST HEALTH CARE	4/18/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	MEDICAL GROUP INC	435 N BEDFORD DR	STE 312	BEVERLY HILLS	CA	90210	4314	19	06037	34.06851281	-118.4056736	Los Angeles County
252720	Fee-for-Service	1841567781	1841567781	1	1	BEST CENTER INC	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	74558	None	None	0	In state provider	None	9940 TALBERT AVENUE	SUITE 201	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166347	-117.955494	Orange County
252748	Fee-for-Service	1619312469	1619312469	1	1	BIGGS, ARTER L II MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141498	36	Psychiatry	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
252778	Fee-for-Service	1427723105	1427723105	1	1	BRADSHAW, ZANIAH PT	12/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1019 S MAIN ST	None	MANTECA	CA	95337	5703	39	06077	37.78880388	-121.2161899	San Joaquin County
252796	Fee-for-Service	1659682532	1659682532	1	1	BOURNE, SIERRA M MD	7/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118544	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
252809	Fee-for-Service	1538395371	1538395371	1	1	BARRY, CELIA V LMFT	12/27/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 N BRAND BLVD	202	GLENDALE	CA	91203	2644	19	06037	34.147521	-118.2549325	Los Angeles County
252845	Fee-for-Service	1619902129	1619902129	1	1	BRAHMBHATT, TEJAL MD	1/16/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
252846	Fee-for-Service	1942435235	1942435235	1	1	BALDWIN, MARTHA B LCSW	5/17/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7777 SUNRISE BLVD	2500	CITRUS HEIGHTS	CA	95610	2372	34	06067	38.706561	-121.2731145	Sacramento County
252925	Fee-for-Service	1326438219	1326438219	1	1	BANNAN, KELSEY L OT	12/28/2018	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
252946	Fee-for-Service	1306151857	1306151857	1	1	BONILLA, EVELYN J MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121635	05	Anesthesiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
252954	Fee-for-Service	1396009916	1396009916	1	1	BHAT, JOY L MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141680	01	General Practice	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
252959	Fee-for-Service	1477767523	1477767523	1	1	BUI, BAO MD	4/18/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191901	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
252991	Fee-for-Service	1760445357	1760445357	1	1	BULGER, ERICA C	8/30/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
252999	Fee-for-Service	1598836892	1598836892	1	1	BEST HEALTH CARE	4/18/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP INC	435 N BEDFORD DR	STE 312	BEVERLY HILLS	CA	90210	4314	19	06037	34.06851281	-118.4056736	Los Angeles County
253017	Fee-for-Service	1972033207	1972033207	1	1	BLANK, RAFAEL MD	9/19/2018	390200000X	NA	Other	026	PHYSICIANS	157323	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
253023	Fee-for-Service	1356375695	1356375695	1	1	BURGOYNE, BRIAN MD	1/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LN	STE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
253052	Fee-for-Service	1578138186	1578138186	1	1	BRANDSTETTER, MEREDITH LMFT	2/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 GATEWAY DR	210 AND 230	LINCOLN	CA	95648	3306	31	06061	38.88433725	-121.2931529	Placer County
253054	Fee-for-Service	1578547519	1578547519	1	1	BEGUM, NASIMA MD	4/2/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54089	77	Infectious Disease	0	In state provider	None	315 N 3RD AVE	STE 206	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
253065	Fee-for-Service	1134207723	1134207723	1	1	BULLOCH, GEORGE III MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
253077	Fee-for-Service	1689633240	1689633240	1	9	BAYSIDE MEDICAL GROUP INC	12/30/2010	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	5173 LONE TREE WAY	None	ANTIOCH	CA	94531	8689	07	06013	37.96178664	-121.7558046	Contra Costa County
253086	Fee-for-Service	1992876254	1992876254	1	1	BOWKER, CAROLINE A MD	2/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	37475	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
253103	Fee-for-Service	1811231145	1811231145	1	1	BURRAGE, HEATHER A LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	88522	-	NOT APPLICABLE	0	In state provider	None	1303 WEST WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
253105	Fee-for-Service	1659463248	1659463248	1	1	BISSADA, ANGELA MARIE	7/1/1996	2084P0804X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	814 WILLOWGLEN RD	None	SANTA BARBARA	CA	93105	2442	42	06083	34.452225	-119.742654	Santa Barbara County
253106	Fee-for-Service	1386190536	1386190536	1	1	BASSETT, ALAINA M	7/16/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
253136	Fee-for-Service	1740458173	1740458173	1	1	BUKUR, MARKO MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102760	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
253177	Fee-for-Service	1972676120	1972676120	1	1	BINIWALE, RESHMA M MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53360	33	Thoracic Surgery	0	In state provider	None	5767 W CENTURY BLVD	None	LOS ANGELES	CA	90045	5655	19	06037	33.94560752	-118.3826655	Los Angeles County
253182	Fee-for-Service	1033211420	1033211420	1	1	BEL AIR MARKET INC.	5/25/2004	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9435 ELK GROVE BLVD	None	ELK GROVE	CA	95624	5013	34	06067	38.409588	-121.3518915	Sacramento County
253185	Fee-for-Service	1407074701	1407074701	1	1	BYERS, DEREK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID AVE	None	SAINT LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
253232	Fee-for-Service	1487725230	1487725230	1	2	BIRD, LYNNE M MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	45464	01	General Practice	0	In state provider	None	3020 CHILDREN'S WAY	STE 5031	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
253235	Fee-for-Service	1255953014	1255953014	1	1	BRIDGE HOME HEALTH SOLANO	7/23/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	1261 TRAVIS BLVD	STE 255	FAIRFIELD	CA	94533	4825	48	06095	38.25812361	-122.0495417	Solano County
253249	Fee-for-Service	1326124843	1326124843	1	1	BHANDARI, RAJAN MD	6/16/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37221	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15891 LOS GATOS ALMADEN	None	LOS GATOS	CA	95032	3742	43	06085	37.24361275	-121.9477516	Santa Clara County
253272	Fee-for-Service	1700068756	1700068756	1	1	BANNERMAN, CHRISTIAN	7/8/2021	207P00000X	NA	Other	026	PHYSICIANS	173323	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
253280	Fee-for-Service	1386776847	1386776847	1	1	BELEN, ALFRED D MD	11/11/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	174792	None	None	0	In state provider	None	1809 W. REDLANDS BLVD	# 234	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
253302	Fee-for-Service	1407449648	1407449648	1	1	BEVERLY ORTHOPEDIC LABORATOR	6/21/2022	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	Y INC	801 N. TUSTIN AVE	#203	SANTA ANA	CA	92705	3600	30	06059	33.752286	-117.8341735	Orange County
253310	Fee-for-Service	1023321221	1023321221	1	1	BONILLA, LINDA R LMFT	12/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
253330	Fee-for-Service	1104817626	1104817626	1	1	BROKAW, JENNIFER JEAN MD	5/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86078	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	0000	38	06075	37.75442388	-122.4064548	San Francisco County
253401	Fee-for-Service	1992804819	1992804819	1	1	BINDER, DEVIN K MD	10/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74558	14	Neurological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
253464	Fee-for-Service	1972676120	1972676120	1	1	BINIWALE, RESHMA M MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53360	02	General Surgery	0	In state provider	None	5767 W CENTURY BLVD	None	LOS ANGELES	CA	90045	5655	19	06037	33.94560752	-118.3826655	Los Angeles County
253489	Fee-for-Service	1902839590	1902839590	1	1	BEDDINGFIELD, FREDERICK,	9/1/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	51146	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	200 MEDICAL PLAZA STE 45	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
253513	Fee-for-Service	1497236293	1497236293	1	1	BRADLEY, LEAH M OD	8/31/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	23000 ATLANTIC CIRCLE	None	MORENO VALLEY	CA	92553	5990	33	06065	33.93307833	-117.2610923	Riverside County
253518	Fee-for-Service	1598774499	1598774499	1	1	BILLINGTON, BARRY B	8/19/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61695	08	Family Practice	0	In state provider	None	1115 WHISKEYTOWN CT	None	REDDING	CA	96001	0227	45	06089	40.58505639	-122.4126224	Shasta County
253524	Fee-for-Service	1962513820	1962513820	1	1	BOWEN, JASON R DPM	10/26/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
253540	Fee-for-Service	1447241617	1447241617	1	1	BLACK, AMY W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76147	20	Orthopedic Surgery	0	In state provider	None	635 ANDERSON RD	STE 18	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
253548	Fee-for-Service	1063420297	1063420297	1	1	BOYER, FRANKLIN M MD	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51868	02	General Surgery	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
253550	Fee-for-Service	1295830917	1295830917	1	1	BEAMAN,DOUGLAS N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	501 N GRAHAM	STE 250	PORTLAND	OR	97227	0000	00	None	45.54285348	-122.671035	Multnomah County
253560	Fee-for-Service	1164484358	1164484358	1	1	BURDICK, CLAUDE O MD	6/30/1983	207ZC0500X	NA	Other	026	PHYSICIANS	23792	22	Pathology (M.D. only)	0	In state provider	None	1111 E STANLEY BLVD	None	LIVERMORE	CA	94550	4115	01	06001	37.67881307	-121.7823992	Alameda County
253579	Fee-for-Service	1275923757	1275923757	1	1	BARON, GIULIANO R PT	1/31/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
253593	Fee-for-Service	1760698690	1760698690	1	1	BUNCH, CORINNE ROBERTA	12/8/2006	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6837 RIDGEWAY DR	None	POLLOCK PINES	CA	95726	9503	09	06017	38.76036498	-120.564244	El Dorado County
253599	Fee-for-Service	1255142873	1255142873	1	1	BAILES, ANNA PT	2/26/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
253606	Fee-for-Service	1538553714	1538553714	1	1	BLOCK, TENNYSON L MD	12/10/2020	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	147885	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
253629	Fee-for-Service	1003303942	1003303942	1	1	BANSAL, SUVIDHA PT	6/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
253640	Fee-for-Service	1508864448	1508864448	1	1	BARAGER, RICHARD R MD	7/1/2016	174400000X	NA	Other	026	PHYSICIANS	52074	45	Nephrology (Renal-Kidney)	0	In state provider	None	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	37	06073	33.18081595	-117.3156434	San Diego County
253676	Fee-for-Service	1851429252	1851429252	1	1	B&D MORGAN, INC	6/1/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	810 S LEILA ST	None	VISALIA	CA	93277	1837	54	06107	36.323496	-119.328795	Tulare County
253711	Fee-for-Service	1578740098	1578740098	1	1	BHAVNANI, SANJEEV P MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56071	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
253714	Fee-for-Service	1114638459	1114638459	1	1	BINNING, GURJEET K	7/7/2023	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
253728	Fee-for-Service	1508800657	1508800657	1	1	BARKMAN, MICHAEL	8/29/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
253732	Fee-for-Service	1700808623	1700808623	1	1	BUI, ALLEN H DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1184 E HOLT AVE	None	POMONA	CA	91767	5833	19	06037	34.06288845	-117.7271268	Los Angeles County
253769	Fee-for-Service	1689825762	1689825762	1	1	BLYTHE, TINA M	2/8/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2560 N TEXAS STREET	SUITE D	FAIRFIELD	CA	94533	1649	48	06095	38.27539711	-122.0340414	Solano County
253795	Fee-for-Service	1003824103	1003824103	1	1	BRICENO, RIGOVERTO C	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3737 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3513	19	06037	33.92872742	-118.2006921	Los Angeles County
253822	Fee-for-Service	1053135798	1053135798	1	1	BARNETT, JORDAN M PT	12/15/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2303 GEER RD	None	TURLOCK	CA	95382	2408	50	06099	37.514097	-120.848997	Stanislaus County
253823	Fee-for-Service	1063471456	1063471456	1	1	BOWERS, KENNETH V MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	42645	08	Family Practice	0	In state provider	None	1440 MILITARY W	None	BENICIA	CA	94510	2451	48	06095	38.06790605	-122.1823312	Solano County
253830	Fee-for-Service	1568510592	1568510592	1	1	BRAR, PRABHJYOT K MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90844	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
253832	Fee-for-Service	1588154751	1588154751	1	1	BLAIBEL, MAHER F MD	9/26/2023	208800000X	NA	Other	026	PHYSICIANS	186729	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
253865	Fee-for-Service	1730478041	1730478041	1	1	BUZI, SHARON MD	4/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127588	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
253882	Fee-for-Service	1760698690	1760698690	1	1	BUNCH, CORINNE ROBERTA	12/8/2006	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6837 RIDGEWAY DR	None	POLLOCK PINES	CA	95726	9503	09	06017	38.76036498	-120.564244	El Dorado County
253887	Fee-for-Service	1326180670	1326180670	1	1	BLESSINGER, SARAH C	3/5/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	534 E PINE ST	STE A	STOCKTON	CA	95204	5536	39	06077	37.97439027	-121.2897236	San Joaquin County
253946	Fee-for-Service	1568628725	1568628725	1	1	BAEZA, JOSE MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120405	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
253957	Fee-for-Service	1174015754	1174015754	1	1	BURKETTE, GILLIAN LMFT	8/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
253959	Fee-for-Service	1164483368	1164483368	1	1	BRIAN ROSE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5012 S US HWY 75	None	DENISON	TX	75020	0000	00	None	33.71120362	-96.58686051	Grayson County
253961	Fee-for-Service	1922000546	1922000546	2	1	BRISTOL DRUG CO INC	2/22/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1770 N ORANGE GROVE AVE	SUITE 100	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
254010	Fee-for-Service	1669442315	1669442315	1	1	BAYER, STEPHEN N MD	11/1/1995	207ZP0102X	NA	Other	026	PHYSICIANS	30890	22	Pathology (M.D. only)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
254043	Fee-for-Service	1932310877	1932310877	1	1	BUSELLI, JAMES V MD	4/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107101	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
254047	Fee-for-Service	1053514109	1053514109	1	1	BROWN, DANESSA M MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130758	01	General Practice	0	In state provider	None	9515 SOQUEL DR	STE 100	APTOS	CA	95003	4135	44	06087	36.9753751	-121.8848219	Santa Cruz County
254064	Fee-for-Service	1205847951	1205847951	1	1	BEATTY, HEATHER MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67735	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1201 ALHAMBRA BLVD	STE 320	SACRAMENTO	CA	95816	5242	34	06067	38.570076	-121.4657145	Sacramento County
254085	Fee-for-Service	1487119681	1487119681	1	1	BITZER, ANDREA LMFT	8/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
254087	Fee-for-Service	1003284803	1003284803	1	1	BLESSING BRIELE HOME HEALTH	5/7/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE LLC	600 N TUSTIN AVE	SUITE 140	SANTA ANA	CA	92705	3723	30	06059	33.75029437	-117.8341815	Orange County
254119	Fee-for-Service	1649494907	1649494907	1	1	BROWN, MARY I LCSW	7/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
254120	Fee-for-Service	1962815068	1962815068	1	1	BHAT, SUNIL J DO	10/4/2019	204D00000X	NA	Other	026	PHYSICIANS	16491	08	Family Practice	0	In state provider	None	325 GELLERT BLVD	None	DALY CITY	CA	94015	2613	41	06081	37.66753085	-122.4686194	San Mateo County
254130	Fee-for-Service	1427744515	1427744515	1	1	BRAWDERS, AMANDA G	5/23/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3003 LOMA VISTA	C	VENTURA	CA	93003	2935	56	06111	34.27572109	-119.255478	Ventura County
254142	Fee-for-Service	1962540575	1962540575	1	1	BOZDECH, ANDREW C MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97530	08	Family Practice	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0000	34	06067	38.669562	-121.31379	Sacramento County
254170	Fee-for-Service	1427721760	1427721760	1	1	BRYAN T IMAYANAGITA DO PC	10/13/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90807	1701	19	06037	33.808185	-118.1850575	Los Angeles County
254181	Fee-for-Service	1669568655	1669568655	1	1	BREW, KRISTIN M MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73735	04	Otology, Laryngology, Rhinology	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
254221	Fee-for-Service	1629089586	1629089586	1	1	BREEDLOVE, ANDREW P LCSW	3/23/2015	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3175 SUNSET BLVD	SUITE 104A	ROCKLIN	CA	95677	2252	31	06061	38.78584705	-121.2496644	Placer County
254227	Fee-for-Service	1619106119	1619106119	1	2	BAILEY, CRAIG A MD	11/1/2022	207R00000X	NA	Other	026	PHYSICIANS	158468	None	None	0	In state provider	None	11942 PARAMOUNT BLVD	STE B	DOWNEY	CA	90242	2306	19	06037	33.93374098	-118.1445557	Los Angeles County
254229	Fee-for-Service	1720308737	1720308737	1	1	BOULAND, DANIEL T MD	5/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141611	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
254256	Fee-for-Service	1801273305	1801273305	1	1	BLOOM, MATTHEW L DO	6/3/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	16383	25	Physical Medicine and Rehabilitation	0	In state provider	None	2221 WANKEL WAY	None	OXNARD	CA	93030	0192	56	06111	34.21677352	-119.1475125	Ventura County
254285	Fee-for-Service	1013076611	1013076611	1	1	BEATTY, BRENNEN J MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69084	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
254306	Fee-for-Service	1669905956	1669905956	1	1	BEAMAN, CHARLES B MD	6/2/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173005	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
254379	Fee-for-Service	1578079919	1578079919	1	1	BEHAVIORAL HEALTH SERVICES	2/4/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2015 W 1ST STREET	SUITE L	SANTA ANA	CA	92703	3536	30	06059	33.74538578	-117.8965217	Orange County
254388	Fee-for-Service	1114151842	1114151842	1	1	BURGER, INGRID M MD	4/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107043	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
254401	Fee-for-Service	1275724320	1275724320	1	1	BADR, YASER MD	8/23/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	126895	None	None	0	In state provider	None	1500 CHEVY CHASE DR	204	GLENDALE	CA	91206	4152	19	06037	34.15201194	-118.2322051	Los Angeles County
254422	Fee-for-Service	1356874317	1356874317	1	1	BUDZYN, JEFFREY D MD	7/19/2022	208800000X	NA	Other	026	PHYSICIANS	176807	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
254462	Fee-for-Service	1265812697	1265812697	1	1	BERRYMAN, ELIZABETH M MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136369	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
254470	Fee-for-Service	1669568655	1669568655	1	1	BREW, KRISTIN M MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73735	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
254476	Fee-for-Service	1134122674	1134122674	1	1	BISHI,GEETA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NEUROPSY,ASSOCI PC	2410 N GLENDALE DR	STE A	FORT WAYNE	IN	46804	8909	00	None	41.0627637	-85.20938573	Allen County
254479	Fee-for-Service	1588240246	1588240246	1	1	BETANCOURT FLORES, MISAEL M	8/16/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	D	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
254496	Fee-for-Service	1285936674	1285936674	1	1	BRESLIN, RAMONA M NP	10/4/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
254498	Fee-for-Service	1992778765	1992778765	1	1	BICKERTON, ROBERT E MD	9/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70406	None	None	0	In state provider	MS317	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
254533	Fee-for-Service	1205987914	1205987914	1	1	BENAVIDEZ, MICHAEL A DO	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	6396	08	Family Practice	0	In state provider	BENACARE MEDICAL GROUP	984 W FOOTHILL BLVD	None	UPLAND	CA	91786	3700	36	06071	34.10650049	-117.6651668	San Bernardino County
254566	Fee-for-Service	1336124221	1336124221	1	1	BRIAN D FEDGCHIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2422 S BROAD ST	None	PHILADELPHIA	PA	19145	4418	00	None	39.92000613	-75.17071424	Philadelphia County
254585	Fee-for-Service	1245285311	1245285311	1	1	B0G0SIAN, JEFFREY A MD	8/3/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	47831	20	Orthopedic Surgery	0	In state provider	None	5230 PACIFIC CONCOURSE D	None	LOS ANGELES	CA	90045	6200	19	06037	33.92774198	-118.3727493	Los Angeles County
254586	Fee-for-Service	1407890288	1407890288	1	1	BATRA, DUTIMA A MD	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114284	08	Family Practice	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
254587	Fee-for-Service	1518948512	1518948512	1	1	BOYDEN, ERIC M MD	4/22/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	555 N ARLINGTON AVE	None	RENO	NV	89503	4723	00	None	39.53124039	-119.8188498	Washoe County
254599	Fee-for-Service	1477940088	1477940088	1	1	BENTON, ANGELA S MD	7/1/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150892	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
254639	Fee-for-Service	1699294074	1699294074	1	1	BOOKSTEIN, ROBERT E MD	11/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	56957	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	RM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
254644	Fee-for-Service	1114911518	1114911518	1	1	BISHARA, NADER P MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53722	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
254667	Fee-for-Service	1578079919	1578079919	1	1	BEHAVIORAL HEALTH SERVICES	2/4/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2015 W 1ST STREET	SUITE L	SANTA ANA	CA	92703	3536	30	06059	33.74538578	-117.8965217	Orange County
254692	Fee-for-Service	1366503484	1366503484	1	1	BROWN, TONYA R	11/21/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4650 PALM AVE	None	SAN DIEGO	CA	92154	8404	37	06073	32.5839467	-117.0337851	San Diego County
254736	Fee-for-Service	1073599551	1073599551	2	1	BEHL, ARVIND K MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55920	None	None	0	In state provider	None	8100 TIMBERLAKE WAY	STE A	SACRAMENTO	CA	95823	5409	34	06067	38.46348	-121.414536	Sacramento County
254765	Fee-for-Service	1023186418	1023186418	1	1	BATIN, RUBY MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	38698	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
254775	Fee-for-Service	1215160791	1215160791	1	1	BHAVSAR, KINNAR V MD	12/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107913	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
254776	Fee-for-Service	1710054655	1710054655	1	1	BAUWENS, MARTINE MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45785	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
254777	Fee-for-Service	1710039680	1710039680	1	1	BECKER-SCHWARM, CANDICE CNM	8/12/2019	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 MED PLAZA STE 430	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
254814	Fee-for-Service	1609912914	1609912914	1	1	BOZUK & ASSOCIATES SURGICAL	1/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73703	02	General Surgery	0	In state provider	INC	3835 CYPRESS DR	STE 404	PETALUMA	CA	94954	6639	49	06097	38.22775419	-122.5891657	Sonoma County
254857	Fee-for-Service	1770524605	1770524605	1	1	BRATHWAITE, DENISE D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58680	05	Anesthesiology	0	In state provider	None	433 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	1413	19	06037	33.969771	-118.343998	Los Angeles County
254880	Fee-for-Service	1407950454	1407950454	1	1	BKNC PHARMACIES INC	10/24/2006	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 W COMPTON BLVD	STE 102	COMPTON	CA	90220	3087	19	06037	33.89593853	-118.233513	Los Angeles County
254913	Fee-for-Service	1629383344	1629383344	1	1	BLINDER, ALLA O DO	7/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12257	41	Internal Medicine	0	In state provider	None	7551 MADISON AVE	None	SACRAMENTO	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento
254969	Fee-for-Service	1992332845	1992332845	1	1	BAILEY, JENNIFER L MD	4/10/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180443	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
254985	Fee-for-Service	1740740125	1740740125	1	1	BLACKWELL, CHRISTOPHER M MD	6/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
255010	Fee-for-Service	1942234935	1942234935	1	1	BROUGH-STEVENSON, G I MD	3/1/1999	207P00000X	NA	Other	026	PHYSICIANS	38221	08	Family Practice	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
255033	Fee-for-Service	1558396663	1558396663	1	1	BURSCH, BRENDA PHD	2/1/2000	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
255034	Fee-for-Service	1902420813	1902420813	1	1	BHAN, KUNAL K DPM	8/5/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 3100	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
255077	Fee-for-Service	1992067631	1992067631	1	1	BRAR, PARDEEP MD INC	3/18/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54142	10	Gastroenterology (M.D. only)	0	In state provider	None	2209 COFFEE RD	STE M	MODESTO	CA	95355	2360	50	06099	37.674603	-120.975788	Stanislaus County
255102	Fee-for-Service	1821454240	1821454240	1	1	BATTISTA, AMADA LMFT	6/7/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1137 2ND ST	UNIT 216	SANTA MONICA	CA	90403	5077	19	06037	34.01807978	-118.5007837	Los Angeles County
255103	Fee-for-Service	1225239684	1225239684	1	1	BRENNAN, JESSICA L NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255148	Fee-for-Service	1154590826	1154590826	1	1	BASI, KANCHAN MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102335	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
255161	Fee-for-Service	1043328503	1043328503	1	1	BENZ, RONALD T MD	1/1/1982	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	18349	04	Otology, Laryngology, Rhinology	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
255172	Fee-for-Service	1346883204	1346883204	1	1	BAKER, BRITNEY OT	3/27/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
255224	Fee-for-Service	1558768861	1558768861	1	1	BERBIC, EDI DO	11/16/2019	207R00000X	NA	Other	026	PHYSICIANS	17422	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
255231	Fee-for-Service	1144639592	1144639592	1	1	BAINS, VANEET CNP	2/18/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	738 BANCROFT RD	None	WALNUT CREEK	CA	94598	1531	07	06013	37.92857256	-122.041705	Contra Costa County
255241	Fee-for-Service	1831391051	1831391051	1	1	BROWNSTEIN, ARTHUR H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KAUAI MEDICAL CLINIC	3-3420 KUHIO HWY, STE B	None	LIHUE	HI	96766	1098	00	None	21.98560043	-159.3663628	Kauai County
255246	Fee-for-Service	1770631616	1770631616	1	1	BHAI, ANNEESH K MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43841	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
255249	Fee-for-Service	1629180948	1629180948	1	1	BONILLA, BURKE J MD	5/13/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	63566	36	Psychiatry	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
255251	Fee-for-Service	1629006408	1629006408	1	1	BRAR, BLABIR S MD	7/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43171	None	None	0	In state provider	None	23861 MCBEAN PKWY	STE B8	VALENCIA	CA	91355	2003	19	06037	34.39567343	-118.5542698	Los Angeles County
255271	Fee-for-Service	1598991671	1598991671	1	1	BODENHAMER, JENNIFER M DO	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
255285	Fee-for-Service	1922374495	1922374495	1	1	BELON, CRAIG A MD	9/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148635	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
255301	Fee-for-Service	1487973582	1487973582	1	1	BASS, DEIDRE E DO	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12404	40	Pediatrics	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
255310	Fee-for-Service	1396290698	1396290698	1	1	BERGH, MADISEN PT	1/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11930 HERITAGE OAK PL	STE 8 & 9	AUBURN	CA	95603	2458	31	06061	38.94059662	-121.0995593	Placer County
255351	Fee-for-Service	1457420713	1457420713	1	1	BEAUCHAMP, JULIA K MD	5/2/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60054	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
255356	Fee-for-Service	1457906489	1457906489	1	1	BADONG, TRISHA NP	4/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
255366	Fee-for-Service	1992067631	1992067631	1	1	BRAR, PARDEEP MD INC	3/18/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54142	41	Internal Medicine	0	In state provider	None	2209 COFFEE RD	STE M	MODESTO	CA	95355	2360	50	06099	37.674603	-120.975788	Stanislaus County
255421	Fee-for-Service	1134288723	1134288723	1	1	BHAT, SHAILESH MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62082	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
255424	Fee-for-Service	1770283996	1770283996	1	1	BAKSHI, MEHA PT	6/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
255464	Fee-for-Service	1275732679	1275732679	1	1	BECKETT,BROOKE R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2314 NW KINGS BLVD	None	CORVALLI	OR	97330	3925	00	None	44.59018248	-123.2774548	Benton County
255466	Fee-for-Service	1104032630	1104032630	1	1	BOSE, ADRIAN A MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89969	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
255467	Fee-for-Service	1558617027	1558617027	1	1	BRINSON, ERIKA L MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128952	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
255496	Fee-for-Service	1669440269	1669440269	1	1	BRIAN CRANDALL	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 HILAND AVE	None	BURLEY	ID	83318	2688	00	None	42.53489313	-113.7833899	Cassia County
255501	Fee-for-Service	1922153014	1922153014	1	1	BASSLER, MARY P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55722	08	Family Practice	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0660	26	06051	37.64575895	-118.9638914	Mono County
255515	Fee-for-Service	1184868226	1184868226	1	1	BROOKSBY, BEN A MD	2/4/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
255542	Fee-for-Service	1326543844	1326543844	1	1	BARJASTEH, TINA MD	10/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163568	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
255552	Fee-for-Service	1023081171	1023081171	1	1	BRADLEY DILDAY	3/10/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	390 E LONGVIEW ST	None	FAYETTEVILLE	AR	72703	4618	00	None	36.111726	-94.1517135	Washington County
255563	Fee-for-Service	1902998958	1902998958	1	1	BOLTON, JOHN C MD	3/6/1975	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30015	40	Pediatrics	0	In state provider	None	3641 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1701	38	06075	37.78628015	-122.4542211	San Francisco County
255576	Fee-for-Service	1629378567	1629378567	1	1	BIOTEL INR, LLC	10/29/2021	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	400 OYSTER POINT BLVD	STE 339	SOUTH SAN FRANCIS	CA	94080	1920	41	06081	37.66637638	-122.3833791	San Mateo County
255577	Fee-for-Service	1588436901	1588436901	1	1	BAUTISTA, VERONICA LCSW	1/12/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	221 TUXEDO CT	SUITE A	STOCKTON	CA	95204	5261	39	06077	37.97154914	-121.3012172	San Joaquin County
255585	Fee-for-Service	1609083773	1609083773	1	1	BANDO, JOANNE M MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86395	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
255638	Fee-for-Service	1457420713	1457420713	1	1	BEAUCHAMP, JULIA K MD	5/2/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60054	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
255676	Fee-for-Service	1629497110	1629497110	1	1	BAUMANN, SARA A MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137684	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
255693	Fee-for-Service	1184791550	1184791550	1	1	BINNO, SHEREEN M MD	4/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53444	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8010 FROST STREET	STE 301	SAN DIEGO	CA	92123	4237	37	06073	32.80026879	-117.1520059	San Diego County
255705	Fee-for-Service	1851584478	1851584478	1	1	BERMUDEZ, MARICRUZ LMFT	10/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	86414	-	NOT APPLICABLE	0	In state provider	None	1295 W STATE ST	SUITE 101-106	EL CENTRO	CA	92243	2881	13	06025	32.79169087	-115.5674379	Imperial County
255713	Fee-for-Service	1467470070	1467470070	1	1	BERGER, CATHERINE A MD	7/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80123	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
255741	Fee-for-Service	1639531742	1639531742	1	1	BUDIN, ROBERT J JR LMFT	6/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 E KATELLA AVE	SUITE H	ORANGE	CA	92867	5094	30	06059	33.80915349	-117.83844	Orange County
255750	Fee-for-Service	1598192254	1598192254	1	1	BRYAN, AYLEEN LMFT	10/16/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW ROUTE	STE 314	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
255785	Fee-for-Service	1770674343	1770674343	1	1	BARRY, KATHLEEN L MD	6/30/1984	174400000X	NA	Other	026	PHYSICIANS	52557	08	Family Practice	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
255795	Fee-for-Service	1942660097	1942660097	1	2	BECKER, ROMYNA A LCSW	12/5/2022	103TP2700X	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3400 CENTRAL AVE	SUITE 215	RIVERSIDE	CA	92506	2175	33	06065	33.95355249	-117.385407	Riverside County
255808	Fee-for-Service	1104261601	1104261601	1	1	BIR, JASMIN K MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141405	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
255840	Fee-for-Service	1306047097	1306047097	1	1	BEVERLY ADULT DAY HEALTH	1/14/2004	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	316 N WESTERN AVE	None	LOS ANGELES	CA	90004	2615	19	06037	34.07685764	-118.3091269	Los Angeles County
255850	Fee-for-Service	1407830185	1407830185	1	1	BUI, VIET-HONG D DO	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7051	08	Family Practice	0	In state provider	None	696 E SANTA CLARA ST	STE 210	SAN JOSE	CA	95112	1911	43	06085	37.34280728	-121.876519	Santa Clara County
255853	Fee-for-Service	1326125816	1326125816	1	1	BEATTY, KIMBERLY A CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
255872	Fee-for-Service	1609083773	1609083773	1	1	BANDO, JOANNE M MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86395	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
255874	Fee-for-Service	1750087219	1750087219	1	1	BLANCA SALOME MALDONADO MARR	2/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	IAGE & FAMILY THERAPIST	78060 CALLE ESTADO	STE 17	LA QUINTA	CA	92253	2960	33	06065	33.67599507	-116.303034	Riverside County
255883	Fee-for-Service	1609038587	1609038587	1	1	BULJAN, MICHAEL M NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255918	Fee-for-Service	1497038285	1497038285	1	1	BOTTORFF, MADISON LCSW	9/30/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24325 MAIN ST	STE 102	NEWHALL	CA	91321	2932	19	06037	34.37920492	-118.5283244	Los Angeles County
255948	Fee-for-Service	1639514144	1639514144	1	1	BASEN, ANGELA P MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141493	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
255987	Fee-for-Service	1205861044	1205861044	1	1	BINA, IOANA A MD INC	7/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85304	10	Gastroenterology (M.D. only)	0	In state provider	None	999 ADAMS ST	SUITE 303	ST HELENA	CA	94574	1148	28	06055	38.5071543	-122.4685546	Napa County
255989	Fee-for-Service	1700937984	1700937984	1	1	BUGLISI, CLAUDINE AU	6/5/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
255992	Fee-for-Service	1467474486	1467474486	1	1	BERGQVIST, KARL D	2/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12421 HESPERIA RD	None	VICTORVILLE	CA	92395	7703	36	06071	34.47763743	-117.2910964	San Bernardino County
256025	Fee-for-Service	1972127298	1972127298	1	1	BETTENCOURT, HAYLEE MD	3/25/2024	261QU0200X	NA	Other	026	PHYSICIANS	190647	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300 & 230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
256028	Fee-for-Service	1275890162	1275890162	1	1	BELLMAN, LILLY A MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128471	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
256036	Fee-for-Service	1770845083	1770845083	1	1	BOURGON, ABIGAIL R MD	7/16/2020	261Q00000X	NA	Other	026	PHYSICIANS	106944	40	Pediatrics	0	In state provider	None	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	01	06001	37.53249631	-121.9198141	Alameda County
256042	Fee-for-Service	1992978399	1992978399	1	4	BRUCE R. CARLTON, M.D., INC.	6/4/2020	207ND0900X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	2101 VALE ROAD	301	SAN PABLO	CA	94806	3835	07	06013	37.95420174	-122.3372902	Contra Costa County
256063	Fee-for-Service	1356414395	1356414395	1	1	BLUE MOUNTAIN HOSPITAL	6/22/2010	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DISTRICT	170 FORD RD	None	JOHN DAY	OR	97845	2009	00	None	44.41742189	-118.9584121	Grant County
256093	Fee-for-Service	1881650737	1881650737	1	1	BENEFIS HEALTHCARE EAST	8/20/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CAMPUS	1101 26TH ST S	None	GREAT FALLS	MT	59405	5104	00	None	47.491965	-111.2617215	Cascade County
256109	Fee-for-Service	1992102842	1992102842	1	1	BARNES, NANCY R LCSW	6/19/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
256120	Fee-for-Service	1225236524	1225236524	1	1	BERRY, STUART MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102794	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE 1700	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
256159	Fee-for-Service	1609083773	1609083773	1	1	BANDO, JOANNE M MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86395	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
256161	Fee-for-Service	1679684450	1679684450	1	1	BLOUNT, ALEXIS M NP	4/20/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
256170	Fee-for-Service	1225038458	1225038458	1	1	BLOCK, PAUL M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5750 W THUNDERBIRD RD	STE B200	GLENDALE	AZ	85306	4664	00	None	33.612507	-112.1822145	Maricopa County
256179	Fee-for-Service	1932130481	1932130481	1	1	BOROVSKY, VICTORIA M MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82605	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
256180	Fee-for-Service	1578512307	1578512307	1	1	BURRALL, BARBARA A	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	45128	01	General Practice	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
256208	Fee-for-Service	1780873216	1780873216	1	1	BROWN, ADAM P MD	5/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103652	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1778	19	06037	34.06373445	-118.443537	Los Angeles County
256257	Fee-for-Service	1396147591	1396147591	1	1	BRADLEY, LATRICE LCSW	3/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12087 LOPEZ CANYON RD	SUITE 128	SYLMAR	CA	91342	6063	19	06037	34.292754	-118.40463	Los Angeles County
256275	Fee-for-Service	1205861044	1205861044	1	1	BINA, IOANA A MD INC	7/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85304	41	Internal Medicine	0	In state provider	None	999 ADAMS ST	SUITE 303	ST HELENA	CA	94574	1148	28	06055	38.5071543	-122.4685546	Napa County
256287	Fee-for-Service	1760707657	1760707657	1	1	BLISS, MORGAN R MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134647	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
256290	Fee-for-Service	1669406468	1669406468	1	1	BRUTTOMESSO, SAMUEL MD	1/1/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	22043	40	Pediatrics	0	In state provider	INC	414 N BOYLE AVE	None	LOS ANGELES	CA	90033	2410	19	06037	34.05043205	-118.2180396	Los Angeles County
256294	Fee-for-Service	1932106986	1932106986	1	1	BONSU, BEMA K MD	5/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55180	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
256300	Fee-for-Service	1710980321	1710980321	1	1	BARLAS, LANCE B MD	4/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	40183	20	Orthopedic Surgery	0	In state provider	None	167 LYNCH CREEK WAY	None	PETALUMA	CA	94954	2343	49	06097	38.25155667	-122.6346031	Sonoma County
256310	Fee-for-Service	1184717233	1184717233	1	1	BLAUSTEIN, AIMEE L MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66479	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
256348	Fee-for-Service	1356414395	1356414395	1	1	BLUE MOUNTAIN HOSPITAL	12/2/2006	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DISTRICT	170 FORD RD	None	JOHN DAY	OR	97845	2009	00	None	44.41742189	-118.9584121	Grant County
256363	Fee-for-Service	1538594544	1538594544	1	1	BREED, COURTNEY H V LCSW	8/30/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	659 CHERRY ST	STE 202	SANTA ROSA	CA	95404	4281	49	06097	38.444841	-122.7151035	Sonoma County
256381	Fee-for-Service	1891192969	1891192969	1	1	BRISSEY, OLESYA V MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132988	41	Internal Medicine	0	In state provider	None	1225 NORTH H ST	None	LOMPOC	CA	93463	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
256383	Fee-for-Service	1912438847	1912438847	1	1	BRYSON, AMANDA E MD	7/18/2023	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	186785	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
256386	Fee-for-Service	1932299450	1932299450	1	1	BANTA, DARYL P MD	2/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88722	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
256389	Fee-for-Service	1598319642	1598319642	1	1	BACH, CODY L CNP	4/2/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2752 HARRISON AVE	STE A	EUREKA	CA	95501	4738	12	06023	40.7831071	-124.139684	Humboldt County
256390	Fee-for-Service	1881650737	1881650737	1	1	BENEFIS HEALTHCARE EAST	8/20/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CAMPUS	1101 26TH ST S	None	GREAT FALLS	MT	59405	5104	00	None	47.491965	-111.2617215	Cascade County
256393	Fee-for-Service	1790702694	1790702694	1	1	BARKAWI-BUCK, KAZARAN	5/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
256395	Fee-for-Service	1780674374	1780674374	1	1	BECKER, TERRY S MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	24684	None	None	0	In state provider	None	65 N MADISON AVENUE	LOWER LEVEL	PASADENA	CA	91101	2000	19	06037	34.14705803	-118.1384317	Los Angeles County
256404	Fee-for-Service	1114006251	1114006251	1	1	BEETS-SHAY, LINDA MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	42184	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
256462	Fee-for-Service	1659670875	1659670875	1	1	BOYCE, JENNIFER D	1/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
256480	Fee-for-Service	1437644457	1437644457	1	2	BEACHVIEW TREATMENT, LLC	3/22/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8161 DEAUVILLE DRIVE	None	HUNTINGTON BEACH	CA	92646	2011	30	06059	33.68561397	-117.9853818	Orange County
256495	Fee-for-Service	1295398519	1295398519	1	1	BERLYANT, MAXWELL J PSYD	5/16/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
256518	Fee-for-Service	1215180187	1215180187	1	1	BELLOTTI, RACHEL A AUD	1/11/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
256562	Fee-for-Service	1972849701	1972849701	1	1	BECK, CORINNE NP	4/25/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
256580	Fee-for-Service	1588681191	1588681191	1	1	BODOR, MARKO V MD	3/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63297	08	Family Practice	0	In state provider	None	980 TRANCAS ST	STE 5	NAPA	CA	94558	2933	28	06055	38.32369771	-122.2951869	Napa County
256603	Fee-for-Service	1144290966	1144290966	1	1	BOWLIN, HEATHER W	3/31/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7780 N FRESNO ST	STE 103	FRESNO	CA	93720	2413	10	06019	36.85162237	-119.7836163	Fresno County
256611	Fee-for-Service	1972538437	1972538437	1	1	BATRA, GOPAL KRISHAN MD	10/1/1979	207R00000X	NA	Other	026	PHYSICIANS	29739	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2428 SANTA MONICA BLVD	STE 402	SANTA MONICA	CA	90404	2047	19	06037	34.0317559	-118.4762013	Los Angeles County
256662	Fee-for-Service	1154552305	1154552305	1	1	BALTAIAN, LILIT MD	6/5/2024	173000000X	NA	Other	026	PHYSICIANS	105197	40	Pediatrics	0	In state provider	None	741 E ALTADENA DR	None	ALTADENA	CA	91001	2302	19	06037	34.19003582	-118.1324756	Los Angeles County
256674	Fee-for-Service	1932299450	1932299450	1	1	BANTA, DARYL P MD	2/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88722	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
256677	Fee-for-Service	1659727949	1659727949	1	1	BREATHE DIAGNOSTICS INC	9/19/2016	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4214 GREEN RIVER RD	STE 100	CORONA	CA	92878	3869	33	06065	33.87932492	-117.6471609	Riverside County
256680	Fee-for-Service	1750775599	1750775599	1	1	BROWN, JOHNNY LMFT	12/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16275 MONTEREY RD	STE C	MORGAN HILL	CA	95037	5466	43	06085	37.11612997	-121.6448825	Santa Clara County
256696	Fee-for-Service	1396064465	1396064465	1	1	BRYAN DONALD	3/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
256698	Fee-for-Service	1356619894	1356619894	1	1	BASSO PHARMACY INC	1/23/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3901 LAS POSAS ROAD	#101	CAMARILLO	CA	93010	1505	56	06111	34.2415821	-119.0183756	Ventura County
256704	Fee-for-Service	1679500557	1679500557	1	1	BALL,SHANE MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK	None	BOISE	ID	83712	0000	00	None	43.6124738	-116.1926844	Ada County
256705	Fee-for-Service	1689135915	1689135915	1	1	BAMGARTNER, MICHELE MD	7/5/2024	207L00000X	NA	Other	026	PHYSICIANS	187011	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
256712	Fee-for-Service	1033386537	1033386537	1	1	BUITRAGO BLANCO, MANUEL M	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122210	None	None	0	In state provider	None	300 MEDICAL PLAZA	SUITE B2OO	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
256718	Fee-for-Service	1215941836	1215941836	1	1	BRUNO, RICHARD	3/1/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
256725	Fee-for-Service	1922055086	1922055086	1	1	BENBASSAT, MAXIM N MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67933	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	# 14-901	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
256744	Fee-for-Service	1861555732	1861555732	1	1	BOLSTER, JOHN MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50763	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
256819	Fee-for-Service	1780816686	1780816686	1	1	BOGARD, BRENDA PT	1/30/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3140 APRON AVE	None	ATWATER	CA	95301	5103	24	06047	37.36532552	-120.5674796	Merced County
256855	Fee-for-Service	1487733515	1487733515	1	1	BERZIN, BELLA Y MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55467	41	Internal Medicine	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
256866	Fee-for-Service	1497935134	1497935134	1	1	BORQUEZ, EDUARDO A MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99526	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
256869	Fee-for-Service	1588681191	1588681191	1	1	BODOR, MARKO V MD	3/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63297	01	General Practice	0	In state provider	None	980 TRANCAS ST	STE 5	NAPA	CA	94558	2933	28	06055	38.32369771	-122.2951869	Napa County
256879	Fee-for-Service	1972705259	1972705259	1	1	BULTRON, GILBERTO MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106843	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
256900	Fee-for-Service	1700230224	1700230224	1	1	BERBERYAN, ANI MD	12/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160957	08	Family Practice	0	In state provider	None	9190 HAVEN AVE	None	RANCHO CUCAMONGA	CA	91730	5431	36	06071	34.086816	-117.5758865	San Bernardino County
256904	Fee-for-Service	1396894242	1396894242	1	1	BENNETT, MATTHEW D PSYD	2/15/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	922 STATE STREET	STE A, OFFICE #2	SANTA BARBARA	CA	93101	6795	42	06083	34.42108289	-119.7013175	Santa Barbara County
256906	Fee-for-Service	1528139268	1528139268	1	1	BURIK, NICOLE A LMFT	2/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4281 KATELLA AVENUE	STE 226	LOS ALAMITOS	CA	90720	6001	30	06059	33.80315853	-118.058328	Orange County
256931	Fee-for-Service	1811969900	1811969900	1	1	BOWEN, A'DELBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3705 5TH AVE	STE 3950	PITTSBURGH	PA	15213	2584	00	None	40.44154544	-79.95885126	Allegheny County
256961	Fee-for-Service	1932299450	1932299450	1	1	BANTA, DARYL P MD	2/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88722	41	Internal Medicine	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
256966	Fee-for-Service	1306606637	1306606637	1	1	BARRETT, SOPHIA PSYD	4/12/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
257053	Fee-for-Service	1538769336	1538769336	1	1	BECKMANN, CARINA K CCC-SLP	10/14/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
257092	Fee-for-Service	1417007089	1417007089	1	1	BROUKHIM, MAHNAZ MD	2/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80576	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
257102	Fee-for-Service	1669447488	1669447488	1	1	BRADLEY R. NICOL, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 RIM DR STE A	None	FLAGSTAFF	AZ	86001	0000	00	None	35.20953	-111.6475785	Coconino County
257122	Fee-for-Service	1427146216	1427146216	1	1	BRINTON, TODD J MD	6/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75795	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
257179	Fee-for-Service	1316185408	1316185408	1	1	BASI, HARJIT S MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121355	01	General Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
257182	Fee-for-Service	1699793885	1699793885	1	1	BERKSON, RICHARD MD INC	7/11/1996	207RE0101X	NA	Endocrinology	026	PHYSICIANS	32311	67	Endocrinology	0	In state provider	None	1868 PACIFIC AVE	None	LONG BEACH	CA	90806	6113	19	06037	33.791391	-118.193652	Los Angeles County
257216	Fee-for-Service	1124033675	1124033675	1	1	BEREITER, JEANNE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
257254	Fee-for-Service	1396851580	1396851580	1	1	BHUTWALA, ASHVIN V MD	11/30/1991	207R00000X	NA	Other	026	PHYSICIANS	51481	41	Internal Medicine	0	In state provider	None	17199 YUMA ST	STE #1	VICTORVILLE	CA	92395	5886	36	06071	34.47340216	-117.2875343	San Bernardino County
257267	Fee-for-Service	1083134225	1083134225	1	1	BERRY, MATTHEW T PT	11/5/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 S CHAPARRAL CT	150	ANAHEIM	CA	92808	2237	30	06059	33.86492127	-117.7445525	Orange County
257286	Fee-for-Service	1053346080	1053346080	1	1	BOSS, GERRY R MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	33967	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	# 5886	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
257380	Fee-for-Service	1417007089	1417007089	1	1	BROUKHIM, MAHNAZ MD	2/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80576	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
257402	Fee-for-Service	1922039577	1922039577	1	1	BARR, MARK L MD	2/8/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75945	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 4300	LOS ANGELES	CA	90033	5330	19	06037	34.06269295	-118.2030006	Los Angeles County
257434	Fee-for-Service	1194210674	1194210674	1	1	BROWER, TAMARA CNM	1/13/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
257442	Fee-for-Service	1801815600	1801815600	1	1	BRODY, ROBERT V MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	22035	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
257470	Fee-for-Service	1841592763	1841592763	1	1	BUSA, SWAPNA P MD	9/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120830	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
257488	Fee-for-Service	1649452236	1649452236	1	1	BORGHEI, SAMAN MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99695	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
257501	Fee-for-Service	1083628499	1083628499	1	1	BROWN, LORI A MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	63722	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
257512	Fee-for-Service	1538643903	1538643903	1	1	BYRNE, MEGAN	11/6/2023	207R00000X	NA	Other	026	PHYSICIANS	180588	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
257534	Fee-for-Service	1780600882	1780600882	1	1	BURSTEIN, JEROME MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	17398	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
257535	Fee-for-Service	1821409855	1821409855	1	1	BIOBAKU, DAVID MD	2/23/2022	207R00000X	NA	Other	026	PHYSICIANS	155957	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
257540	Fee-for-Service	1790254597	1790254597	1	1	BRIGGS, SARAH M NP	9/15/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
257542	Fee-for-Service	1326348319	1326348319	1	1	BAGHDADI MEDICAL INC	1/1/2011	207L00000X	NA	Other	026	PHYSICIANS	50810	05	Anesthesiology	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
257566	Fee-for-Service	1578643060	1578643060	1	1	BLOOM, STUART M MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	27742	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
257570	Fee-for-Service	1528009685	1528009685	2	1	BROOKS, KENNETH R MD	12/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	62755	08	Family Practice	0	In state provider	None	1301 PINOLE VALLEY ROAD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
257579	Fee-for-Service	1023344926	1023344926	1	2	BERI, SIMONE R PHD	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	26981	-	NOT APPLICABLE	0	In state provider	None	370 S CRENSHAW BLVD	SUITE E-100	TORRANCE	CA	90503	1727	19	06037	33.84549	-118.3287415	Los Angeles County
257620	Fee-for-Service	1659001105	1659001105	1	1	BARBER, LYDIA AU	9/20/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
257637	Fee-for-Service	1255482758	1255482758	1	1	BEZIKIAN, NORAIR G	2/17/1998	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	UC MEDICAL SUPPLY	3535 CAHUENGA BLVD W	STE 203	LOS ANGELES	CA	90068	1359	19	06037	34.13338191	-118.3569444	Los Angeles County
257688	Fee-for-Service	1922039577	1922039577	1	1	BARR, MARK L MD	2/8/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75945	02	General Surgery	0	In state provider	None	1520 SAN PABLO ST	STE 4300	LOS ANGELES	CA	90033	5330	19	06037	34.06269295	-118.2030006	Los Angeles County
257690	Fee-for-Service	1114920733	1114920733	1	1	BATIN, RONALD S MD	3/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77080	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6009 PENTZ RD	# B	PARADISE	CA	95969	5542	04	06007	39.75746555	-121.5723505	Butte County
257714	Fee-for-Service	1851738108	1851738108	1	1	BALU, ARTHI MD	4/10/2017	207R00000X	NA	Other	026	PHYSICIANS	133680	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
257723	Fee-for-Service	1164447900	1164447900	1	1	BEREK, JONATHAN S MD	8/23/1981	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39480	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
257728	Fee-for-Service	1386615714	1386615714	1	1	BERGDAHL, DAVID M MD	8/31/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44803	40	Pediatrics	0	In state provider	None	3755 E SHIELDS AVE	None	FRESNO	CA	93726	7029	10	06019	36.7796958	-119.7618088	Fresno County
257744	Fee-for-Service	1396909966	1396909966	1	1	BEHJATNIA, BITA MD	10/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79031	22	Pathology (M.D. only)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
257767	Fee-for-Service	1578539169	1578539169	1	1	BARROWS, EDWARD B MD	4/7/2023	208800000X	NA	Other	026	PHYSICIANS	53896	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
257778	Fee-for-Service	1972985216	1972985216	1	1	BARON, JULIA PSYD	6/5/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2340 CLAY ST	2ND FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
257789	Fee-for-Service	1083628499	1083628499	1	1	BROWN, LORI A MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	63722	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
257791	Fee-for-Service	1801054002	1801054002	1	1	BROMLEY, NICHOLLE D MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110254	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
257798	Fee-for-Service	1992822027	1992822027	1	1	BROWNE II, LAWRENCE W MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85973	None	None	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
257818	Fee-for-Service	1174635544	1174635544	1	1	BIBBY, E SUSAN LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	6621 E PACIFIC COAST HWY	STE 220	LONG BEACH	CA	90803	4239	19	06037	33.755373	-118.105911	Los Angeles County
257846	Fee-for-Service	1073991709	1073991709	1	1	BRESSLER, ALEXANDER J DO	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14899	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
257853	Fee-for-Service	1518149186	1518149186	1	1	BAUTISTA, ROSA C NP	11/19/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1058 3RD AVE	None	CHULA VISTA	CA	91911	2009	37	06073	32.61443652	-117.0694147	San Diego County
257863	Fee-for-Service	1326056557	1326056557	1	1	BOYD, CLARENCE A	3/19/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	36912	47	Miscellaneous	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
257868	Fee-for-Service	1134396187	1134396187	1	1	BEN A FICKENSCHER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	736 N BATTLEFIELD BLVD	None	CHESAPEAKE	VA	23320	4941	00	None	36.74619744	-76.24489616	Chesapeake city
257901	Fee-for-Service	1538648894	1538648894	1	1	BCRX INC	12/3/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13081 CENTRAL AVE	None	BOULDER CREEK	CA	95006	9119	44	06087	37.12385547	-122.1218943	Santa Cruz County
257904	Fee-for-Service	1356376347	1356376347	1	1	BROWN, STUART I MD	3/31/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40767	18	Ophthalmology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
257911	Fee-for-Service	1184827073	1184827073	1	1	BISHOP, ALLEN PHD	4/17/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	510 CASTILLO STREET	SUITE 105	SANTA BARBARA	CA	93101	3406	42	06083	34.41279777	-119.700057	Santa Barbara County
257949	Fee-for-Service	1447517784	1447517784	1	1	BEHBEHANI, MARIAM DO	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13205	01	General Practice	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
257978	Fee-for-Service	1114920733	1114920733	1	1	BATIN, RONALD S MD	3/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77080	01	General Practice	0	In state provider	None	6009 PENTZ RD	# B	PARADISE	CA	95969	5542	04	06007	39.75746555	-121.5723505	Butte County
257993	Fee-for-Service	1396933156	1396933156	1	2	BEVERLY RADIOLOGY MEDICAL GR	8/23/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP	18133 VENTURA BLVD	SUITE 100	TARZANA	CA	91356	3616	19	06037	34.1657808	-118.5283188	Los Angeles County
258002	Fee-for-Service	1851817233	1851817233	1	1	BRADLEY, ANTHONY C	1/23/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EAST FLORIDA AVE	STE 312 & 314	HEMET	CA	92544	8643	33	06065	33.74768747	-116.9557425	Riverside County
258015	Fee-for-Service	1467477109	1467477109	1	1	BERKOWITZ,BRUCE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2127 E HARMONY RD	STE 125	FORT COLLINS	CO	80528	8052	00	None	40.52313048	-105.036552	Larimer County
258016	Fee-for-Service	1992899090	1992899090	1	1	BERGMANN, CYNTHIA A MD	11/7/1989	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	45975	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5677 N FRESNO ST	# 101	FRESNO	CA	93710	6008	10	06019	36.820908	-119.7813475	Fresno County
258071	Fee-for-Service	1851769871	1851769871	1	1	BARRACK, VALERIE LMFT	7/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
258073	Fee-for-Service	1528158359	1528158359	1	1	BISWAL,SANDIP MD	7/1/2001	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	65553	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
258120	Fee-for-Service	1427658129	1427658129	2	1	BRONZAN, LINDA J LMFT	8/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	950 COUNTY SQUARE DR	112	VENTURA	CA	93003	5410	56	06111	34.26650142	-119.2145321	Ventura County
258134	Fee-for-Service	1518036565	1518036565	1	1	BANJ HEALTH CENTER INC	11/20/2018	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	201 N CENTRAL AVE	None	COMPTON	CA	90220	1425	19	06037	33.89691267	-118.2522574	Los Angeles County
258153	Fee-for-Service	1326056557	1326056557	1	1	BOYD, CLARENCE A	3/19/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	36912	20	Orthopedic Surgery	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
258161	Fee-for-Service	1740471531	1740471531	1	2	BURWICK, RICHARD M MD	4/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	101683	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	STE 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
258162	Fee-for-Service	1629412895	1629412895	1	1	BENDER, ARON B MD	4/8/2021	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	137195	None	None	0	In state provider	None	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
258182	Fee-for-Service	1265651574	1265651574	1	1	BAHOH JAVETE, CAROLYN PSYD	11/16/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
258196	Fee-for-Service	1346722352	1346722352	1	1	BANKS, LAUREN PT	2/26/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
258200	Fee-for-Service	1366451601	1366451601	1	1	BOLOTIN, GREGG S MD	11/30/1994	207P00000X	NA	Other	026	PHYSICIANS	70468	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1688 E MAIN ST	None	EL CAJON	CA	92021	5204	37	06073	32.81173156	-116.9190219	San Diego County
258206	Fee-for-Service	1922493220	1922493220	1	1	BOZORGNIA, FARSHID MD	10/28/2022	207RR0500X	NA	Other	026	PHYSICIANS	166743	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
258228	Fee-for-Service	1740228501	1740228501	1	1	BENNETT, JOHATHAN C CRNA	10/26/2010	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
258263	Fee-for-Service	1255059077	1255059077	1	1	BAKER & VU AN OPTOMETRIC PRO	6/30/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	516 E PALMDALE BLVD	None	PALMDALE	CA	93550	4603	19	06037	34.57961309	-118.1198918	Los Angeles County
258274	Fee-for-Service	1083060602	1083060602	1	1	BERMUDEZ, EDUARDO B MD	5/13/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	155262	None	None	0	In state provider	None	3031 G STREET	None	SACRAMENTO	CA	95816	3811	34	06067	38.576304	-121.4639955	Sacramento County
258275	Fee-for-Service	1730316928	1730316928	1	1	BAHADOR, FARSHAD M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129414	30	Radiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
258281	Fee-for-Service	1003852336	1003852336	1	1	BURT, PHYLLIS	6/9/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	47 MARIA DR	STE 812	PETALUMA	CA	94954	3567	49	06097	38.25083868	-122.6203398	Sonoma County
258292	Fee-for-Service	1003320045	1003320045	1	1	BRODEUR, NOELLE CNM	12/10/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3101 TELEGRAPH AVE	None	BERKELEY	CA	94705	1984	01	06001	37.85361291	-122.2600247	Alameda County
258309	Fee-for-Service	1114910908	1114910908	1	1	BHADRA, SHAMIK, MD	7/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124360	45	Nephrology (Renal-Kidney)	0	In state provider	None	3650 E SOUTH ST	STE 301	LAKEWOOD	CA	90712	1513	19	06037	33.8601747	-118.1494013	Los Angeles County
258339	Fee-for-Service	1225266315	1225266315	1	1	BONDADE, NINA P MD	3/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115995	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
258368	Fee-for-Service	1750818357	1750818357	1	1	BUCHANAN, CHRISTINA J MD	8/6/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171955	None	None	0	In state provider	None	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
258371	Fee-for-Service	1023093556	1023093556	1	1	BIASCAN, ANTHONY C MD	2/8/2023	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	52974	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
258380	Fee-for-Service	1417067299	1417067299	1	1	BOOZER, JENNIFER R DO	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	8927	01	General Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
258404	Fee-for-Service	1790963668	1790963668	1	1	BOWMAN, GERALD D CPO	3/24/2009	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	16430 VENTURA BLVD	304	ENCINO	CA	91436	2133	19	06037	34.15736278	-118.4911768	Los Angeles County
258468	Fee-for-Service	1649367426	1649367426	1	1	BINDER, ANDREW S MD	1/7/2020	207R00000X	NA	Other	026	PHYSICIANS	30340	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3200 TELEGRAPH RD	None	VENTURA	CA	93003	3232	56	06111	34.27239076	-119.2522635	Ventura County
258474	Fee-for-Service	1568632321	1568632321	1	1	BOND, JANE T LMFT	12/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
258483	Fee-for-Service	1679718753	1679718753	1	2	BENJAMIN J REMINGTON M D INC	12/10/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
258495	Fee-for-Service	1982759247	1982759247	1	1	BELZER, MAYNARD D MD	12/29/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	41252	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2486 N PONDEROSA DR	STE 202	CAMARILLO	CA	93010	2376	56	06111	34.24266768	-119.0228157	Ventura County
258500	Fee-for-Service	1245482017	1245482017	1	1	BENDELE, CANDACE C LMFT	11/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2342 PROFESSIONAL PARKWA	SUITE 300	SANTA MARIA	CA	93455	6819	42	06083	34.91786968	-120.4383001	Santa Barbara County
258534	Fee-for-Service	1609068972	1609068972	1	1	BELLO, NATALIE A MD	9/17/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	173610	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
258583	Fee-for-Service	1518936657	1518936657	1	1	BERNET, DAN E OD	9/12/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2890 VENTURA ST	None	ANDERSON	CA	96007	3553	45	06089	40.45284128	-122.2938885	Shasta County
258595	Fee-for-Service	1114910908	1114910908	1	1	BHADRA, SHAMIK, MD	7/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124360	41	Internal Medicine	0	In state provider	None	3650 E SOUTH ST	STE 301	LAKEWOOD	CA	90712	1513	19	06037	33.8601747	-118.1494013	Los Angeles County
258612	Fee-for-Service	1447225206	1447225206	1	1	BAZAR, KIMBERLY A MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54780	07	Dermatology	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
258633	Fee-for-Service	1841343076	1841343076	1	1	BUSTER, R WILLIAM MD	2/8/2015	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	24799	41	Internal Medicine	0	In state provider	None	845 W LA VETA AVE	STE 108	ORANGE	CA	92868	3930	30	06059	33.78064548	-117.8611107	Orange County
258668	Fee-for-Service	1659798825	1659798825	1	1	BAFTJARI, EVIS DO	6/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21418	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
258670	Fee-for-Service	1558499954	1558499954	1	1	B&D MORGAN, INC	6/1/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	306 PLUM ST	None	EXETER	CA	93221	1228	54	06107	36.30183821	-119.1409185	Tulare County
258682	Fee-for-Service	1073596557	1073596557	1	1	BOGER, DONALD MD	5/31/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33861	30	Radiology	0	In state provider	None	1355 SAN PABLO ST	BLDG 404	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
258706	Fee-for-Service	1609302678	1609302678	1	1	BLACK, LISA J PSYD	6/19/2017	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
258728	Fee-for-Service	1447246434	1447246434	1	1	BATTY, WILLIAM G MD	2/20/2008	207R00000X	NA	Other	026	PHYSICIANS	86397	41	Internal Medicine	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3473	30	06059	33.89344341	-117.9338865	Orange County
258754	Fee-for-Service	1346274602	1346274602	1	1	BENEDICK, BRUCE A MD	3/31/1991	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	65711	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	770 WELCH RD	STE 100	PALO ALTO	CA	94304	1505	43	06085	37.43748087	-122.1759625	Santa Clara County
258763	Fee-for-Service	1235178955	1235178955	1	1	BERGER, JEFFREY J. MD	12/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 FIRST COLONIAL RD	STE 203	VIRGINIA BCH	VA	23454	2418	00	None	36.8666554	-76.02945618	Virginia Beach city
258778	Fee-for-Service	1538365234	1538365234	1	1	BONDOC, MARNEL M DO	5/13/2008	390200000X	NA	Other	026	PHYSICIANS	1002	08	Family Practice	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
258799	Fee-for-Service	1598843245	1598843245	1	1	BAKER, TIMOTHY M MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70392	07	Dermatology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
258805	Fee-for-Service	1598835142	1598835142	1	1	BROMLEY, JASON T MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	79728	36	Psychiatry	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
258823	Fee-for-Service	1740273606	1740273606	1	1	BOEHM, JOSEPH N PT	10/1/1996	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LOS OSOS PHYSICAL THERPY	2115 10TH ST	STE B	LOS OSOS	CA	93402	3244	40	06079	35.312823	-120.8322495	San Luis Obispo County
258844	Fee-for-Service	1265812119	1265812119	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/2/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	CENTER, INC.	1923 COFFEE RD	12C	MODESTO	CA	95355	2708	50	06099	37.67156536	-120.9757491	Stanislaus County
258859	Fee-for-Service	1205869286	1205869286	1	1	BERBERICH, FELIX R MD	4/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	17754	40	Pediatrics	0	In state provider	None	2320 WOOLSEY ST	301	BERKELEY	CA	94705	1976	01	06001	37.85282167	-122.2609028	Alameda County
258869	Fee-for-Service	1467618363	1467618363	1	1	BARSOUM, YASSER W MD	2/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	91481	45	Nephrology (Renal-Kidney)	0	In state provider	None	500 S SANTA FE ST	None	VISALIA	CA	93292	2941	54	06107	36.326232	-119.28744	Tulare County
258870	Fee-for-Service	1699112169	1699112169	1	1	BIBAL, XYLONA R MD	11/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134695	41	Internal Medicine	0	In state provider	None	2235 HAYES STREET	5TH FLOOR	SAN FRANCISCO	CA	94117	1082	38	06075	37.77302045	-122.4529717	San Francisco County
258918	Fee-for-Service	1134297260	1134297260	2	2	BAIG & ADMANI A PARTNERSHIP	4/7/2014	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1560 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.779782	-115.569736	Imperial County
258926	Fee-for-Service	1518915487	1518915487	1	1	BHATTI, TAHIR I MD	8/25/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	54139	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
258950	Fee-for-Service	1215987532	1215987532	1	1	BY THE BAY HEALTH	1/1/1988	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	180 REDWOOD STREET	STE 350	SAN FRANCISCO	CA	94102	3282	38	06075	37.78062442	-122.4199012	San Francisco County
258972	Fee-for-Service	1295884260	1295884260	1	1	BURKE, SHEILA B	12/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
258989	Fee-for-Service	1750920419	1750920419	1	1	BERRY-MILLETT, KATE S CNM	3/3/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
258998	Fee-for-Service	1194736652	1194736652	1	1	BRIAR-GARNER, SHARON A LMFT	1/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	41169 PAMELA WAY	None	OAKHURST	CA	93644	9598	20	06039	37.34698622	-119.7059012	Madera County
259036	Fee-for-Service	1932132339	1932132339	1	1	BRYANT-BRUCE, CHERYL D	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86766	08	Family Practice	0	In state provider	MD	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
259037	Fee-for-Service	1518386168	1518386168	1	1	BODDEN, LARRY O MD	9/8/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	186236	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
259079	Fee-for-Service	1457310583	1457310583	2	1	BONDADE, PRAKASH G MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37862	None	None	0	In state provider	None	17150 EUCLID ST	SUITE B218	FOUNTAIN VALLEY	CA	92708	4092	30	06059	33.714171	-117.9369905	Orange County
259146	Fee-for-Service	1669065140	1669065140	1	1	BUTLER, TAYLOR K LMFT	1/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
259151	Fee-for-Service	1467618363	1467618363	1	1	BARSOUM, YASSER W MD	2/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	91481	41	Internal Medicine	0	In state provider	None	500 S SANTA FE ST	None	VISALIA	CA	93292	2941	54	06107	36.326232	-119.28744	Tulare County
259182	Fee-for-Service	1508278573	1508278573	1	1	BARNES-BROWN, ASHLEY LMFT	10/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3960 INDUSTRIAL BLVD	200	WEST SACRAMENTO	CA	95691	5024	57	06113	38.57029234	-121.5767941	Yolo County
259206	Fee-for-Service	1457058471	1457058471	1	1	BANG, NICOLE M PT	4/7/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
259216	Fee-for-Service	1609891340	1609891340	1	1	BURT, STEVEN R MD	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	842 E MAIN STREET	None	MEDFORD	OR	97504	7155	00	None	42.32787853	-122.863311	Jackson County
259236	Fee-for-Service	1396786315	1396786315	1	1	BRYAN, PAUL A MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65000	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
259237	Fee-for-Service	1215987532	1215987532	1	1	BY THE BAY HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	180 REDWOOD STREET	STE 350	SAN FRANCISCO	CA	94102	3282	38	06075	37.78062442	-122.4199012	San Francisco County
259243	Fee-for-Service	1821103524	1821103524	1	1	BAUER, CHRISTOPHER M PHD	8/24/2022	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
259258	Fee-for-Service	1649331372	1649331372	1	1	BRANDSTATER, NIGEL S MD	6/15/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60336	08	Family Practice	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 200	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
259259	Fee-for-Service	1285108399	1285108399	1	1	BENTON, LEANN L RCP	8/30/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
259310	Fee-for-Service	1003865072	1003865072	1	1	BLACK, DAVID M MD	9/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	625 9TH AVE ST 210	None	LONGVIEW	WA	98632	2465	00	None	46.12378087	-122.9340848	Cowlitz County
259327	Fee-for-Service	1497012629	1497012629	1	1	BARRETO CHANG, ODMARA L MD	6/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134066	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
259405	Fee-for-Service	1992798698	1992798698	1	1	BIG 1 INC	9/16/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	415 W VALLEY BLVD	STE B	SAN GABRIEL	CA	91776	3728	19	06037	34.07948039	-118.1058412	Los Angeles County
259484	Fee-for-Service	1639756075	1639756075	1	1	BEAUDOIN, GABRIEL E MD	11/30/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	185583	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
259514	Fee-for-Service	1508883257	1508883257	1	1	BRYSON, DAVID R MD	12/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71842	41	Internal Medicine	0	In state provider	BRYSON CANCER CARE INC	5345 W HILLSDALE AVE	None	VISALIA	CA	93291	5143	54	06107	36.32886	-119.3506785	Tulare County
259539	Fee-for-Service	1699921783	1699921783	1	1	BAY IMAGING CONSULTANTS	2/28/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MED GRP INC	20103 LAKE CHABOT RD	STE 103	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
259545	Fee-for-Service	1104214709	1104214709	1	1	BECKER, HANS CHRISTOPH R MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
259554	Fee-for-Service	1023307089	1023307089	1	1	BABIKIAN, TALIN PHD	1/28/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.07067	-118.4432445	Los Angeles County
259588	Fee-for-Service	1427340223	1427340223	1	1	BELSKY, KATHERINE A C MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121938	01	General Practice	0	In state provider	None	2210 DEL PASO ROAD	SUITE A	SACRAMENTO	CA	95834	9676	34	06067	38.655189	-121.5091575	Sacramento County
259591	Fee-for-Service	1427016039	1427016039	1	1	BRISTOW, ROBERT E MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81369	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
259606	Fee-for-Service	1285211318	1285211318	1	1	BORDEN, WEATHERALL CRNA	8/16/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
259628	Fee-for-Service	1962972794	1962972794	1	1	BEACHLER, KRYSTAL LMFT	1/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23332 HAWTHORNE BLVD	STE 304	TORRANCE	CA	90505	3749	19	06037	33.813747	-118.3510045	Los Angeles County
259630	Fee-for-Service	1063964070	1063964070	1	1	BERGER, SHELLEY M OT	10/23/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
259637	Fee-for-Service	1942660097	1942660097	1	1	BECKER, ROMYNA A LCSW	5/23/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
259658	Fee-for-Service	1467696633	1467696633	1	1	BRYAN T PRANGE	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7026 OLD KATY RD	STE 276	HOUSTON	TX	77024	2187	00	None	29.78388299	-95.44503208	Harris County
259664	Fee-for-Service	1700934528	1700934528	1	1	BUI, NELSON N MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83793	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
259716	Fee-for-Service	1356631303	1356631303	1	1	BANGALORE PRASANNA KUMAR,	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145463	41	Internal Medicine	0	In state provider	NILIMA MD	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
259723	Fee-for-Service	1902835416	1902835416	1	1	BAYDUR, AHMET	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	20722	01	General Practice	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
259733	Fee-for-Service	1548407554	1548407554	1	1	BURBACH,ANTHONY DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20 S PLUM ST	None	VERMILLION	SD	57069	0000	00	None	42.77803274	-96.91990777	Clay County
259734	Fee-for-Service	1407925860	1407925860	2	1	BREDY, BRUNEL MD	5/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75486	08	Family Practice	0	In state provider	None	9201 BIGHORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
259777	Fee-for-Service	1578911145	1578911145	1	1	BAART BEHAVIORAL HEALTH SERV	7/1/2017	261QM2800X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	89 E MILL AVE	None	PORTERVILLE	CA	93257	3808	54	06107	36.06877628	-119.014426	Tulare County
259787	Fee-for-Service	1326819434	1326819434	1	1	BRINE, MARCO	5/15/2024	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1775 HARRISON AVE	None	EUREKA	CA	95501	1338	12	06023	40.79191911	-124.1395817	Humboldt County
259809	Fee-for-Service	1508883257	1508883257	1	1	BRYSON, DAVID R MD	12/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71842	78	Neoplastic Diseases/Oncology	0	In state provider	BRYSON CANCER CARE INC	5345 W HILLSDALE AVE	None	VISALIA	CA	93291	5143	54	06107	36.32886	-119.3506785	Tulare County
259826	Fee-for-Service	1346437332	1346437332	1	1	BARRETT, DEAN N CPO	7/30/2014	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	104 MARGARET LANE	#A	GRASS VALLEY	CA	95945	5164	29	06057	39.22982781	-121.046717	Nevada County
259927	Fee-for-Service	1417036559	1417036559	1	1	BRUENS, PATRICIA MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	84168	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
259948	Fee-for-Service	1063818912	1063818912	1	1	BUCK, LINDA J NP	9/6/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18111 BROOKHURST ST	STE 1100	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
259957	Fee-for-Service	1093169757	1093169757	1	1	BOBKER, SARAH M MD	6/11/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	167582	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
259958	Fee-for-Service	1922471291	1922471291	1	1	BERTELSEN, CAITLIN MD	10/11/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	138856	None	None	0	In state provider	None	433 E WARDLOW RD	None	LONG BEACH	CA	90807	4507	19	06037	33.81894073	-118.1875504	Los Angeles County
259968	Fee-for-Service	1164421137	1164421137	1	1	BOWMAN, MARY JO A MD	9/30/2020	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
259977	Fee-for-Service	1114938032	1114938032	1	1	BHARGAVA, ADITYA MD	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55118	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
260012	Fee-for-Service	1811153547	1811153547	1	2	BEST RIDE, INC.	8/21/2020	2278P4000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5437 LAUREL CANYON BLVD	STE 102	VALLEY VILLAGE	CA	91607	2193	19	06037	34.16976	-118.3965275	Los Angeles County
260014	Fee-for-Service	1801913363	1801913363	1	1	BORDAS, MARIANA E LMFT	7/30/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15373 INNOVATION DR	STE 395	SAN DIEGO	CA	92128	3429	37	06073	32.99427342	-117.0794782	San Diego County
260020	Fee-for-Service	1629120845	1629120845	1	1	BERNSTEIN, WENDY J MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54310	None	None	0	In state provider	None	2041 BANCROFT WAY	STE 307	BERKELEY	CA	94704	1406	01	06001	37.86751817	-122.2687345	Alameda County
260021	Fee-for-Service	1407925860	1407925860	2	1	BREDY, BRUNEL MD	5/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75486	01	General Practice	0	In state provider	None	9201 BIGHORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
260049	Fee-for-Service	1962488148	1962488148	1	1	BINDRA, JASJEET MD	2/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88196	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
260090	Fee-for-Service	1841326741	1841326741	1	1	BORGIDA, BERNARD M MD	1/1/1982	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	31659	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
260091	Fee-for-Service	1265565956	1265565956	1	1	BELLS AMBULANCE SVC	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	434 POWELL AVE	None	HEALDSBURG	CA	95448	3430	49	06097	38.62065448	-122.864121	Sonoma County
260093	Fee-for-Service	1508883257	1508883257	1	1	BRYSON, DAVID R MD	12/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71842	68	Hematology	0	In state provider	BRYSON CANCER CARE INC	5345 W HILLSDALE AVE	None	VISALIA	CA	93291	5143	54	06107	36.32886	-119.3506785	Tulare County
260104	Fee-for-Service	1801896907	1801896907	1	1	BUTLER, FRED JR MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	48183	01	General Practice	0	In state provider	None	1760 CHICAGO AVE	STE J3	RIVERSIDE	CA	92507	2300	33	06065	33.995538	-117.348333	Riverside County
260114	Fee-for-Service	1528004496	1528004496	1	1	BAUMGARTL, WILLIAM H MD	3/2/2022	208VP0014X	NA	Other	026	PHYSICIANS	67802	None	None	0	In state provider	None	5395 RUFFIN ROAD	STE. 204	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
260123	Fee-for-Service	1790517993	1790517993	1	1	BERNARDO, ELLINA NP	10/17/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	19	06037	34.24862229	-118.2886742	Los Angeles County
260127	Fee-for-Service	1164551966	1164551966	1	1	BYERS, MARK B OD	11/27/2017	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	429 D ST	None	MARYSVILLE	CA	95901	5706	58	06115	39.14014224	-121.5889158	Yuba County
260185	Fee-for-Service	1457834731	1457834731	1	1	BASS, RACHEL B MD	3/13/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190319	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
260187	Fee-for-Service	1043239387	1043239387	1	1	BRADLEY S RIEDERS M.D.	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	210 E SUNRISE HWY	STE 304	VALLEY STREAM	NY	11581	1328	00	None	40.657473	-73.6909605	Nassau County
260204	Fee-for-Service	1134692049	1134692049	1	2	BE AUTHENTIC FAMILY THERAPY	1/23/2023	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC.	2377 W FOOTHILL BLVD	STE 11	UPLAND	CA	91786	3577	36	06071	34.10690963	-117.6975663	San Bernardino County
260222	Fee-for-Service	1194819888	1194819888	1	1	BELL, NORMAN J MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	16386	40	Pediatrics	0	In state provider	None	770 10TH ST	None	ARCATA	CA	95521	6210	12	06023	40.86976947	-124.0859772	Humboldt County
260224	Fee-for-Service	1790863447	1790863447	1	1	BUEFF, HANS U MD	12/17/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48991	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
260245	Fee-for-Service	1427163443	1427163443	1	1	BI RITE QUALITY PHARMACY	5/30/1995	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	340 N HARBOR BLVD	None	LA HABRA	CA	90631	4847	30	06059	33.93434555	-117.932984	Orange County
260288	Fee-for-Service	1114098092	1114098092	1	1	BIRUSINGH, KURTIS C MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60249	04	Otology, Laryngology, Rhinology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
260304	Fee-for-Service	1821165549	1821165549	1	1	BRAR, RAMANDEEP K MD	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73497	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3771 KATELLA AVE	STE 300	LOS ALAMITOS	CA	90720	3115	30	06059	33.80319153	-118.067274	Orange County
260309	Fee-for-Service	1760877906	1760877906	1	1	BRAHMA, VENKATESH MD	12/29/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	176645	None	None	0	In state provider	None	3035 CLEVELAND AVE	100	SANTA ROSA	CA	95403	2122	49	06097	38.468088	-122.729283	Sonoma County
260316	Fee-for-Service	1518025535	1518025535	1	1	BLAUSTEIN, JOHN CHARLES	6/1/1989	207ZP0102X	NA	Other	026	PHYSICIANS	65482	22	Pathology (M.D. only)	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
260320	Fee-for-Service	1306970066	1306970066	1	1	BERMUDEZ, NORMA	4/1/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
260327	Fee-for-Service	1235472648	1235472648	1	1	BUREN, MARC A MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137198	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
260360	Fee-for-Service	1598813503	1598813503	1	1	BROWN, LISA M MD	8/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91098	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
260393	Fee-for-Service	1891025565	1891025565	1	1	BASSI, HARJOT K MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137189	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
260396	Fee-for-Service	1841634805	1841634805	1	1	BELEFORD, DANIAH A D T MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143531	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
260481	Fee-for-Service	1265476857	1265476857	1	1	BORRELLO, MICHAEL T MD	7/12/2019	208VP0014X	NA	Other	026	PHYSICIANS	163019	05	Anesthesiology	0	In state provider	None	2675 HARRIS ST	None	EUREKA	CA	95503	4806	12	06023	40.78053022	-124.1369379	Humboldt County
260491	Fee-for-Service	1952552440	1952552440	1	1	BLUE DOVE REHABILITATION INC	2/8/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 N PRAIRIE AVE	STE 201	INGLEWOOD	CA	90301	4509	19	06037	33.965712	-118.3439965	Los Angeles County
260493	Fee-for-Service	1134692049	1134692049	1	2	BE AUTHENTIC FAMILY THERAPY	1/23/2023	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC.	2377 W FOOTHILL BLVD	STE 11	UPLAND	CA	91786	3577	36	06071	34.10690963	-117.6975663	San Bernardino County
260499	Fee-for-Service	1922110238	1922110238	1	1	BOWMAN, GLEN F MD	8/31/2023	207L00000X	NA	Other	026	PHYSICIANS	185046	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
260507	Fee-for-Service	1356732135	1356732135	2	1	BRAND NEW PHARMACY INC	3/29/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1819 W REDLANDS BLVD.	SUITE 101	REDLANDS	CA	92373	3120	36	06071	34.0628739	-117.2157065	San Bernardino County
260513	Fee-for-Service	1235190265	1235190265	1	1	BHASIN, PARAMDEEP S M D INC	4/5/2012	207LP2900X	NA	Other	026	PHYSICIANS	66108	05	Anesthesiology	0	In state provider	None	2131 WEST 3RD STREET	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
260534	Fee-for-Service	1972270932	1972270932	1	1	BLAST PHARMA INC	10/11/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 W. KATELLA AVE	#J	ANAHEIM	CA	92804	6100	30	06059	33.80326448	-117.942084	Orange County
260544	Fee-for-Service	1831605575	1831605575	1	1	BROWN, ALYSHA M LMFT	6/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
260574	Fee-for-Service	1851515126	1851515126	1	1	BALLARD, BRYAN C	11/30/1994	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 S SANTA CRUZ AVE	STE 100	LOS GATOS	CA	95030	6743	43	06085	37.22004633	-121.9856938	Santa Clara County
260584	Fee-for-Service	1124386776	1124386776	1	1	BARNETT, BRADEN G MD	9/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126735	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
260610	Fee-for-Service	1104952548	1104952548	1	2	BUSI, YURI MD INC	4/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	40872	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1030 S GLENDALE AVE	STE 302	GLENDALE	CA	91205	5612	19	06037	34.13381535	-118.2519184	Los Angeles County
260624	Fee-for-Service	1073543781	1073543781	2	1	BOONE, GARY K MD	5/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	31968	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6465A BALBOA AVE	None	SAN DIEGO	CA	92111	3155	37	06073	32.8201707	-117.1728367	San Diego County
260632	Fee-for-Service	1386998664	1386998664	1	1	BAY VIEW REHABILITATION	3/1/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL LLC	516 WILLOW STREET	None	ALAMEDA	CA	94501	6232	01	06001	37.76011202	-122.2549417	Alameda County
260637	Fee-for-Service	1558362749	1558362749	1	1	BROWN, CARL A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 PARK AVE S	None	MINNEAPOLIS	MN	55404	0000	00	None	44.96030972	-93.26503033	Hennepin County
260680	Fee-for-Service	1255689519	1255689519	1	1	BIRDSONG, VANESSA LMFT	9/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27951 SMYTH DR	None	VALENCIA	CA	91355	1224	19	06037	34.44222202	-118.5700452	Los Angeles County
260703	Fee-for-Service	1912017856	1912017856	1	1	BILELLO, JOHN F MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84890	89	Surgery-Traumatic	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
260722	Fee-for-Service	1548402258	1548402258	1	1	BUDOVSKY, INNA V	1/24/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
260759	Fee-for-Service	1184646549	1184646549	1	1	BRANCHE, CHRISTOPHER C	4/1/1992	207L00000X	NA	Other	026	PHYSICIANS	45719	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
260777	Fee-for-Service	1134692049	1134692049	1	2	BE AUTHENTIC FAMILY THERAPY	1/23/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC.	2377 W FOOTHILL BLVD	STE 11	UPLAND	CA	91786	3577	36	06071	34.10690963	-117.6975663	San Bernardino County
260781	Fee-for-Service	1225666829	1225666829	1	1	BRAR, ISUSAN K MD	11/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187575	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
260783	Fee-for-Service	1710175104	1710175104	1	1	BREEN, NATALIE E LCSW	6/13/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
260784	Fee-for-Service	1225012016	1225012016	1	1	BORTZ, WALTER M MD	8/9/1996	207P00000X	NA	Other	026	PHYSICIANS	83310	41	Internal Medicine	0	In state provider	None	242 HOSPITAL DR	STE A	UKIAH	CA	95482	4556	23	06045	39.15258291	-123.2037212	Mendocino County
260796	Fee-for-Service	1306499132	1306499132	1	1	BAQIR, HUMA MD	10/3/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	188608	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
260839	Fee-for-Service	1477105062	1477105062	1	1	BUCKINGHAM, JACLYN D OT	5/17/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
260861	Fee-for-Service	1255838363	1255838363	1	1	BHALANI, NIRAJ DO	8/1/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	17979	10	Gastroenterology (M.D. only)	0	In state provider	None	7102 N. FRESNO ST	SUITE 108	FRESNO	CA	93720	2905	10	06019	36.83941007	-119.7813045	Fresno County
260872	Fee-for-Service	1124386776	1124386776	1	1	BARNETT, BRADEN G MD	9/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126735	67	Endocrinology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
260881	Fee-for-Service	1144400706	1144400706	3	1	BOIES MEDICAL CENTER PHARMAC	8/1/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6110 FAIR OAKS BLVD.	STE E	CARMICHAEL	CA	95608	4873	34	06067	38.612241	-121.3284015	Sacramento County
260898	Fee-for-Service	1104952548	1104952548	1	2	BUSI, YURI MD INC	4/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	40872	41	Internal Medicine	0	In state provider	None	1030 S GLENDALE AVE	STE 302	GLENDALE	CA	91205	5612	19	06037	34.13381535	-118.2519184	Los Angeles County
260902	Fee-for-Service	1457436941	1457436941	1	1	BRIAN C PIEN M.D.	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1010 S KING ST	STE 111	HONOLULU	HI	96814	1702	00	None	21.30137157	-157.8483439	Honolulu County
260941	Fee-for-Service	1215348750	1215348750	1	1	BOWERS, PATRICIA K LCSW	6/8/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
260942	Fee-for-Service	1184636375	1184636375	1	1	BARKER, LISA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1620 S CELEBRATION AVE	None	MERIDIAN	ID	83642	2779	00	None	43.589718	-116.3654235	Ada County
260997	Fee-for-Service	1821486093	1821486093	1	1	BRIDGE 2 LIFE-EL NIDO LLC	8/27/2020	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1637 EL NIDO AVE	None	PERRIS	CA	92571	3878	33	06065	33.802488	-117.1952515	Riverside County
261008	Fee-for-Service	1790866838	1790866838	1	1	BARNARD, RAND S MD	2/28/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63501	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
261019	Fee-for-Service	1780666065	1780666065	1	1	BRICK, ROBERT A MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	47604	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
261020	Fee-for-Service	1467472308	1467472308	1	1	BOYLE SARAH J.M. MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42948	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
261097	Fee-for-Service	1053522276	1053522276	1	1	BATISTA, BENAKAR F MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140277	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
261106	Fee-for-Service	1104217165	1104217165	1	1	BROADWAY PHARMACY CORPORATIO	3/26/2015	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7581 BROADWAY	None	LEMON GROVE	CA	91945	1605	37	06073	32.74257451	-117.0349425	San Diego County
261121	Fee-for-Service	1669842985	1669842985	1	1	BLACK TIGER LIMO, INC.	11/18/2019	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	9090 BIRCH ST	None	SPRING VALLEY	CA	91977	4107	37	06073	32.71667263	-117.0037443	San Diego County
261151	Fee-for-Service	1255838363	1255838363	1	1	BHALANI, NIRAJ DO	8/1/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	17979	41	Internal Medicine	0	In state provider	None	7102 N. FRESNO ST	SUITE 108	FRESNO	CA	93720	2905	10	06019	36.83941007	-119.7813045	Fresno County
261161	Fee-for-Service	1063983997	1063983997	1	1	BETA HOSPICE CARE INC	10/12/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1525 N D ST	STE 10	SAN BERNARDINO	CA	92405	4774	36	06071	34.127433	-117.2918945	San Bernardino County
261174	Fee-for-Service	1922047190	1922047190	1	1	BAIN, ERIC S MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60368	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
261198	Fee-for-Service	1235691999	1235691999	1	1	BOYER, REBECCA MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	178691	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
261209	Fee-for-Service	1851583900	1851583900	1	1	BHANDARI, RITESH R MD	1/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52778	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
261224	Fee-for-Service	1336304013	1336304013	2	1	BARZEY, JENNIFER M LCSW	3/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6 GOVERNORS LN	STE. A	CHICO	CA	95926	2282	04	06007	39.75531581	-121.8582802	Butte County
261248	Fee-for-Service	1942332655	1942332655	1	1	BAKERSFIELD RECOVERY	7/25/2017	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	600 BERNARD ST	None	BAKERSFIELD	CA	93305	3020	15	06029	35.39027907	-118.9888977	Kern County
261253	Fee-for-Service	1508210444	1508210444	1	1	BURNETT THERAPEUTIC SERVICES	5/23/2024	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	, INC.	3419 VALLE VERDE DR	None	NAPA	CA	94558	2414	28	06055	38.32542048	-122.292335	Napa County
261262	Fee-for-Service	1154615383	1154615383	1	1	BROWNE, ANDREW W MD	8/5/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	126196	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
261267	Fee-for-Service	1609932466	1609932466	1	1	BLUME, JOSHUA A MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135557	36	Psychiatry	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
261280	Fee-for-Service	1538136692	1538136692	1	1	BARRETT, MARK F MD	10/12/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74404	66	Emergency Medicine (Urgent Care)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
261306	Fee-for-Service	1467472308	1467472308	1	1	BOYLE SARAH J.M. MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42948	89	Surgery-Traumatic	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
261355	Fee-for-Service	1669587937	1669587937	1	1	BANFRO, FRANCIS T MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2386	00	None	36.1590063	-115.1674415	Clark County
261406	Fee-for-Service	1730239989	1730239989	1	1	BROWN, CRAIG A MD INC	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	28188	36	Psychiatry	0	In state provider	None	480 4TH AVE	STE 511	CHULA VISTA	CA	91910	4414	37	06073	32.63411298	-117.0816772	San Diego County
261424	Fee-for-Service	1295758688	1295758688	1	3	BRADEN PARTNERS LP	7/19/2019	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4882 MCGRATH ST	STE 220	VENTURA	CA	93003	7721	56	06111	34.25466859	-119.2252103	Ventura County
261446	Fee-for-Service	1750317251	1750317251	1	1	BOROK, ZEA MD	10/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47911	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
261449	Fee-for-Service	1063983997	1063983997	1	1	BETA HOSPICE CARE INC	10/12/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1525 N D ST	STE 10	SAN BERNARDINO	CA	92405	4774	36	06071	34.127433	-117.2918945	San Bernardino County
261457	Fee-for-Service	1952500977	1952500977	1	1	BECKERMAN, NATHAN S MD	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123310	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
261534	Fee-for-Service	1861666703	1861666703	1	1	BOECKMANN, JACOB O MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123972	24	Plastic Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	BLDG 25	ORANGE	CA	92863	4091	30	06059	33.78674051	-117.8888713	Orange County
261537	Fee-for-Service	1356800312	1356800312	1	1	BARRAGAN, FATIMA MD	6/29/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179468	None	None	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
261540	Fee-for-Service	1508210444	1508210444	1	1	BURNETT THERAPEUTIC SERVICES	5/23/2024	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	, INC.	3419 VALLE VERDE DR	None	NAPA	CA	94558	2414	28	06055	38.32542048	-122.292335	Napa County
261556	Fee-for-Service	1306913637	1306913637	1	1	BROWN, KIM C NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6670 ALTON PKWY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
261562	Fee-for-Service	1528328531	1528328531	1	1	BULLEN, ALEXANDER L MD	6/22/2018	163WN0300X	NA	Other	026	PHYSICIANS	135902	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
261569	Fee-for-Service	1538136692	1538136692	1	1	BARRETT, MARK F MD	10/12/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74404	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
261570	Fee-for-Service	1346657566	1346657566	1	1	BASS LAKE JOINT UNION ESD	7/1/2014	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	40096 INDIAN SPRINGS RD	None	OAKHURST	CA	93644	8729	20	06039	37.33155	-119.6416575	Madera County
261592	Fee-for-Service	1013002328	1013002328	1	1	BHATIA, PERMINDER J MD	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61797	13	Neurology (M.D. only)	0	In state provider	NEURO-PAIN MEDICAL CENTR	736 E BULLARD AVE	STE 101	FRESNO	CA	93710	5473	10	06019	36.82313353	-119.7736695	Fresno County
261616	Fee-for-Service	1699176511	1699176511	1	1	BALL, DESTINEE A LCSW	10/25/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
261631	Fee-for-Service	1215668363	1215668363	1	1	BREDIN, PHOEBE MD	2/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190200	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
261639	Fee-for-Service	1265563241	1265563241	1	1	BAGHDASARIAN, SARKIS B	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100791	41	Internal Medicine	0	In state provider	MD	445 S CEDAR AVE	None	FRESNO	CA	93701	2168	10	06019	36.7382512	-119.7543688	Fresno County
261642	Fee-for-Service	1669587937	1669587937	1	1	BANFRO, FRANCIS T MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2386	00	None	36.1590063	-115.1674415	Clark County
261647	Fee-for-Service	1578940698	1578940698	1	1	BUTLER, CHRISTOPHER C CRNA	1/11/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
261671	Fee-for-Service	1124373212	1124373212	1	1	BHATT, AMI MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122965	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
261705	Fee-for-Service	1437271483	1437271483	1	1	BANUELOS, LIZZETE LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	482 N ROSEMEAD BLVD	STE 103	PASADENA	CA	91107	3000	19	06037	34.15457831	-118.078192	Los Angeles County
261739	Fee-for-Service	1063983997	1063983997	1	1	BETA HOSPICE CARE INC	3/6/2024	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	1525 N D ST	STE 10	SAN BERNARDINO	CA	92405	4774	36	06071	34.127433	-117.2918945	San Bernardino County
261782	Fee-for-Service	1386878247	1386878247	1	1	BERKOWITZ, AARON L MD	5/25/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	166152	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
261784	Fee-for-Service	1013405166	1013405166	1	1	BHATTACHARYA, DIPANKAN MD	3/9/2023	390200000X	NA	Other	026	PHYSICIANS	165825	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
261787	Fee-for-Service	1477702280	1477702280	1	1	BOZORGMEHR, JAFAR MD	4/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	102884	36	Psychiatry	0	In state provider	None	1501 CLAUS RD	None	MODESTO	CA	95355	9711	50	06099	37.66541403	-120.9213226	Stanislaus County
261821	Fee-for-Service	1861666703	1861666703	1	1	BOECKMANN, JACOB O MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123972	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 THE CITY DRIVE SOUTH	BLDG 25	ORANGE	CA	92863	4091	30	06059	33.78674051	-117.8888713	Orange County
261835	Fee-for-Service	1154326262	1154326262	1	1	BANGALORE, NEELESH S MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70883	78	Neoplastic Diseases/Oncology	0	In state provider	None	1801 E MARCH LN	None	STOCKTON	CA	95210	5668	39	06077	38.00315652	-121.2868715	San Joaquin County
261845	Fee-for-Service	1871167874	1871167874	1	1	BRUNE, TYRA MD	7/9/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183767	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
261853	Fee-for-Service	1851679062	1851679062	1	1	BUTLER, JAMES MD	6/25/2019	208600000X	NA	General Surgery	026	PHYSICIANS	160255	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
261855	Fee-for-Service	1881700599	1881700599	1	1	BROOKES, LYNN A NP	11/2/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6120 VINELAND AVE	None	NORTH HOLLYWOOD	CA	91606	4914	19	06037	34.1819583	-118.3702737	Los Angeles County
261882	Fee-for-Service	1013002328	1013002328	1	1	BHATIA, PERMINDER J MD	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61797	41	Internal Medicine	0	In state provider	NEURO-PAIN MEDICAL CENTR	736 E BULLARD AVE	STE 101	FRESNO	CA	93710	5473	10	06019	36.82313353	-119.7736695	Fresno County
261911	Fee-for-Service	1407841174	1407841174	1	1	BENG CHOON HO MD	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
261926	Fee-for-Service	1265563241	1265563241	1	1	BAGHDASARIAN, SARKIS B	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100791	06	Cardiovascular Disease (M.D. only)	0	In state provider	MD	445 S CEDAR AVE	None	FRESNO	CA	93701	2168	10	06019	36.7382512	-119.7543688	Fresno County
261934	Fee-for-Service	1215370879	1215370879	1	1	BERGER, ALEXANDER A MD	7/28/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148132	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
261941	Fee-for-Service	1184998049	1184998049	1	1	BROOK, RACHEL P MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119836	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
261951	Fee-for-Service	1720196744	1720196744	1	1	BELAGA, GARY A MD	2/1/2001	2084N0400X	NA	Neurology	026	PHYSICIANS	52395	None	None	0	In state provider	None	2001 UNION STREET	SUITE 104	SAN FRANCISCO	CA	94123	4136	38	06075	37.7974427	-122.432532	San Francisco County
261974	Fee-for-Service	1740685692	1740685692	1	1	BARSALLO, CATHLEEN LPCC	1/23/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
261979	Fee-for-Service	1558058156	1558058156	1	1	BYER, BENJAMIN OT	4/27/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
261980	Fee-for-Service	1871925065	1871925065	1	1	BULANADI, JOSAH NP	3/3/2020	261QM1300X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
261983	Fee-for-Service	1548366602	1548366602	1	1	BYRD, JOEL P MD	11/24/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	67286	-	NOT APPLICABLE	0	In state provider	None	637 E ALBERTONI STREET	SUITE 200	CARSON	CA	90746	1543	19	06037	33.87193192	-118.2647009	Los Angeles County
261985	Fee-for-Service	1588648299	1588648299	1	1	BOLTON, DAN W III DO	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	5444	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1065 BUCKS LAKE ROAD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
262022	Fee-for-Service	1003203233	1003203233	1	1	BROWN, GABRIELLE	3/10/2018	390200000X	NA	Other	026	PHYSICIANS	148514	07	Dermatology	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
262026	Fee-for-Service	1265400337	1265400337	1	1	BOYADJIEV BOYD,SIMEON A	4/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52633	40	Pediatrics	0	In state provider	MD	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.55204	-121.455387	Sacramento County
262058	Fee-for-Service	1972981926	1972981926	1	1	BULLOCK, KELSEY M MD	8/28/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148182	36	Psychiatry	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
262066	Fee-for-Service	1679651244	1679651244	1	1	BASIN, LEV MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90842	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
262068	Fee-for-Service	1366497505	1366497505	1	1	BRUNILDA A ROSARIO DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9305 W THOMAS	STE 155	PHOENIX	AZ	85037	3360	00	None	33.47802	-112.2604065	Maricopa County
262084	Fee-for-Service	1700935632	1700935632	1	1	BRITTAIN, ANA M MD	1/30/2008	208M00000X	NA	Other	026	PHYSICIANS	97724	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
262088	Fee-for-Service	1710057195	1710057195	1	1	BISEK, DONALD A	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2801 WATERMAN BLVD	STE 160	FAIRFIELD	CA	94534	2987	48	06095	38.26944343	-122.0624411	Solano County
262091	Fee-for-Service	1528487089	1528487089	1	1	BYUN, JOHN K MD	7/8/2024	2085R0001X	NA	Other	026	PHYSICIANS	None	32	Radiation Therapy (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
262093	Fee-for-Service	1578627642	1578627642	1	1	BENNETT, KRISTIN E MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10800	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
262120	Fee-for-Service	1871660886	1871660886	1	1	BLOND, RONALD PHILIP MD	10/2/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67155	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
262141	Fee-for-Service	1952350936	1952350936	1	1	BEAMER, MARIA E MD	1/31/1985	193400000X	NA	Other	026	PHYSICIANS	40292	40	Pediatrics	0	In state provider	None	828 SAN PABLO AVE	None	ALBANY	CA	94706	1567	01	06001	37.89159884	-122.2994097	Alameda County
262158	Fee-for-Service	1154341386	1154341386	1	1	BASTIEN, ROCHELLE T PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	850 JAMACHA RD	STE 103	EL CAJON	CA	92019	3200	37	06073	32.784354	-116.9279575	San Diego County
262171	Fee-for-Service	1629575741	1629575741	1	1	BHATT, SALONI A MD	12/27/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	182642	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
262184	Fee-for-Service	1801423728	1801423728	1	1	BLANKERS, RANDALL MD	8/2/2023	207R00000X	NA	Other	026	PHYSICIANS	184556	None	None	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91931	1800	37	06073	32.62382113	-116.9960539	San Diego County
262229	Fee-for-Service	1578519476	1578519476	1	1	BERKOWITZ, ALAN L MD	1/31/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	55943	36	Psychiatry	0	In state provider	None	2810 LYTTON ST	None	SAN DIEGO	CA	92110	4810	37	06073	32.74324463	-117.2107383	San Diego County
262232	Fee-for-Service	1114956299	1114956299	1	1	BEDOLLA, DARREN L MD	6/30/1995	207P00000X	NA	Other	026	PHYSICIANS	60151	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
262236	Fee-for-Service	1114939022	1114939022	1	1	BAQAI, SALAHUDDIN A	11/30/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35119	40	Pediatrics	0	In state provider	None	6850 BROCKTON AVE	STE 106	RIVERSIDE	CA	92506	3808	33	06065	33.9493261	-117.3967206	Riverside County
262237	Fee-for-Service	1962998104	1962998104	1	1	BALAKHANEH, AFSANEH Y LCSW	1/8/2021	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NEH LCSW	5315 LAUREL CANYON BLVD	201	VALLEY VILLAGE	CA	91607	4916	19	06037	34.16713798	-118.3965446	Los Angeles County
262239	Fee-for-Service	1922369743	1922369743	1	1	BELGRAVE, KEVIN O	2/14/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	142990	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
262255	Fee-for-Service	1679059109	1679059109	1	1	BROWN, KATHERINE E LCSW	2/8/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
262261	Fee-for-Service	1831491695	1831491695	1	1	BOTZLER, TIN C MD	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112613	41	Internal Medicine	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
262281	Fee-for-Service	1780683334	1780683334	1	1	BELT, LINDA M LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1001 DOVE ST	STE 140	NEWPORT BEACH	CA	92660	2846	30	06059	33.65946971	-117.8644015	Orange County
262311	Fee-for-Service	1558347393	1558347393	1	1	BAYARDO, CARLOS F MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	91684	08	Family Practice	0	In state provider	None	12586 AVENUE 408	None	OROSI	CA	93647	9454	54	06107	36.53030229	-119.2915122	Tulare County
262312	Fee-for-Service	1265400337	1265400337	1	1	BOYADJIEV BOYD,SIMEON A	4/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52633	38	Geriatrics	0	In state provider	MD	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.55204	-121.455387	Sacramento County
262316	Fee-for-Service	1033147202	1033147202	1	1	BROWN, BRUCE A MD	9/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	41253	20	Orthopedic Surgery	0	In state provider	None	108333 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06391926	-118.4418606	Los Angeles County
262385	Fee-for-Service	1881171387	1881171387	1	1	BONURA, JANELLE A	2/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
262388	Fee-for-Service	1275752677	1275752677	1	1	BISTRONG, LAWRENCE D MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91686	26	Psychiatry (child)	0	In state provider	None	3637 MISSION AVE	STE 7	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
262391	Fee-for-Service	1346893310	1346893310	1	1	BRINKMANN, STACY K NP	4/19/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
262410	Fee-for-Service	1871660886	1871660886	1	1	BLOND, RONALD PHILIP MD	10/2/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67155	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
262421	Fee-for-Service	1316993249	1316993249	2	1	BONK, ROY T MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142327	30	Radiology	0	In state provider	None	3161 L STREET	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
262513	Fee-for-Service	1821273137	1821273137	1	1	BAHRI, SEAN S MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51230	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
262517	Fee-for-Service	1578519476	1578519476	1	1	BERKOWITZ, ALAN L MD	1/31/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	55943	01	General Practice	0	In state provider	None	2810 LYTTON ST	None	SAN DIEGO	CA	92110	4810	37	06073	32.74324463	-117.2107383	San Diego County
262521	Fee-for-Service	1114956299	1114956299	1	1	BEDOLLA, DARREN L MD	6/30/1995	207P00000X	NA	Other	026	PHYSICIANS	60151	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
262539	Fee-for-Service	1134174170	1134174170	1	1	BIJAN, BIJAN MD	7/17/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72232	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
262548	Fee-for-Service	1891884318	1891884318	1	1	BOWERS, HILARY	5/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78338	None	None	0	In state provider	None	15725 POMERADO RD	STE 203	POWAY	CA	92064	2068	37	06073	33.00037882	-117.0580735	San Diego County
262549	Fee-for-Service	1679075162	1679075162	1	1	BOLANDI, LAUREN E CCC-SLP	7/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
262553	Fee-for-Service	1952434136	1952434136	2	1	BARNARD, LYNN D LCSW	5/3/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	879 190TH ST	SUITE 400	GARDENA	CA	90248	4220	19	06037	33.85927671	-118.2896516	Los Angeles County
262555	Fee-for-Service	1326138892	1326138892	1	1	BRUNER, DAVID I MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124549	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
262651	Fee-for-Service	1811153547	1811153547	1	1	BEST RIDE, INC.	5/26/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5437 LAUREL CANYON BLVD	#102	VALLEY VILLAGE	CA	91607	2193	19	06037	34.16976	-118.3965275	Los Angeles County
262653	Fee-for-Service	1932383411	1932383411	1	1	BRANNEN, JOHN H MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90386	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
262674	Fee-for-Service	1275752677	1275752677	1	1	BISTRONG, LAWRENCE D MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91686	41	Internal Medicine	0	In state provider	None	3637 MISSION AVE	STE 7	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
262679	Fee-for-Service	1710306592	1710306592	1	1	BHATTASALI, ONITA MD	3/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139820	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
262691	Fee-for-Service	1952640591	1952640591	1	1	BARRIENTOS, WENDY LCSW	8/20/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
262692	Fee-for-Service	1245203082	1245203082	1	1	BLACKMAN, ROBERT A MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	19423	41	Internal Medicine	0	In state provider	None	1414 S HOPE ST	None	LOS ANGELES	CA	90015	2904	19	06037	34.03801945	-118.2665952	Los Angeles County
262699	Fee-for-Service	1225179013	1225179013	1	1	BAGHERI, SEPIDEH MD	3/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80026	07	Dermatology	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
262726	Fee-for-Service	1154414639	1154414639	1	1	BASSIRI, DARYOUSH MD	2/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75836	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
262747	Fee-for-Service	1194817841	1194817841	1	1	BEHAR, SOLOMON M MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71487	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
262797	Fee-for-Service	1154340784	1154340784	1	2	BASS, SCOTT R PSYD	7/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	496 S. SPALDING DR	None	BEVERLY HILLS	CA	90212	4104	19	06037	34.05611965	-118.4065534	Los Angeles County
262801	Fee-for-Service	1417340456	1417340456	1	1	BLISS HOME HEALTH INC	5/22/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14349 VICTORY BLVD	SUITE 105B	VAN NUYS	CA	91401	6519	19	06037	34.18669646	-118.4460435	Los Angeles County
262831	Fee-for-Service	1215639232	1215639232	1	1	BOWERS, ALLISON P LCSW	6/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
262835	Fee-for-Service	1376524033	1376524033	1	1	BENGS, BENJAMIN C MD	10/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95204	20	Orthopedic Surgery	0	In state provider	None	2300 S FLOWER ST	STE 200	LOS ANGELES	CA	90007	2676	19	06037	34.0294397	-118.2734132	Los Angeles County
262846	Fee-for-Service	1902911845	1902911845	1	1	BURT, ANDREW G MD	11/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88778	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
262882	Fee-for-Service	1124122684	1124122684	1	1	BAILON, TERESITA G MD	3/1/2000	207L00000X	NA	Other	026	PHYSICIANS	67619	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
262895	Fee-for-Service	1457510018	1457510018	1	1	BAUER, DEBORAH	3/29/2024	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
262898	Fee-for-Service	1649375445	1649375445	1	1	BROWN, CANDIDA M MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46000	79	Neurology-Child	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
262930	Fee-for-Service	1558451237	1558451237	1	1	BERL,THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	DENVER	CO	80045	0000	00	None	39.742182	-104.8408515	Adams County
262946	Fee-for-Service	1134105513	1134105513	1	1	BAILIE, VALERIE J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2200 NE PROFESSIONAL CT	None	BEND	OR	97701	6063	00	None	44.06492445	-121.270761	Deschutes County
262958	Fee-for-Service	1841378247	1841378247	1	1	BURGETT, JOSHUA M NP	12/27/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
262982	Fee-for-Service	1740481118	1740481118	1	1	BROWN, DAWN MD	9/13/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	188157	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
262994	Fee-for-Service	1902044985	1902044985	1	1	BRADEN, BEAU R DO	2/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11433	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
263015	Fee-for-Service	1558546929	1558546929	1	1	BURBANK UNIF SCH DIST	4/6/1998	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1900 W OLIVE AVE	None	BURBANK	CA	91506	2438	19	06037	34.16549174	-118.3249735	Los Angeles County
263035	Fee-for-Service	1194817841	1194817841	1	1	BEHAR, SOLOMON M MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71487	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
263065	Fee-for-Service	1477962645	1477962645	1	1	BAJWA, TANVEER S MD INC	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129058	None	None	0	In state provider	None	5345 N EL DORADO ST	SUITE 3	STOCKTON	CA	95207	5848	39	06077	37.99932454	-121.3063516	San Joaquin County
263067	Fee-for-Service	1003101098	1003101098	1	1	BOWMAN, BRIANNA	4/29/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
263086	Fee-for-Service	1013009778	1013009778	1	2	BELZER, MARVIN ERIC MD	9/2/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	61403	-	NOT APPLICABLE	0	In state provider	None	5000 SUNSET BLVD	SUITE 701	LOS ANGELES	CA	90027	5861	19	06037	34.0981066	-118.2986382	Los Angeles County
263101	Fee-for-Service	1285910679	1285910679	1	1	BROBERG, MARC A	2/3/2017	2251N0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
263117	Fee-for-Service	1063668648	1063668648	1	1	BIRING, INDERPAL K DO	8/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10975	41	Internal Medicine	0	In state provider	None	2801 K ST	#520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
263157	Fee-for-Service	1750439014	1750439014	1	1	BECKERMAN, KAREN P MD	4/22/2020	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43045	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2920 TELEGRAPH AVE	None	BERKELEY	CA	94705	2031	01	06001	37.85686573	-122.2596307	Alameda County
263185	Fee-for-Service	1649375445	1649375445	1	1	BROWN, CANDIDA M MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46000	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
263193	Fee-for-Service	1023129335	1023129335	1	1	BLUSTEIN, RONALD S MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23195	36	Psychiatry	0	In state provider	None	500 FIRST AVE	None	PORTOLA	CA	96122	9406	32	06063	39.80595392	-120.4626723	Plumas County
263204	Fee-for-Service	1699410449	1699410449	1	1	BERNARD, HANNAH LCSW	11/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
263206	Fee-for-Service	1073523577	1073523577	1	1	BAYWEST FAMILY HEALTH	2/13/1998	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CARE MEDICAL GROUP INC	1580 VALENCIA ST	STE 201	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
263271	Fee-for-Service	1659390219	1659390219	1	2	BROECKEL, WILLIAM F MD	10/1/2015	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	475 BRUCE STREET	None	YREKA	CA	96097	3474	47	06093	41.71860037	-122.6467317	Siskiyou County
263319	Fee-for-Service	1689667495	1689667495	1	1	BREDEEK MENDES, ULF FRITZ M	3/2/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	74974	None	None	0	In state provider	D	2950 WHIPPLE AVE	STE 3	REDWOOD CITY	CA	94062	2842	41	06081	37.4783159	-122.2550908	San Mateo County
263337	Fee-for-Service	1639208499	1639208499	1	1	BORGES-O'DELL, CYNTHIA LMFT	1/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	615 13TH ST	SUITE B	MODESTO	CA	95354	2435	50	06099	37.6392035	-120.9933879	Stanislaus County
263389	Fee-for-Service	1447324140	1447324140	1	1	BREWER,CORA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	STE 100	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
263409	Fee-for-Service	1548933914	1548933914	1	1	BARAJAS, KIMBERLY GUADALUPE	7/20/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
263429	Fee-for-Service	1700568078	1700568078	1	1	BODY AND MIND HEALTHCARE SER	9/15/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	VICES - A NURSE CORPOR	1085 SANDERS AVE	None	CLOVIS	CA	93619	3935	10	06019	36.81692816	-119.6418339	Fresno County
263432	Fee-for-Service	1457663452	1457663452	1	1	BRITTO-WILLIAMS, PAMELA MD	6/27/2019	207K00000X	NA	Other	026	PHYSICIANS	145265	03	Allergy	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
263495	Fee-for-Service	1821122052	1821122052	1	1	BROWN, JACQUELYN A PSYD	8/16/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
263543	Fee-for-Service	1982789517	1982789517	1	1	BRADLEY, KATHLEEN E MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	50764	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1135 S SUNSET AVE	STE 402	WEST COVINA	CA	91790	3938	19	06037	34.06215064	-117.9453997	Los Angeles County
263550	Fee-for-Service	1396148649	1396148649	1	1	BIG SUR ANESTHESIA GROUP PC	4/16/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
263562	Fee-for-Service	1164619086	1164619086	1	1	BISWAS, SUBARNA MD	9/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	94102	02	General Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
263574	Fee-for-Service	1659420404	1659420404	1	1	BURNS, JARRETT M DO	11/11/2021	207P00000X	NA	Other	026	PHYSICIANS	18898	None	None	0	In state provider	None	31001 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	8703	30	06059	33.50974262	-117.6596065	Orange County
263580	Fee-for-Service	1982202453	1982202453	1	1	BT MOLECULAR LLC	9/21/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	12351 GATEWAY PARK PL	SUITE D500	DRAPER	UT	84020	9581	00	None	40.52576346	-111.9029955	Salt Lake County
263582	Fee-for-Service	1518595446	1518595446	1	1	BROWN, AKEMI L MD	10/5/2023	207R00000X	NA	Other	026	PHYSICIANS	190041	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
263604	Fee-for-Service	1598774259	1598774259	1	1	BLAU, CARL I MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23803	10	Gastroenterology (M.D. only)	0	In state provider	None	5400 BALBOA BLVD	STE 228	ENCINO	CA	91316	5212	19	06037	34.169283	-118.501072	Los Angeles County
263615	Fee-for-Service	1942342274	1942342274	1	1	BROWN, AMY N PHD	4/10/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	937 COFFEE RD	500	MODESTO	CA	95355	4240	50	06099	37.65636629	-120.9756356	Stanislaus County
263633	Fee-for-Service	1962552703	1962552703	1	1	BENDECK, SANDRA E MD	12/19/2007	207N00000X	NA	Dermatology	026	PHYSICIANS	80276	07	Dermatology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
263659	Fee-for-Service	1477563583	1477563583	1	1	BORDOW, RICHARD A MD	2/1/1982	225500000X	NA	Other	026	PHYSICIANS	31546	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
263685	Fee-for-Service	1730350125	1730350125	1	1	BHASIN, NEHA MD	1/6/2021	2080P0207X	NA	Hematology	026	PHYSICIANS	123769	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
263705	Fee-for-Service	1912145327	1912145327	1	1	BRUENING FOOT AND ANKLE INC	5/24/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	219 W BADILLO ST	SUITE A	COVINA	CA	91723	1907	19	06037	34.0863333	-117.8928703	Los Angeles County
263741	Fee-for-Service	1205031473	1205031473	1	1	BAXTER, LORI A LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
263744	Fee-for-Service	1881608370	1881608370	1	1	BLOOM, MYRON J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	17159	24	Plastic Surgery	0	In state provider	None	10861 CHERRY ST	STE 105	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
263769	Fee-for-Service	1851553267	1851553267	1	1	BELL, MAURICE A MD INC	7/28/2008	193400000X	NA	Other	026	PHYSICIANS	75981	41	Internal Medicine	0	In state provider	None	4100 LONG BEACH BLVD	#200	LONG BEACH	CA	90807	2696	19	06037	33.832323	-118.1893205	Los Angeles County
263794	Fee-for-Service	1710365614	1710365614	1	1	BADHWAR, ANSHUL K MD	1/26/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	181177	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
263830	Fee-for-Service	1144506833	1144506833	1	1	BRENT LOFTIS, DO INC.	8/14/2012	193400000X	NA	Other	026	PHYSICIANS	11845	None	None	0	In state provider	None	3230 BEARD ROAD	SUITE 2	NAPA	CA	94558	3659	28	06055	38.3216968	-122.2953847	Napa County
263831	Fee-for-Service	1063414027	1063414027	1	1	BARSEMIAN, WANES MD	1/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66186	66	Emergency Medicine (Urgent Care)	0	In state provider	None	624 E ELDER ST	None	FALLBROOK	CA	92028	3004	37	06073	33.38020455	-117.2446307	San Diego County
263839	Fee-for-Service	1629119888	1629119888	1	2	BUTWICK, ALEXANDER J MD	5/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105781	05	Anesthesiology	0	In state provider	None	725 WELCH RD	MC:5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
263851	Fee-for-Service	1497912091	1497912091	1	1	BRUSH, DAVID R MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117108	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
263853	Fee-for-Service	1790785152	1790785152	1	1	BOLTON, MARK J	3/1/2023	207P00000X	NA	Other	026	PHYSICIANS	64578	None	None	0	In state provider	None	1225 WILSHIRE BOULEVARD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
263901	Fee-for-Service	1265944813	1265944813	1	1	BRIGHTSIDE HOME HEALTH CARE	3/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	8949 RESEDA BLVD	SUITE 203	NORTHRIDGE	CA	91324	5819	19	06037	34.233255	-118.536109	Los Angeles County
263907	Fee-for-Service	1649697095	1649697095	1	1	BOYDSTON, ELAINE A MD	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154581	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
263917	Fee-for-Service	1245837145	1245837145	1	1	BROUILLARD, ALISON F CRNA	6/18/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
263936	Fee-for-Service	1316903461	1316903461	1	1	BANCROFT PEDIATRIC MED	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GRP	1300 BANCROFT AVE	None	SAN LEANDRO	CA	94577	5147	01	06001	37.72690979	-122.1477291	Alameda County
263938	Fee-for-Service	1477503878	1477503878	1	1	BOMBECK, CHRISTOPER A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3680 NW SAMARITAN DR	None	CORVALLIS	OR	97330	3737	00	None	44.60268509	-123.2548681	Benton County
263941	Fee-for-Service	1144274085	1144274085	1	1	BLEVANS, JOHNICA A MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98308	None	None	0	In state provider	None	2420 CAMINO RAMON	None	SAN RAMON	CA	94583	4385	07	06013	37.77229042	-121.9634581	Contra Costa County
263970	Fee-for-Service	1063415065	1063415065	1	1	BROOKS, DUANE T OD	6/28/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 CHESTNUT ST	None	MOUNT SHASTA	CA	96067	2209	47	06093	41.31295849	-122.3110503	Siskiyou County
264009	Fee-for-Service	1437218328	1437218328	1	1	BLEECKER, MICHAEL D MD	4/30/1974	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16234	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
264064	Fee-for-Service	1245391184	1245391184	1	1	BOETTCHER, JOANNA	1/24/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
264068	Fee-for-Service	1831230218	1831230218	1	1	BRABETZ, INC	10/1/1999	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AT HOME NURSING SERVICES	1378 CORPORATE CNTR PKWY	STE A	SANTA ROSA	CA	95407	5483	49	06097	38.418084	-122.7544785	Sonoma County
264092	Fee-for-Service	1396060364	1396060364	1	1	BROOKER, MATTHEW DO	8/6/2024	207P00000X	NA	Other	026	PHYSICIANS	22683	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
264094	Fee-for-Service	1306338397	1306338397	1	1	BOULOS, ALEXANDRE R MD	8/1/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
264100	Fee-for-Service	1720011810	1720011810	1	1	BANNER HEALTH ARIZONA	6/1/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	BANNER DESERT MED CTR	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
264137	Fee-for-Service	1659656668	1659656668	1	1	BRAR, HARINDER S MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38963	42	Nuclear Medicine	0	In state provider	None	5020 COMMERCE DRIVE	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
264227	Fee-for-Service	1730542689	1730542689	1	1	BEHL, PREETI	3/26/2024	207ZP0102X	NA	Other	026	PHYSICIANS	177727	None	None	0	In state provider	None	4301 NORTHSTAR WAY	None	MODESTO	CA	95356	9535	50	06099	0	0	None
264238	Fee-for-Service	1982619409	1982619409	1	1	BRANER, DANA A MD	4/27/2009	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
264253	Fee-for-Service	1043238900	1043238900	1	1	BORRERO, GUILLERMO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	575 COAL VALLEY RD	STE 303	CLAIRTON	PA	15025	3730	00	None	40.31860672	-79.93518326	Allegheny County
264315	Fee-for-Service	1083006597	1083006597	1	1	BIANCHI-ALLEN, RAFFAELLA N	7/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	113 E LAKE AVE	None	WATSONVILLE	CA	95076	3305	44	06087	36.91288645	-121.756702	Santa Cruz County
264336	Fee-for-Service	1063726172	1063726172	1	1	BATEMAN, STACIE C MD	9/13/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
264387	Fee-for-Service	1720011810	1720011810	1	1	BANNER HEALTH ARIZONA	6/1/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	BANNER DESERT MED CTR	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
264404	Fee-for-Service	1316141898	1316141898	1	1	BRELAND, GANNA L DO	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	8612	14	Neurological Surgery	0	In state provider	None	10350 BARNES CANYON RD	STE 200	SAN DIEGO	CA	92121	2709	37	06073	32.9005814	-117.1946684	San Diego County
264426	Fee-for-Service	1043421761	1043421761	1	1	BRESNAHAN, GERALD F MD	11/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	14924	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	575 E HARDY STREET	SUITE 305	INGLEWOOD	CA	90301	4083	19	06037	33.94909392	-118.3477665	Los Angeles County
264457	Fee-for-Service	1063028207	1063028207	1	1	BURGIS, NICOLE J AU	12/15/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
264461	Fee-for-Service	1770528457	1770528457	1	1	BRACY, MARC S MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77398	66	Emergency Medicine (Urgent Care)	0	In state provider	None	560 HOSPITAL LN	None	SUSANVILLE	CA	96130	4809	18	06035	40.40754008	-120.6666326	Lassen County
264525	Fee-for-Service	1972175750	1972175750	1	1	BALLEZA, RONALDO DANIEL S	10/7/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	19225 PINTO WAY	None	APPLE VALLEY	CA	92308	6719	36	06071	34.47717258	-117.2437915	San Bernardino County
264535	Fee-for-Service	1285731703	1285731703	1	1	BOERO, SALLY E MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64736	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5 BON AIR RD	STE 117	LARKSPUR	CA	94939	1138	21	06041	37.9438204	-122.5395357	Marin County
264645	Fee-for-Service	1912184383	1912184383	1	1	BAGHDASRAIAN, EVELYN MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98181	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
264648	Fee-for-Service	1740474337	1740474337	1	1	BENSON, JOHN DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3500 W WHEATLAND RD	None	DALLAS	TX	75237	3460	00	None	32.64745255	-96.8764365	Dallas County
264651	Fee-for-Service	1871652180	1871652180	1	1	BARKLEY, STEVEN C MD	7/31/1984	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	43355	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
264664	Fee-for-Service	1902123060	1902123060	1	1	BERNARDO, DANILO R MD	6/4/2019	2084N0402X	NA	Neurology	026	PHYSICIANS	131083	79	Neurology-Child	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264679	Fee-for-Service	1386818607	1386818607	1	1	BIRLADEANU, ADRIAN B MD	7/24/2018	163WP0000X	NA	Other	026	PHYSICIANS	55791	25	Physical Medicine and Rehabilitation	0	In state provider	None	5255 ELKHORN BLVD	None	SACRAMENTO	CA	95840	2506	34	06067	38.687364	-121.3417035	Sacramento County
264685	Fee-for-Service	1457364184	1457364184	1	1	BALAGURU, KALPANA A MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93260	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
264688	Fee-for-Service	1144316878	1144316878	2	1	BROWN, JEFFRY A MD	2/6/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44931	10	Gastroenterology (M.D. only)	0	In state provider	None	117 BUNNY	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
264692	Fee-for-Service	1316141898	1316141898	1	1	BRELAND, GANNA L DO	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	8612	01	General Practice	0	In state provider	None	10350 BARNES CANYON RD	STE 200	SAN DIEGO	CA	92121	2709	37	06073	32.9005814	-117.1946684	San Diego County
264701	Fee-for-Service	1649794850	1649794850	1	1	BADER, JOSHUA I	9/26/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
264735	Fee-for-Service	1548547656	1548547656	1	1	BENEDICT, REBECCA R	4/17/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
264748	Fee-for-Service	1770528457	1770528457	1	1	BRACY, MARC S MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77398	02	General Surgery	0	In state provider	None	560 HOSPITAL LN	None	SUSANVILLE	CA	96130	4809	18	06035	40.40754008	-120.6666326	Lassen County
264757	Fee-for-Service	1346502085	1346502085	1	1	BHULLAR, RUBY MD	4/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
264784	Fee-for-Service	1801827449	1801827449	1	1	BRIAN WEIS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S COULTER ST	None	AMARILLO	TX	79106	1786	00	None	35.200422	-101.924559	Potter County
264786	Fee-for-Service	1447507728	1447507728	1	1	BOURDON, CHEVELLE M LCSW	10/21/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99121	-	NOT APPLICABLE	0	In state provider	None	13921 COURAGE ST.	None	MORENO VALLEY	CA	92553	8757	33	06065	33.91845722	-117.2651088	Riverside County
264812	Fee-for-Service	1972175750	1972175750	1	1	BALLEZA, RONALDO DANIEL S	10/7/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	19225 PINTO WAY	None	APPLE VALLEY	CA	92308	6719	36	06071	34.47717258	-117.2437915	San Bernardino County
264825	Fee-for-Service	1528051968	1528051968	1	1	BROOKSBY, NORMAN G MD	2/28/1987	207L00000X	NA	Other	026	PHYSICIANS	59869	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
264828	Fee-for-Service	1760628663	1760628663	1	1	BERNABA, BETHANI A MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101549	01	General Practice	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
264869	Fee-for-Service	1508296443	1508296443	1	1	BAYFRONT YOUTH AND FAMILY	7/1/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	900 E WARDLOW ROAD	None	LONG BEACH	CA	90807	4630	19	06037	33.81888354	-118.181367	Los Angeles County
264915	Fee-for-Service	1770649386	1770649386	1	1	BERMAN, RYAN M PHD	4/27/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
264943	Fee-for-Service	1417124264	1417124264	1	1	BRUCKNER, RICHARD L MD	3/17/2025	2080P0204X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3849 EAST FOOTHILL BLVD	None	PASADENA	CA	91107	2204	19	06037	34.15029861	-118.0690163	Los Angeles County
264967	Fee-for-Service	1497168074	1497168074	1	1	BAE, JASON W MD	7/2/2019	207R00000X	NA	Other	026	PHYSICIANS	147848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
264975	Fee-for-Service	1144316878	1144316878	2	1	BROWN, JEFFRY A MD	2/6/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44931	41	Internal Medicine	0	In state provider	None	117 BUNNY	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
264980	Fee-for-Service	1346696564	1346696564	1	1	BIKHCHANDANI, MIHIR MD	11/8/2022	390200000X	NA	Other	026	PHYSICIANS	153563	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
264999	Fee-for-Service	1578651832	1578651832	2	1	BRODBECK-ROOK, CHRISTINA	12/27/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1001 E COOLEY DR	STE 101	COLTON	CA	92324	0000	36	06071	34.0546353	-117.3110923	San Bernardino County
265016	Fee-for-Service	1720468580	1720468580	1	1	BANANKHAH, POOYA MD	7/30/2018	208M00000X	NA	Other	026	PHYSICIANS	144606	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
265072	Fee-for-Service	1467223412	1467223412	1	1	BOBILA, MELANIE PT	6/10/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
265074	Fee-for-Service	1134431877	1134431877	1	1	BEREKET ALEMU, MD	9/20/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6917 N MAY AVE	None	OKLAHOMA CITY	OK	73116	3238	00	None	35.541027	-97.56570949	Oklahoma County
265075	Fee-for-Service	1720081342	1720081342	1	1	BASHIR, MUHAMMAD T MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50356	41	Internal Medicine	0	In state provider	None	530 COHASSET RD	# 9	CHICO	CA	95926	2212	04	06007	39.75152454	-121.848976	Butte County
265114	Fee-for-Service	1689787202	1689787202	1	2	BUSSELEN, STEVEN C MD	2/25/2022	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	None	-	NOT APPLICABLE	0	In state provider	None	106 S C ST	A, B, AND C	LOMPOC	CA	93436	7339	42	06083	34.63853189	-120.4514745	Santa Barbara County
265129	Fee-for-Service	1790704765	1790704765	1	1	BAUM, JACK S MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	40264	05	Anesthesiology	0	In state provider	None	20750 VENTURA BLVD	STE 210	WOODLAND HILLS	CA	91364	6235	19	06037	34.16652116	-118.5855291	Los Angeles County
265160	Fee-for-Service	1528216645	1528216645	1	1	BALEKIAN, CHRISTINE Y MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	95392	77	Infectious Disease	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
265174	Fee-for-Service	1962985291	1962985291	1	1	BUI, LILIAN B	10/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
265175	Fee-for-Service	1811491749	1811491749	1	1	BORTNER, ADAM C	2/10/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164879	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
265192	Fee-for-Service	1225482425	1225482425	1	1	BLACK, KENDRA M MD	7/18/2023	208600000X	NA	General Surgery	026	PHYSICIANS	176120	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
265220	Fee-for-Service	1730156670	1730156670	1	1	BROWNE, PETER M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24986	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	111 CONGRESS ST STE C	None	PASADENA	CA	91105	0000	19	06037	34.13403798	-118.1534579	Los Angeles County
265233	Fee-for-Service	1982694170	1982694170	1	1	BANKER, NITESH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9250 PINECROFT	None	WOODLANDS	TX	77380	0000	00	None	30.17422759	-95.45611699	Montgomery County
265254	Fee-for-Service	1497168074	1497168074	1	1	BAE, JASON W MD	7/2/2019	207R00000X	NA	Other	026	PHYSICIANS	147848	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
265353	Fee-for-Service	1801239900	1801239900	1	1	BOWLBY, MELINDA A DPM	8/20/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
265361	Fee-for-Service	1720081342	1720081342	1	1	BASHIR, MUHAMMAD T MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50356	45	Nephrology (Renal-Kidney)	0	In state provider	None	530 COHASSET RD	# 9	CHICO	CA	95926	2212	04	06007	39.75152454	-121.848976	Butte County
265363	Fee-for-Service	1508341256	1508341256	1	1	BUSHATI, ELEA R OT	7/23/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	667 LIGHTHOUSE AVE	201	PACIFIC GROVE	CA	93950	2644	27	06053	36.62205802	-121.9200608	Monterey County
265409	Fee-for-Service	1881014454	1881014454	1	1	BABARAN, MARIA C MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147667	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	92335	6720	15	06029	35.393499	-119.008257	Kern County
265420	Fee-for-Service	1467567982	1467567982	1	1	BRENNEMAN, CALVIN D MD	8/16/1976	207R00000X	NA	Other	026	PHYSICIANS	28199	01	General Practice	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
265463	Fee-for-Service	1629058615	1629058615	1	1	BRENEISEN, JEFFREY R MD	2/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86677	41	Internal Medicine	0	In state provider	None	3443 VILLA LN	STE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
265476	Fee-for-Service	1558695791	1558695791	1	1	BEDFORD-OPPONG, EVA RN	4/8/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3737 MARTIN L KING JR BL	# 605 B	LYNWOOD	CA	90262	3543	19	06037	33.92872742	-118.2006921	Los Angeles County
265487	Fee-for-Service	1578785275	1578785275	1	1	BAGHERI, PEDRAM MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97085	41	Internal Medicine	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
265492	Fee-for-Service	1639259716	1639259716	1	1	BREEN, PETER H MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	78104	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
265529	Fee-for-Service	1447990734	1447990734	1	1	BASHARA, TAYLOR MD	6/25/2024	390200000X	NA	Other	026	PHYSICIANS	190483	66	Emergency Medicine (Urgent Care)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
265536	Fee-for-Service	1013677814	1013677814	1	1	BENSON, JANET A	12/28/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	605 MAIN ST	A	ALTURAS	CA	96101	3489	25	06049	41.489415	-120.5425775	Modoc County
265554	Fee-for-Service	1659511665	1659511665	1	1	BECKER, SUSANNAH M LCSW	6/19/2014	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	38970 BLACOW RD	STE C	FREMONT	CA	94536	7380	01	06001	37.53694107	-121.999284	Alameda County
265558	Fee-for-Service	1023299351	1023299351	1	1	BLOE, LUCY S CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18080 IMPERIAL HWY	None	YORBA LINDA	CA	92886	3436	30	06059	33.89287302	-117.8194305	Orange County
265620	Fee-for-Service	1487737847	1487737847	1	1	BAINTER, PATRICIA C MD	4/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86883	18	Ophthalmology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
265636	Fee-for-Service	1558323360	1558323360	1	1	BANEZ, MARY ANN MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84218	18	Ophthalmology	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
265637	Fee-for-Service	1689638959	1689638959	1	1	BASS, NATHAN M MD	11/30/1982	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	39874	10	Gastroenterology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	RM 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
265649	Fee-for-Service	1275530917	1275530917	1	1	BOTNICK, LESLIE E MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37645	78	Neoplastic Diseases/Oncology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
265661	Fee-for-Service	1881177137	1881177137	1	1	BAQUET, ARI PT	8/19/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
265675	Fee-for-Service	1053518274	1053518274	1	1	BEKEMEIER, ERIC C DO	11/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	10708	01	General Practice	0	In state provider	None	17500 FOOTHILL BLVD	None	FONTANA	CA	92335	3798	36	06071	34.1067065	-117.4218885	San Bernardino County
265677	Fee-for-Service	1457386278	1457386278	1	1	BERK, MICHELE S PHD	8/1/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
265712	Fee-for-Service	1598337677	1598337677	1	1	BRANDON MANSOURI MARRIAGE &	12/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY THERAPIST, INC.	4344 LATHAM ST	110	RIVERSIDE	CA	92501	1773	33	06065	34.00198519	-117.3739252	Riverside County
265721	Fee-for-Service	1619327392	1619327392	1	1	BASU, RIYA MD	8/9/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179592	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
265723	Fee-for-Service	1477130235	1477130235	1	1	BONYADI, ARMAN DO	4/2/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	22807	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
265767	Fee-for-Service	1184958696	1184958696	1	1	BARUCH, KALANETE R NP	3/3/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
265769	Fee-for-Service	1104023514	1104023514	1	1	BELTRAN, ANTONIO MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99751	41	Internal Medicine	0	In state provider	None	3605 LONG BEACH BLVD	SUITE 405	LONG BEACH	CA	90807	4026	19	06037	33.822693	-118.1893765	Los Angeles County
265809	Fee-for-Service	1316656655	1316656655	1	1	BITAR, PATRICIA LCSW	1/20/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
265832	Fee-for-Service	1689752495	1689752495	1	1	BARBOZA, ASHLEY J MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62079	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
265873	Fee-for-Service	1568783223	1568783223	1	1	BRIDGE, LAUREN E MD	5/10/2024	207P00000X	NA	Other	026	PHYSICIANS	182615	66	Emergency Medicine (Urgent Care)	0	In state provider	None	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	36	06071	34.06914052	-117.2695442	San Bernardino County
265878	Fee-for-Service	1457304776	1457304776	1	1	BIGLER,DIRK E DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	0000	00	None	43.470198	-111.9901955	Bonneville County
265889	Fee-for-Service	1396927968	1396927968	1	1	BATT, KAREN S LMFT	3/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
265934	Fee-for-Service	1215087093	1215087093	1	2	BUI, TRINH N MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	10402 WESTMINSTER AVE	STE 100C	GARDEN GROVE	CA	92843	4862	30	06059	33.75951204	-117.9478527	Orange County
265942	Fee-for-Service	1275530917	1275530917	1	1	BOTNICK, LESLIE E MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37645	30	Radiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
265971	Fee-for-Service	1811022064	1811022064	1	1	BOUTROS, SAMIH W MD	12/31/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51600	36	Psychiatry	0	In state provider	None	37 QUAIL CT	STE 200	WALNUT CREEK	CA	94596	5593	07	06013	37.88807861	-122.0553842	Contra Costa County
265989	Fee-for-Service	1629197496	1629197496	1	1	BERNECKER, ERIK L PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
266003	Fee-for-Service	1336291038	1336291038	1	1	BLACK, STACEY R MD	7/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153467	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
266052	Fee-for-Service	1497076301	1497076301	1	1	BEHAZIN, NEGIN MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131359	41	Internal Medicine	0	In state provider	None	12462 BROOKHURST ST	STE A&B	GARDEN GROVE	CA	92840	4759	30	06059	33.78155073	-117.9584596	Orange County
266056	Fee-for-Service	1740953975	1740953975	1	1	BROWN, TYIES LMFT	3/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24050 MADISON ST	SUITE 217	TORRANCE	CA	90505	6017	19	06037	33.80594851	-118.348558	Los Angeles County
266060	Fee-for-Service	1104023514	1104023514	1	1	BELTRAN, ANTONIO MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99751	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3605 LONG BEACH BLVD	SUITE 405	LONG BEACH	CA	90807	4026	19	06037	33.822693	-118.1893765	Los Angeles County
266069	Fee-for-Service	1326242959	1326242959	1	1	BIEHL, KURT E MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51073	36	Psychiatry	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
266082	Fee-for-Service	1720093495	1720093495	1	1	BOWER, BRADLEY B MD	5/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85574	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
266107	Fee-for-Service	1922333533	1922333533	1	1	BARRACA, YOKO N PHD	1/27/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
266123	Fee-for-Service	1194325431	1194325431	1	1	BYEON, KEUMHEE NP	8/2/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
266133	Fee-for-Service	1801948633	1801948633	1	1	BENSON, KIM B MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73888	41	Internal Medicine	0	In state provider	None	225 DICKERSON ST	None	SAN DIEGO	CA	92103	0000	37	06073	32.75514083	-117.1655414	San Diego County
266143	Fee-for-Service	1861091316	1861091316	1	1	BOMMIREDDI, AKSHAY R MD	4/28/2023	207R00000X	NA	Other	026	PHYSICIANS	182196	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
266152	Fee-for-Service	1609270073	1609270073	1	1	BAYPOINT HOME HEALTH INC	4/29/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2515 SANTA CLARA AVENUE	SUITE 105	ALAMEDA	CA	94501	9051	01	06001	37.76410718	-122.2394708	Alameda County
266153	Fee-for-Service	1871595736	1871595736	1	1	BROWN, FARAH I MD	10/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89189	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
266155	Fee-for-Service	1306934153	1306934153	1	1	BERNARD, ANDREA PHD	2/8/2015	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	206 MEADOW VISTA WAY	None	ENCINITAS	CA	92024	4320	37	06073	33.04401338	-117.2407235	San Diego County
266160	Fee-for-Service	1871201244	1871201244	1	1	BRINKMAN, ANGELLA LMFT	11/25/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
266169	Fee-for-Service	1497182489	1497182489	1	1	BROWNSTEIN, JEREMY L LCSW	5/29/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ED CLINICAL SOCIAL WORKE	3114 WILLOW AVE	102	CLOVIS	CA	93612	4750	10	06019	36.79547557	-119.7274817	Fresno County
266182	Fee-for-Service	1235978321	1235978321	1	1	BAKER, OLGA DOULA	12/1/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
266197	Fee-for-Service	1801201553	1801201553	1	1	BAJA, DIOSDADO A JR MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141564	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
266198	Fee-for-Service	1386703973	1386703973	1	1	BAUMAN, ROSELIE A MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	67234	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
266210	Fee-for-Service	1417527961	1417527961	1	1	BECERRA MARRIAGE FAMILY AND	1/24/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	13601 WHITTIER BLVD	STE 208	WHITTIER	CA	90605	1955	19	06037	33.96101144	-118.0289736	Los Angeles County
266211	Fee-for-Service	1831648310	1831648310	1	1	BRITT, MIKAL A LCSW	11/9/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
266213	Fee-for-Service	1740466945	1740466945	1	1	BALADJAY LINDLEY, LESLEY	1/6/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10097	08	Family Practice	0	In state provider	JO DO	9089 BASELINE ROAD	SUITE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
266220	Fee-for-Service	1215087093	1215087093	1	2	BUI, TRINH N MD	9/1/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10402 WESTMINSTER AVE	STE 100C	GARDEN GROVE	CA	92843	4862	30	06059	33.75951204	-117.9478527	Orange County
266305	Fee-for-Service	1871946277	1871946277	1	1	BALDERRAMA, MELISSA C PSYD	9/19/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
266401	Fee-for-Service	1922080779	1922080779	1	1	BURKE, LENNIS P MD	7/31/1984	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	42405	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	50 BELLEFONTAINE ST	STE 405	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
266431	Fee-for-Service	1356473029	1356473029	1	1	BERGER, ANTHONY L MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102527	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
266432	Fee-for-Service	1376555862	1376555862	1	1	BAGAI LAPSI, SHELLY MD	10/22/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	114121	None	None	0	In state provider	None	554 E SAN BERNARDINO RD	SUITE 102	COVINA	CA	91723	1747	19	06037	34.09085021	-117.8800144	Los Angeles County
266439	Fee-for-Service	1679607980	1679607980	1	1	BENJAMIN, JOHN T MD	9/3/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
266447	Fee-for-Service	1235661471	1235661471	1	1	BROWN, DANIELLE	9/6/2024	390200000X	NA	Other	026	PHYSICIANS	159524	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
266522	Fee-for-Service	1023213386	1023213386	1	2	BI-BETT	2/24/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CENTER/EAST COUNTY WOLL	2, 4, 12, 14, 22, 24, 32	None	PITTSBURG	CA	94565	3701	07	06013	0	0	None
266523	Fee-for-Service	1083137467	1083137467	1	1	BLACK, CAMILLE A LMFT	5/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
266576	Fee-for-Service	1063625424	1063625424	1	1	BENJAMIN, SAMUEL D MD	12/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134668	01	General Practice	0	In state provider	None	123 S ALVARADO AVE	None	LOS ANGELES	CA	90057	6052	19	06037	34.06593048	-118.2708351	Los Angeles County
266610	Fee-for-Service	1336183367	1336183367	1	1	BOTSFORD GENERAL HOSP	3/3/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	28050 GRAND RIVER AVE	None	FARMINGTON HILLS	MI	48336	5933	00	None	42.4467	-83.324007	Oakland County
266615	Fee-for-Service	1477116200	1477116200	1	1	BARR, JESSICA C DO	8/18/2023	390200000X	NA	Other	026	PHYSICIANS	20692	None	None	0	In state provider	None	1220 HEMLOCK WAY	200	SANTA ANA	CA	92707	3655	30	06059	33.70975375	-117.8842792	Orange County
266618	Fee-for-Service	1568557163	1568557163	1	1	BOLISAJIAN, SARKIS MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	73922	None	None	0	In state provider	None	215 WEST JANS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
266629	Fee-for-Service	1407020209	1407020209	1	1	BRAMBILA, SUSANA	11/25/2008	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	475 PIONEER AVE	#200	WOODLAND	CA	95776	4905	57	06113	38.67357823	-121.7456787	Yolo County
266641	Fee-for-Service	1194886119	1194886119	1	1	BARON, STEVEN H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36288	41	Internal Medicine	0	In state provider	None	23928 LYONS AVE	STE 107	NEWHALL	CA	91321	2453	19	06037	34.37895689	-118.5532505	Los Angeles County
266648	Fee-for-Service	1992800668	1992800668	1	1	BAUDINO, FRANK J MD	8/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	39566	08	Family Practice	0	In state provider	None	830 W OLIVE AVE	STE C	MERCED	CA	95348	2420	24	06047	37.31914899	-120.4828231	Merced County
266673	Fee-for-Service	1649205899	1649205899	1	1	BRYER-ASH MICHAEL MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39345	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
266685	Fee-for-Service	1649319492	1649319492	1	1	BARTZ, ROBERT J MD	3/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65915	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266686	Fee-for-Service	1699057505	1699057505	1	1	BARSOUM, Y WILLIAM MD INC	8/18/2014	193400000X	NA	Other	026	PHYSICIANS	91481	None	None	0	In state provider	None	1700 S COURT ST	SUITE D	VISALIA	CA	93277	4931	54	06107	36.315108	-119.2916925	Tulare County
266743	Fee-for-Service	1962434241	1962434241	1	1	BESHAY, ISAAC N MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89039	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
266756	Fee-for-Service	1558626796	1558626796	1	1	BITTON-FAIWISZEWSKI, YONATAN	10/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129133	41	Internal Medicine	0	In state provider	M MD	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
266762	Fee-for-Service	1851790687	1851790687	1	1	BENSON, ERIC R	3/20/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
266792	Fee-for-Service	1275656761	1275656761	1	1	BIR, RAGHBIR S MD	7/1/1998	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	280 N RIVERSIDE AVE	None	RIALTO	CA	92376	5924	36	06071	34.10384154	-117.370545	San Bernardino County
266814	Fee-for-Service	1154852754	1154852754	1	1	BODINE, BILL MD	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
266844	Fee-for-Service	1831393446	1831393446	1	1	BACONPUTIRKA, HEATHER MARIE	8/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PT	2960 E NEES AVE	108	FRESNO	CA	93720	6012	10	06019	36.85224946	-119.731689	Fresno County
266846	Fee-for-Service	1467764175	1467764175	1	1	BASSERI, ROBERT J MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117195	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
266851	Fee-for-Service	1477577716	1477577716	1	1	BEST, ALLEN E MD	4/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71410	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2701 W ALAMEDA AVE	STE 203	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
266869	Fee-for-Service	1316070881	1316070881	1	1	BRAMLETTE, JAMES MD	10/17/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53193	30	Radiology	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
266896	Fee-for-Service	1336183367	1336183367	1	1	BOTSFORD GENERAL HOSP	3/3/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	28050 GRAND RIVER AVE	None	FARMINGTON HILLS	MI	48336	5933	00	None	42.4467	-83.324007	Oakland County
266912	Fee-for-Service	1386725463	1386725463	1	1	BODOR, RICHARD MICHAEL	4/1/1995	208200000X	NA	General Surgery	026	PHYSICIANS	53083	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
266918	Fee-for-Service	1457807588	1457807588	1	1	BUI, NHAT M CNP	12/9/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266950	Fee-for-Service	1700015609	1700015609	1	2	BELAJIC, DANIEL A OD	9/7/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3211 FORTUNE CT	STE A	AUBURN	CA	95602	9245	31	06061	38.94234896	-121.1015805	Placer County
266955	Fee-for-Service	1649205899	1649205899	1	1	BRYER-ASH MICHAEL MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39345	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
266968	Fee-for-Service	1649319492	1649319492	1	1	BARTZ, ROBERT J MD	3/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65915	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266988	Fee-for-Service	1982925616	1982925616	1	1	BUTERA, JENIFER LMFT	7/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
266991	Fee-for-Service	1609840776	1609840776	1	1	BRESNAHAN, WILLIAM J MD	8/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55660	10	Gastroenterology (M.D. only)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
267033	Fee-for-Service	1093764565	1093764565	1	1	BLOOMER, COURTNAY W MD	4/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103127	None	None	0	In state provider	None	400 PARNASSUS AVENUE	0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267040	Fee-for-Service	1265921118	1265921118	1	1	BYLER, REBECCA A LPCC	4/3/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
267046	Fee-for-Service	1336624733	1336624733	1	1	BRIONES, WESLEY PT	3/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
267077	Fee-for-Service	1194124214	1194124214	1	1	BRYAN RIVERA MD INC	3/22/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	18144 US HIGHWAY 18	130	APPLE VALLEY	CA	92307	2219	36	06071	34.54085172	-117.2681464	San Bernardino County
267082	Fee-for-Service	1518161314	1518161314	2	1	BEST CARE HOME HEALTH GROUP	5/28/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	126 S JACKSON ST	SUITE 303	GLENDALE	CA	91205	4921	19	06037	34.14533965	-118.2500741	Los Angeles County
267104	Fee-for-Service	1154724037	1154724037	1	1	BIXBY KNOLLS HOME HEALTH LLC	7/24/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3450 EAST SPRING ST	STE 105	LONG BEACH	CA	90806	6866	19	06037	33.81039852	-118.1527065	Los Angeles County
267105	Fee-for-Service	1649296138	1649296138	1	1	BARNES, MALKA MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40491	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16311 VENTURA BLVD	STE 745	ENCINO	CA	91436	4324	19	06037	34.15706864	-118.4885978	Los Angeles County
267116	Fee-for-Service	1780618314	1780618314	1	1	BALASUBRAMANIAM, SUSHEELA K	6/13/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44907	03	Allergy	0	In state provider	MD	399 E HIGHLAND AVE	STE 301	SAN BERNARDINO	CA	92404	3852	36	06071	34.1358627	-117.2757898	San Bernardino County
267117	Fee-for-Service	1043230824	1043230824	1	1	BISWAS, SHANKHA S MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	95947	33	Thoracic Surgery	0	In state provider	None	4500 BROCKTON AVE	STE 317	RIVERSIDE	CA	92501	4028	33	06065	33.97785263	-117.3836152	Riverside County
267120	Fee-for-Service	1235983107	1235983107	1	1	BURKE INFECTIOUS DISEASES	5/9/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	2181 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11995854	-117.1204723	San Diego County
267131	Fee-for-Service	1548250426	1548250426	1	1	BENSON, ADAM J. MD	11/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BROADWAY ST	None	MISSOULA	MT	59802	4008	00	None	46.87419951	-114.0007525	Missoula County
267206	Fee-for-Service	1083794069	1083794069	1	1	BRIAN DOERING POESCHLA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98109	0000	00	None	47.621466	-122.339816	King County
267226	Fee-for-Service	1467122192	1467122192	1	1	BUCHANAN TRAUMA RECOVERY FAM	12/31/2021	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ILY THERAPY	1410 3RD ST	12	RIVERSIDE	CA	92507	3422	33	06065	33.98297949	-117.3436605	Riverside County
267243	Fee-for-Service	1487736484	1487736484	1	1	BEAL, JOLAINE P MD	11/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93262	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
267251	Fee-for-Service	1649319492	1649319492	1	1	BARTZ, ROBERT J MD	3/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65915	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267262	Fee-for-Service	1689633240	1689633240	1	8	BAYSIDE MEDICAL GROUP INC	2/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2915 TELEGRAPH AVE	STE 101	BERKELEY	CA	94705	2069	01	06001	37.85719633	-122.2595246	Alameda County
267276	Fee-for-Service	1609840776	1609840776	1	1	BRESNAHAN, WILLIAM J MD	8/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55660	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
267290	Fee-for-Service	1689145120	1689145120	2	1	BORDER VILLAGE PHARMACY INC	1/27/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7339 EL CAJON BLVD	L	LA MESA	CA	91942	7435	37	06073	32.76875533	-117.0388333	San Diego County
267291	Fee-for-Service	1962540260	1962540260	1	1	BOE, KATHLEEN M LMFT	11/20/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18205	-	NOT APPLICABLE	0	In state provider	None	2310 1ST STREET	None	NAPA	CA	94559	2239	28	06055	38.29806271	-122.2989388	Napa County
267326	Fee-for-Service	1639656903	1639656903	1	1	BULLERT, RILEY R OD	8/6/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	114 MISSION RANCH BLVD	STE 50	CHICO	CA	95926	5137	04	06007	39.75356438	-121.8600403	Butte County
267338	Fee-for-Service	1407388796	1407388796	1	1	BARNETT, JONATHAN F MD	4/11/2022	207L00000X	NA	Other	026	PHYSICIANS	173825	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
267341	Fee-for-Service	1750440681	1750440681	1	1	BEHROOZAN, BENJAMIN MD	12/18/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41374	01	General Practice	0	In state provider	None	2221 LINCOLN BLVD	# 200	SANTA MONICA	CA	90405	1320	19	06037	34.00977424	-118.479803	Los Angeles County
267356	Fee-for-Service	1952551772	1952551772	1	1	BHARADIA, JUMA A MD INC	11/7/2008	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56515	41	Internal Medicine	0	In state provider	None	22617 HAWTHORNE BLVD	None	TORRANCE	CA	90505	2510	19	06037	33.822666	-118.3512275	Los Angeles County
267417	Fee-for-Service	1437277282	1437277282	1	1	BOEGEL, MARY L MD	4/29/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61295	08	Family Practice	0	In state provider	None	3536 MENDOCINO AVE	STE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
267441	Fee-for-Service	1609924562	1609924562	1	1	BAUTISTA, BRIAN G MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85008	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
267447	Fee-for-Service	1942753884	1942753884	1	1	BAILEY, ALEX LPCC	9/28/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
267450	Fee-for-Service	1255894515	1255894515	1	1	BENNETT ACUPUNCTURE INC	10/17/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	18046 MAGNOLIA	None	FOUNTAIN VALLEY	CA	92708	2863	30	06059	33.7003385	-117.9715282	Orange County
267452	Fee-for-Service	1447641410	1447641410	1	1	BAKERSFIELD PROTHETICS AND	3/23/2015	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS CENTER INC	323 S LEXINGTON ST	None	DELANO	CA	93215	3693	15	06029	35.75575551	-119.2408457	Kern County
267453	Fee-for-Service	1386938686	1386938686	1	1	BROWN, JENNIFER G MD	11/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157801	01	General Practice	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
267456	Fee-for-Service	1902912892	1902912892	1	1	BLUMING, AVRUM Z MD INC	8/12/1977	207RH0003X	NA	Oncology	026	PHYSICIANS	15859	41	Internal Medicine	0	In state provider	None	16311 VENTURA BLVD	STE 780	ENCINO	CA	91436	4327	19	06037	34.15706864	-118.4885978	Los Angeles County
267464	Fee-for-Service	1336312834	1336312834	1	1	BENNETT, RYAN E MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55952	20	Orthopedic Surgery	0	In state provider	None	THREE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
267500	Fee-for-Service	1063980175	1063980175	1	1	BOZEMAN, SARAH PT	12/20/2018	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1906 VISTA DEL LAGO DRIV	A	VALLEY SPRINGS	CA	95252	9700	05	06009	38.16810805	-120.8383709	Calaveras County
267572	Fee-for-Service	1003864737	1003864737	1	1	BUCHANAN, DENNIS J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42457	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 E VALENCIA MESA DR	STE 310	FULLERTON	CA	92835	3800	30	06059	33.89343304	-117.9279349	Orange County
267578	Fee-for-Service	1902886393	1902886393	1	1	BONGARD, FREDERIC	7/31/1988	2086S0129X	NA	General Surgery	026	PHYSICIANS	43307	02	General Surgery	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
267585	Fee-for-Service	1912062316	1912062316	1	1	BAKERSFIELD CITY SCHOOL DIST	11/1/2018	No Taxonomy Provided	NA	None	101	UNIFIED SCHOOL DISTRICT	-	-	NOT APPLICABLE	0	In state provider	None	1300 BAKER ST	None	BAKERSFIELD	CA	93305	4326	15	06029	35.38256022	-118.990868	Kern County
267642	Fee-for-Service	1740841949	1740841949	1	1	BOLEN-RAMOS, ALISSA LCSW	10/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
267674	Fee-for-Service	1003136482	1003136482	1	1	BUIVIDS, RACHEL R PT	8/15/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3908 10 STREET	None	RIVERSIDE	CA	92501	3522	33	06065	33.98117228	-117.3785355	Riverside County
267721	Fee-for-Service	1861570376	1861570376	1	1	BRENT-AIR PHARMACY INC	12/3/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	134 S BARRINGTON AVE	None	LOS ANGELES	CA	90049	3309	19	06037	34.06480581	-118.4693443	Los Angeles County
267728	Fee-for-Service	1669575593	1669575593	1	1	BIELA, BARBARA H MD	11/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81930	22	Pathology (M.D. only)	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
267732	Fee-for-Service	1942305313	1942305313	1	1	BARENGOLTS, ELENA I MD	11/2/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	134217	67	Endocrinology	0	In state provider	None	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
267737	Fee-for-Service	1568502011	1568502011	1	1	BROWN, TAMY MD	7/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74561	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
267743	Fee-for-Service	1497840839	1497840839	1	1	BUSTAMANTE, ALFONSO PHD	10/10/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
267761	Fee-for-Service	1063695302	1063695302	1	1	BERZON, BORIS MD INC	10/5/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70349	30	Radiology	0	In state provider	None	3055 WILSHIRE BLVD	STE 150	LOS ANGELES	CA	90020	1118	19	06037	34.06185807	-118.2880358	Los Angeles County
267803	Fee-for-Service	1669705786	1669705786	1	1	BRESS, JOSHUA N MD	7/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107972	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
267820	Fee-for-Service	1639286388	1639286388	1	1	BUI, QUYNH T MD	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53651	08	Family Practice	0	In state provider	None	350 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
267829	Fee-for-Service	1790914422	1790914422	1	1	BAILONY, AHMAD L MD	2/24/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	108665	40	Pediatrics	0	In state provider	None	655 EUCLID AVENUE	STE 205	NATIONAL CITY	CA	91950	2967	37	06073	32.68353398	-117.082625	San Diego County
267859	Fee-for-Service	1972983815	1972983815	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/1/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	1415 BADGER FLAT RD	A	LOS BANOS	CA	93635	8600	24	06047	37.05576382	-120.8782498	Merced County
267868	Fee-for-Service	1093290371	1093290371	1	1	BROKATE, KIMBERLY R CNM	6/3/2019	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
267869	Fee-for-Service	1912062316	1912062316	1	1	BAKERSFIELD CITY SCHOOL DIST	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1300 BAKER ST	None	BAKERSFIELD	CA	93305	4326	15	06029	35.38256022	-118.990868	Kern County
267873	Fee-for-Service	1215685920	1215685920	1	1	BRADLEY, DONALD LCSW	9/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
267900	Fee-for-Service	1821311358	1821311358	1	1	BOEHME, JASON T MD	6/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111249	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
267927	Fee-for-Service	1073722492	1073722492	1	1	BELL GARDENS FAMILY	8/15/2003	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	19	06037	33.97292523	-118.1475473	Los Angeles County
267947	Fee-for-Service	1467538520	1467538520	1	4	BAKERSFIELD MEMORIAL	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
267985	Fee-for-Service	1851325716	1851325716	1	1	BEHROOZAN, DANIEL S MD	8/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76756	07	Dermatology	0	In state provider	None	200 MED PLAZA #365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
268005	Fee-for-Service	1275571176	1275571176	1	1	BROWNE, SARA H MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51877	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
268075	Fee-for-Service	1538134796	1538134796	1	1	BISHOP, FRANK M MD	4/26/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	96257	18	Ophthalmology	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
268078	Fee-for-Service	1700804424	1700804424	1	1	BARKER, JENNIFER E CRNA	12/1/1998	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	202 E AIRPORT DR	STE 120	SN BERNRDNO	CA	92408	3429	36	06071	34.06737938	-117.2834702	San Bernardino County
268090	Fee-for-Service	1124042635	1124042635	1	1	BREALL, WILLIAM S MD	5/21/1971	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	16635	41	Internal Medicine	0	In state provider	None	350 PARNASSUS AVE	STE 609	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
268110	Fee-for-Service	1295737583	1295737583	1	1	BRECKWOLDT, REID D MD	6/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	140663	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
268143	Fee-for-Service	1467727297	1467727297	1	1	BANAS, MAREK K DO	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14423	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2594	48	06095	38.13070051	-122.237307	Solano County
268167	Fee-for-Service	1801892526	1801892526	2	1	BARTON, ALAN J MD	5/13/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	5330 HIGHWAY 95	None	FORT MOHAVE	AZ	86426	5330	00	None	35.002656	-114.595893	Mohave County
268177	Fee-for-Service	1851785299	1851785299	1	1	BARRETTE, KEVIN F MD	6/21/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	144154	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
268182	Fee-for-Service	1366580540	1366580540	1	2	BAART BEHAVIORAL HEALTH SERV	10/1/2016	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	539 NORTH VAN NESS AVE	None	FRESNO	CA	93728	3419	10	06019	36.751158	-119.7989285	Fresno County
268185	Fee-for-Service	1467538520	1467538520	1	5	BAKERSFIELD MEMORIAL	6/28/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6501 TRUXTUN AVENUE	INFUSION SUITE	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
268192	Fee-for-Service	1376980227	1376980227	1	1	BOUTTE, WANDA R LCSW	11/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5241 MEDEA WAY	None	ANTIOCH	CA	94531	8727	07	06013	37.95248635	-121.7623501	Contra Costa County
268200	Fee-for-Service	1851476915	1851476915	1	1	BARAK YOUNOSZAI	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
268208	Fee-for-Service	1275133209	1275133209	1	1	BEYROOTY, ANDREW I PT	2/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 S CHAPARRAL CT	150	ANAHEIM	CA	92808	2237	30	06059	33.86492127	-117.7445525	Orange County
268210	Fee-for-Service	1568486108	1568486108	2	1	BRADEN PARTNERS LP	9/25/2018	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	440 WESTRIDGE DRIVE	None	WATSONVILLE	CA	95076	4159	44	06087	36.91145639	-121.7834839	Santa Cruz County
268232	Fee-for-Service	1407623317	1407623317	1	1	BITAR, DEMA	1/3/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2102 BUSINESS CENTER DR	STE 250	IRVINE	CA	92612	1001	30	06059	33.68027087	-117.855546	Orange County
268241	Fee-for-Service	1942615109	1942615109	1	1	BORDES, JUAN	10/17/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
268255	Fee-for-Service	1548588221	1548588221	1	1	BERKOWITZ, RACHEL M MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136664	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
268270	Fee-for-Service	1245373448	1245373448	1	1	BABCOCK, DEBRA A MD	6/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65426	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
268280	Fee-for-Service	1093342933	1093342933	1	1	BOURNE, SARAH J MD	6/13/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183509	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
268289	Fee-for-Service	1841625779	1841625779	1	1	BONILLA, JUAN J LCSW	2/28/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 NORTH LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
268340	Fee-for-Service	1902154420	1902154420	1	1	BURKE, HAYDEN M MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150361	77	Infectious Disease	0	In state provider	None	320 SUPERIOR AVE	STE 310	NEWPORT BEACH	CA	92663	2716	30	06059	33.62657138	-117.9330754	Orange County
268370	Fee-for-Service	1780635508	1780635508	1	1	BERNARD, MARK S MD	12/1/2003	207U00000X	NA	Other	026	PHYSICIANS	66845	None	None	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
268406	Fee-for-Service	1649461377	1649461377	1	1	BEAUREGARD, ROBIN M PT	8/8/2024	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
268440	Fee-for-Service	1689207094	1689207094	1	1	BRIDGE HOSPICE RIVERSIDE LLC	5/26/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	38977 SKY CANYON DR	STE 110	MURRIETA	CA	92563	2615	33	06065	33.55500597	-117.1377043	Riverside County
268466	Fee-for-Service	1841298221	1841298221	1	1	BIMAL, PATEL J MD	2/25/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50475	41	Internal Medicine	0	In state provider	None	400 TAYLOR BLVD	STE 201	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
268473	Fee-for-Service	1962622274	1962622274	1	1	BARROWS, VALERIE L LMFT	8/19/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10918 HESPERIA RD	STE B	HESPERIA	CA	92345	2151	36	06071	34.44933232	-117.2964082	San Bernardino County
268481	Fee-for-Service	1821768284	1821768284	1	1	BRIMHALL PHARMACY INC	2/21/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6348 ASHE ROAD	300-400	BAKERSFIELD	CA	93313	9490	15	06029	35.297262	-119.0743645	Kern County
268506	Fee-for-Service	1215529201	1215529201	1	1	BELOVED HOUSING, LLC	11/15/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	20923 CAYUGA RD	None	APPLE VALLEY	CA	92308	6407	36	06071	34.49181498	-117.2072845	San Bernardino County
268510	Fee-for-Service	1912987942	1912987942	1	1	BEHAR, JEFFREY C MD	4/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89898	None	None	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
268535	Fee-for-Service	1922205350	1922205350	1	1	BROYLES, MICHAEL E MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106126	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
268554	Fee-for-Service	1801056569	1801056569	1	1	BAHAR, ZADEH MD	6/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102753	08	Family Practice	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
268580	Fee-for-Service	1811542673	1811542673	1	1	BLANCHER, BREANNA K PT	12/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
268594	Fee-for-Service	1063554145	1063554145	1	1	BELL, MATTHEW L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	677 N WILMONT RD	None	TUCSON	AZ	85711	2701	00	None	32.230476	-110.8585575	Pima County
268609	Fee-for-Service	1194116988	1194116988	1	1	BADIEE, MANIJEH PHD	5/8/2019	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
268621	Fee-for-Service	1902154420	1902154420	1	1	BURKE, HAYDEN M MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150361	41	Internal Medicine	0	In state provider	None	320 SUPERIOR AVE	STE 310	NEWPORT BEACH	CA	92663	2716	30	06059	33.62657138	-117.9330754	Orange County
268624	Fee-for-Service	1891725602	1891725602	1	1	BAUGH, WILLIAM P MD	4/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77769	07	Dermatology	0	In state provider	None	333 W BASTANCHURY RD	STE 110	FULLERTON	CA	92835	3433	30	06059	33.89358012	-117.9327635	Orange County
268637	Fee-for-Service	1316929615	1316929615	1	1	BALLOCH, JODY L MD	6/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77362	01	General Practice	0	In state provider	None	5051 VERDUGO WAY	SUITE 110	CAMARILLO	CA	93012	8680	56	06111	34.21524684	-119.0033176	Ventura County
268652	Fee-for-Service	1740289099	1740289099	1	1	BRADFORD, MICHAEL S MD	4/30/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	600 S RANCHO DR	None	LAS VEGAS	NV	89106	4867	00	None	36.16385627	-115.1727818	Clark County
268716	Fee-for-Service	1346922713	1346922713	1	1	BALBOA ASSISTED LIVING INC	9/26/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7647 PASO ROBLES AVE	None	LAKE BALBOA	CA	91406	2142	19	06037	34.20988074	-118.5023955	Los Angeles County
268719	Fee-for-Service	1487854691	1487854691	1	1	BERGUM, SHELLY K NP	3/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
268720	Fee-for-Service	1336884204	1336884204	1	1	BOKTOR, CHRISTINE PT	11/29/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
268722	Fee-for-Service	1689207094	1689207094	1	1	BRIDGE HOSPICE RIVERSIDE LLC	5/26/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	38977 SKY CANYON DR	STE 110	MURRIETA	CA	92563	2615	33	06065	33.55500597	-117.1377043	Riverside County
268729	Fee-for-Service	1083754675	1083754675	1	1	BYERS-LUND, KIMBERLY DO	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7010	08	Family Practice	0	In state provider	None	230 PROSPECT PL	STE 340D	CORONADO	CA	92118	1993	37	06073	32.69468235	-117.1677128	San Diego County
268740	Fee-for-Service	1710370598	1710370598	1	1	BRATTON, BARBARA J NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268748	Fee-for-Service	1841298221	1841298221	1	1	BIMAL, PATEL J MD	2/25/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50475	68	Hematology	0	In state provider	None	400 TAYLOR BLVD	STE 201	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
268776	Fee-for-Service	1649685397	1649685397	1	1	BRADLEY, ALBERT B NP	3/3/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
268845	Fee-for-Service	1578533477	1578533477	1	1	BROWN, JASON C MD	7/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74409	05	Anesthesiology	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
268891	Fee-for-Service	1841501640	1841501640	1	1	BLAIR, CLYDE A LMFT	12/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	790 E SANTA CLARA ST	STE 106	VENTURA	CA	93001	2937	56	06111	34.27950947	-119.2888755	Ventura County
268894	Fee-for-Service	1477625671	1477625671	1	1	BUENA PARK MEDICAL GROUP	3/17/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	6301 BEACH BLVD	STE 101	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
268931	Fee-for-Service	1174601785	1174601785	1	1	BARTON, JAMES C MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78852	07	Dermatology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
268934	Fee-for-Service	1801015227	1801015227	1	1	BENNETT-DEGUZMAN, PATTI	3/20/2008	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	11515 EL CAMINO REAL	STE 160	SAN DIEGO	CA	92130	3038	37	06073	32.92795071	-117.2379436	San Diego County
268967	Fee-for-Service	1124486527	1124486527	1	1	BONWELLNESS CLINIC, INC	1/13/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7212 ORANGETHORPE AVE	STE 6	BUENA PARK	CA	90621	3341	30	06059	33.85890953	-118.007244	Orange County
268988	Fee-for-Service	1194789818	1194789818	1	1	BAPTIST MEMORIAL HOSPITAL	5/23/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DESOTO, INC	7601 SOUTHCREST PKWY	None	SOUTHAVEN	MS	38671	4739	00	None	34.97007309	-89.99667857	DeSoto County
269009	Fee-for-Service	1558738971	1558738971	1	1	BUSTAMANTE, LILIANA	2/12/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8263 GROVE AVE	STE 203	RANCHO CUCAMONGA	CA	91730	3107	36	06071	34.10436536	-117.6285141	San Bernardino County
269014	Fee-for-Service	1083257935	1083257935	1	1	BEST MATCH HOME HEALTH INC	8/6/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9003 RESEDA BLVD	SUITE 202B	NORTHRIDGE	CA	91324	3920	19	06037	34.233885	-118.5360995	Los Angeles County
269024	Fee-for-Service	1588646103	1588646103	1	1	BARADARIAN, SAM MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85381	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8008 FROST ST	STE 104	SAN DIEGO	CA	92123	4206	37	06073	32.80027859	-117.1524832	San Diego County
269028	Fee-for-Service	1861048118	1861048118	1	1	BREEDING, CAROLINE B CCC-SLP	10/5/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6965 SAN LUIS AVE	None	ATASCADERO	CA	93422	5201	40	06079	35.48021573	-120.6597811	San Luis Obispo County
269032	Fee-for-Service	1841298221	1841298221	1	1	BIMAL, PATEL J MD	2/25/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50475	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 TAYLOR BLVD	STE 201	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
269051	Fee-for-Service	1922567585	1922567585	1	1	BREJEYEH, SARAH L OT	8/31/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 N CENTRAL AVE	850	GLENDALE	CA	91203	3905	19	06037	34.15321627	-118.2578985	Los Angeles County
269063	Fee-for-Service	1780743401	1780743401	1	1	BENSUSSEN, STEPHAN A OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11001 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1413	19	06037	34.26991066	-118.4671653	Los Angeles County
269069	Fee-for-Service	1497872865	1497872865	1	1	BARASH, KIRSTEN L CRNA	6/17/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
269099	Fee-for-Service	1720013717	1720013717	1	1	BAAS, ARNOLD S MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51919	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1245 16TH ST	STE 307	SANTA MONICA	CA	90404	1239	19	06037	34.02726451	-118.4857138	Los Angeles County
269113	Fee-for-Service	1265543292	1265543292	1	1	BORDENAVE, TYRONE C MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	37644	41	Internal Medicine	0	In state provider	None	644 E REGENT ST	STE 200	INGLEWOOD	CA	90301	1444	19	06037	33.96448447	-118.345059	Los Angeles County
269135	Fee-for-Service	1174617708	1174617708	1	1	BERNEY, RHONDA C MD	8/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	42950	08	Family Practice	0	In state provider	None	517 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39783697	-122.8208805	Sonoma County
269141	Fee-for-Service	1023344926	1023344926	1	1	BERI, SIMONE R PHD	1/4/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
269144	Fee-for-Service	1649462805	1649462805	1	1	BREKKEN, RAQUEL R MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107100	40	Pediatrics	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
269148	Fee-for-Service	1700062270	1700062270	1	1	BHUTANI, SHIVANI MD	2/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146231	38	Geriatrics	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
269157	Fee-for-Service	1508173352	1508173352	1	1	BLAIR, BRITNEY PSYD	6/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94303	3341	43	06085	37.43304542	-122.1759654	Santa Clara County
269164	Fee-for-Service	1073553756	1073553756	1	1	BEAR VALLEY COMMUNITY HEALTH	12/21/1990	282NR1301X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	41870 GARSTIN RD	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
269173	Fee-for-Service	1477625671	1477625671	1	1	BUENA PARK MEDICAL GROUP	3/17/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	6301 BEACH BLVD	STE 101	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
269180	Fee-for-Service	1033670278	1033670278	1	1	BOZEMAN, ASHANTI	5/17/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	38603 FALKIRK DR	None	MURRIETA	CA	92563	5842	33	06065	33.55959009	-117.1423193	Riverside County
269198	Fee-for-Service	1790709095	1790709095	1	1	BOLTON, STEPHANIE L MD	7/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89346	36	Psychiatry	0	In state provider	None	11374 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3830	36	06071	34.0465275	-117.2436991	San Bernardino County
269229	Fee-for-Service	1053343384	1053343384	1	1	BLUSH, THOMAS W MD	2/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	26158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
269266	Fee-for-Service	1194789818	1194789818	1	1	BAPTIST MEMORIAL HOSPITAL	5/23/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DESOTO, INC	7601 SOUTHCREST PKWY	None	SOUTHAVEN	MS	38671	4739	00	None	34.97007309	-89.99667857	DeSoto County
269280	Fee-for-Service	1477751667	1477751667	1	1	BENSON, JIMI O MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116611	41	Internal Medicine	0	In state provider	None	1201 SOUTH ORANGE AVE	None	EL CAJON	CA	92020	7521	37	06073	32.77914448	-116.9639444	San Diego County
269281	Fee-for-Service	1124461280	1124461280	1	1	BARNES, CHAD MD	8/6/2020	208600000X	NA	General Surgery	026	PHYSICIANS	169268	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
269288	Fee-for-Service	1457674426	1457674426	1	1	BBK GLOBAL CORP.	10/24/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11670 SAN VICENTE BLVD	#A	LOS ANGELES	CA	90049	5121	19	06037	34.05377548	-118.4641869	Los Angeles County
269300	Fee-for-Service	1588646103	1588646103	1	1	BARADARIAN, SAM MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85381	33	Thoracic Surgery	0	In state provider	None	8008 FROST ST	STE 104	SAN DIEGO	CA	92123	4206	37	06073	32.80027859	-117.1524832	San Diego County
269330	Fee-for-Service	1710312251	1710312251	1	1	BERRA, TIFFANI M	6/12/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
269332	Fee-for-Service	1881241297	1881241297	1	1	BIGOS, PAULINA PT	5/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
269350	Fee-for-Service	1164500989	1164500989	1	1	BISSELL, KAREN B MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55596	07	Dermatology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
269351	Fee-for-Service	1982211546	1982211546	1	1	BARRETTO, LAUREN LMFT	9/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
269368	Fee-for-Service	1932385846	1932385846	1	1	BLAIR, JUDY L MD	11/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108798	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
269383	Fee-for-Service	1720013717	1720013717	1	1	BAAS, ARNOLD S MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51919	41	Internal Medicine	0	In state provider	None	1245 16TH ST	STE 307	SANTA MONICA	CA	90404	1239	19	06037	34.02726451	-118.4857138	Los Angeles County
269384	Fee-for-Service	1306006879	1306006879	1	1	BAYVIEW GASTROENTEROLOGY	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7421	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL CORPORATION	4145 CLARES ST	SUITE A	CAPITOLA	CA	95010	2053	44	06087	36.97837345	-121.964319	Santa Cruz County
269385	Fee-for-Service	1659350973	1659350973	1	1	BRADBURN, CHRISTOPHER DO	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7376	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
269389	Fee-for-Service	1215085014	1215085014	1	1	BARRON, KENNETH G MD	6/7/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	24270	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
269392	Fee-for-Service	1568987824	1568987824	1	1	BENAVIDES, BARBARA S LMFT	11/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
269404	Fee-for-Service	1497972145	1497972145	1	1	BAXTER, ROSALYN P MD	5/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54625	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
269414	Fee-for-Service	1174617708	1174617708	1	1	BERNEY, RHONDA C MD	8/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	42950	38	Geriatrics	0	In state provider	None	517 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39783697	-122.8208805	Sonoma County
269419	Fee-for-Service	1457308603	1457308603	1	1	BAUER, BRINDUSA CRNA	3/18/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 N STATE ST	STE 14-901	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
269441	Fee-for-Service	1073553756	1073553756	1	1	BEAR VALLEY COMMUNITY HEALTH	12/21/1990	282NR1301X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	41870 GARSTIN RD	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
269459	Fee-for-Service	1033670278	1033670278	1	1	BOZEMAN, ASHANTI	5/17/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	38603 FALKIRK DR	None	MURRIETA	CA	92563	5842	33	06065	33.55959009	-117.1423193	Riverside County
269484	Fee-for-Service	1447839956	1447839956	1	1	BESHAI, MARIAM MD	9/9/2024	208M00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
269525	Fee-for-Service	1902973332	1902973332	1	1	BEAN, KRISTY L	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1333 19TH ST	APT 4	SANTA MONICA	CA	90404	1948	19	06037	34.02855104	-118.4816982	Los Angeles County
269564	Fee-for-Service	1245436328	1245436328	1	1	BHATTA, BHUTANESH K MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101900	40	Pediatrics	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
269571	Fee-for-Service	1467462457	1467462457	1	1	BARTON, ARNOLD MD	4/21/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	10818	None	None	0	In state provider	None	23861 MCBEAN PKWY	E12	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
269575	Fee-for-Service	1639160112	1639160112	1	1	BACHARACH, JASON MD	3/1/1996	207W00000X	NA	Ophthalmology	026	PHYSICIANS	73984	18	Ophthalmology	0	In state provider	None	380 TESCONI CT	None	SANTA ROSA	CA	95401	4653	49	06097	38.447631	-122.7345885	Sonoma County
269579	Fee-for-Service	1588646103	1588646103	1	1	BARADARIAN, SAM MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85381	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8008 FROST ST	STE 104	SAN DIEGO	CA	92123	4206	37	06073	32.80027859	-117.1524832	San Diego County
269584	Fee-for-Service	1437118163	1437118163	1	1	BROOKENTHAL, KEITH R MD	3/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79821	40	Pediatrics	0	In state provider	None	2400 S FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
269625	Fee-for-Service	1891112678	1891112678	1	1	BLYTHE, JASON DPM INC	6/23/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2480 MISSION ST	SUITE 327	SAN FRANCISCO	CA	94110	2463	38	06075	37.75745685	-122.418984	San Francisco County
269634	Fee-for-Service	1073831590	1073831590	1	1	BEARD, MAUREE	10/19/2020	207L00000X	NA	Other	026	PHYSICIANS	169123	05	Anesthesiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
269644	Fee-for-Service	1245275106	1245275106	1	1	BIOCORP CLINICAL LAB INC	8/29/2006	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	9825 PAINTER AVE	None	WHITTIER	CA	90605	2700	19	06037	33.94750494	-118.0487081	Los Angeles County
269649	Fee-for-Service	1568795391	1568795391	1	1	BASSIOUNI, NORA I MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116152	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
269665	Fee-for-Service	1700211802	1700211802	1	1	BUSS, PHILIP A MD	12/30/2018	207P00000X	NA	Other	026	PHYSICIANS	144246	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
269680	Fee-for-Service	1407838220	1407838220	1	1	BERRY, RAVI K MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42441	40	Pediatrics	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
269687	Fee-for-Service	1245265560	1245265560	1	1	BUSCH, RICHARD F MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	52715	04	Otology, Laryngology, Rhinology	0	In state provider	None	1830 FLOWER ST	# 217	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
269740	Fee-for-Service	1215322144	1215322144	1	2	BOWEN, JOHN E MD	4/27/2023	207P00000X	NA	Other	026	PHYSICIANS	153066	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
269831	Fee-for-Service	1194740217	1194740217	1	1	BRADFORD, LETITIA L MD	4/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70194	20	Orthopedic Surgery	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
269832	Fee-for-Service	1649299827	1649299827	1	1	BARNES-JEWISH HOSP	7/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	216 N KINGS HWY	None	SAINT LOUIS	MO	63108	1212	00	None	38.57481547	-90.2822582	City of St. Louis
269837	Fee-for-Service	1548260284	1548260284	1	1	BEDFORD REG MED CTR INC	4/17/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2900 16TH ST	None	BEDFORD	IN	47421	3510	00	None	38.86094749	-86.51318508	Lawrence County
269858	Fee-for-Service	1437118163	1437118163	1	1	BROOKENTHAL, KEITH R MD	3/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79821	20	Orthopedic Surgery	0	In state provider	None	2400 S FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
269859	Fee-for-Service	1528052495	1528052495	1	1	BIBB, JOHN D MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	21778	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
269863	Fee-for-Service	1396219051	1396219051	1	1	BIDDLE, PATRICIA NP	5/30/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
269869	Fee-for-Service	1215281019	1215281019	1	1	BROWN, ELIZABETH R DO	9/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12407	15	Obstetrics (D.O. only)	0	In state provider	None	100A DRAKES LANDING RD	SUITE 225	GREENBRAE	CA	94904	3119	21	06041	37.94379317	-122.5182162	Marin County
269892	Fee-for-Service	1487021051	1487021051	1	1	BOATRIGHT, HEIDI M LMFT	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 E LELAND RD	C	PITTSBURG	CA	94565	4983	07	06013	38.01186589	-121.8902232	Contra Costa County
269913	Fee-for-Service	1831102235	1831102235	1	1	BUDRIS, LANCE M MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85284	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
269923	Fee-for-Service	1679739551	1679739551	1	1	BOTROS, AMGAD E MD	2/28/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	107097	None	None	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
269940	Fee-for-Service	1003508003	1003508003	1	1	BUCYK, TAYLOR MD	9/9/2023	207L00000X	NA	Other	026	PHYSICIANS	185979	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
269963	Fee-for-Service	1013922525	1013922525	1	1	BUCKMASTER,JOHN G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PK	RD	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
269992	Fee-for-Service	1295780583	1295780583	1	1	BOPARAI, MEET S MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68462	08	Family Practice	0	In state provider	None	1026 CHASE AVE	None	CORCORAN	CA	93212	2334	16	06031	36.09829118	-119.5610193	Kings County
270034	Fee-for-Service	1235265083	1235265083	1	1	BAKER, TIMOTHY K MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
270041	Fee-for-Service	1972527380	1972527380	1	1	BORDEN, PETER S MD	8/4/2022	174400000X	NA	Other	026	PHYSICIANS	62201	None	None	0	In state provider	None	5750 DOWNEY AVE	STE 308	LAKEWOOD	CA	90712	1482	19	06037	33.859611	-118.1511435	Los Angeles County
270071	Fee-for-Service	1326099268	1326099268	1	1	BALDAUF, TAMRA	2/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	64373	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
270074	Fee-for-Service	1609934801	1609934801	1	1	BARGER, JOSEPH MD	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	45426	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
270079	Fee-for-Service	1659114130	1659114130	1	1	BRIDGE PRENATAL, PC	11/13/2024	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	502 EUCLID AVE	300	NATIONAL CITY	CA	91950	2931	37	06073	32.68505421	-117.0832793	San Diego County
270098	Fee-for-Service	1134381619	1134381619	1	1	BAHAMONDE, LOURDES G MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13517	10	Gastroenterology (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
270107	Fee-for-Service	1649299827	1649299827	1	1	BARNES-JEWISH HOSP	7/1/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	216 N KINGS HWY	None	SAINT LOUIS	MO	63108	1212	00	None	38.57481547	-90.2822582	City of St. Louis
270108	Fee-for-Service	1497765937	1497765937	1	1	BETH ELLEN LAPKA MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
270115	Fee-for-Service	1548260284	1548260284	1	1	BEDFORD REG MED CTR INC	4/17/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2900 16TH ST	None	BEDFORD	IN	47421	3510	00	None	38.86094749	-86.51318508	Lawrence County
270141	Fee-for-Service	1215281019	1215281019	1	1	BROWN, ELIZABETH R DO	9/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12407	09	Gynecology (D.O. only)	0	In state provider	None	100A DRAKES LANDING RD	SUITE 225	GREENBRAE	CA	94904	3119	21	06041	37.94379317	-122.5182162	Marin County
270164	Fee-for-Service	1366461816	1366461816	1	1	BILELLO, KATHRYN L MD	7/1/1998	207RP1001X	NA	Pulmonology	026	PHYSICIANS	84862	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
270180	Fee-for-Service	1346225059	1346225059	1	1	B & E CONVALESCENT CENTER	3/1/1966	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	14819 S VERMONT AVE	None	GARDENA	CA	90247	3097	19	06037	33.896934	-118.2919955	Los Angeles County
270181	Fee-for-Service	1659634772	1659634772	1	1	BLANKENSHIP, LEANN M MD	7/30/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	173627	None	None	0	In state provider	None	400 TAYLOR BLVD	SUITE 201	PLEASANT HILL	CA	94523	2163	07	06013	37.96132631	-122.0740275	Contra Costa County
270219	Fee-for-Service	1518309814	1518309814	1	1	BUSICK, ANN-MARIE DO	7/26/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	20514	67	Endocrinology	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
270248	Fee-for-Service	1770727034	1770727034	1	1	BAUTISTA, JENNIFER D MD	10/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112993	41	Internal Medicine	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
270250	Fee-for-Service	1306208855	1306208855	1	1	BROWN, ADAM DO	11/24/2019	207P00000X	NA	Other	026	PHYSICIANS	17158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
270268	Fee-for-Service	1174633069	1174633069	1	1	BUXBAUM, EVAN R MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116531	40	Pediatrics	0	In state provider	None	3305 RENNER DRIVE	None	FORTUNA	CA	95540	3119	12	06023	40.58238894	-124.1358909	Humboldt County
270301	Fee-for-Service	1760867824	1760867824	1	1	BELINSKY, MARIA T LCSW	11/24/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
270303	Fee-for-Service	1770503708	1770503708	1	1	BOGETTI-DUMLAO, ANGELA NP	8/15/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
270308	Fee-for-Service	1699394460	1699394460	1	1	BAY AREA KIDNEY CARE MEDICAL	10/26/2020	261QM2500X	NA	Other	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC.	13855 14TH	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
270313	Fee-for-Service	1558370023	1558370023	1	1	BEVERLY ORTHOPEDIC LABORATOR	7/1/1982	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	237 E BEVERLY BLVD	None	MONTEBELLO	CA	90640	3776	19	06037	34.01498968	-118.0958398	Los Angeles County
270327	Fee-for-Service	1548283724	1548283724	1	1	BUCHELE, MICHAEL MD	7/1/1993	207P00000X	NA	Other	026	PHYSICIANS	29252	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
270336	Fee-for-Service	1083025597	1083025597	1	1	BOCIAN, HILLEL S MD	7/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142028	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
270347	Fee-for-Service	1376572875	1376572875	1	1	BACK, STEVEN M MD	2/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78879	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
270412	Fee-for-Service	1750716924	1750716924	1	1	BALLARD, ASHLEY	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12897	08	Family Practice	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
270414	Fee-for-Service	1881718021	1881718021	1	1	BAYNOSA, RICHARD C MD	11/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	24	Plastic Surgery	1	Border provider	None	3600 S MARYLAND PARKWAY	SUITE 315	LAS VEGAS	NV	89109	8206	00	None	36.12442337	-115.1372245	Clark County
270419	Fee-for-Service	1083690101	1083690101	1	1	BERKE, REBECCA G MD	11/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53243	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
270420	Fee-for-Service	1730490418	1730490418	1	1	BYERLEY, WILLIAM F MD	7/13/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	41578	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
270449	Fee-for-Service	1366461816	1366461816	1	1	BILELLO, KATHRYN L MD	7/1/1998	207RP1001X	NA	Pulmonology	026	PHYSICIANS	84862	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
270485	Fee-for-Service	1801274006	1801274006	1	1	BENKO, MICHAEL J DO	1/27/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	19654	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
270492	Fee-for-Service	1073000279	1073000279	1	1	BATES, SHANNON M PSYD	5/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	6968	19	06037	34.07067	-118.4432445	Los Angeles County
270525	Fee-for-Service	1780305953	1780305953	1	1	BURGER, OLIVIA R OD	12/20/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
270550	Fee-for-Service	1093931727	1093931727	1	1	BOLANDGRAY, LEILA S MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72176	41	Internal Medicine	0	In state provider	None	8610 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90045	4008	19	06037	33.959448	-118.396202	Los Angeles County
270562	Fee-for-Service	1144086109	1144086109	1	1	BALLARD, MIRANDA NP	3/30/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
270572	Fee-for-Service	1174643647	1174643647	1	1	BARRIOS, CARLOS MD	3/1/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	55096	None	None	0	In state provider	None	421 N BROOKHURST ST	STE 119	ANAHEIM	CA	92801	5618	30	06059	33.83743497	-117.9590498	Orange County
270597	Fee-for-Service	1568572782	1568572782	1	1	BRIAR-BONPANE, JENOA S LCSW	11/1/2010	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	801 CRESCENT WY	STE #3	ARCATA	CA	95521	6780	12	06023	40.85906241	-124.0735719	Humboldt County
270618	Fee-for-Service	1073766226	1073766226	1	1	BOWMAN, ADAM R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
270628	Fee-for-Service	1164567004	1164567004	1	1	BERG, ALAN M MD	2/28/1991	207W00000X	NA	Ophthalmology	026	PHYSICIANS	34555	18	Ophthalmology	0	In state provider	None	13320 RIVERSIDE DR	STE 114	SHERMAN OAKS	CA	91423	2519	19	06037	34.15758348	-118.423233	Los Angeles County
270629	Fee-for-Service	1437104502	1437104502	1	1	BROSNAN, DAVID C OD	10/2/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2171 JUNIPERO SERRA BLVD	SUITE 100	DALY CITY	CA	94014	1987	41	06081	37.69836798	-122.4706688	San Mateo County
270653	Fee-for-Service	1649217936	1649217936	1	1	BEUTNER, KARL R MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43543	07	Dermatology	0	In state provider	None	635 ANDERSON RD	STE 17	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
270662	Fee-for-Service	1366736290	1366736290	1	1	BRADLEY S KURGIS DO, INC	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	5517	None	None	0	In state provider	None	1320 LAS TABLAS ROAD	SUITE B	TEMPLETON	CA	93465	9711	40	06079	35.5544315	-120.7225935	San Luis Obispo County
270689	Fee-for-Service	1619420825	1619420825	1	1	BAROS, MICHAEL J NP	6/8/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
270693	Fee-for-Service	1336344308	1336344308	1	1	BAAS PACE, ERIN E MD	3/9/2024	207P00000X	NA	Other	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
270712	Fee-for-Service	1760574156	1760574156	1	1	BLUE, BETTY R PHD	11/12/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12842 VALLEY VIEW ST	SUITE 201	GARDEN GROVE	CA	92845	2517	30	06059	33.77717962	-118.0346285	Orange County
270722	Fee-for-Service	1366461816	1366461816	1	1	BILELLO, KATHRYN L MD	7/1/1998	207RP1001X	NA	Pulmonology	026	PHYSICIANS	84862	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
270791	Fee-for-Service	1619278108	1619278108	1	1	BUI, PATRICK L MD	3/15/2011	207R00000X	NA	Other	026	PHYSICIANS	114638	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	3RD FL	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
270858	Fee-for-Service	1124106604	1124106604	1	1	BINKLEY, CHARLES E MD	10/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92600	02	General Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
270894	Fee-for-Service	1659867984	1659867984	1	1	BANATAO, MARLOWE M PT	3/25/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
270896	Fee-for-Service	1013028315	1013028315	1	1	BARCELONA, EDGARDO S MD	4/9/1991	208600000X	NA	General Surgery	026	PHYSICIANS	37647	02	General Surgery	0	In state provider	None	1669 W AVENUE J	None	LANCASTER	CA	93534	2866	19	06037	34.68944746	-118.1608785	Los Angeles County
270900	Fee-for-Service	1043309008	1043309008	1	1	BAKER, MICHAEL S MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	31440	02	General Surgery	0	In state provider	None	130 LA CASA VIA BLDG 3	STE 211	WALNUT CREEK	CA	94598	3405	07	06013	37.91170205	-122.0412378	Contra Costa County
270906	Fee-for-Service	1134257678	1134257678	1	1	BURKE, JASMINE MD	12/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100598	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
270920	Fee-for-Service	1831277664	1831277664	1	1	BLANTON, JONATHAN MD INC	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	32421	01	General Practice	0	In state provider	None	632 W 6TH ST	None	SAN PEDRO	CA	90731	2524	19	06037	33.7388253	-118.2908982	Los Angeles County
270925	Fee-for-Service	1528039526	1528039526	1	1	BROUDY, ABRAHAM E MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71609	40	Pediatrics	0	In state provider	None	1001 E GRAND AVE	None	ESCONDIDO	CA	92025	4604	37	06073	33.12634291	-117.0682058	San Diego County
270926	Fee-for-Service	1093137531	1093137531	1	1	BERNABE, DARRELL S JR CRNA	6/12/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
270937	Fee-for-Service	1497858930	1497858930	1	1	BAI, STEVEN IN HWAN	9/15/1985	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SEVERANCE VISION CENTER	3030 W OLYMPIC BLVD	STE 110	LOS ANGELES	CA	90006	6504	19	06037	34.05260995	-118.3015825	Los Angeles County
270963	Fee-for-Service	1801288774	1801288774	1	1	BESSLER MD PLLC	8/1/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
270972	Fee-for-Service	1073035788	1073035788	1	1	BLESSING PHARMACY INC	12/18/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL CIRCLE	None	WESTMINSTER	CA	92683	3953	30	06059	33.76421517	-117.9954669	Orange County
270981	Fee-for-Service	1225172182	1225172182	1	1	BINDER, STEVEN W	12/1/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2100 WEBSTER ST	STE 214	SAN FRANCISCO	CA	94115	2375	38	06075	37.7904826	-122.4324477	San Francisco County
270991	Fee-for-Service	1518408772	1518408772	1	1	BOATMAN, CHAD DO	10/7/2020	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
271014	Fee-for-Service	1285196733	1285196733	1	1	BUI, STEPHANIE DO	4/2/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	23680	40	Pediatrics	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
271068	Fee-for-Service	1386650083	1386650083	1	1	BAILEY, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
271087	Fee-for-Service	1235162066	1235162066	1	1	BULGARELLI, MARK DO	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	6215	41	Internal Medicine	0	In state provider	None	823 GATEWAY CENTER WAY	None	SAN DIEGO	CA	92102	4541	37	06073	32.71503452	-117.1134945	San Diego County
271095	Fee-for-Service	1174715965	1174715965	1	1	BROUKHIM, SEPEHR DO	7/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9307	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
271271	Fee-for-Service	1245215748	1245215748	1	1	BOKOSKY, JOHN E MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51651	18	Ophthalmology	0	In state provider	None	3939 3RD AVE	None	SAN DIEGO	CA	92103	3002	37	06073	32.74905668	-117.16268	San Diego County
271305	Fee-for-Service	1023189289	1023189289	1	1	BOROOKHIM, MICHAEL D MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68706	41	Internal Medicine	0	In state provider	INC	9301 WILSHIRE BLVD	STE 602	BEVERLY HILLS	CA	90210	6161	19	06037	34.06707307	-118.3946743	Los Angeles County
271326	Fee-for-Service	1174848121	1174848121	1	1	BABIN, DENISE L MD	9/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121825	08	Family Practice	0	In state provider	None	7225 RAINBOW DR	None	SAN JOSE	CA	95129	4552	43	06085	37.30146258	-122.0315034	Santa Clara County
271332	Fee-for-Service	1760838981	1760838981	1	2	BAIDWAN, DAMANDEEP K MD	8/4/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	158001	-	NOT APPLICABLE	0	In state provider	None	7225 E SOUTHGATE DR	STE D	SACRAMENTO	CA	95823	2620	34	06067	38.49489	-121.435704	Sacramento County
271377	Fee-for-Service	1922033935	1922033935	1	1	BECKER, MITCHELL D MD	4/29/1999	207R00000X	NA	Other	026	PHYSICIANS	68472	41	Internal Medicine	0	In state provider	None	100 UCLA MEDICAL PLZ	STE 455	LOS ANGELES	CA	90024	6999	19	06037	34.06544724	-118.4459249	Los Angeles County
271390	Fee-for-Service	1942347612	1942347612	1	1	BISHOP, RONALD E MD INC	1/5/2011	207LP2900X	NA	Other	026	PHYSICIANS	60758	05	Anesthesiology	0	In state provider	None	880 S ATLANTIC BLVD	STE 205	MONTEREY PARK	CA	91754	4782	19	06037	34.05038485	-118.1383456	Los Angeles County
271429	Fee-for-Service	1255717864	1255717864	1	1	BRESLIN, KAYLA PSYD	5/4/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
271435	Fee-for-Service	1801685565	1801685565	1	1	BROUHARD, MARIE	5/8/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
271436	Fee-for-Service	1114548880	1114548880	1	1	BERISTAIN-BARAJAS, ALEJANDRA	8/15/2024	390200000X	NA	Other	026	PHYSICIANS	184380	08	Family Practice	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
271446	Fee-for-Service	1558330118	1558330118	1	1	BEDROSIAN, SETA A MD	5/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	38699	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
271451	Fee-for-Service	1811105414	1811105414	1	1	BOSCH, KELLEEN M DO	11/24/2008	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9211	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	445 SOUTH CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
271453	Fee-for-Service	1396972139	1396972139	1	1	BURTON, LYNDSEY A MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133942	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
271485	Fee-for-Service	1407114044	1407114044	1	1	BLOCK, BRIAN L MD	7/6/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
271539	Fee-for-Service	1891526752	1891526752	1	1	BIKRAM SHARMA	1/24/2025	207RC0200X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
271622	Fee-for-Service	1922088236	1922088236	1	1	BOUTIN, ROBERT D MD	1/1/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	81243	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
271627	Fee-for-Service	1790837136	1790837136	1	1	BARRON, DINA R LCSW	3/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
271642	Fee-for-Service	1689198061	1689198061	1	1	BATAL MEDICAL, INC	7/31/2018	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1041 E YORBA LINDA BLVD	209	PLACENTIA	CA	92870	3728	30	06059	33.88848865	-117.8451029	Orange County
271645	Fee-for-Service	1689987505	1689987505	1	1	BOWNS, GERALD T MD APC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24388	18	Ophthalmology	0	In state provider	None	10 CONGRESS STREET	#340	PASADENA	CA	91105	3020	19	06037	34.13396893	-118.1528162	Los Angeles County
271657	Fee-for-Service	1538521570	1538521570	1	1	BROWN, JARED MD	7/14/2021	207L00000X	NA	Other	026	PHYSICIANS	156600	None	None	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
271662	Fee-for-Service	1609076223	1609076223	1	1	BREAUX, RAKESHIA J LMFT	6/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9220 HAVEN AVE	100	RANCHO CUCAMONGA	CA	91730	8551	36	06071	34.08525	-117.5758875	San Bernardino County
271701	Fee-for-Service	1700990710	1700990710	1	1	BLUMENTHAL, MELANIE J MD	3/6/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	75946	40	Pediatrics	0	In state provider	None	3772 KATELLA AVE	STE 101	LOS ALAMITOS	CA	90720	6420	30	06059	33.8029895	-118.0670445	Orange County
271725	Fee-for-Service	1457556607	1457556607	1	1	BALELO JR, RICHARD G	9/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 CRAVEN ROAD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
271732	Fee-for-Service	1275558348	1275558348	1	1	BERSOHN, MALCOLM M MD	3/31/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40062	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA #365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
271757	Fee-for-Service	1437715885	1437715885	1	1	BROWN, BRITTANY LCSW	11/16/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
271761	Fee-for-Service	1326361585	1326361585	1	1	BUI, THOMAS T MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105271	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
271804	Fee-for-Service	1629236039	1629236039	1	1	BARLIN, STEPHANIE R T MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136951	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
271813	Fee-for-Service	1538231337	1538231337	1	1	BAIRD, DARCY P MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71376	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
271852	Fee-for-Service	1588983498	1588983498	1	1	BRAATEN, MARY ELLEN LMFT	3/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
271854	Fee-for-Service	1285675439	1285675439	1	1	BUCHWALD, JASON MD	1/27/2025	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
271883	Fee-for-Service	1487064143	1487064143	1	1	BELLVIEW HOSPICE CARE INC	10/19/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	255 N D STREET	STE 214	SAN BERNARDINO	CA	92401	1735	36	06071	34.1036709	-117.291874	San Bernardino County
271900	Fee-for-Service	1538691373	1538691373	1	1	BAUER, JUSTIN L MD	6/7/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	157028	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271917	Fee-for-Service	1508974395	1508974395	1	1	BROWN, JIMMY J MD	12/19/1991	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	67891	04	Otology, Laryngology, Rhinology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
271996	Fee-for-Service	1033186010	1033186010	1	1	BRADY, WANDA A MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62753	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
272006	Fee-for-Service	1467594838	1467594838	1	1	BARAK, MARK H MD	1/23/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	74472	18	Ophthalmology	0	In state provider	None	1911 FOOTHILL BLVD	STE A	LA VERNE	CA	91750	3516	19	06037	34.11460289	-117.7686102	Los Angeles County
272032	Fee-for-Service	1063764744	1063764744	1	1	BECKWITH, RYAN J CRNA	12/1/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
272075	Fee-for-Service	1548759046	1548759046	1	1	BAHMANI KAZEROONI, LEILA Z M	8/2/2022	207R00000X	NA	Other	026	PHYSICIANS	179920	None	None	0	In state provider	D	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
272108	Fee-for-Service	1578625810	1578625810	1	1	BEERS, DANIEL J MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80902	18	Ophthalmology	0	In state provider	None	1174 CASTRO ST	STE 100	MOUNTAIN VIEW	CA	94040	2572	43	06085	37.3822628	-122.0861276	Santa Clara County
272115	Fee-for-Service	1659457083	1659457083	1	1	BAHK, DENNIS E CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CLNC OF BAHKS ACU & HERB	2518 W LINCOLN AVE	None	ANAHEIM	CA	92801	6432	30	06059	33.83216326	-117.9734705	Orange County
272128	Fee-for-Service	1730251950	1730251950	1	1	BERG, ANDERS H MD	7/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155375	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1839	19	06037	34.07671715	-118.3799413	Los Angeles County
272131	Fee-for-Service	1235434119	1235434119	1	1	BIN, HANNA C NP	8/23/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
272154	Fee-for-Service	1295743045	1295743045	1	1	BULLOCK, ANDREW C DO	2/22/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	6842	25	Physical Medicine and Rehabilitation	0	In state provider	None	251 LANDIS AVE	STE 201	CHULA VISTA	CA	91910	2629	37	06073	32.6425313	-117.0814859	San Diego County
272156	Fee-for-Service	1487064143	1487064143	1	1	BELLVIEW HOSPICE CARE INC	10/19/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	255 N D STREET	STE 214	SAN BERNARDINO	CA	92401	1735	36	06071	34.1036709	-117.291874	San Bernardino County
272170	Fee-for-Service	1467500397	1467500397	1	1	BERNER, MICHAEL C OD	12/16/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
272193	Fee-for-Service	1508974395	1508974395	1	1	BROWN, JIMMY J MD	12/19/1991	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	67891	01	General Practice	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
272203	Fee-for-Service	1992872915	1992872915	1	1	BEEZY, JOSEPH E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32197	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
272218	Fee-for-Service	1235483934	1235483934	1	1	BLANC, GEORGINA M OD	12/4/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	613 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.1245479	-117.0739933	San Diego County
272255	Fee-for-Service	1689787202	1689787202	1	1	BUSSELEN, STEVEN C MD	3/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	133684	-	NOT APPLICABLE	0	In state provider	None	1020 PLACIDO AVE	None	SANTA BARBARA	CA	93101	3684	42	06083	34.41834626	-119.7065415	Santa Barbara County
272256	Fee-for-Service	1164748562	1164748562	1	1	BALASUBRAMANIAN, SHAILESH A	6/2/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168744	41	Internal Medicine	0	In state provider	MD	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
272286	Fee-for-Service	1104353879	1104353879	1	1	BURKY, MATTHEW J DO	8/2/2024	207ZP0102X	NA	Other	026	PHYSICIANS	22990	22	Pathology (M.D. only)	0	In state provider	None	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
272378	Fee-for-Service	1467538520	1467538520	1	2	BAKERSFIELD MEMORIAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
272381	Fee-for-Service	1073638581	1073638581	1	1	BHATTACHARYA, SOMANGSU M	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38383	02	General Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
272398	Fee-for-Service	1245473719	1245473719	1	1	BANDARU, VARALAKSHMI V MD	5/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119020	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
272423	Fee-for-Service	1801896311	1801896311	1	1	BRION, PETER L MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53147	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
272431	Fee-for-Service	1992835797	1992835797	1	1	BERJIS, SHIVA MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	34043	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
272456	Fee-for-Service	1497813869	1497813869	1	1	BRODERICK, JOSEPH JR MD	7/31/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	74701	36	Psychiatry	0	In state provider	SCHUMAN-LILES PSYCHIATRI	10850 MACARTHUR BLVD	STE 300	OAKLAND	CA	94605	5266	01	06001	37.7414325	-122.1498379	Alameda County
272475	Fee-for-Service	1992872915	1992872915	1	1	BEEZY, JOSEPH E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32197	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
272524	Fee-for-Service	1093942526	1093942526	1	1	BARBARO, CASEY E MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107741	02	General Surgery	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
272525	Fee-for-Service	1164748562	1164748562	1	1	BALASUBRAMANIAN, SHAILESH A	6/2/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168744	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
272545	Fee-for-Service	1477868933	1477868933	1	1	BORBOR, SHARIAR MD	8/8/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	123079	None	None	0	In state provider	None	521 N AZUSA AVE	None	AZUSA	CA	91702	2936	19	06037	34.1306038	-117.9075906	Los Angeles County
272560	Fee-for-Service	1104353879	1104353879	1	1	BURKY, MATTHEW J DO	8/2/2024	207ZP0102X	NA	Other	026	PHYSICIANS	22990	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
272622	Fee-for-Service	1073511796	1073511796	1	1	BLUNDELL, MATTHEW C MD	1/27/2014	193400000X	NA	Other	026	PHYSICIANS	62659	41	Internal Medicine	0	In state provider	None	1771 NORTHCREST DRIVE	None	CRESCENT CITY	CA	95531	8922	08	06015	41.77784772	-124.1992249	Del Norte County
272652	Fee-for-Service	1073638581	1073638581	1	1	BHATTACHARYA, SOMANGSU M	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38383	34	Urology and Urological Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
272658	Fee-for-Service	1235337148	1235337148	1	1	BACA, ELIZABETH A MD	5/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100241	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
272694	Fee-for-Service	1801896311	1801896311	1	1	BRION, PETER L MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53147	41	Internal Medicine	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
272698	Fee-for-Service	1336219526	1336219526	1	1	BAE, SUNG H	10/17/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
272724	Fee-for-Service	1114144284	1114144284	1	1	BAVA, ERIC D MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93261	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
272755	Fee-for-Service	1457738494	1457738494	1	3	BLACKBURN, WALTER L DO	3/2/2022	207L00000X	NA	Other	026	PHYSICIANS	19254	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
272758	Fee-for-Service	1508109794	1508109794	1	1	BALTAIAN, LILIT MD INC	6/5/2024	207R00000X	NA	Other	026	PHYSICIANS	105197	41	Internal Medicine	0	In state provider	None	7412 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2722	19	06037	34.25156083	-118.2936644	Los Angeles County
272759	Fee-for-Service	1568785319	1568785319	2	1	BAKER, ANN B NP	6/23/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
272769	Fee-for-Service	1184864423	1184864423	1	1	BATA, AHMED S MD	2/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137199	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3312	36	06071	34.04805253	-117.249534	San Bernardino County
272779	Fee-for-Service	1194821595	1194821595	1	1	BREVARD COUNTY	7/1/2006	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1140 FLORIDA AVE S	None	ROCKLEDGE	FL	32955	2431	00	None	28.34204556	-80.72594753	Brevard County
272794	Fee-for-Service	1922060573	1922060573	1	1	BREATHE LLC	2/23/2005	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	7171 W 95TH STREET	SUITE 320	OVERLAND PARK	KS	66212	2249	00	None	38.95660789	-94.66957968	Johnson County
272803	Fee-for-Service	1992779425	1992779425	1	1	BRENDAN P CASSIDY MD	12/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1331 N 7TH ST	STE 100	PHOENIX	AZ	85006	2765	00	None	33.463404	-112.0643505	Maricopa County
272819	Fee-for-Service	1538189873	1538189873	1	1	BUDHRAJA, ARUN MD	10/9/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39298	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	17822 BEACH BLVD	STE 173	HUNTINGTON BEACH	CA	92647	7177	30	06059	33.70331388	-117.9890471	Orange County
272822	Fee-for-Service	1750687497	1750687497	1	1	BADALOVA, YELENA MD	1/22/2025	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	115507	None	None	0	In state provider	None	816 N HOLLYWOOD WAY	1	BURBANK	CA	91505	2831	19	06037	34.16503922	-118.3455811	Los Angeles County
272834	Fee-for-Service	1467898825	1467898825	1	1	BEKOWIES, PAUL D	12/7/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
272857	Fee-for-Service	1134148869	1134148869	1	1	BERNARD, TIMOTHY N DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
272863	Fee-for-Service	1801045679	1801045679	1	1	BAQAI, SUMBELLA F MD	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105374	41	Internal Medicine	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
272930	Fee-for-Service	1568642460	1568642460	1	1	BROSNAN, DOUGLAS P MD	2/25/2008	207P00000X	NA	Other	026	PHYSICIANS	97725	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
272961	Fee-for-Service	1801896311	1801896311	1	1	BRION, PETER L MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53147	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
272989	Fee-for-Service	1386102697	1386102697	1	1	BIDWAL, SIMREN K OD	9/25/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
272996	Fee-for-Service	1598031304	1598031304	1	1	BARRY, JEFFREY J MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128858	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
273011	Fee-for-Service	1902342785	1902342785	1	1	BROWN, NATALIE A CRNA	6/19/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
273026	Fee-for-Service	1508109794	1508109794	1	1	BALTAIAN, LILIT MD INC	6/5/2024	207R00000X	NA	Other	026	PHYSICIANS	105197	01	General Practice	0	In state provider	None	7412 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2722	19	06037	34.25156083	-118.2936644	Los Angeles County
273080	Fee-for-Service	1497218739	1497218739	1	1	BALLARD, BRIAN M DO	7/19/2022	390200000X	NA	Other	026	PHYSICIANS	19811	None	None	0	In state provider	None	160 E ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
273088	Fee-for-Service	1538189873	1538189873	1	1	BUDHRAJA, ARUN MD	10/9/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39298	41	Internal Medicine	0	In state provider	None	17822 BEACH BLVD	STE 173	HUNTINGTON BEACH	CA	92647	7177	30	06059	33.70331388	-117.9890471	Orange County
273094	Fee-for-Service	1043769342	1043769342	1	1	BARRAZA, BERTHA NP	6/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	143 KERN AVE	None	MC FARLAND	CA	93250	1348	15	06029	35.67801355	-119.228976	Kern County
273095	Fee-for-Service	1174092423	1174092423	1	1	BRIDGE HOME HEALTH RIVERSIDE	2/13/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	38975 SKY CANYON DR	STE 208	MURRIETA	CA	92563	2678	33	06065	33.555438	-117.1376775	Riverside County
273153	Fee-for-Service	1891872735	1891872735	1	1	BLUM, JONATHAN H MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86553	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
273213	Fee-for-Service	1326322405	1326322405	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	1334 POST AVENUE	None	TORRANCE	CA	90501	2620	19	06037	33.83521638	-118.3175802	Los Angeles County
273216	Fee-for-Service	1386971505	1386971505	1	1	BRENNER, STACEY R MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110567	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
273229	Fee-for-Service	1437384096	1437384096	1	1	BARTH, KIMBERLY A PSYD	7/19/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25850	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
273269	Fee-for-Service	1730621715	1730621715	1	1	BETTER DECISIONS COUNSELING	3/26/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	10366 ROCKINGHAM DRIVE	None	SACRAMENTO	CA	95827	2546	34	06067	38.573622	-121.30623	Sacramento County
273295	Fee-for-Service	1508109794	1508109794	1	1	BALTAIAN, LILIT MD INC	6/5/2024	207R00000X	NA	Other	026	PHYSICIANS	105197	40	Pediatrics	0	In state provider	None	7412 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2722	19	06037	34.25156083	-118.2936644	Los Angeles County
273310	Fee-for-Service	1770535171	1770535171	1	1	BAARAT, TOLLIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2550 S TELEGRAPH RD	STE 235	BLOOMFIELD	MI	48302	0909	00	None	42.60210271	-83.28888598	Oakland County
273312	Fee-for-Service	1003987900	1003987900	1	1	BRUNNER, LANCE C MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61115	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
273331	Fee-for-Service	1154526952	1154526952	1	1	BREDA, ALBERTO MD	4/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	7002	19	06037	34.06373445	-118.443537	Los Angeles County
273352	Fee-for-Service	1679586218	1679586218	1	1	BAYRAK, AYKUT B MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78769	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
273379	Fee-for-Service	1962983627	1962983627	1	1	BORJA, KATERINA NP	11/15/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	19	06037	33.98867148	-118.3837334	Los Angeles County
273396	Fee-for-Service	1194030593	1194030593	1	1	BELAY, ABREN D MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122037	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
273422	Fee-for-Service	1891872735	1891872735	1	1	BLUM, JONATHAN H MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86553	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
273435	Fee-for-Service	1770698144	1770698144	1	1	BRENNAN, DANIEL R MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70562	40	Pediatrics	0	In state provider	None	51 HITCHCOCK WAY	None	SANTA BARBARA	CA	93105	3101	42	06083	34.43833587	-119.7444336	Santa Barbara County
273472	Fee-for-Service	1164612339	1164612339	1	1	BERGES, STEPHANIE DAWN	3/9/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1566 HEATHER LN	None	RIVERSIDE	CA	92504	5517	33	06065	33.89769363	-117.3991527	Riverside County
273479	Fee-for-Service	1578641601	1578641601	1	1	BOUVIER, LUCIENNE S MD	5/27/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	79050	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
273525	Fee-for-Service	1275236234	1275236234	1	1	BARILLAS, MELANIE C OT	6/13/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4010 ORANGE AVE	None	LONG BEACH	CA	90807	3717	19	06037	33.831612	-118.176291	Los Angeles County
273531	Fee-for-Service	1437644457	1437644457	1	1	BEACHVIEW TREATMENT, LLC	4/9/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	19126 MAGNOLIA STREET	UNIT 201	HUNTINGTON BEACH	CA	92648	3802	30	06059	33.685533	-117.9713915	Orange County
273551	Fee-for-Service	1609985639	1609985639	1	1	BLOCK, JULIE S MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	60016	40	Pediatrics	0	In state provider	None	477 N EL CAMINO REAL	B-105	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
273560	Fee-for-Service	1710074869	1710074869	1	1	BEAN, ASHELY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
273569	Fee-for-Service	1316342884	1316342884	1	1	BHAVSAR, ASHISH MD INC	3/25/2016	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117360	01	General Practice	0	In state provider	None	410 W CENTRAL AVE	STE 105	BREA	CA	92821	3009	30	06059	33.93194416	-117.9031642	Orange County
273590	Fee-for-Service	1104937937	1104937937	1	1	BARKER, APRIL M LMFT	8/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39180 LIBERTY ST	205	FREMONT	CA	94538	2586	01	06001	37.55089505	-121.982082	Alameda County
273603	Fee-for-Service	1467794974	1467794974	1	1	BHULLAR, PREETINDER S MD	7/11/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	175399	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
273618	Fee-for-Service	1730529256	1730529256	1	1	BERNARDI, CHRISTOPHER J DO	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13591	01	General Practice	0	In state provider	None	4663 SCOTTS VALLEY DRIVE	None	SCOTTS VALLEY	CA	95066	4202	44	06087	37.04973619	-122.0157773	Santa Cruz County
273621	Fee-for-Service	1235105321	1235105321	1	1	BULTMAN, LAURA L MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91750	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
273702	Fee-for-Service	1598936841	1598936841	1	1	BARRETT, AMANDA C MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103266	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
273717	Fee-for-Service	1437333846	1437333846	1	1	BECK, MCALLISTER D MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115204	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
273724	Fee-for-Service	1376596403	1376596403	1	1	BLIKIAN, ANAHIT H MD	9/20/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39608	05	Anesthesiology	0	In state provider	None	5020 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5820	19	06037	34.09809851	-118.2990799	Los Angeles County
273742	Fee-for-Service	1164612339	1164612339	1	1	BERGES, STEPHANIE DAWN	10/6/2005	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1566 HEATHER LN	None	RIVERSIDE	CA	92504	5517	33	06065	33.89769363	-117.3991527	Riverside County
273763	Fee-for-Service	1417971029	1417971029	1	1	BUCHANAN, SHANTWANIA A MD	5/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141026	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	450 EAST ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
273777	Fee-for-Service	1376963785	1376963785	1	1	BEAUMONT MANOR LLC	8/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1441 N MICHIGAN AVE	None	BEAUMONT	CA	92223	1728	33	06065	33.94838739	-116.9689449	Riverside County
273852	Fee-for-Service	1972189975	1972189975	1	1	BUSH, ALLANA K	2/9/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
273870	Fee-for-Service	1083781975	1083781975	1	1	BUCH, DAVID MD	6/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84005	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
273906	Fee-for-Service	1013058403	1013058403	1	1	BAROKOV, JULIA M LMFT	1/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2534 10TH AVE	None	OAKLAND	CA	94606	2706	01	06001	37.79966296	-122.2389673	Alameda County
273918	Fee-for-Service	1891722658	1891722658	1	1	BURNEY, BRIAN W CRNA	4/8/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
273931	Fee-for-Service	1528889581	1528889581	1	1	BEYER, HANNAH E DOULA	10/25/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
273958	Fee-for-Service	1093889693	1093889693	1	1	BERTSCH, RUTH A MD	11/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84484	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
273965	Fee-for-Service	1154354918	1154354918	1	1	BARROWS, JOSEPH J MD	12/14/2010	207L00000X	NA	Other	026	PHYSICIANS	112561	05	Anesthesiology	0	In state provider	None	5900 W OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
273971	Fee-for-Service	1720087406	1720087406	1	1	BAER, MONIQUE M MD	4/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68374	08	Family Practice	0	In state provider	None	1294 W 6TH ST	STE 103	SAN PEDRO	CA	90731	2997	19	06037	33.73885348	-118.3056165	Los Angeles County
273989	Fee-for-Service	1134692049	1134692049	1	1	BE AUTHENTIC FAMILY THERAPY	5/23/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC.	2335 W FOOTHILL BLVD	SUITE 11	UPLAND	CA	91786	3577	36	06071	34.1069073	-117.6972257	San Bernardino County
274045	Fee-for-Service	1831334044	1831334044	1	1	BOYD, JACK H MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132612	33	Thoracic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274048	Fee-for-Service	1609166727	1609166727	1	1	BRADLEY, GAIL M LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
274049	Fee-for-Service	1780881045	1780881045	1	1	BAGATELOS, KAREN C NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
274053	Fee-for-Service	1841378452	1841378452	1	1	BLACKER, KERRY L MD	3/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60335	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
274063	Fee-for-Service	1700822913	1700822913	1	1	BAGGA, HARPRABHJOT MD	1/23/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53143	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
274089	Fee-for-Service	1285193292	1285193292	1	1	BERENSON, MARC G MD	6/27/2023	207P00000X	NA	Other	026	PHYSICIANS	184357	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274122	Fee-for-Service	1629010327	1629010327	1	1	BATTEN, CASEY G MD	8/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96253	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
274143	Fee-for-Service	1437852027	1437852027	1	1	BAWITDABA LLC	9/29/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	455 FLORIN ROAD	None	SACRAMENTO	CA	95831	2024	34	06067	38.506833	-121.5391725	Sacramento County
274158	Fee-for-Service	1730343914	1730343914	1	1	BERG, KARRIE N DO	9/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10828	67	Endocrinology	0	In state provider	None	1868 PACIFIC AVENUE	None	LONG BEACH	CA	90806	6113	19	06037	33.791391	-118.193652	Los Angeles County
274171	Fee-for-Service	1396298675	1396298675	1	1	BIE, ERIN LCSW	9/10/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
274189	Fee-for-Service	1346398369	1346398369	1	1	BRENNAN, ROBYN E NP	10/21/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	400 CRAVEN RD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
274211	Fee-for-Service	1689633240	1689633240	1	5	BAYSIDE MEDICAL GROUP INC	2/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	5201 NORRIS CANYON RD	STE 140	SAN RAMON	CA	94583	5410	07	06013	37.77779028	-121.9600626	Contra Costa County
274241	Fee-for-Service	1215252671	1215252671	1	1	BEATY, MATTHEW	1/28/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT STREET	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
274291	Fee-for-Service	1700032612	1700032612	1	1	BEYER, APRIL PT	5/23/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
274308	Fee-for-Service	1942398862	1942398862	1	1	BURTON, THOMAS M	10/30/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S FIRST ST	STE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
274318	Fee-for-Service	1952588105	1952588105	1	1	BARR, STEVEN J MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105198	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
274341	Fee-for-Service	1013328251	1013328251	1	1	BARROWS, TESSA LMFT	3/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	37 QUAIL CT	STE 201	WALNUT CREEK	CA	94596	5593	07	06013	37.88807861	-122.0553842	Contra Costa County
274342	Fee-for-Service	1437375128	1437375128	1	1	BERZ, DAVID MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118786	78	Neoplastic Diseases/Oncology	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
274376	Fee-for-Service	1306860622	1306860622	1	1	BAJO, JOSEPH T DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	SOUTHWEST EMERGENCY SVS	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
274395	Fee-for-Service	1639398704	1639398704	1	1	BUDDHIST TZU CHI	11/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FREE CLINIC	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
274405	Fee-for-Service	1154765394	1154765394	1	1	BROOKS, NATHAN A MD	11/25/2017	390200000X	NA	Other	026	PHYSICIANS	148850	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
274421	Fee-for-Service	1811138043	1811138043	1	1	BEGGS, NATALIE J	2/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
274422	Fee-for-Service	1730343914	1730343914	1	1	BERG, KARRIE N DO	9/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10828	41	Internal Medicine	0	In state provider	None	1868 PACIFIC AVENUE	None	LONG BEACH	CA	90806	6113	19	06037	33.791391	-118.193652	Los Angeles County
274440	Fee-for-Service	1730507575	1730507575	1	1	BUI, PETER V MD	4/1/2025	207P00000X	NA	Other	026	PHYSICIANS	171028	None	None	0	In state provider	None	1111 LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
274446	Fee-for-Service	1366574048	1366574048	1	1	BARRY, ROBERT S MD INC	12/1/2001	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1420 S MILLER ST	STE A	SANTA MARIA	CA	93454	6960	42	06083	34.936479	-120.4315845	Santa Barbara County
274467	Fee-for-Service	1194754572	1194754572	1	1	BARBERS, RICHARD G MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	31953	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2250 ALCAZAR ST	None	LOS ANGELES	CA	90089	0229	19	06037	34.06313563	-118.1997071	Los Angeles County
274509	Fee-for-Service	1609824325	1609824325	1	1	BOKEN, LORIANNE M MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83279	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 WILLOW PLZ	STE 201	VISALIA	CA	93291	6213	54	06107	36.328527	-119.292885	Tulare County
274529	Fee-for-Service	1225066947	1225066947	1	1	BINDRA, ARCHANA S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75781	67	Endocrinology	0	In state provider	None	3805 SAN DIMAS ST	STE B	BAKERSFIELD	CA	93301	5725	15	06029	35.39508529	-119.0082516	Kern County
274583	Fee-for-Service	1689994014	1689994014	1	1	BRAMHAM, AMANDA MD	10/10/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184922	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
274604	Fee-for-Service	1124224803	1124224803	1	1	BURGESS, JANICE M LMFT	3/10/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52321	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	STE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
274607	Fee-for-Service	1437375128	1437375128	1	1	BERZ, DAVID MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118786	68	Hematology	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
274627	Fee-for-Service	1316676612	1316676612	1	1	BALDWIN, MARY E OT	6/12/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3416 AMERICAN RIVER DR	STE B	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
274658	Fee-for-Service	1639398704	1639398704	1	1	BUDDHIST TZU CHI	11/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	FREE CLINIC	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
274659	Fee-for-Service	1861767352	1861767352	1	1	BEASON, LAUREL A LCSW	7/18/2012	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	THERAPY	1140 RAILROAD STREET	None	PASO ROBLES	CA	93446	2532	40	06079	35.62645486	-120.6881426	San Luis Obispo County
274686	Fee-for-Service	1760942452	1760942452	1	1	BADER, ELIZABETH M	6/19/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
274699	Fee-for-Service	1841794344	1841794344	1	1	BOHR, CHRISTINA DO	6/30/2021	208M00000X	NA	Other	026	PHYSICIANS	17702	None	None	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
274815	Fee-for-Service	1952359671	1952359671	1	1	BEJINEZ-EASTMAN, ANA MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67654	01	General Practice	0	In state provider	None	12291 WASHINGTON BLVD	STE 500	WHITTIER	CA	90606	2551	19	06037	33.96734104	-118.0508773	Los Angeles County
274869	Fee-for-Service	1437375128	1437375128	1	1	BERZ, DAVID MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118786	41	Internal Medicine	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
274890	Fee-for-Service	1356984793	1356984793	1	1	BOUNNOY, ALEXANDRA E AU	2/16/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
274894	Fee-for-Service	1679728281	1679728281	1	1	BALBOA ACUPUNCTURE CLINIC IN	9/16/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C.	10515 BALBOA BLVD	SUITE 175	GRANADA HILLS	CA	91344	6382	19	06037	34.261497	-118.502318	Los Angeles County
274921	Fee-for-Service	1639398704	1639398704	1	1	BUDDHIST TZU CHI	11/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FREE CLINIC	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
274947	Fee-for-Service	1073191607	1073191607	1	1	BRAUNREUTHER, ELIZABETH MD	12/10/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
274950	Fee-for-Service	1619269297	1619269297	1	1	BELTRAN, CHRISTOPHER M	12/24/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1073 ROSS AVE	STE F	EL CENTRO	CA	92243	9783	13	06025	32.78146253	-115.5644505	Imperial County
274963	Fee-for-Service	1336193432	1336193432	1	1	BRANDTMAN, TODD MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	42020	None	None	0	In state provider	YUBA FEATHER HEALTH CTR	16911 WILLOW GLEN RD	None	BROWNSVILLE	CA	95919	9707	58	06115	39.46025309	-121.2838218	Yuba County
275021	Fee-for-Service	1801998349	1801998349	1	1	BERKOWITZ, SUSAN F	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11298 DUENDA RD	None	SAN DIEGO	CA	92127	1014	37	06073	33.03734263	-117.0849048	San Diego County
275049	Fee-for-Service	1811221823	1811221823	1	1	BULLARD, KATRINA K LCSW	5/26/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
275059	Fee-for-Service	1649739764	1649739764	1	1	BOLAND, NELSON F MD	8/1/2022	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	179762	None	None	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
275069	Fee-for-Service	1871573493	1871573493	1	1	BENENATI,DIANA V MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6567 E CARONDELET DR	STE 305	TUCSON	AZ	85710	0000	00	None	32.226876	-110.8535445	Pima County
275078	Fee-for-Service	1245251792	1245251792	1	1	BOYD, STUART D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34280	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	STE 7416	LOS ANGELES	CA	90089	0178	19	06037	34.06169385	-118.2044698	Los Angeles County
275086	Fee-for-Service	1487150371	1487150371	1	1	BILLINGHAM, CAITLIN I MD	5/20/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164870	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
275128	Fee-for-Service	1326347998	1326347998	1	1	BENHAMMOU, JIHANE N MD	8/18/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	123193	10	Gastroenterology (M.D. only)	0	In state provider	None	100 MEDICAL PLAZA STE 70	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
275150	Fee-for-Service	1457501157	1457501157	1	1	BOKOCH, NATALYA A NP	6/22/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	614336	-	NOT APPLICABLE	0	In state provider	None	7240 SOUTHGATE	B, E, G, AND F	SACRAMENTO	CA	95823	2627	34	06067	38.494359	-121.438377	Sacramento County
275166	Fee-for-Service	1003981887	1003981887	1	1	BARRINGHAM, ANITA D MD	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83171	40	Pediatrics	0	In state provider	None	1711 ORANGE ST	None	REDLANDS	CA	92374	2254	36	06071	34.0796409	-117.1824145	San Bernardino County
275169	Fee-for-Service	1659574945	1659574945	1	1	BYEON, SANGJUN MD	4/2/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	103605	None	None	0	In state provider	None	18391 COLIMA RD	STE 201	ROWLAND HEIGHTS	CA	91748	2730	19	06037	33.98844297	-117.9041666	Los Angeles County
275206	Fee-for-Service	1215108808	1215108808	1	1	BRAVERMAN, IRA R MD INC	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	37912	41	Internal Medicine	0	In state provider	None	610 EUCLID AVE	STE 201	NATIONAL CITY	CA	91950	2952	37	06073	32.68419388	-117.0829524	San Diego County
275224	Fee-for-Service	1528092079	1528092079	1	1	BRAHN, ERNEST MD	1/1/1995	207RR0500X	NA	Other	026	PHYSICIANS	42065	None	None	0	In state provider	UCLA CTR FOR HLTH SCIENC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
275243	Fee-for-Service	1538267042	1538267042	1	1	BIRNBAUM, PETER S DO	12/23/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	7133	None	None	0	In state provider	None	1211 WEST LA PALMA AVE	SUITE # 506	ANAHEIM	CA	92801	9280	30	06059	33.84718298	-117.933758	Orange County
275256	Fee-for-Service	1447251681	1447251681	1	1	BURGER, HAROLD MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42458	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
275287	Fee-for-Service	1538414800	1538414800	1	1	BOUSLOUGH, CLAUDIA A LMFT	2/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5053 LA MART DR	SUITE 105	RIVERSIDE	CA	92507	0609	33	06065	33.95818206	-117.3320081	Riverside County
275300	Fee-for-Service	1770667024	1770667024	1	1	BROWN, GAYLIA D PHD	4/1/1995	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	591 CAMINO DE LA REINA	STE 812	SAN DIEGO	CA	92108	3105	37	06073	32.76632791	-117.1616245	San Diego County
275325	Fee-for-Service	1871504027	1871504027	1	1	BRASLOW, JOEL T MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	59388	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
275334	Fee-for-Service	1619040953	1619040953	1	1	BURNS, JANE C MD	3/5/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68119	40	Pediatrics	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
275338	Fee-for-Service	1851476519	1851476519	1	1	BHARADHWAJ, GAYATRI MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51648	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
275339	Fee-for-Service	1235173253	1235173253	1	1	BRYSON, JULIE H MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64881	08	Family Practice	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
275378	Fee-for-Service	1538417225	1538417225	1	1	BRANDON, PHILIP R A	12/8/2014	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	24012 CALLE DE LA PLATA	STE 215	LAGUNA HILLS	CA	92653	7624	30	06059	33.61012113	-117.7115908	Orange County
275382	Fee-for-Service	1366420630	1366420630	1	1	BARDWELL, WAYNE A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3110 CAMINO DEL RIO S	STE 219	SAN DIEGO	CA	92108	3831	37	06073	32.77300039	-117.1262698	San Diego County
275396	Fee-for-Service	1144754490	1144754490	1	1	BACHIR, SUHA MD	3/23/2022	207SG0201X	NA	Other	026	PHYSICIANS	175514	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
275417	Fee-for-Service	1073641478	1073641478	1	1	BEHAVIORAL HEALTH SERVICES	8/6/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	4099 NORTH MISSION ROAD	UNIT A	LOS ANGELES	CA	90032	2554	19	06037	34.07633798	-118.1949294	Los Angeles County
275423	Fee-for-Service	1326579814	1326579814	1	1	BROWN, LOVELEE MD	5/14/2020	207R00000X	NA	Other	026	PHYSICIANS	161702	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
275434	Fee-for-Service	1164245510	1164245510	1	1	BEAN, TIMAYA L POSTPARTUM DO	2/13/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
275436	Fee-for-Service	1538187547	1538187547	1	1	BERKOWITZ, MAURICE J MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69972	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
275453	Fee-for-Service	1457310583	1457310583	2	2	BONDADE, PRAKASH G MD	12/21/2020	207RP1001X	NA	Pulmonology	086	MEDICAL DIRECTORS	37862	-	NOT APPLICABLE	0	In state provider	None	16581 BROOKHURST	None	FOUNTAIN VALLEY	CA	92708	2344	30	06059	33.7215297	-117.9547079	Orange County
275455	Fee-for-Service	1518497973	1518497973	1	1	BERERA, DANIELLE MD	1/23/2023	208600000X	NA	General Surgery	026	PHYSICIANS	162192	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
275497	Fee-for-Service	1619608353	1619608353	1	1	BATES, EUGENE MCLUTHER	3/16/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11111 IRIS CT	None	CORONOA	CA	92883	3112	33	06065	33.75320801	-117.4665059	Riverside County
275499	Fee-for-Service	1235349499	1235349499	1	1	BORGESON, JAMES K LMFT	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
275536	Fee-for-Service	1457360927	1457360927	1	1	BOWERS, MARALEE CARTNER MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110564	08	Family Practice	0	In state provider	None	225 SPRUCE STREET	None	GRIDLEY	CA	95948	2215	04	06007	39.36695351	-121.68954	Butte County
275561	Fee-for-Service	1326115437	1326115437	1	1	BURTON SCHOOL DISTRICT	12/4/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	264 N WESTWOOD ST	None	PORTERVILLE	CA	93257	2542	54	06107	36.07088914	-119.0707651	Tulare County
275564	Fee-for-Service	1285471979	1285471979	1	1	BURRIEL, ABIGAIL R DOULA	9/3/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	54	06107	0	0	None
275565	Fee-for-Service	1124519418	1124519418	1	1	BATISH, SURAJ R MD	8/2/2021	208M00000X	NA	Other	026	PHYSICIANS	164696	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
275589	Fee-for-Service	1619040953	1619040953	1	1	BURNS, JANE C MD	3/5/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68119	03	Allergy	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
275599	Fee-for-Service	1235173253	1235173253	1	1	BRYSON, JULIE H MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64881	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
275617	Fee-for-Service	1629363726	1629363726	1	1	BETANCOURTH, MARIA D LPCC	3/29/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
275645	Fee-for-Service	1932580925	1932580925	1	1	BHURGRI, ASHHAR MD	10/5/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159297	None	None	0	In state provider	None	8329 BRIMHALL RD	804	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
275666	Fee-for-Service	1518184241	1518184241	1	1	BAREH, MARIAN M MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94632	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
275673	Fee-for-Service	1154361871	1154361871	1	1	BERAL, RABIN DPM	12/3/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1141 W REDONDO BEACH BLV	STE 302	GARDENA	CA	90247	3583	19	06037	33.89247036	-118.2941482	Los Angeles County
275694	Fee-for-Service	1366571309	1366571309	1	1	BANG, MICHAEL C MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82873	01	General Practice	0	In state provider	None	1433 N HOLLENBECK AVE	STE 200	COVINA	CA	91722	1588	19	06037	34.105518	-117.8989985	Los Angeles County
275716	Fee-for-Service	1063449874	1063449874	1	1	BARTIS, DAVID G DPM	9/1/1995	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13132 STUDEBAKER RD	STE 9	NORWALK	CA	90650	2575	19	06037	33.911874	-118.099151	Los Angeles County
275718	Fee-for-Service	1306897095	1306897095	1	1	BRADLEY S HULSEY, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 W THOMAS RD	STE 102	PHOENIX	AZ	85013	4493	00	None	33.480558	-112.077027	Maricopa County
275760	Fee-for-Service	1619608353	1619608353	1	1	BATES, EUGENE MCLUTHER	3/16/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11111 IRIS CT	None	CORONOA	CA	92883	3112	33	06065	33.75320801	-117.4665059	Riverside County
275770	Fee-for-Service	1376610295	1376610295	1	1	BRAGANZA, ROY J MD	12/1/1997	207L00000X	NA	Other	026	PHYSICIANS	81187	05	Anesthesiology	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
275790	Fee-for-Service	1972124998	1972124998	1	1	BIGGS, MORGAN MD	8/5/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
275909	Fee-for-Service	1447683313	1447683313	1	1	BARISH, MICHAEL MD	12/13/2024	208M00000X	NA	Other	026	PHYSICIANS	159486	41	Internal Medicine	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
275944	Fee-for-Service	1568624708	1568624708	1	1	BEGLEY, BRANDON C DO	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11640	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
275949	Fee-for-Service	1609831312	1609831312	1	1	BURKHARDT, DANIEL H MD	2/1/1999	207L00000X	NA	Other	026	PHYSICIANS	60149	05	Anesthesiology	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
276012	Fee-for-Service	1801077557	1801077557	1	1	BENSEN, RACHEL S MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105052	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
276037	Fee-for-Service	1811061468	1811061468	2	1	BUI, CHRISTOPHER D MD	10/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	49625	41	Internal Medicine	0	In state provider	None	10301 BOLSA AVE	#101	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
276039	Fee-for-Service	1255599221	1255599221	1	1	BOWER, CAROLYN R	8/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2815 CAMINO DEL RIO S	STE 220	SAN DIEGO	CA	92108	3817	37	06073	32.77000054	-117.1343627	San Diego County
276091	Fee-for-Service	1477741973	1477741973	1	1	BERRY, BRIGITTE L MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66846	None	None	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
276094	Fee-for-Service	1275846966	1275846966	1	1	BHAKHRANI, SANA T OD	1/21/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
276102	Fee-for-Service	1760782817	1760782817	1	1	BEAN, LISA M MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125372	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
276126	Fee-for-Service	1932587748	1932587748	1	1	BORNA, MAYA INC	7/20/2015	252Y00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1501 CAMERON AVE	110-24	WEST COVINA	CA	91790	2724	19	06037	34.06831975	-117.9417887	Los Angeles County
276140	Fee-for-Service	1457599946	1457599946	1	1	BANGERA, NATASHA MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112707	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
276161	Fee-for-Service	1316108343	1316108343	1	1	BENJAMIN C GILLEN MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2845 GREENBRIER RD	None	GREEN BAY	WI	54311	6519	00	None	44.47337651	-87.940791	Brown County
276180	Fee-for-Service	1851449706	1851449706	1	1	BHATT, MANISHA K MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69238	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
276200	Fee-for-Service	1548536188	1548536188	1	1	BUI, ALBERT K MD	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128400	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
276226	Fee-for-Service	1902935703	1902935703	1	1	BRAY, ALYSSA E LMFT	10/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 E DEL MAR BLVD	202	PASADENA	CA	91105	2544	19	06037	34.14047497	-118.1464685	Los Angeles County
276228	Fee-for-Service	1164529285	1164529285	1	1	BALICH, JODY E MD	3/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52253	30	Radiology	0	In state provider	None	3200 TELEGRAPH AVE	None	OAKLAND	CA	94609	3016	01	06001	37.82094258	-122.2666409	Alameda County
276237	Fee-for-Service	1023473055	1023473055	1	1	BRUSH, LISA J NP	5/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3109 COFFEE RD	STE A	MODESTO	CA	95350	1733	50	06099	37.68319185	-120.9760342	Stanislaus County
276292	Fee-for-Service	1811061468	1811061468	2	1	BUI, CHRISTOPHER D MD	10/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	49625	10	Gastroenterology (M.D. only)	0	In state provider	None	10301 BOLSA AVE	#101	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
276319	Fee-for-Service	1124210018	1124210018	2	1	BROWN, SPENCER L MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	46653	02	General Surgery	0	In state provider	None	2080 CENTURY PARK E	STE 1807	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
276324	Fee-for-Service	1740390954	1740390954	1	1	BATTEN, CURTIS L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	450 E 23RD ST	None	FREMONT	NE	68025	2303	00	None	41.454306	-96.491349	Dodge County
276356	Fee-for-Service	1881096113	1881096113	1	1	BROWN, MARIA A LMFT	1/10/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2431 W MARCH LN	210	STOCKTON	CA	95207	8211	39	06077	37.985267	-121.3372349	San Joaquin County
276358	Fee-for-Service	1275929838	1275929838	1	1	BAUM, ANDY M CRNA	12/18/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
276378	Fee-for-Service	1245596188	1245596188	1	1	BERNET, LAURA L MD	4/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126851	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
276405	Fee-for-Service	1568515112	1568515112	1	1	BROWN, BENJAMIN R	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77821	08	Family Practice	0	In state provider	None	#3 SIXTH ST	None	PT REYES STA	CA	94956	0910	21	06041	38.06926923	-122.8086302	Marin County
276431	Fee-for-Service	1760446306	1760446306	1	1	BERNSTEIN, KEITH A MD	1/9/2023	2085N0700X	NA	MRI Provider	026	PHYSICIANS	83148	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
276435	Fee-for-Service	1518328459	1518328459	1	1	BLOOMSBURY HOME HEALTH CARE	9/29/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1000 BUSINESS CENTER CIR	SUITE 213	NEWBURY PARK	CA	91320	1254	56	06111	34.19271	-118.9425915	Ventura County
276482	Fee-for-Service	1467530113	1467530113	1	1	BRUGGER, DAN L MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67935	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
276510	Fee-for-Service	1295197937	1295197937	1	1	BENTZLEY, BRANDON S MD	6/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	150851	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
276514	Fee-for-Service	1346729159	1346729159	1	1	BAYLOR SCOTT & WHITE MEDICAL	4/24/2024	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - PFLUGERVILLE	2600 E PFLUGERVILLE PKWY	STE 100	PFLUGERVILLE	TX	78660	5999	00	None	30.45072169	-97.59186687	Travis County
276522	Fee-for-Service	1710311980	1710311980	1	1	BRICENO, JORGE A LMFT	4/13/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104716	-	NOT APPLICABLE	0	In state provider	None	2219 ODESSA CT	None	LEMON GROVE	CA	91945	3609	37	06073	32.72894008	-117.0384673	San Diego County
276544	Fee-for-Service	1346850013	1346850013	1	1	BOTELHO, DESIREE D LMFT	5/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
276582	Fee-for-Service	1447825971	1447825971	1	1	BURGESS-PAL, CATALEEN E	6/15/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12368 WOODS RD	None	WILTON	CA	95693	8506	34	06067	38.35683	-121.2117165	Sacramento County
276585	Fee-for-Service	1568795730	1568795730	1	1	BEROUKHIM, SHAHRAM S MD INC	8/17/2009	193400000X	NA	Other	026	PHYSICIANS	96801	05	Anesthesiology	0	In state provider	None	1720 E CEASAR E CHAVEZ	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
276625	Fee-for-Service	1396341053	1396341053	1	1	BHULLAR, JASKARANJEET NP	4/5/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
276663	Fee-for-Service	1144754912	1144754912	1	1	BEATTIE, BRYAN J MD	8/9/2021	207P00000X	NA	Other	026	PHYSICIANS	172312	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
276673	Fee-for-Service	1043697113	1043697113	1	1	BLACK, ELIZABETH A MD	8/6/2021	2080P0210X	NA	Nephrology	026	PHYSICIANS	151555	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
276676	Fee-for-Service	1164579702	1164579702	1	1	BECERRA, MARINA LMFT	9/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
276679	Fee-for-Service	1306024104	1306024104	1	1	BAGGA, HARMOHINA MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104390	None	None	0	In state provider	None	450 N ROXBURY DR	3RD FL	BEVERLY HILLS	CA	90210	4238	19	06037	34.06820793	-118.4070317	Los Angeles County
276680	Fee-for-Service	1356359335	1356359335	1	1	BRIAN J MILES MD	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	23900 KATY FWY	None	KATY	TX	77494	1323	00	None	29.78594112	-95.78613398	Harris County
276683	Fee-for-Service	1922074350	1922074350	1	1	BAKTANIAN, EDWIN MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85580	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
276702	Fee-for-Service	1780819292	1780819292	1	1	BRISCOE, HEATHER L MD	7/13/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	107391	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
276748	Fee-for-Service	1548792526	1548792526	1	1	BLOOMING ROSE CONGREGATE	10/24/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	LIVING, INC	14417 COHASSET ST	None	VAN NUYS	CA	91405	1431	19	06037	34.20665752	-118.447092	Los Angeles County
276766	Fee-for-Service	1346729159	1346729159	1	1	BAYLOR SCOTT & WHITE MEDICAL	4/24/2024	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - PFLUGERVILLE	2600 E PFLUGERVILLE PKWY	STE 100	PFLUGERVILLE	TX	78660	5999	00	None	30.45072169	-97.59186687	Travis County
276820	Fee-for-Service	1811195795	1811195795	1	1	BUTEAU, CAROL L	3/17/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
276825	Fee-for-Service	1730427808	1730427808	1	1	BOWER, DAWN CD	7/1/2024	174N00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
276833	Fee-for-Service	1447825971	1447825971	1	1	BURGESS-PAL, CATALEEN E	6/15/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12368 WOODS RD	None	WILTON	CA	95693	8506	34	06067	38.35683	-121.2117165	Sacramento County
276847	Fee-for-Service	1467538520	1467538520	1	6	BAKERSFIELD MEMORIAL	9/20/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	3838 SAN DIMAS STREET	BUILDING A, SUITE 140	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
276888	Fee-for-Service	1871680868	1871680868	1	1	BARISH, DEBBIE E NP	4/3/2023	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2915 TELEGRAPH AVENUE	SUITE 101	BERKELEY	CA	94705	2069	01	06001	37.85719633	-122.2595246	Alameda County
276899	Fee-for-Service	1144480245	1144480245	1	1	BOLDT, BRIAN M DO	4/29/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	12923	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
276907	Fee-for-Service	1558571786	1558571786	1	1	BROWN, ANDREA H	10/12/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
276948	Fee-for-Service	1568514891	1568514891	1	1	BROOKS, ALBERT L MD	10/28/1993	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	36600	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2999 REGENT ST	STE 301	BERKELEY	CA	94705	2118	01	06001	37.85592021	-122.2566436	Alameda County
276958	Fee-for-Service	1801651450	1801651450	1	1	BAIRD, CICILY LMFT	10/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
276961	Fee-for-Service	1508375429	1508375429	1	1	BARTON, YAKOV A PHD	1/22/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
276971	Fee-for-Service	1720374622	1720374622	1	1	BEVINS, TYLER G MD	7/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125068	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
276972	Fee-for-Service	1063937092	1063937092	1	1	BEHBEHANI, SADIKAH MD	3/6/2020	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163186	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
277001	Fee-for-Service	1124675509	1124675509	1	1	BIRTHING & BABIES, LLC	1/6/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
277011	Fee-for-Service	1942358890	1942358890	1	1	BRACAMONTE, DEBBIE J MD	8/8/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63627	68	Hematology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
277031	Fee-for-Service	1356569628	1356569628	1	1	BOURNE, RAE L MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94483	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
277064	Fee-for-Service	1538480603	1538480603	1	1	BASILICO, LEOPOLDO M MD	9/20/2018	207R00000X	NA	Other	026	PHYSICIANS	152830	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
277095	Fee-for-Service	1679990071	1679990071	1	1	BORETA, LAUREN C MD	6/25/2019	2085R0001X	NA	Other	026	PHYSICIANS	138986	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
277100	Fee-for-Service	1861985285	1861985285	1	1	BARNES, MACEY L MD	9/1/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	177807	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
277101	Fee-for-Service	1801128418	1801128418	1	1	BRANDON, SHARON H LMFT	8/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
277135	Fee-for-Service	1740346394	1740346394	1	1	BURG, ANDREW C MD INC	10/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
277141	Fee-for-Service	1649273434	1649273434	1	1	BAYLOR REGIONAL MEDICAL	8/8/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OF PLANO	4700 ALLIANCE BLVD	None	PLANO	TX	75093	5323	00	None	33.01431904	-96.79079573	Collin County
277145	Fee-for-Service	1124425558	1124425558	1	1	BAKER, MARY LMFT	9/28/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107830	-	NOT APPLICABLE	0	In state provider	None	905,907 & 909 PICO BLVD	None	SANTA MONICA	CA	90405	0000	19	06037	34.01310292	-118.481541	Los Angeles County
277165	Fee-for-Service	1396243416	1396243416	1	1	BAGGS, KELSEY CCC-SLP	6/14/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
277172	Fee-for-Service	1578057576	1578057576	1	1	BUENO, JOANA RUBY C NP	10/7/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
277177	Fee-for-Service	1811441322	1811441322	1	1	BUENO, DAISY	8/15/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	38378 LEAFWOOD LANE	None	OAKHURST	CA	93644	9360	20	06039	37.30600965	-119.5986192	Madera County
277199	Fee-for-Service	1598733933	1598733933	1	1	BROOKE, JOHN D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
277224	Fee-for-Service	1447472659	1447472659	1	1	BROCKTON SURGERY CENTER	10/8/2007	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	6958 BROCKTON AVE	None	RIVERSIDE	CA	92506	3829	33	06065	33.947244	-117.3967305	Riverside County
277230	Fee-for-Service	1669640082	1669640082	1	1	BALOGUN, ABIODUN LAWAL	8/26/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1525 NORTH D STREET	STE 14	SAN BERNARDINO	CA	92405	4774	36	06071	34.127433	-117.2918945	San Bernardino County
277248	Fee-for-Service	1255394227	1255394227	1	1	BORG, BRYSON D MD	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	111300	30	Radiology	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
277249	Fee-for-Service	1275618936	1275618936	1	1	BRUNETTI, CHERILYN M MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	67715	40	Pediatrics	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
277257	Fee-for-Service	1942358890	1942358890	1	1	BRACAMONTE, DEBBIE J MD	8/8/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63627	78	Neoplastic Diseases/Oncology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
277262	Fee-for-Service	1457443525	1457443525	1	1	BIRSNER, JOHN W	6/30/1986	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37218	None	None	0	In state provider	None	44439 17TH ST W	STE 203	LANCASTER	CA	93534	2856	19	06037	34.69070437	-118.161312	Los Angeles County
277265	Fee-for-Service	1780917492	1780917492	1	1	BALDACCHINO, ELISABETH K LMF	3/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	104 S C ST	SUITE F	LOMPOC	CA	93436	6924	42	06083	34.638645	-120.4514709	Santa Barbara County
277296	Fee-for-Service	1831388602	1831388602	1	1	BAGWAT, BAL MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	29999	24	Plastic Surgery	0	In state provider	None	631 MENLO AVE	None	MENLO PARK	CA	94025	4701	41	06081	37.45206139	-122.1824345	San Mateo County
277299	Fee-for-Service	1972558922	1972558922	1	1	BARAKOS, JEROME A MD	9/30/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	63097	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
277305	Fee-for-Service	1992242598	1992242598	1	1	BADRAN, FATIN CRNA	9/29/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1400 REYNOLDS AVE	125	IRVINE	CA	92614	5559	30	06059	33.6957272	-117.8542013	Orange County
277306	Fee-for-Service	1558350140	1558350140	1	1	BAKER EMERGENCY MEDICAL SERV	7/1/1993	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ICES, INC	633 FRONT STREET	None	NEEDLES	CA	92363	2950	36	06071	34.83883594	-114.6026265	San Bernardino County
277326	Fee-for-Service	1487808275	1487808275	1	1	BLEY, BRENNA C DO	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10300	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
277378	Fee-for-Service	1720019961	1720019961	1	1	BATRA, POONAM MD	6/30/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36322	30	Radiology	0	In state provider	UCLA RADIOLOGY MED GRP	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
277388	Fee-for-Service	1649273434	1649273434	1	1	BAYLOR REGIONAL MEDICAL	8/8/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OF PLANO	4700 ALLIANCE BLVD	None	PLANO	TX	75093	5323	00	None	33.01431904	-96.79079573	Collin County
277392	Fee-for-Service	1770669277	1770669277	1	1	BIGGS, ROBERT H MD	4/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64405	01	General Practice	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
277393	Fee-for-Service	1679665053	1679665053	1	1	BUTTE VALLEY AMBULANCE	10/12/1995	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	306 N CALIFORNIA	None	DORRIS	CA	96023	0009	47	06093	41.97041757	-121.9195691	Siskiyou County
277400	Fee-for-Service	1477596518	1477596518	1	1	BERTRAND, SCOTT W MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83930	08	Family Practice	0	In state provider	None	1450 MEDICAL CENTER DR	None	ROHNERT PARK	CA	94928	2924	49	06097	38.34758366	-122.6816633	Sonoma County
277421	Fee-for-Service	1811441322	1811441322	1	1	BUENO, DAISY	8/15/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	38378 LEAFWOOD LANE	None	OAKHURST	CA	93644	9360	20	06039	37.30600965	-119.5986192	Madera County
277442	Fee-for-Service	1548429954	1548429954	1	1	BALLEDUX, JEROEN P MD	3/10/2022	208200000X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
277443	Fee-for-Service	1972062883	1972062883	1	1	BELONWU, GLORIA MD	8/25/2023	207L00000X	NA	Other	026	PHYSICIANS	179970	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
277502	Fee-for-Service	1912213331	1912213331	1	1	BYRNE, ANDREW L LMFT	4/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	127 E LEXINGTON AVE	None	EL CAJON	CA	92020	4537	37	06073	32.79269801	-116.9617323	San Diego County
277556	Fee-for-Service	1316566532	1316566532	1	1	BRADY, ALICIA M MD	4/23/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	1801 WILSHIRE BLVD	100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
277631	Fee-for-Service	1639391170	1639391170	1	1	BARNETT, FARRELL MD	12/1/1998	207R00000X	NA	Other	026	PHYSICIANS	50042	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
277648	Fee-for-Service	1477596518	1477596518	1	1	BERTRAND, SCOTT W MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83930	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1450 MEDICAL CENTER DR	None	ROHNERT PARK	CA	94928	2924	49	06097	38.34758366	-122.6816633	Sonoma County
277675	Fee-for-Service	1407697857	1407697857	1	1	BAKER, TIMOTHY	2/5/2025	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
277701	Fee-for-Service	1497738355	1497738355	1	1	BRAVEMAN, FERNE R MD	12/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151372	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
277737	Fee-for-Service	1902977952	1902977952	1	1	BALAKRISHNAN, C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26443	40	Pediatrics	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
277739	Fee-for-Service	1225462112	1225462112	1	1	BURGE, KATHRYN L MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126124	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
277771	Fee-for-Service	1679127187	1679127187	1	1	BRIDGES OF THE MIND PSYCHOLO	6/1/2021	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GICAL SERVICES, INC.	1550 HARBOR BLVD	200	WEST SACRAMENTO	CA	95691	3828	57	06113	38.56976322	-121.5493138	Yolo County
277817	Fee-for-Service	1477571347	1477571347	1	1	BOLYANATZ, PAMELA NP	7/16/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
277831	Fee-for-Service	1154534782	1154534782	2	1	BIAG, MARITA BARLAHAN MD INC	3/7/2014	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67369	40	Pediatrics	0	In state provider	None	11200 GOLD EXPRESS DRIVE	SUITE D	GOLD RIVER	CA	95670	4400	34	06067	38.622546	-121.265685	Sacramento County
277855	Fee-for-Service	1831517358	1831517358	1	1	BAUTISTA, JHOANNE MD	4/6/2023	208600000X	NA	General Surgery	026	PHYSICIANS	138904	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
277875	Fee-for-Service	1053538314	1053538314	1	1	BELL, MICHAEL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 N MACARTHUR BLVD	None	IRVING	TX	75061	2220	00	None	32.834691	-96.95924802	Dallas County
277927	Fee-for-Service	1144374257	1144374257	2	1	BAILEY, CINDY I	8/1/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
277936	Fee-for-Service	1215201108	1215201108	1	1	BALOUCH, MARYAM MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121988	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1955 CITRACADO PARKWAY	SUITE 300	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
277961	Fee-for-Service	1083173041	1083173041	1	1	BEAMESDERFER, MARIELLE M MD	6/14/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	179591	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
278017	Fee-for-Service	1245626472	1245626472	1	1	BARNEY, JENNIFER M NP	2/18/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
278068	Fee-for-Service	1639450711	1639450711	1	1	BLANTON, TIFFANY D LCSW	8/20/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
278100	Fee-for-Service	1255771135	1255771135	1	1	BUSTOS OLIVER, CRISTINA E PH	4/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
278152	Fee-for-Service	1023315728	1023315728	1	1	BRUQUE, GEORGE MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114285	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95661	2912	31	06061	38.74730831	-121.2613758	Placer County
278160	Fee-for-Service	1801944277	1801944277	1	1	BAHERI, MEHRAN MD	3/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87581	41	Internal Medicine	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
278178	Fee-for-Service	1164849535	1164849535	1	1	BEAN, GREGORY R MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140301	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
278192	Fee-for-Service	1114957693	1114957693	1	1	BELEW, CINDY F CNM	12/6/2005	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
278201	Fee-for-Service	1417044819	1417044819	1	1	BHATT, HILAREY MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62752	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
278209	Fee-for-Service	1447548011	1447548011	1	1	BOUNVILLE, ROBIN C LCSW	12/22/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
278260	Fee-for-Service	1639352859	1639352859	1	1	BARTOK, BEATRIX MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102792	83	Rheumatology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
278277	Fee-for-Service	1609968346	1609968346	1	1	BUNYAK, ALEXANDRA R MD	7/11/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78808	25	Physical Medicine and Rehabilitation	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
278340	Fee-for-Service	1831553718	1831553718	1	1	BUI, QUAN MD	7/6/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150740	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
278360	Fee-for-Service	1497940134	1497940134	1	1	BERKELEY ADDICTION TREATMENT	2/5/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2975 SACRAMENTO STREET	None	BERKELEY	CA	94702	2534	01	06001	37.85378295	-122.2790418	Alameda County
278370	Fee-for-Service	1730170887	1730170887	1	1	BASHOURA, HABIB M MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52519	01	General Practice	0	In state provider	None	1234 FOOTHILL BLVD	STE 2	LA VERNE	CA	91750	3329	19	06037	34.11800774	-117.7794559	Los Angeles County
278441	Fee-for-Service	1841827433	1841827433	1	1	BOGEN, HANNAH MD	11/17/2023	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	180135	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
278448	Fee-for-Service	1396984951	1396984951	1	1	BANKS, MARCIA LMFT	1/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
278459	Fee-for-Service	1679581268	1679581268	1	1	BUHARI, CYRUS F DO	6/9/2010	207R00000X	NA	Other	026	PHYSICIANS	9123	41	Internal Medicine	0	In state provider	None	110 N VALERIA ST	STE 508	FRESNO	CA	93701	2168	10	06019	36.74388938	-119.7847725	Fresno County
278491	Fee-for-Service	1760406086	1760406086	1	1	BERKUS, DEAN B MD	11/1/1995	207L00000X	NA	Other	026	PHYSICIANS	34100	05	Anesthesiology	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
278492	Fee-for-Service	1790766533	1790766533	1	1	BARGAN, MIKHAIL A MD	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVENUE	STE A	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
278543	Fee-for-Service	1174641302	1174641302	1	1	BARRAZA, MICHAEL PSYD	11/3/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
278556	Fee-for-Service	1609855741	1609855741	1	1	BERNSTEIN, GEOFFREY MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46099	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
278563	Fee-for-Service	1497996763	1497996763	1	1	BARRAGAN, DAVID A CRNA	6/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
278577	Fee-for-Service	1548983869	1548983869	1	1	BELLA GARDEN LLC	2/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	22790 VAN BUREN ST	None	GRAND TERRACE	CA	92313	3600	36	06071	34.02664707	-117.3069842	San Bernardino County
278596	Fee-for-Service	1619226420	1619226420	1	1	BAKHSH, MUHAMMAD U MD	6/28/2021	390200000X	NA	Other	026	PHYSICIANS	134291	None	None	0	In state provider	None	5945 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0610	15	06029	35.36322921	-119.0706029	Kern County
278605	Fee-for-Service	1245779933	1245779933	1	1	BROWN, CINDY L	4/17/2017	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	14911 NATIONAL AVE	STE 2	LOS GATOS	CA	95032	2632	43	06085	37.25172742	-121.951483	Santa Clara County
278607	Fee-for-Service	1942658091	1942658091	1	1	BURFIEND, KIMBERLY L MD	7/12/2022	2080P0203X	NA	Other	026	PHYSICIANS	161792	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
278669	Fee-for-Service	1801869003	1801869003	1	1	BRUNKO, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 W 16TH AVE	None	DENVER	CO	80204	1335	00	None	39.74280302	-105.0412741	City and County of Denver
278689	Fee-for-Service	1861835951	1861835951	1	1	BACON, EMILY R MD	7/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142488	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
278711	Fee-for-Service	1366820474	1366820474	1	1	BLUM, JENNIFER E PSYD	9/24/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1144 SONOMA AVE	SUITE 104	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
278712	Fee-for-Service	1225505886	1225505886	1	1	BURLINGAME SCHOOL DISTRICT	1/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1825 TROUSDALE DR	None	BURLINGAME	CA	94010	4509	41	06081	37.59192684	-122.3859909	San Mateo County
278715	Fee-for-Service	1790866283	1790866283	1	1	BONNEAU, RAYMOND MD INC	3/13/2009	174400000X	NA	Other	026	PHYSICIANS	30247	20	Orthopedic Surgery	0	In state provider	None	165 ROWLAND WAY	STE 100	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
278717	Fee-for-Service	1598165201	1598165201	1	1	BRISTOL PLAZA FAMILY	2/12/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7903	None	None	0	In state provider	MEDICINE A PROFESSIONAL	3743 S PLAZA DR	None	SANTA ANA	CA	92704	7463	30	06059	33.69825517	-117.888643	Orange County
278722	Fee-for-Service	1245388040	1245388040	1	1	BORIRAKCHANYAVAT, S MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	76948	34	Urology and Urological Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
278723	Fee-for-Service	1043576069	1043576069	1	1	BYERS, HEATHER M MD	7/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148626	01	General Practice	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
278730	Fee-for-Service	1790766533	1790766533	1	1	BARGAN, MIKHAIL A MD	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2400 SOUTH AVENUE	STE A	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
278743	Fee-for-Service	1063468304	1063468304	1	1	BUSTAMANTE, PETER J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1801 N SENATE BLVD	STE 355	INDIANAPOLIS	IN	46202	1252	00	None	39.7904427	-86.16522239	Marion County
278762	Fee-for-Service	1003048331	1003048331	1	1	BATEMAN, LARISSA J LMFT	11/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
278763	Fee-for-Service	1659429553	1659429553	1	1	BRAND, JEFFREY J MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74209	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
278814	Fee-for-Service	1346869732	1346869732	1	1	BISHOP, GRACE OT	6/16/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
278838	Fee-for-Service	1558513812	1558513812	1	1	BLUE MOUNTAIN HOSPITAL	4/30/2016	261QC0050X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	802 SOUTH 200 WEST	None	BLANDING	UT	84511	3910	00	None	37.61345749	-109.4816433	San Juan County
278859	Fee-for-Service	1902494628	1902494628	1	1	BETTER DAYS PSYCHIATRIC NURS	4/11/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	ING INC	1412 S STREET	100	SACRAMENTO	CA	95811	0104	34	06067	38.568438	-121.4917245	Sacramento County
278882	Fee-for-Service	1912318106	1912318106	1	1	BHATIA, TAVLEEN	3/1/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	180978	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
278890	Fee-for-Service	1104986421	1104986421	1	1	BEKHIT, MARY H MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96597	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
278911	Fee-for-Service	1770766479	1770766479	1	1	BREITERMAN, ANDREW MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54442	30	Radiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
278922	Fee-for-Service	1205085925	1205085925	1	1	BERSAMINA, MELISSA B OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
278923	Fee-for-Service	1922481324	1922481324	1	1	BUI, CINDY MD	2/12/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
278951	Fee-for-Service	1437183787	1437183787	1	1	BORD, AIMEE R	2/8/2007	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
278973	Fee-for-Service	1912909938	1912909938	1	1	BODNAR, JOHN A MD	3/31/1994	207P00000X	NA	Other	026	PHYSICIANS	52145	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
278979	Fee-for-Service	1033193669	1033193669	1	1	BRUMUND, KEVIN T MD	5/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91099	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
278980	Fee-for-Service	1821557984	1821557984	1	1	BUI, AI-VY H DO	8/4/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19363	None	None	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
279074	Fee-for-Service	1558513812	1558513812	1	1	BLUE MOUNTAIN HOSPITAL	4/30/2016	261QC0050X	NA	Other	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	802 SOUTH 200 WEST	None	BLANDING	UT	84511	3910	00	None	37.61345749	-109.4816433	San Juan County
279085	Fee-for-Service	1801924733	1801924733	1	1	BURSTIN, CHARLES J MD	5/26/1973	207RN0300X	NA	Nephrology	026	PHYSICIANS	20389	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	9001 WILSHIRE BLVD	STE 203	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
279090	Fee-for-Service	1609952431	1609952431	1	1	BASHOURA, HABIB M MD INC	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52519	01	General Practice	0	In state provider	None	1234 FOOTHILL BLVD	STE 2	LA VERNE	CA	91750	3329	19	06037	34.11800774	-117.7794559	Los Angeles County
279095	Fee-for-Service	1346897592	1346897592	1	1	BROOKS, JORDAN PSYD	5/8/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	601 DUBOCE AVE	STE 250	SAN FRANCISCO	CA	94117	3389	38	06075	37.7691148	-122.4344597	San Francisco County
279156	Fee-for-Service	1356652622	1356652622	1	1	BRACKEN, KENNETH T OD	7/20/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1356A E MAIN ST	None	BARSTOW	CA	92311	3241	36	06071	34.89517129	-117.0057978	San Bernardino County
279190	Fee-for-Service	1679003917	1679003917	1	1	BEARD, BRITTANY N LPCC	8/12/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
279222	Fee-for-Service	1942771811	1942771811	1	1	BAIZAS, CARLA E CRNA	2/13/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
279244	Fee-for-Service	1801961453	1801961453	1	1	BOYER, KENNETH J OD	6/30/1991	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1255 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4122	19	06037	33.99914104	-117.8123495	Los Angeles County
279248	Fee-for-Service	1245340918	1245340918	1	1	BEL AIR PHARMACY #517	2/3/1993	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2222 GRASS VALLEY HWY	None	AUBURN	CA	95603	2536	31	06061	38.93409026	-121.0923246	Placer County
279261	Fee-for-Service	1912046038	1912046038	1	1	BASTEDO, CHARLES E LMFT	11/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5199 E PACIFIC COAST HWY	SUITE 504	LONG BEACH	CA	90804	3371	19	06037	33.78293818	-118.1329326	Los Angeles County
279267	Fee-for-Service	1386151595	1386151595	1	1	B & C PHYSICAL THERAPY, INC.	2/10/2021	225100000X	NA	Physical Therapist	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	41 N GARFIELD AVE	STE #102	ALHAMBRA	CA	91801	7501	19	06037	34.09590269	-118.1274015	Los Angeles County
279277	Fee-for-Service	1376537076	1376537076	1	1	BLOOM, GENEVIEVE E MD	7/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55250	05	Anesthesiology	0	In state provider	None	1117 10TH ST	None	CORONADO	CA	92118	3401	37	06073	32.68577283	-117.1793826	San Diego County
279318	Fee-for-Service	1801924733	1801924733	1	1	BURSTIN, CHARLES J MD	5/26/1973	207RN0300X	NA	Nephrology	026	PHYSICIANS	20389	45	Nephrology (Renal-Kidney)	0	In state provider	A PROFESSIONAL CORP	9001 WILSHIRE BLVD	STE 203	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
279333	Fee-for-Service	1326382318	1326382318	1	1	BAILEY, ETTIE J LMFT	9/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
279341	Fee-for-Service	1801877733	1801877733	1	1	BLAM, MICHAEL E MD	10/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53305	41	Internal Medicine	0	In state provider	None	2925 N. PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
279342	Fee-for-Service	1184834954	1184834954	1	1	BAHRAMI, SHAHNAM N MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107510	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
279358	Fee-for-Service	1699920769	1699920769	1	1	BOSQUE, JOSE R JR MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111402	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
279360	Fee-for-Service	1609869395	1609869395	1	1	BEDROSSIAN, ANNA OD	9/1/1999	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	42002 FOX FARM RD	STE 100	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24855001	-116.8860153	San Bernardino County
279408	Fee-for-Service	1073746467	1073746467	1	1	BERNAL, EVELIN LISSET	7/13/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	GCI MEDICAL SUPPLIES	12053 PARAMOUNT BLVD	None	DOWNEY	CA	90242	2337	19	06037	33.93226565	-118.1458033	Los Angeles County
279468	Fee-for-Service	1821872466	1821872466	1	1	BALL, ELIZABETH LCSW	9/5/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
279478	Fee-for-Service	1982882254	1982882254	1	1	BHANGOO, AMRIT PAL S MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119707	40	Pediatrics	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
279509	Fee-for-Service	1376537076	1376537076	1	1	BLOOM, GENEVIEVE E MD	7/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55250	41	Internal Medicine	0	In state provider	None	1117 10TH ST	None	CORONADO	CA	92118	3401	37	06073	32.68577283	-117.1793826	San Diego County
279520	Fee-for-Service	1356306815	1356306815	1	1	BURKHARDT, JOHN D MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53265	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
279559	Fee-for-Service	1518197250	1518197250	1	1	BAKHTARI, ROSTAM MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108314	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
279571	Fee-for-Service	1801877733	1801877733	1	1	BLAM, MICHAEL E MD	10/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53305	10	Gastroenterology (M.D. only)	0	In state provider	None	2925 N. PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
279579	Fee-for-Service	1447317664	1447317664	1	1	BILLY, HELMUTH T MD	5/31/2006	208600000X	NA	General Surgery	026	PHYSICIANS	72954	02	General Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
279603	Fee-for-Service	1912464017	1912464017	1	1	BOATENG, BETTY N	8/2/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7313 FALLBROOK AVENUE	None	WEST HILLS	CA	91307	2105	19	06037	34.203141	-118.6234595	Los Angeles County
279609	Fee-for-Service	1730167222	1730167222	1	1	BAKER, JEFF P DO	5/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	67559	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 NORTH INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
279615	Fee-for-Service	1942407556	1942407556	1	1	BAVOLEK, REBECCA A MD	11/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145441	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
279623	Fee-for-Service	1154406239	1154406239	1	1	BORBON, JOSEFINA	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56579	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
279637	Fee-for-Service	1316162407	1316162407	1	1	BRAGG, MASON A MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112998	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
279709	Fee-for-Service	1265476196	1265476196	1	1	BRADY, KATHARINE A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78588	22	Pathology (M.D. only)	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
279740	Fee-for-Service	1992935795	1992935795	1	1	BORGIDA, AMANDA K	8/10/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
279774	Fee-for-Service	1528573615	1528573615	1	1	BRAINPOWER WELLNESS INSTITUT	11/3/2024	193400000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	E NURSING CORPORATION	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
279775	Fee-for-Service	1326432600	1326432600	1	1	BAR-ZION, DANI MD	5/25/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164543	40	Pediatrics	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
279780	Fee-for-Service	1255523569	1255523569	1	1	BOONE, SUSAN L MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118004	07	Dermatology	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
279799	Fee-for-Service	1437165107	1437165107	1	1	BAVUSO, FRANK R MD	5/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	15463	22	Pathology (M.D. only)	0	In state provider	None	400 MORRIS ST	STE H	SEBASTOPOL	CA	95472	3830	49	06097	38.40685624	-122.8200572	Sonoma County
279810	Fee-for-Service	1760968754	1760968754	1	1	BAILEY, CEDRIC DO	6/29/2023	207ZP0102X	NA	Other	026	PHYSICIANS	20696	None	None	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
279811	Fee-for-Service	1447317664	1447317664	1	1	BILLY, HELMUTH T MD	5/31/2006	208600000X	NA	General Surgery	026	PHYSICIANS	72954	33	Thoracic Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
279829	Fee-for-Service	1205094935	1205094935	1	1	BASEL ALEBRAHIM	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4530 E MUIRWOOD DR	STE 105	PHOENIX	AZ	85048	7693	00	None	33.303006	-111.9855375	Maricopa County
279842	Fee-for-Service	1164540118	1164540118	1	1	BERMANI, JAWAD MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39444	33	Thoracic Surgery	0	In state provider	None	44725 10TH ST W	STE 120	LANCASTER	CA	93534	3051	19	06037	34.695693	-118.1480965	Los Angeles County
279846	Fee-for-Service	1174656110	1174656110	1	1	BROCK, RACHEL E MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116673	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
279847	Fee-for-Service	1265987267	1265987267	1	1	B & R FAMILY THERAPY, INC.	12/13/2024	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	155 GRANADA ST	STE N	CAMARILLO	CA	93010	7866	56	06111	34.21527102	-119.0535007	Ventura County
279862	Fee-for-Service	1275556706	1275556706	1	1	BELKNAPP, IRENE L NP	7/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
279886	Fee-for-Service	1043316656	1043316656	1	1	BISWAS, NANDA MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47740	68	Hematology	0	In state provider	None	12677 HESPERIA RD	STE 170	VICTORVILLE	CA	92395	7754	36	06071	34.48148078	-117.2906175	San Bernardino County
279897	Fee-for-Service	1215936778	1215936778	1	1	BUSS, WILLIAM C MD	10/1/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	16053	01	General Practice	0	In state provider	None	1500 W 17TH ST	None	SAN BERNARDINO	CA	92411	1203	36	06071	34.13066426	-117.3197549	San Bernardino County
280001	Fee-for-Service	1528573615	1528573615	1	1	BRAINPOWER WELLNESS INSTITUT	1/10/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	E NURSING CORPORATION	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
280002	Fee-for-Service	1487117974	1487117974	1	1	BEHIZAD, KASRA J MD	8/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179102	None	None	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
280017	Fee-for-Service	1932767035	1932767035	1	1	BERTONE, AGUSTINA PHD	7/27/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
280020	Fee-for-Service	1528573615	1528573615	1	3	BRAINPOWER WELLNESS INSTITUT	12/2/2024	261QM0850X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	E NURSING CORPORATION	2230 W CHAPMAN AVE	212	ORANGE	CA	92868	2316	30	06059	33.78787947	-117.8766225	Orange County
280030	Fee-for-Service	1699853283	1699853283	1	1	BERNSTEIN, ALLAN R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	28058	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
280033	Fee-for-Service	1518461862	1518461862	1	1	BRITTEN, KARISSA N MD	3/31/2021	207R00000X	NA	Other	026	PHYSICIANS	166753	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
280050	Fee-for-Service	1316075542	1316075542	1	1	BAEK, DONNY N MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86630	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
280113	Fee-for-Service	1043316656	1043316656	1	1	BISWAS, NANDA MD	5/20/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	12677 HESPERIA RD	STE 170	VICTORVILLE	CA	92395	7754	36	06071	34.48148078	-117.2906175	San Bernardino County
280122	Fee-for-Service	1275065732	1275065732	1	1	BASS, ERICA MD	1/11/2021	208M00000X	NA	Other	026	PHYSICIANS	161379	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
280213	Fee-for-Service	1356392716	1356392716	1	1	BURNS III, ALBERT E DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	669 CRESPI DR	None	PACIFICA	CA	94044	3486	41	06081	37.59659077	-122.4969488	San Mateo County
280226	Fee-for-Service	1144630344	1144630344	1	1	BEAR, JESSICA MD	3/19/2021	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	131284	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
280228	Fee-for-Service	1528573615	1528573615	1	1	BRAINPOWER WELLNESS INSTITUT	1/10/2024	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	E NURSING CORPORATION	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
280243	Fee-for-Service	1396157285	1396157285	1	1	BAILOWITZ, ZACHARY P MD	6/14/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	162964	25	Physical Medicine and Rehabilitation	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
280246	Fee-for-Service	1528573615	1528573615	1	3	BRAINPOWER WELLNESS INSTITUT	8/26/2024	261QM0850X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	E NURSING CORPORATION	2230 W CHAPMAN AVE	212	ORANGE	CA	92868	2316	30	06059	33.78787947	-117.8766225	Orange County
280260	Fee-for-Service	1518127695	1518127695	1	1	BURUGAPALLI, BHUVANESWARI MD	7/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156713	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
280270	Fee-for-Service	1023271871	1023271871	1	1	BENNIE, JAMES R MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115773	None	None	0	In state provider	None	2510 AIRPARK DR	STE 201	REDDING	CA	96001	2461	45	06089	40.57119566	-122.4016582	Shasta County
280316	Fee-for-Service	1417005497	1417005497	1	1	BROMBERGER, PATRICIA MD	11/30/1992	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	38537	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
280337	Fee-for-Service	1114424173	1114424173	1	1	BURNETT, CLAY LMFT	5/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3419 VALLE VERDE DR	None	NAPA	CA	94558	2414	28	06055	38.32542048	-122.292335	Napa County
280347	Fee-for-Service	1487740262	1487740262	1	1	BOVETAS, CHRISTOS G DO MD	6/26/2018	207R00000X	NA	Other	026	PHYSICIANS	82511	41	Internal Medicine	0	In state provider	None	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
280350	Fee-for-Service	1669650099	1669650099	1	1	BRENNER, JOANNE T	12/24/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2201 BROADWAY	STE M-2	OAKLAND	CA	94612	3048	01	06001	37.81102599	-122.267067	Alameda County
280357	Fee-for-Service	1174878151	1174878151	1	1	BUSH, CLARISSA M NP	11/30/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 7M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
280399	Fee-for-Service	1043899651	1043899651	1	1	BAGHDADI, SOROUSH MD	9/18/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
280413	Fee-for-Service	1376690016	1376690016	1	1	BURNS, SHANNON L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
280419	Fee-for-Service	1093988628	1093988628	1	1	BAYE, ZEBAYEL A MD	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115627	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
280434	Fee-for-Service	1780620955	1780620955	1	1	BLACK, MICHAEL L MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	55416	None	None	0	In state provider	None	16300 SAND CANYON AVE	STE 102	IRVINE	CA	92618	3704	30	06059	33.66115075	-117.7742405	Orange County
280452	Fee-for-Service	1528573615	1528573615	1	1	BRAINPOWER WELLNESS INSTITUT	5/4/2024	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	E NURSING CORPORATION	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
280462	Fee-for-Service	1144626417	1144626417	1	1	BARBIERI, KELSEY L LCSW	12/22/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
280470	Fee-for-Service	1538250808	1538250808	1	1	BOKEN, DANIEL J MD	8/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86899	77	Infectious Disease	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
280471	Fee-for-Service	1528573615	1528573615	1	3	BRAINPOWER WELLNESS INSTITUT	8/26/2024	261QM0850X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	E NURSING CORPORATION	2230 W CHAPMAN AVE	212	ORANGE	CA	92868	2316	30	06059	33.78787947	-117.8766225	Orange County
280485	Fee-for-Service	1417484585	1417484585	1	1	BOLDT, HALLIE R LCSW	7/3/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
280495	Fee-for-Service	1922485093	1922485093	1	1	BOYNTON, HEATHER E MD	12/8/2018	207P00000X	NA	Other	026	PHYSICIANS	144245	66	Emergency Medicine (Urgent Care)	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
280506	Fee-for-Service	1578791265	1578791265	1	1	BRADY, DENISE LMFT	12/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4401 ATLANTIC AVE	200	LONG BEACH	CA	90807	2218	19	06037	33.836976	-118.185096	Los Angeles County
280508	Fee-for-Service	1194709956	1194709956	1	1	BAKSHI, SANJEEV MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	STE 13	RENO	NV	89509	6120	00	None	39.47672552	-119.796471	Washoe County
280558	Fee-for-Service	1821061128	1821061128	1	1	BRANNEY, SCOTT W. MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 W 16TH AVE	None	DENVER	CO	80204	1335	00	None	39.74280302	-105.0412741	City and County of Denver
280572	Fee-for-Service	1265675243	1265675243	1	1	BOAL, HANNAH E MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119650	40	Pediatrics	0	In state provider	None	2200 O'FARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
280606	Fee-for-Service	1992024640	1992024640	1	1	BROWN, ISRAEL K O DO	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11716	09	Gynecology (D.O. only)	0	In state provider	None	378 W OLIVE AVE	SUITE D	MERCED	CA	95348	3182	24	06047	37.31916808	-120.4752646	Merced County
280611	Fee-for-Service	1255659827	1255659827	1	1	BAXTER, PETER C MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143254	04	Otology, Laryngology, Rhinology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
280675	Fee-for-Service	1528573615	1528573615	1	1	BRAINPOWER WELLNESS INSTITUT	1/10/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	E NURSING CORPORATION	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
280689	Fee-for-Service	1952324360	1952324360	2	1	BRADEN PARTNERS L P	6/20/2017	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	340 W FALLBROOK AVE	STE 109-110	FRESNO	CA	93711	6177	10	06019	36.8493895	-119.797497	Fresno County
280691	Fee-for-Service	1538250808	1538250808	1	1	BOKEN, DANIEL J MD	8/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86899	41	Internal Medicine	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
280695	Fee-for-Service	1528573615	1528573615	1	3	BRAINPOWER WELLNESS INSTITUT	11/3/2024	261QM0850X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	E NURSING CORPORATION	2230 W CHAPMAN AVE	212	ORANGE	CA	92868	2316	30	06059	33.78787947	-117.8766225	Orange County
280781	Fee-for-Service	1093710022	1093710022	1	1	BIRKENSTEIN, KENNETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35452	08	Family Practice	0	In state provider	None	16960 BASTANCHURY RD	STE A	YORBA LINDA	CA	92886	1711	30	06059	33.8992167	-117.838452	Orange County
280785	Fee-for-Service	1245319375	1245319375	1	1	BAROUMAND SHAMSALDINI, FARDA	12/7/2023	207L00000X	NA	Other	026	PHYSICIANS	103643	None	None	0	In state provider	D MD	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
280795	Fee-for-Service	1912507997	1912507997	1	1	BELLEVUE HOSPICE CARE INC	2/17/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19634 VENTURA BLVD	STE 217	TARZANA	CA	91356	2948	19	06037	34.17264197	-118.5613482	Los Angeles County
280801	Fee-for-Service	1023164365	1023164365	1	1	BERMAN, BLAKE W DO	4/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	8839	14	Neurological Surgery	0	In state provider	None	26520 CACTUS AVE	STE A2006	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
280826	Fee-for-Service	1992024640	1992024640	1	1	BROWN, ISRAEL K O DO	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11716	11	Aviation (M.D. only)	0	In state provider	None	378 W OLIVE AVE	SUITE D	MERCED	CA	95348	3182	24	06047	37.31916808	-120.4752646	Merced County
280836	Fee-for-Service	1912932211	1912932211	1	1	BARNUM, JEFFREY E MD	8/31/1987	207R00000X	NA	Other	026	PHYSICIANS	27231	41	Internal Medicine	0	In state provider	None	9727 ELK GROVE FLORIN RD	None	ELK GROVE	CA	95624	2264	34	06067	38.404503	-121.370994	Sacramento County
280837	Fee-for-Service	1033594783	1033594783	1	1	BIERY, EDWARD A PHD	11/8/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10 HILLSIDE CT	None	CLOVERDALE	CA	95425	3168	49	06097	38.8114478	-123.0273676	Sonoma County
280898	Fee-for-Service	1033382346	1033382346	1	1	BUESCHER, ELIZABETH A MD	4/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115930	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	455 O'CONNOR DRIVE	None	SAN JOSE	CA	95128	1633	43	06085	37.326654	-121.939897	Santa Clara County
280905	Fee-for-Service	1285031625	1285031625	1	1	BORUNDA, FRANK A LMFT	5/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
280908	Fee-for-Service	1316911084	1316911084	1	1	BOWER, BRUCE L MD	1/31/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68737	30	Radiology	0	In state provider	None	8008 FROST ST	STE 106	SAN DIEGO	CA	92123	4229	37	06073	32.80027859	-117.1524832	San Diego County
280913	Fee-for-Service	1538250808	1538250808	1	1	BOKEN, DANIEL J MD	8/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86899	40	Pediatrics	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
280932	Fee-for-Service	1174935670	1174935670	1	1	BESHIR, JACKELYN T MD	11/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156540	07	Dermatology	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
280957	Fee-for-Service	1558411025	1558411025	1	1	BJORNSON, MICHAEL J PHD	2/7/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
280970	Fee-for-Service	1801590393	1801590393	1	1	BL HOMES, INC.	6/7/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	106 VIVIAN DRIVE	None	PLEASANT HILL	CA	94523	2936	07	06013	37.95169579	-122.0633518	Contra Costa County
280986	Fee-for-Service	1134216930	1134216930	1	1	BISWAS, ARNAB DO	6/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	9189	10	Gastroenterology (M.D. only)	0	In state provider	None	12565 HESPERIA RD	STE 1	VICTORVILLE	CA	92395	8318	36	06071	34.47971486	-117.2908434	San Bernardino County
281014	Fee-for-Service	1912507997	1912507997	1	1	BELLEVUE HOSPICE CARE INC	2/17/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19634 VENTURA BLVD	STE 217	TARZANA	CA	91356	2948	19	06037	34.17264197	-118.5613482	Los Angeles County
281029	Fee-for-Service	1083793590	1083793590	1	1	BUU, THAO THI DONG OPT	8/10/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	61 SERRA WAY	STE 128	MILPITAS	CA	95035	8519	43	06085	37.42799329	-121.907974	Santa Clara County
281030	Fee-for-Service	1326525890	1326525890	1	1	BRADLEY, ALYSSA R LMFT	5/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	737 SAVORY LN	None	SAN JACINTO	CA	92582	6231	33	06065	33.80540746	-116.9868373	Riverside County
281113	Fee-for-Service	1649750803	1649750803	1	1	BEDOLLA, CARINA P	2/24/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	33	06065	33.99323085	-117.3355363	Riverside County
281130	Fee-for-Service	1316077522	1316077522	1	1	BARAJAS-CALKINS, ROSALINDA L	9/20/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1274 CENTER COURT DR	#112	COVINA	CA	91724	3668	19	06037	34.07278979	-117.8637519	Los Angeles County
281146	Fee-for-Service	1033143300	1033143300	1	1	BJORK, ROBERT L JR MD	8/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39787	40	Pediatrics	0	In state provider	None	7300 GIRARD AVE	STE 106	LA JOLLA	CA	92037	5138	37	06073	32.83772948	-117.2716382	San Diego County
281164	Fee-for-Service	1447516950	1447516950	1	1	BEHREND, TRAVIS L MD	2/3/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
281202	Fee-for-Service	1427642461	1427642461	1	1	BLUE SHIELD HOSPICE	3/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	269 W ALAMEDA AVE	STE B	BURBANK	CA	91502	2594	19	06037	34.16723083	-118.3075057	Los Angeles County
281230	Fee-for-Service	1629176284	1629176284	1	1	BROWNE, RICHARD MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	25064	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PLAZA DR	None	SANTA MARIA	CA	93454	6907	42	06083	34.93736276	-120.4298781	Santa Barbara County
281256	Fee-for-Service	1194146688	1194146688	1	1	BERGHEIM, TERESE S MD	10/7/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	138240	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
281336	Fee-for-Service	1992833727	1992833727	1	1	BRIDWELL, MARGARET L	8/8/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
281357	Fee-for-Service	1528573615	1528573615	1	2	BRAINPOWER WELLNESS INSTITUT	6/3/2024	261QM0850X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	E NURSING CORPORATION	1101 CALIFORNIA AVE	STE 100-18	CORONA	CA	92881	6470	33	06065	33.86171794	-117.5440764	Riverside County
281363	Fee-for-Service	1710204540	1710204540	1	1	BRIAN A MCDOWELL PODIATRY	9/14/2011	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	DICS	6620 COYLE AVE	STE 202	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
281375	Fee-for-Service	1194096602	1194096602	1	1	BIRCH, KARA M NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
281399	Fee-for-Service	1891876652	1891876652	1	1	BROUKHIM, KAMRAN H MD	11/30/1990	207L00000X	NA	Other	026	PHYSICIANS	68940	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
281400	Fee-for-Service	1659576544	1659576544	1	1	BHATIA, SUNDEEP MD	2/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87935	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
281418	Fee-for-Service	1427642461	1427642461	1	1	BLUE SHIELD HOSPICE	3/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	269 W ALAMEDA AVE	STE B	BURBANK	CA	91502	2594	19	06037	34.16723083	-118.3075057	Los Angeles County
281470	Fee-for-Service	1467647636	1467647636	1	1	BEVERLY RADIOLOGY MED GR	2/13/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IMAGING	12677 HESPERIA RD	STE 190	VICTORVILLE	CA	92395	7735	36	06071	34.48148078	-117.2906175	San Bernardino County
281476	Fee-for-Service	1093548141	1093548141	1	1	BETCHART, JULIA PT	10/28/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
281515	Fee-for-Service	1578571170	1578571170	1	1	BUI, GENE P MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32706	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
281533	Fee-for-Service	1578518486	1578518486	1	1	BRIAN TIFFANY, M.D.	11/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
281543	Fee-for-Service	1568705374	1568705374	1	1	BAJAJ, CHHAVI MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133435	None	None	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
281569	Fee-for-Service	1528573615	1528573615	1	2	BRAINPOWER WELLNESS INSTITUT	6/3/2024	261QM0850X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	E NURSING CORPORATION	1101 CALIFORNIA AVE	STE 100-18	CORONA	CA	92881	6470	33	06065	33.86171794	-117.5440764	Riverside County
281576	Fee-for-Service	1710204540	1710204540	1	1	BRIAN A MCDOWELL PODIATRY	4/10/2020	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DICS	6620 COYLE AVE	STE 202	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
281592	Fee-for-Service	1225228851	1225228851	1	1	BAKHDA, SAMEER R MD	2/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77630	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
281615	Fee-for-Service	1215627328	1215627328	1	1	BAILEY, DYLAN PT	7/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7900 DISTRICT BLVD	C	BAKERSFIELD	CA	93313	4844	15	06029	35.31318383	-119.0908089	Kern County
281766	Fee-for-Service	1790273001	1790273001	1	1	BAJWA, ALISHA DO	12/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19052	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
281769	Fee-for-Service	1194926089	1194926089	1	1	BALQUIEDRA, NADIA CRNA	11/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
281782	Fee-for-Service	1528573615	1528573615	1	2	BRAINPOWER WELLNESS INSTITUT	11/3/2024	261QM0850X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	E NURSING CORPORATION	1101 CALIFORNIA AVE	STE 100-18	CORONA	CA	92881	6470	33	06065	33.86171794	-117.5440764	Riverside County
281851	Fee-for-Service	1891787289	1891787289	1	1	BROWN, HOSEA E MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33523	03	Allergy	0	In state provider	None	1276 N PALM CANYON DR	STE 110	PALM SPRINGS	CA	92262	4429	33	06065	33.84050023	-116.5467455	Riverside County
281858	Fee-for-Service	1720598154	1720598154	1	1	BICKELMAN, SARAH M	1/19/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
281863	Fee-for-Service	1235153735	1235153735	1	1	BLACKMON, GARYUN B MD	6/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98899	30	Radiology	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
281878	Fee-for-Service	1659489979	1659489979	1	1	BACHWANI, JYOTHI MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100924	41	Internal Medicine	0	In state provider	None	3466 MT DIABLO BLVD	C-100	ORINDA	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
281881	Fee-for-Service	1346375565	1346375565	1	1	BOYD, NANCY D MD	1/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44984	01	General Practice	0	In state provider	None	3630 GOLDEN SPUR ST	STE C	LAKE ISABELLA	CA	93240	9495	15	06029	35.62611033	-118.4705046	Kern County
281888	Fee-for-Service	1396391454	1396391454	1	1	BOLANOS, VERONICA J CNP	7/8/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
281917	Fee-for-Service	1225246366	1225246366	1	1	BRIAN GABRIEL SCHWARTZ M.D.	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4708 ALLIANCE BLVD	STE 650	PLANO	TX	75093	5319	00	None	33.01436822	-96.79188861	Collin County
281932	Fee-for-Service	1356599443	1356599443	1	1	BUCHNER, WILLIAM H JR MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109750	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
281939	Fee-for-Service	1295166296	1295166296	1	1	BAXTER, HEIDI OD	5/8/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1026-B WEST COVINA PKWY	None	WEST COVINA	CA	91790	8212	19	06037	34.06855822	-117.9319371	Los Angeles County
281960	Fee-for-Service	1518968767	1518968767	1	1	BISBEE HOSPITAL ASSOCIATION	5/27/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	101 COLE AVE	None	BISBEE	AZ	85603	1327	00	None	31.417632	-109.883106	Cochise County
281984	Fee-for-Service	1871151894	1871151894	1	1	BIG DOG CITY CORPORATION	4/1/2021	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	531 BAYSHORE BLVD	None	SAN FRANCISCO	CA	94124	1639	38	06075	37.738728	-122.407003	San Francisco County
281990	Fee-for-Service	1528573615	1528573615	1	2	BRAINPOWER WELLNESS INSTITUT	6/3/2024	261QM0850X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	E NURSING CORPORATION	1101 CALIFORNIA AVE	STE 100-18	CORONA	CA	92881	6470	33	06065	33.86171794	-117.5440764	Riverside County
282001	Fee-for-Service	1306900402	1306900402	1	2	BHARMAL, NAZLEEN H MD	8/6/2024	207R00000X	NA	Other	026	PHYSICIANS	99524	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282044	Fee-for-Service	1275776106	1275776106	1	1	BATSULI, GLAIVY M MD	9/20/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	190233	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
282090	Fee-for-Service	1346375565	1346375565	1	1	BOYD, NANCY D MD	1/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44984	40	Pediatrics	0	In state provider	None	3630 GOLDEN SPUR ST	STE C	LAKE ISABELLA	CA	93240	9495	15	06029	35.62611033	-118.4705046	Kern County
282100	Fee-for-Service	1619498078	1619498078	1	1	BURMAYAN, SUZAN	2/2/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3658 NOGALES ST	None	WEST COVINA	CA	91792	2714	19	06037	34.0113478	-117.8866414	Los Angeles County
282120	Fee-for-Service	1417333782	1417333782	1	1	BETTER HEALTH PHARMACY &	11/2/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL SUPPLY	7802 FOOTHILL BLVD	UNIT G	SUNLAND	CA	91040	2993	19	06037	34.25927158	-118.3029748	Los Angeles County
282132	Fee-for-Service	1225128713	1225128713	1	1	BURNETT,ALEXANDER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 WEST MARKHAM	None	LITTLEROCK	AR	72205	0000	00	None	34.749009	-92.320101	Pulaski County
282140	Fee-for-Service	1649686163	1649686163	1	1	BASU, PIALI DO	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	14469	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
282156	Fee-for-Service	1700844743	1700844743	1	1	BERG, TERESA G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
282165	Fee-for-Service	1336202977	1336202977	1	1	BLUMENTHAL, PAUL MD	3/31/1982	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	47601	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
282168	Fee-for-Service	1518968767	1518968767	1	1	BISBEE HOSPITAL ASSOCIATION	3/25/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	101 COLE AVE	None	BISBEE	AZ	85603	1327	00	None	31.417632	-109.883106	Cochise County
282171	Fee-for-Service	1093853285	1093853285	1	1	BAART BEHAVI0RAL HEALTH	8/1/1988	261QC1500X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1926 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2402	19	06037	34.06588198	-118.2686209	Los Angeles County
282236	Fee-for-Service	1407103401	1407103401	1	1	BANSAL, SURBHI OD	10/24/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282255	Fee-for-Service	1205018546	1205018546	1	1	BAHLING, JOHN R MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
282261	Fee-for-Service	1225490741	1225490741	1	1	BA'GAH, REBECCA T MD	4/16/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	167087	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
282281	Fee-for-Service	1538549852	1538549852	1	1	BAKERSFIELD SPECIALISTS	2/16/2016	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGICAL CENTER, LLC	4500 MORNING DR	SUITE 102	BAKERSFIELD	CA	93306	7275	15	06029	35.39343836	-118.9166214	Kern County
282311	Fee-for-Service	1982232146	1982232146	1	1	BAUMANN, DANIELA N OD	2/6/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	504	LOS ANGELES	CA	90017	3906	19	06037	34.05270508	-118.2641005	Los Angeles County
282329	Fee-for-Service	1992860951	1992860951	1	1	BIKO, DAVID M MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121882	30	Radiology	0	In state provider	None	2801 K STREET	SUITE 502	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
282369	Fee-for-Service	1659473486	1659473486	1	1	BROWN, JAMES C JR	2/28/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5317	08	Family Practice	0	In state provider	None	225 SPRUCE ST	None	GRIDLEY	CA	95948	2215	04	06007	39.36695351	-121.68954	Butte County
282413	Fee-for-Service	1023029766	1023029766	1	1	BAKER, GARY L MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	52700	05	Anesthesiology	0	In state provider	None	30777 HIGHLAND AVE	None	REDLANDS	CA	92374	7686	36	06071	34.05177733	-117.1331046	San Bernardino County
282460	Fee-for-Service	1205018546	1205018546	1	1	BAHLING, JOHN R MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
282463	Fee-for-Service	1912009697	1912009697	1	1	BABBITT, CHRISTOPHER MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60042	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
282464	Fee-for-Service	1144218090	1144218090	1	1	BURNS, JOSEPH E MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	7851	30	Radiology	0	In state provider	None	2320 BATH ST	STE 208	SANTA BARBARA	CA	93105	5322	42	06083	34.43082689	-119.7223032	Santa Barbara County
282472	Fee-for-Service	1154409290	1154409290	1	1	BHASKER-RAO, BOBBY S MD	11/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76846	02	General Surgery	0	In state provider	None	1100 N PALM CANYON DR	STE 206	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
282473	Fee-for-Service	1922147602	1922147602	1	1	BROOKS,STEPHEN N MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70461	13	Neurology (M.D. only)	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
282488	Fee-for-Service	1124316559	1124316559	1	1	BASKIN, LIANE LMFT	9/14/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
282503	Fee-for-Service	1669843728	1669843728	2	1	BECKLES, MELISSA	8/10/2024	103TP2700X	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1234 ASHBY AVE.	UNIT D	BERKELEY	CA	94702	4220	01	06001	37.85242937	-122.2851332	Alameda County
282539	Fee-for-Service	1811077704	1811077704	1	1	BALTINS, ALDIS MD	11/22/1977	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	28762	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	1165 S DORA ST	STE C1	UKIAH	CA	95482	6353	23	06045	39.13602308	-123.2095502	Mendocino County
282566	Fee-for-Service	1497745202	1497745202	1	1	BUNTIC, RUDOLF F MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	74250	46	Hand Surgery	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
282596	Fee-for-Service	1881155497	1881155497	1	1	BLANC, THEDDY R DO	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
282602	Fee-for-Service	1598476699	1598476699	1	1	BETD SAN FERNANDO CARE LLC	6/7/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	628 N LAZARD STREET	None	SAN FERNANDO	CA	91340	1927	19	06037	34.29565213	-118.4394324	Los Angeles County
282616	Fee-for-Service	1023029766	1023029766	1	1	BAKER, GARY L MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	52700	08	Family Practice	0	In state provider	None	30777 HIGHLAND AVE	None	REDLANDS	CA	92374	7686	36	06071	34.05177733	-117.1331046	San Bernardino County
282621	Fee-for-Service	1184647158	1184647158	1	1	BIO MEDICAL APPLICATIONS	11/29/2006	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA INC	8625 LIBERTY PARK DR	STE 102	BAKERSFIELD	CA	93311	1381	15	06029	35.34199554	-119.099718	Kern County
282635	Fee-for-Service	1760786818	1760786818	1	1	BAYKANER, TINA MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	120124	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282669	Fee-for-Service	1649332990	1649332990	1	1	BEERS, DANIEL J MD	12/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1174 CASTRO ST	STE 100	MOUNTAIN VIEW	CA	94040	2572	43	06085	37.3822628	-122.0861276	Santa Clara County
282709	Fee-for-Service	1801114111	1801114111	1	1	BAILONY, MOHAMMED R	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120308	01	General Practice	0	In state provider	None	1650 S AMPHLETT BLVD	SUITE 216	SAN MATEO	CA	94402	2517	41	06081	37.55960048	-122.3025678	San Mateo County
282740	Fee-for-Service	1811077704	1811077704	1	1	BALTINS, ALDIS MD	11/22/1977	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	28762	20	Orthopedic Surgery	0	In state provider	None	1165 S DORA ST	STE C1	UKIAH	CA	95482	6353	23	06045	39.13602308	-123.2095502	Mendocino County
282761	Fee-for-Service	1689731416	1689731416	1	1	BELL-ANDERSON, CHRISTINE M	6/13/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	15525 POMERADO RD	STE C1	POWAY	CA	92064	2435	37	06073	32.99479918	-117.0579468	San Diego County
282767	Fee-for-Service	1497745202	1497745202	1	1	BUNTIC, RUDOLF F MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	74250	24	Plastic Surgery	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
282795	Fee-for-Service	1992068159	1992068159	1	1	BERNSTEIN, JESSE S MD	1/6/2021	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	153776	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
282833	Fee-for-Service	1760786818	1760786818	1	1	BAYKANER, TINA MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	120124	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282843	Fee-for-Service	1700898988	1700898988	1	1	BAICK, DONNA G MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70561	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
282845	Fee-for-Service	1952150823	1952150823	1	1	BISHOP, VIVIAN	1/21/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	15	06029	0	0	None
282853	Fee-for-Service	1043337173	1043337173	1	1	BUDIHARDJO, IMAWATI MD	12/21/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	84421	83	Rheumatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
282892	Fee-for-Service	1639357841	1639357841	1	1	BAJWA, MEERA MD	6/26/2020	174400000X	NA	Other	026	PHYSICIANS	83248	41	Internal Medicine	0	In state provider	None	1300 S ELISEO DRIVE	SUITE 104	GREENBRAE	CA	94904	2014	21	06041	37.94447529	-122.53657	Marin County
282898	Fee-for-Service	1659656528	1659656528	1	1	BRADLEY, TROY D II LCSW	6/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
282908	Fee-for-Service	1801114111	1801114111	1	1	BAILONY, MOHAMMED R	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120308	08	Family Practice	0	In state provider	None	1650 S AMPHLETT BLVD	SUITE 216	SAN MATEO	CA	94402	2517	41	06081	37.55960048	-122.3025678	San Mateo County
282923	Fee-for-Service	1437644457	1437644457	1	3	BEACHVIEW TREATMENT, LLC	4/9/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	602 GENEVA AVENUE	None	HUNTINGTON BEACH	CA	92648	3802	30	06059	33.66311539	-117.9917155	Orange County
282926	Fee-for-Service	1750328373	1750328373	1	1	BERNARD, LISA D MD	6/1/1999	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62336	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	# M1477	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
282928	Fee-for-Service	1871645002	1871645002	1	1	BROZELL, DOUGLAS P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44535	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
282935	Fee-for-Service	1811077704	1811077704	1	1	BALTINS, ALDIS MD	1/1/1979	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1165 S DORA ST	STE C1	UKIAH	CA	95482	6353	23	06045	39.13602308	-123.2095502	Mendocino County
282936	Fee-for-Service	1306926787	1306926787	1	1	BRUNS, JAMES E 0D	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6180 STATE FARM DR	None	ROHNERT PARK	CA	94928	2135	49	06097	38.350017	-122.7059605	Sonoma County
282941	Fee-for-Service	1225046352	1225046352	1	1	BAK, ROY M MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79654	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
282966	Fee-for-Service	1669550307	1669550307	1	1	BERRY, CAROL D	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
283008	Fee-for-Service	1720763451	1720763451	1	1	BACA, TODD CNP	12/11/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
283020	Fee-for-Service	1528321767	1528321767	1	1	BALASUBRAMANIAM, SARANYA C	7/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143000	None	None	0	In state provider	MD	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
283026	Fee-for-Service	1760786818	1760786818	1	1	BAYKANER, TINA MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	120124	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
283048	Fee-for-Service	1043337173	1043337173	1	1	BUDIHARDJO, IMAWATI MD	12/21/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	84421	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283056	Fee-for-Service	1407836323	1407836323	1	1	BERNAT, AVIVA S MD	1/17/2020	207R00000X	NA	Other	026	PHYSICIANS	98681	41	Internal Medicine	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
283071	Fee-for-Service	1164678058	1164678058	1	1	BAY IMAGING CONSULTANTS	6/30/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
283072	Fee-for-Service	1699081091	1699081091	1	1	BENNETT, SARA G	11/21/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
283074	Fee-for-Service	1750440491	1750440491	1	1	BECKHAM, GERALD E MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95410	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
283095	Fee-for-Service	1366446312	1366446312	1	1	BONAVITA, FRANK A MD	8/31/1983	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52398	41	Internal Medicine	0	In state provider	None	2720 N HARBOR BLVD	STE 210	FULLERTON	CA	92835	2626	30	06059	33.90126238	-117.9292154	Orange County
283098	Fee-for-Service	1780926154	1780926154	1	1	BATH, AMANPREET K MD	4/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138365	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
283100	Fee-for-Service	1558454355	1558454355	1	1	BRESENO, JUSTINA M MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	50599	40	Pediatrics	0	In state provider	None	26520 CACTUS AVENUE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
283127	Fee-for-Service	1962452680	1962452680	1	1	BERTE, LARRY E MD	6/21/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	42762	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 UNIVERSITY AVE	STE 18	SACRAMENTO	CA	95825	6504	34	06067	38.568402	-121.418019	Sacramento County
283142	Fee-for-Service	1154716454	1154716454	1	1	BENDER, MATTHEW T MD	8/22/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	179187	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283146	Fee-for-Service	1073949517	1073949517	1	1	BELTRAN, JOYCE M D MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132532	01	General Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
283182	Fee-for-Service	1508957895	1508957895	1	1	BUFFENN, ANGELA N MD	8/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76397	18	Ophthalmology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
283185	Fee-for-Service	1477735421	1477735421	1	1	BISCONTI, KIMBERLY L	9/17/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	24422 AVENIDA DE LA CARL	STE 165	LAGUNA HILLS	CA	92653	3670	30	06059	33.56726005	-117.705397	Orange County
283206	Fee-for-Service	1487098497	1487098497	1	1	BELLA, ARCHIE P MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134155	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
283211	Fee-for-Service	1538505938	1538505938	1	1	BEACH CITIES VEIN CENTER INC	4/10/2014	2085R0204X	NA	Other	026	PHYSICIANS	64513	30	Radiology	0	In state provider	None	390 N SEPULVEDA BLVD	STE 1030	EL SEGUNDO	CA	90245	0015	19	06037	33.92077214	-118.3960953	Los Angeles County
283254	Fee-for-Service	1710035662	1710035662	1	1	BALTAZAR, SANDRA CRNA	9/1/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
283256	Fee-for-Service	1437242856	1437242856	1	1	BOUTROS,LETICIA R RN	2/1/2000	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
283267	Fee-for-Service	1063948651	1063948651	1	1	BROWN, VICTORIA LMFT	2/19/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	265 S RANDOLPH AVE	STE 120	BREA	CA	92821	5798	30	06059	33.91513051	-117.8897392	Orange County
283268	Fee-for-Service	1750325502	1750325502	1	1	BARBER, CAROLYN R MD	10/31/1995	207P00000X	NA	Other	026	PHYSICIANS	54384	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
283356	Fee-for-Service	1902995400	1902995400	1	1	BUCKLEY, BYRON J MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94237	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
283380	Fee-for-Service	1891022778	1891022778	1	1	BOUTARY, MYRIAM CNP	7/31/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14735 VENTURA BLVD	None	SHERMAN OAKS	CA	91403	3679	19	06037	34.15187275	-118.4543653	Los Angeles County
283386	Fee-for-Service	1376734087	1376734087	1	1	BROADVIEW RESD CARE CNT	6/15/2007	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	535 W BROADWAY	None	GLENDALE	CA	91204	1131	19	06037	34.14684107	-118.2664059	Los Angeles County
283514	Fee-for-Service	1699775528	1699775528	1	1	BOSWELL, DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 W SAINT MARYS RD	None	TUCSON	AZ	85745	2623	00	None	32.228199	-111.0000825	Pima County
283518	Fee-for-Service	1437178951	1437178951	1	1	BATTAGLIA, STEVEN A	2/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	78370	None	None	0	In state provider	None	65 N MADISON AVE	STE 709	PASADENA	CA	91101	2097	19	06037	34.14705803	-118.1384317	Los Angeles County
283525	Fee-for-Service	1295843977	1295843977	1	1	BAILEY, JOSELYN E MD	4/18/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	34767	45	Nephrology (Renal-Kidney)	0	In state provider	None	4305 TORRANCE BLVD	STE 506	TORRANCE	CA	90503	4492	19	06037	33.83759546	-118.359342	Los Angeles County
283528	Fee-for-Service	1356471254	1356471254	1	1	BOLTON, JULIE DO	7/1/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7690	08	Family Practice	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
283552	Fee-for-Service	1518120252	1518120252	1	1	BENNETT, JEREMY S MD	3/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112564	01	General Practice	0	In state provider	None	51 HITCHCOCK	None	SANTA BARBARA	CA	93105	3101	42	06083	34.43833587	-119.7444336	Santa Barbara County
283555	Fee-for-Service	1568532349	1568532349	1	1	BUTTAN, POONAM MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43173	01	General Practice	0	In state provider	None	166 N VILLA ST	None	PORTERVILLE	CA	93257	3218	54	06107	36.06885992	-119.0306664	Tulare County
283569	Fee-for-Service	1497822373	1497822373	1	1	BECKER, MATTHEW A MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	80057	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
283581	Fee-for-Service	1528246451	1528246451	1	1	BEATTIE, KATHLEEN C LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
283606	Fee-for-Service	1154409878	1154409878	1	1	BAHL, CAROLYN A MD	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	62472	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
283666	Fee-for-Service	1497983498	1497983498	1	1	BEAUCHMAN, NASEEM N MD	2/26/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	152220	20	Orthopedic Surgery	0	In state provider	None	3329 G ST	A	MERCED	CA	95340	1005	24	06047	37.32376785	-120.4693349	Merced County
283678	Fee-for-Service	1790717650	1790717650	1	1	BRIGHAM & WOMEN'S HOSP.	1/1/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	75 FRANCIS ST	None	BOSTON	MA	02115	6106	00	None	42.335946	-71.10675	Suffolk County
283684	Fee-for-Service	1669419602	1669419602	1	1	BAKER, DENNIS H MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50855	41	Internal Medicine	0	In state provider	None	515 E MICHELTORENA ST	SUITE C	SANTA BARBARA	CA	93103	2257	42	06083	34.43172339	-119.7024817	Santa Barbara County
283702	Fee-for-Service	1396462123	1396462123	1	1	BARNETT, SARAH LCSW	10/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
283707	Fee-for-Service	1952797540	1952797540	1	1	BRADY, KATELYN A NP	1/30/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283711	Fee-for-Service	1295843977	1295843977	1	1	BAILEY, JOSELYN E MD	4/18/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	34767	41	Internal Medicine	0	In state provider	None	4305 TORRANCE BLVD	STE 506	TORRANCE	CA	90503	4492	19	06037	33.83759546	-118.359342	Los Angeles County
283718	Fee-for-Service	1992342141	1992342141	1	1	BORKOWICZ, KELLY CCC-SP	11/23/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3518 JEFFERSON AVE	None	REDWOOD CITY	CA	94062	3136	41	06081	37.46715891	-122.2492205	San Mateo County
283732	Fee-for-Service	1205397361	1205397361	1	1	BUI, ANDREW DO	8/29/2023	207R00000X	NA	Other	026	PHYSICIANS	19860	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
283737	Fee-for-Service	1518120252	1518120252	1	1	BENNETT, JEREMY S MD	3/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112564	08	Family Practice	0	In state provider	None	51 HITCHCOCK	None	SANTA BARBARA	CA	93105	3101	42	06083	34.43833587	-119.7444336	Santa Barbara County
283739	Fee-for-Service	1568532349	1568532349	1	1	BUTTAN, POONAM MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43173	40	Pediatrics	0	In state provider	None	166 N VILLA ST	None	PORTERVILLE	CA	93257	3218	54	06107	36.06885992	-119.0306664	Tulare County
283753	Fee-for-Service	1386753630	1386753630	1	1	BROWNE, VAUGHN A MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
283756	Fee-for-Service	1902068562	1902068562	1	1	BHAT, ANITA MD	9/15/2010	207RE0101X	NA	Endocrinology	026	PHYSICIANS	103188	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
283764	Fee-for-Service	1881776524	1881776524	1	1	BLAND, PHILLIP STEPHEN	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	62795	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	STE 1010	LOS ANGELES	CA	90017	4001	19	06037	34.05270508	-118.2641005	Los Angeles County
283802	Fee-for-Service	1417667890	1417667890	1	1	BORJA, CAMILA CNM	3/24/2025	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
283809	Fee-for-Service	1487711560	1487711560	1	1	BLACK OAK MINE UNIFIED	10/24/2002	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	6450 WENTWORTH SPRINGS R	None	GEORGETOWN	CA	95634	9701	09	06017	38.91079831	-120.8345004	El Dorado County
283840	Fee-for-Service	1710151683	1710151683	1	1	BATJARGAL MANALJAV	5/2/2011	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	700 25TH AVE	None	SAN FRANCISCO	CA	94121	3612	38	06075	37.77614003	-122.4844007	San Francisco County
283860	Fee-for-Service	1790717650	1790717650	1	1	BRIGHAM & WOMEN'S HOSP.	1/1/2003	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	75 FRANCIS ST	None	BOSTON	MA	02115	6106	00	None	42.335946	-71.10675	Suffolk County
283867	Fee-for-Service	1407983554	1407983554	1	1	BLACKMAN, BONNIE LMFT	9/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
283873	Fee-for-Service	1811981004	1811981004	1	1	BENSY,JOSEPH J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 BOWER HILL RD	None	PITTSBURGH	PA	15243	0000	00	None	40.37744491	-80.06601413	Allegheny County
283878	Fee-for-Service	1972705457	1972705457	1	1	BALASUBRAMANIAN, VIDHYA MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108315	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
283894	Fee-for-Service	1710920327	1710920327	1	1	BLANCHARD VALLEY REGIONAL	3/15/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH CENTER	1900 S MAIN STREET	None	FINDLAY	OH	45840	1239	00	None	41.0177728	-83.65037449	Hancock County
283911	Fee-for-Service	1326154063	1326154063	1	1	BALKIAN, GARO K MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63683	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DESOTO AVE	None	WOODLAND HILLS	CA	91367	0000	19	06037	34.17030266	-118.5881699	Los Angeles County
283999	Fee-for-Service	1386223998	1386223998	1	1	BANH, HELEN DO	7/10/2024	390200000X	NA	Other	026	PHYSICIANS	23061	08	Family Practice	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
284001	Fee-for-Service	1316025810	1316025810	1	1	BUI-THOMPSON, LOAN K DO	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8188	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
284058	Fee-for-Service	1972705457	1972705457	1	1	BALASUBRAMANIAN, VIDHYA MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108315	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
284078	Fee-for-Service	1710920327	1710920327	1	1	BLANCHARD VALLEY REGIONAL	3/15/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH CENTER	1900 S MAIN STREET	None	FINDLAY	OH	45840	1239	00	None	41.0177728	-83.65037449	Hancock County
284108	Fee-for-Service	1023395829	1023395829	1	1	BEYERS PHARMACY SERVICES,	7/12/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	4184 C PIEDMONT AVE	None	OAKLAND	CA	94611	5174	01	06001	37.8271698	-122.2513854	Alameda County
284113	Fee-for-Service	1649439449	1649439449	1	1	BHE, ANTHONY J MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118394	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
284152	Fee-for-Service	1922409556	1922409556	1	1	BEELI, KIMBERELY D LCSW	7/31/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	SUITE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
284169	Fee-for-Service	1689924649	1689924649	1	1	BASARAN, IRMAK LPCC	6/15/2020	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	244 CALIFORNIA	STE 300	SAN FRANCISCO	CA	94111	4302	38	06075	37.79331375	-122.3995607	San Francisco County
284239	Fee-for-Service	1972705457	1972705457	1	1	BALASUBRAMANIAN, VIDHYA MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108315	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
284263	Fee-for-Service	1467680892	1467680892	1	1	BRAGG, CERELIA LCSW	3/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST STE 308	None	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
284272	Fee-for-Service	1225071418	1225071418	1	1	BAHRANI, AWATIF A MD	11/27/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42101	36	Psychiatry	0	In state provider	None	16152 BEACH BLVD	#200	HUNTINGTON BEACH	CA	92647	3806	30	06059	33.72889962	-117.9891397	Orange County
284316	Fee-for-Service	1154316693	1154316693	1	1	BEVERLY A GOLDBERG, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	275 VARNUM AVE	STE 203	LOWELL	MA	01854	2109	00	None	42.646932	-71.340453	Middlesex County
284320	Fee-for-Service	1588059281	1588059281	1	1	BARKSDALE, LETICIA MD	2/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157377	None	None	0	In state provider	None	1984 INDIAN HILL BLVD	None	POMONA	CA	91767	3620	19	06037	34.07932777	-117.7191928	Los Angeles County
284363	Fee-for-Service	1225242159	1225242159	1	1	BANDY, KRISTEN R MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97671	05	Anesthesiology	0	In state provider	None	11234 ANDERSON STREET	None	LOMA LINDA	CA	92359	2804	36	06071	34.049547	-117.264078	San Bernardino County
284369	Fee-for-Service	1538378716	1538378716	1	1	BURKETT, PAMELA M LMFT	6/12/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	45710	-	NOT APPLICABLE	0	In state provider	None	1342 E 27TH ST	None	OAKLAND	CA	94606	3266	01	06001	37.79774266	-122.2348494	Alameda County
284372	Fee-for-Service	1073575312	1073575312	1	1	BIRTWHISTLE, WILLIAM MD	3/15/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	27815	40	Pediatrics	0	In state provider	None	2141 MONO WAY	None	SONORA	CA	95370	0000	55	06109	37.9798368	-120.3087913	Tuolumne County
284480	Fee-for-Service	1700894540	1700894540	1	1	BESANA, MARY ANN CAROL C	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97087	08	Family Practice	0	In state provider	MD	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
284497	Fee-for-Service	1528406881	1528406881	1	1	BENHAM, JOSHUA J MD	9/14/2017	390200000X	NA	Other	026	PHYSICIANS	148739	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2300 CALIFORNIA ST	101	SAN FRANCISCO	CA	94115	2753	38	06075	37.78910083	-122.4323944	San Francisco County
284561	Fee-for-Service	1922569433	1922569433	1	1	BRADY, REBECCA G MD	6/26/2024	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
284562	Fee-for-Service	1154578060	1154578060	1	1	BOCK, MARGRET E MD	12/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	13199 E MOUNTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
284566	Fee-for-Service	1053448787	1053448787	1	1	BURGOS, RAQUEL E MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63138	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
284595	Fee-for-Service	1225618978	1225618978	1	1	BENAKANAKERE, INDIRA MD	8/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
284605	Fee-for-Service	1699846576	1699846576	1	1	BAISCH, NANCY MARIE MD	5/21/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68594	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
284633	Fee-for-Service	1316967474	1316967474	1	1	BURACK, JEFFREY H MD	2/5/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67962	41	Internal Medicine	0	In state provider	None	2850 TELEGRAPH AVE	STE 110	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
284660	Fee-for-Service	1710296371	1710296371	1	1	BRISTOW, BENJAMIN N MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105377	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
284686	Fee-for-Service	1104060466	1104060466	1	1	BIELAWIEC, IRENE K MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117875	02	General Surgery	0	In state provider	None	19333 BEAR VALLEY ROAD	SUITE 104	APPLE VALLEY	CA	92308	5149	36	06071	34.47104148	-117.2413863	San Bernardino County
284697	Fee-for-Service	1467631218	1467631218	1	1	BRUCE L. WHITNEY, PH.D., A P	7/29/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SYCHOLOGY CORPORATION	2393 TOWNSGATE RD	100A	WESTLAKE VILLAGE	CA	91361	2513	56	06111	34.16103602	-118.834026	Ventura County
284731	Fee-for-Service	1104838754	1104838754	1	1	BERNSTEIN, LAWRENCE G	7/1/1993	207R00000X	NA	Other	026	PHYSICIANS	71974	41	Internal Medicine	0	In state provider	None	17075 DEVONSHIRE ST	STE 300	NORTHRIDGE	CA	91325	5409	19	06037	34.25755945	-118.50471	Los Angeles County
284764	Fee-for-Service	1700463312	1700463312	1	1	BELL, ORLY N MD	10/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186572	08	Family Practice	0	In state provider	None	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
284796	Fee-for-Service	1679964365	1679964365	1	1	BILSKI, ANNA MD	6/12/2021	207P00000X	NA	Other	026	PHYSICIANS	160661	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
284800	Fee-for-Service	1316967474	1316967474	1	1	BURACK, JEFFREY H MD	2/5/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67962	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2850 TELEGRAPH AVE	STE 110	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
284801	Fee-for-Service	1316929490	1316929490	1	1	BHAT, AMOGH MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82046	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
284836	Fee-for-Service	1902970320	1902970320	1	1	BELANT, SIMONETTA CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
284854	Fee-for-Service	1104040443	1104040443	1	1	BANIGA, ULYSSES V MD	5/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98183	08	Family Practice	0	In state provider	None	14427 CHASE ST	None	PANORAMA CITY	CA	91402	3020	19	06037	34.22477664	-118.4478733	Los Angeles County
284860	Fee-for-Service	1972920247	1972920247	1	1	BERTSCH, AUDREY J DC	12/31/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	23	06045	39.68781544	-123.4842982	Mendocino County
284871	Fee-for-Service	1740455120	1740455120	1	1	BAUTISTA, FERLEINE M MD	3/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113972	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W RODONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
284878	Fee-for-Service	1912205121	1912205121	1	1	BAYLES, MUMTAZ K	11/4/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
284920	Fee-for-Service	1396831145	1396831145	1	1	BEDOY, JUDITH M MD FAAP	11/6/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79434	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
284931	Fee-for-Service	1396268041	1396268041	1	1	BEL AIR CRITICAL CARE MEDICA	9/1/2017	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L GROUP, INC.	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
284951	Fee-for-Service	1548641202	1548641202	1	1	BADAL, JUSTIN MD	3/23/2021	208800000X	NA	Other	026	PHYSICIANS	147267	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
284962	Fee-for-Service	1669042008	1669042008	1	1	BORCHIK, GRACE J PT	12/10/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
284971	Fee-for-Service	1104914530	1104914530	1	1	BRUNSMAN, WILLIAM J MD	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89158	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
284985	Fee-for-Service	1356581482	1356581482	1	1	BEROUKHIM, SHAHRAM S MD	8/17/2009	207L00000X	NA	Other	026	PHYSICIANS	96801	05	Anesthesiology	0	In state provider	None	1720 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
285011	Fee-for-Service	1821627639	1821627639	1	1	BL ANDERSON MEDICAL CORPORAT	9/11/2024	207P00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	VICES OF CALIFORNIA	10890 THORNMINT RD	202	SAN DIEGO	CA	92127	2402	37	06073	33.01658024	-117.0992159	San Diego County
285017	Fee-for-Service	1528083573	1528083573	1	1	BARONE, ROBERT M MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	22669	02	General Surgery	0	In state provider	None	3075 HEALTH CENTER DR	STE 102	SAN DIEGO	CA	92123	2773	37	06073	32.79963065	-117.1556197	San Diego County
285048	Fee-for-Service	1801044961	1801044961	1	1	BUKOV, KONSTANTIN D MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116876	01	General Practice	0	In state provider	None	1002 WEST FREMONT AVE	None	SUNNYVALE	CA	94087	3031	43	06085	37.35204451	-122.055822	Santa Clara County
285061	Fee-for-Service	1831397835	1831397835	1	1	BURRIESCI, MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	0000	00	None	43.61455048	-116.256231	Ada County
285146	Fee-for-Service	1568738219	1568738219	1	1	BUI, DUONG CHRISTOPHER MD	6/11/2012	174400000X	NA	Other	026	PHYSICIANS	49625	41	Internal Medicine	0	In state provider	INC	202 NORTH EUCLID ST	STE 201	SANTA ANA	CA	92703	3006	30	06059	33.74648511	-117.9375318	Orange County
285147	Fee-for-Service	1730267642	1730267642	1	1	BOBO, D'WAINE A	9/30/2008	207L00000X	NA	Other	026	PHYSICIANS	67673	05	Anesthesiology	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
285168	Fee-for-Service	1821627639	1821627639	1	1	BL ANDERSON MEDICAL CORPORAT	9/11/2024	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	VICES OF CALIFORNIA	10890 THORNMINT RD	202	SAN DIEGO	CA	92127	2402	37	06073	33.01658024	-117.0992159	San Diego County
285195	Fee-for-Service	1902246382	1902246382	1	1	BRANDT, HARRY F JR CO	12/18/2013	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	3814 AUBURN BLVD	STE 75	SACRAMENTO	CA	95821	2123	34	06067	38.639034	-121.375305	Sacramento County
285242	Fee-for-Service	1518036060	1518036060	1	1	BURBANK HEALTHCARE	11/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& REHABILITATION CENTER	1041 S MAIN ST	None	BURBANK	CA	91506	3205	19	06037	34.16274994	-118.311275	Los Angeles County
285243	Fee-for-Service	1891865689	1891865689	1	1	BELL, MICHAEL MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	57098	66	Emergency Medicine (Urgent Care)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
285252	Fee-for-Service	1740589290	1740589290	1	1	BRUMAND, KAVEH MD	8/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129620	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
285262	Fee-for-Service	1366048118	1366048118	1	1	BRYANT, ASANTEWA R	7/8/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2699 E 20TH ST	APT A	SIGNAL HILL	CA	90755	1057	19	06037	33.79352806	-118.1603626	Los Angeles County
285265	Fee-for-Service	1114232964	1114232964	1	1	BRASIL, OLIVIA LMFT	10/7/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
285307	Fee-for-Service	1568738219	1568738219	1	1	BUI, DUONG CHRISTOPHER MD	6/11/2012	174400000X	NA	Other	026	PHYSICIANS	49625	10	Gastroenterology (M.D. only)	0	In state provider	INC	202 NORTH EUCLID ST	STE 201	SANTA ANA	CA	92703	3006	30	06059	33.74648511	-117.9375318	Orange County
285309	Fee-for-Service	1730267642	1730267642	1	1	BOBO, D'WAINE A	9/30/2008	207L00000X	NA	Other	026	PHYSICIANS	67673	01	General Practice	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
285369	Fee-for-Service	1043454838	1043454838	1	1	BURNHAM, KEVIN J MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113676	41	Internal Medicine	0	In state provider	None	4600 BROADWAY	STE 1100	SACRAMENTO	CA	95820	1527	34	06067	38.546127	-121.452669	Sacramento County
285403	Fee-for-Service	1891865689	1891865689	1	1	BELL, MICHAEL MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	57098	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
285421	Fee-for-Service	1366048118	1366048118	1	1	BRYANT, ASANTEWA R	7/8/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2699 E 20TH ST	APT A	SIGNAL HILL	CA	90755	1057	19	06037	33.79352806	-118.1603626	Los Angeles County
285436	Fee-for-Service	1548849938	1548849938	1	1	BRANDT, JANETTA MD	8/19/2024	208M00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
285440	Fee-for-Service	1295009256	1295009256	1	1	BOONE, JACOB E MD	7/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115292	34	Urology and Urological Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
285501	Fee-for-Service	1235797705	1235797705	1	1	BROWN, DARIAH LMFT	1/31/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
285506	Fee-for-Service	1184674145	1184674145	1	1	BROOME, HELEN ELIZABETH	11/30/1990	207ZP0102X	NA	Other	026	PHYSICIANS	71604	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
285520	Fee-for-Service	1649305269	1649305269	1	1	BROWN, LOURDES OROCEO MD	3/1/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44183	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
285548	Fee-for-Service	1790049591	1790049591	1	1	BRUGGEMAN, ANDREW R MD	8/15/2019	2085R0001X	NA	Other	026	PHYSICIANS	126549	32	Radiation Therapy (D.O. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
285594	Fee-for-Service	1023272051	1023272051	1	1	BROWN, KRISTIAN L MD	7/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124291	02	General Surgery	0	In state provider	None	7910 FROST ST	STE 250	SAN DIEGO	CA	92123	2752	37	06073	32.80027449	-117.153846	San Diego County
285605	Fee-for-Service	1548653413	1548653413	1	1	BALIZAN, KATHLEEN M NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
285616	Fee-for-Service	1144394867	1144394867	1	1	BOWDEN, DENISE M LCA	4/13/2016	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
285660	Fee-for-Service	1568910065	1568910065	1	1	BARRY, SAMANTHA A PHD	4/12/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
285664	Fee-for-Service	1912985466	1912985466	1	1	BRET LANGERMAN, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 S BRYANT AVE	None	EDMOND	OK	73034	6309	00	None	35.654526	-97.46049903	Oklahoma County
285688	Fee-for-Service	1811998248	1811998248	1	1	BRANT, ADAM J MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60203	14	Neurological Surgery	0	In state provider	None	7130 N SHARON AVE	STE 100	FRESNO	CA	93720	3386	10	06019	36.83983419	-119.7592871	Fresno County
285724	Fee-for-Service	1952557654	1952557654	1	1	BRAVO, JOSE J MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99490	08	Family Practice	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
285733	Fee-for-Service	1407436108	1407436108	1	1	BOWMAN, HILARY C MD	5/19/2024	208M00000X	NA	Other	026	PHYSICIANS	188399	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
285741	Fee-for-Service	1306027503	1306027503	1	1	BABADI, PEDRAM MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102334	41	Internal Medicine	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
285783	Fee-for-Service	1003303744	1003303744	1	1	BHAKTA, SAAJAN DO	9/1/2021	390200000X	NA	Other	026	PHYSICIANS	17900	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
285790	Fee-for-Service	1699125880	1699125880	1	1	BOUTROS, FADY G	1/7/2025	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	157668	25	Physical Medicine and Rehabilitation	0	In state provider	None	15120 KENSINGTON PARK DR	None	TUSTIN	CA	92782	1801	30	06059	33.71335852	-117.8170952	Orange County
285795	Fee-for-Service	1508854282	1508854282	1	1	BENEFIEL, BRYAN C MD	9/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64645	08	Family Practice	0	In state provider	None	1652 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1602957	Los Angeles County
285817	Fee-for-Service	1265121776	1265121776	1	1	BYRD, HEATHER R	7/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
285853	Fee-for-Service	1942261235	1942261235	1	1	BAUMAN, IRENA MD INC	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54440	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
285881	Fee-for-Service	1972351385	1972351385	1	1	BRONSON, LISA LCSW	6/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
285883	Fee-for-Service	1790863363	1790863363	1	1	BAKER, SEAN R MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71606	18	Ophthalmology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
285918	Fee-for-Service	1770743759	1770743759	1	1	BROWN, MATTHEW S DO	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12711	25	Physical Medicine and Rehabilitation	0	In state provider	None	700 EAST CALAVERAS BLVD	None	MILPITAS	CA	95035	5439	43	06085	37.43308793	-121.8951311	Santa Clara County
285947	Fee-for-Service	1972856714	1972856714	1	1	BURRUS, TAMIKA MD PC	12/3/2012	2084N0400X	NA	Neurology	026	PHYSICIANS	110775	13	Neurology (M.D. only)	0	In state provider	None	1300 N VERMONT AVENUE	1ST FL DOCTORS TOWER	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
285950	Fee-for-Service	1508854282	1508854282	1	1	BENEFIEL, BRYAN C MD	9/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64645	01	General Practice	0	In state provider	None	1652 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1602957	Los Angeles County
285976	Fee-for-Service	1588712434	1588712434	1	1	BICKLER, CLARE K NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5225 CANYON CREST DR	STE 13	RIVERSIDE	CA	92507	6320	33	06065	33.95618617	-117.3293404	Riverside County
285978	Fee-for-Service	1063918506	1063918506	1	1	BROPHY, CHRISTOPHER MD	7/5/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	159364	None	None	0	In state provider	None	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	31	06061	38.73444822	-121.2720033	Placer County
286065	Fee-for-Service	1336709914	1336709914	1	1	BROWN, ERIN-ASHLEY LMFT	9/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
286099	Fee-for-Service	1295179901	1295179901	1	1	BOPARAI, RUHEL	11/28/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	159340	-	NOT APPLICABLE	0	In state provider	None	301 E 13TH STREET	SUITE A	MERCED	CA	95341	6211	24	06047	37.29248035	-120.4730619	Merced County
286115	Fee-for-Service	1508334863	1508334863	1	1	BANTING, JAN KENNETH C PT	4/27/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3803 S BASCOM AVE	STE 102 & 104	CAMPBELL	CA	95008	7310	43	06085	37.25907527	-121.9475431	Santa Clara County
286134	Fee-for-Service	1437186400	1437186400	1	1	BADRI, MOHAMAD S MD INC	5/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30279	40	Pediatrics	0	In state provider	None	135 N JACKSON AVE	STE 202	SAN JOSE	CA	95116	1917	43	06085	37.36164758	-121.8466827	Santa Clara County
286154	Fee-for-Service	1558419440	1558419440	1	1	BRANKS, DIANE D DPM	5/19/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
286175	Fee-for-Service	1154340784	1154340784	1	1	BASS, SCOTT R PHD	5/8/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2080 CENTURY PARK E	STE 308	LOS ANGELES	CA	90067	2006	19	06037	34.05887194	-118.4122914	Los Angeles County
286197	Fee-for-Service	1346232683	1346232683	1	1	BERKMEN, TURGUT MD	10/16/2019	2085R0204X	NA	Other	026	PHYSICIANS	164232	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
286234	Fee-for-Service	1063761815	1063761815	1	1	BASHEER, HIBA MD	4/27/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	132719	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
286258	Fee-for-Service	1144269937	1144269937	1	1	BALAKRISHNAN, DHEEPA MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103832	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
286263	Fee-for-Service	1881854651	1881854651	1	1	BANSAL, SUMATI DO	11/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10202	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
286266	Fee-for-Service	1801957022	1801957022	1	1	BALDI, PHILLIP B DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	4854	08	Family Practice	0	In state provider	None	1600 CREEKSIDE DR	STE 1300B	FOLSOM	CA	95630	3445	34	06067	38.669994	-121.147488	Sacramento County
286267	Fee-for-Service	1205879830	1205879830	1	1	BENNETT, FREDERICK S MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64646	20	Orthopedic Surgery	0	In state provider	None	1405 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4557	49	06097	38.44377	-122.699016	Sonoma County
286275	Fee-for-Service	1861880536	1861880536	1	1	BEARMAN, SAGE CNP	8/3/2021	363LW0102X	NA	Nurse Practitioner	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
286278	Fee-for-Service	1184902405	1184902405	1	2	BAZ ALLERGY, ASTHMA & SINUS	9/2/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, INC.	505 CLOVIS AVE	None	FRESNO	CA	93727	2617	10	06019	36.75083028	-119.7003361	Fresno County
286316	Fee-for-Service	1780732586	1780732586	1	1	BOURAS, MARY MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60406	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
286325	Fee-for-Service	1801025317	1801025317	1	1	BRIDGES, DAVID L MD	9/4/2013	207L00000X	NA	Other	026	PHYSICIANS	126649	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
286382	Fee-for-Service	1063761815	1063761815	1	1	BASHEER, HIBA MD	4/27/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	132719	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
286413	Fee-for-Service	1205879830	1205879830	1	1	BENNETT, FREDERICK S MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64646	10	Gastroenterology (M.D. only)	0	In state provider	None	1405 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4557	49	06097	38.44377	-122.699016	Sonoma County
286422	Fee-for-Service	1669899779	1669899779	1	1	BUSBY, ELIZABETH M DO	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16045	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 EAST CHURCH STREET	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
286449	Fee-for-Service	1447951421	1447951421	1	1	BLACK WHITE LOGISTICS, LLC	3/15/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6020 RUTLAND DR	UNIT 22	CARMICHAEL	CA	95608	0515	34	06067	38.663145	-121.324266	Sacramento County
286456	Fee-for-Service	1356394589	1356394589	1	1	BUCKWALTER, MARION MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65940	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
286527	Fee-for-Service	1164567004	1164567004	1	2	BERG, ALAN M MD	10/31/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	48218	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2625 W ALAMEDA AVE	STE 208	BURBANK	CA	91505	4823	19	06037	34.1577056	-118.329779	Los Angeles County
286528	Fee-for-Service	1285210963	1285210963	1	1	BROWN, KATHRYN H MD	10/31/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	184064	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
286550	Fee-for-Service	1285344309	1285344309	1	1	BADILLO, BERNARD FAUSTOS	5/13/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
286603	Fee-for-Service	1295834927	1295834927	1	1	BORDAS, JULIO J MD	5/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55479	08	Family Practice	0	In state provider	None	1532 ANACPA STREET	SUITE 5	SANTA BARBARA	CA	93101	1950	42	06083	34.42806081	-119.7082542	Santa Barbara County
286627	Fee-for-Service	1366492803	1366492803	1	1	BROWN, NORMAN N MD	7/22/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	50657	14	Neurological Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
286641	Fee-for-Service	1538270822	1538270822	1	1	BAUTISTA, NATHANIEL S MD	7/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49430	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
286653	Fee-for-Service	1033152285	1033152285	1	1	BACKUS, LISA MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55785	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
286671	Fee-for-Service	1164567004	1164567004	1	2	BERG, ALAN M MD	10/31/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	48218	41	Internal Medicine	0	In state provider	None	2625 W ALAMEDA AVE	STE 208	BURBANK	CA	91505	4823	19	06037	34.1577056	-118.329779	Los Angeles County
286743	Fee-for-Service	1780023804	1780023804	1	1	BIGNAMI, JACADI D MD	12/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136277	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
286781	Fee-for-Service	1538270822	1538270822	1	1	BAUTISTA, NATHANIEL S MD	7/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49430	41	Internal Medicine	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
286795	Fee-for-Service	1033152285	1033152285	1	1	BACKUS, LISA MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55785	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
286819	Fee-for-Service	1245858810	1245858810	1	1	BONE, SIERRA CCC-SLP	6/5/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 29TH ST	SUITE 317	OAKLAND	CA	94609	3522	01	06001	37.81784861	-122.2652263	Alameda County
286826	Fee-for-Service	1679886501	1679886501	1	1	BHASIN, EVELEEN DO	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12077	41	Internal Medicine	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
286844	Fee-for-Service	1174515969	1174515969	1	1	BALCAZAR, MIRTHA L MD	4/15/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44843	41	Internal Medicine	0	In state provider	None	2110 FERRY ST	None	ANDERSON	CA	96007	3459	45	06089	40.45112301	-122.298562	Shasta County
286870	Fee-for-Service	1770739989	1770739989	1	1	BIYO, EULE N MD	11/24/2008	261QP2300X	NA	Other	026	PHYSICIANS	95948	40	Pediatrics	0	In state provider	None	740 OAK AVENUE PKWY	STE 145	FOLSOM	CA	95630	6815	34	06067	38.665917	-121.1367735	Sacramento County
286879	Fee-for-Service	1710049796	1710049796	1	1	BREEN, ELISE E LCSW	8/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
286905	Fee-for-Service	1154368868	1154368868	1	1	BLISS, LAUREL A MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98561	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
286917	Fee-for-Service	1881119063	1881119063	1	1	BARRIGA, JESSICA LCSW	1/31/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
286935	Fee-for-Service	1255048328	1255048328	1	1	BEGUE, ALEXIS A LMFT	2/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
286953	Fee-for-Service	1023188760	1023188760	1	1	BROCKMAN, CRAIG REECE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
286957	Fee-for-Service	1912934621	1912934621	2	1	BAKER, RODNEY L MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	28383	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
286964	Fee-for-Service	1376584433	1376584433	1	1	BECKER, BRUCE B MD	8/1/1983	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40316	18	Ophthalmology	0	In state provider	None	5363 BALBOA BLVD	STE 246	ENCINO	CA	91316	2828	19	06037	34.169058	-118.5011265	Los Angeles County
286995	Fee-for-Service	1427443811	1427443811	1	1	BAINBRIDGE, EMMA D MD	7/9/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	149016	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
287009	Fee-for-Service	1801905690	1801905690	1	1	BHATTACHARYA, JOYDIP DO	8/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8773	13	Neurology (M.D. only)	0	In state provider	MEDICAL CORPORATION	1575 SOQUEL DR	STE B	SANTA CRUZ	CA	95065	1700	44	06087	36.98861921	-121.9831127	Santa Cruz County
287016	Fee-for-Service	1942385612	1942385612	1	1	BAYNE, OMAR MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	54981	20	Orthopedic Surgery	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
287056	Fee-for-Service	1508960667	1508960667	1	1	BROOKS, NORMAN A MD INC	1/1/1979	207N00000X	NA	Dermatology	026	PHYSICIANS	25704	07	Dermatology	0	In state provider	None	16311 VENTURA BLVD	STE 690	ENCINO	CA	91436	4322	19	06037	34.15706864	-118.4885978	Los Angeles County
287059	Fee-for-Service	1548282817	1548282817	1	1	BRANNAN, WALTER S MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79512	05	Anesthesiology	0	In state provider	None	23500 MADISON ST	None	TORRANCE	CA	90505	4702	19	06037	33.81231995	-118.3477041	Los Angeles County
287063	Fee-for-Service	1265486815	1265486815	1	1	BAL, INDERPAL K MD	1/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86518	41	Internal Medicine	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
287071	Fee-for-Service	1467842385	1467842385	1	1	BUNTER, SARAH K LMFT	1/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
287076	Fee-for-Service	1912754565	1912754565	1	1	B A R E HOLISTIC & WELLNESS	5/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	THERAPY, INC.	12440 FIRESTONE BLVD	STE 105	NORWALK	CA	90650	9325	19	06037	33.90523023	-118.0681168	Los Angeles County
287113	Fee-for-Service	1154563963	1154563963	3	1	BONNER GENERAL HOSPITAL INC.	11/8/2019	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	520 N 3RD AVE	None	SANDPOINT	ID	83864	1507	00	None	48.27786153	-116.5503511	Bonner County
287120	Fee-for-Service	1447646104	1447646104	1	1	BEGGAN, HANNAH E OT	11/14/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
287136	Fee-for-Service	1194719302	1194719302	1	1	BLAUROCK, BURTON C OD	4/1/2000	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	42452 BOB HOPE DR	STE 1	RANCHO MIRAGE	CA	92270	4470	33	06065	33.73771302	-116.4084969	Riverside County
287156	Fee-for-Service	1033760863	1033760863	1	1	BRAR, JESKEITH NP	7/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
287250	Fee-for-Service	1154563963	1154563963	3	1	BONNER GENERAL HOSPITAL INC.	11/8/2019	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	520 N 3RD AVE	None	SANDPOINT	ID	83864	1507	00	None	48.27786153	-116.5503511	Bonner County
287275	Fee-for-Service	1891800736	1891800736	1	1	BURKE, KELLY E DO	5/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9480	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
287280	Fee-for-Service	1124516398	1124516398	1	1	BROWN, RANDALL J MD	7/1/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	178460	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287324	Fee-for-Service	1942737176	1942737176	1	1	BOUCHIER-PRITCHETT FAMILY ME	10/23/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DICINE PC	280 SIERRA COLLEGE DR	SUITE 207	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
287332	Fee-for-Service	1821223843	1821223843	1	1	BROOKS, ALISON LMFT	8/29/2024	101YS0200X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	720 RIVER STREET	SUITE 1	SANTA CRUZ	CA	95060	2748	44	06087	36.98383328	-122.0296395	Santa Cruz County
287335	Fee-for-Service	1457523466	1457523466	1	1	BHAKTA, NIRAV R MD	4/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102883	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
287348	Fee-for-Service	1699787572	1699787572	1	1	BONNELL JR MD, WILLIAM	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COOK CHILDRENS PHYS NTWK	801 SEVENTH AVENUE	None	FORT WORTH	TX	76104	0000	00	None	32.73710364	-97.3419336	Tarrant County
287468	Fee-for-Service	1457523466	1457523466	1	1	BHAKTA, NIRAV R MD	4/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102883	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
287473	Fee-for-Service	1861187833	1861187833	1	1	BEWELL LLC	12/5/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5346 MADISON AVE	STE A	SACRAMENTO	CA	95841	3166	34	06067	38.660319	-121.3393905	Sacramento County
287490	Fee-for-Service	1568662187	1568662187	1	1	BAK, EUGENE L MD	8/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91479	05	Anesthesiology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
287497	Fee-for-Service	1508218314	1508218314	1	1	BLAIR, BELINDA S CNP	9/9/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
287519	Fee-for-Service	1073553756	1073553756	1	4	BEAR VALLEY COMMUNITY HEALTH	6/26/1991	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE DISTRICT	41870 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
287558	Fee-for-Service	1578521274	1578521274	1	1	BALBOA HEALTHCARE INC	10/1/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& REHABILITATION CTR	3520 4TH AVE	None	SAN DIEGO	CA	92103	4913	37	06073	32.741955	-117.1615965	San Diego County
287581	Fee-for-Service	1659433720	1659433720	2	1	BEBAN, MARYLOU LCSW	3/4/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	610 16TH STREET	M8	OAKLAND	CA	94612	1282	01	06001	37.80722783	-122.2742936	Alameda County
287611	Fee-for-Service	1932217411	1932217411	1	1	BEHRMAN, MICHAEL J MD	10/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71132	46	Hand Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 201	SANTA BARBARA	CA	93105	3879	42	06083	34.43202913	-119.7212339	Santa Barbara County
287649	Fee-for-Service	1073553756	1073553756	1	4	BEAR VALLEY COMMUNITY HEALTH	11/3/2021	261QR1300X	NA	Rural Health Center	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	CARE DISTRICT	41870 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
287662	Fee-for-Service	1922050095	1922050095	1	1	BRAKER, MARTIN J MD	4/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	15523	41	Internal Medicine	0	In state provider	None	1455 MONTEGO	STE 205	WALNUT CREEK	CA	94598	2957	07	06013	37.91046956	-122.0418669	Contra Costa County
287669	Fee-for-Service	1518022698	1518022698	1	1	BLANKENBERG, TIKOES A MD	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56842	22	Pathology (M.D. only)	0	In state provider	None	2036 RAILROAD AVE	None	REDDING	CA	96001	1801	45	06089	40.57806515	-122.3920754	Shasta County
287676	Fee-for-Service	1336745967	1336745967	1	1	BLESSED HOSPICE CALIFORNIA,	6/20/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	4540 KEARNY VILLA RD	STE 105	SAN DIEGO	CA	92123	1564	37	06073	32.82260734	-117.144126	San Diego County
287686	Fee-for-Service	1497708648	1497708648	1	1	BENTELY, BARBARA L PHD	5/23/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287706	Fee-for-Service	1437186087	1437186087	1	1	BONNER,KEVIN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE VANTAGE WAY	STE B240	NASHVILLE	TN	37228	0000	00	None	36.19232503	-86.79194122	Davidson County
287709	Fee-for-Service	1932535168	1932535168	1	1	BYUN, INHWA	11/18/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
287732	Fee-for-Service	1851406201	1851406201	1	1	BRAEMER, LLOYD G MD	10/11/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54939	40	Pediatrics	0	In state provider	None	1135 WEST ST	None	REDDING	CA	96001	0424	45	06089	40.58664359	-122.3992375	Shasta County
287742	Fee-for-Service	1932217411	1932217411	1	1	BEHRMAN, MICHAEL J MD	10/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71132	20	Orthopedic Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 201	SANTA BARBARA	CA	93105	3879	42	06083	34.43202913	-119.7212339	Santa Barbara County
287760	Fee-for-Service	1740540244	1740540244	1	1	BASTIAN, SEVAG A MD	1/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	147241	20	Orthopedic Surgery	0	In state provider	None	2625 W ALAMEDA AVE	STE 116	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
287779	Fee-for-Service	1073553756	1073553756	1	4	BEAR VALLEY COMMUNITY HEALTH	11/3/2021	261QR1300X	NA	Rural Health Center	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	CARE DISTRICT	41870 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
287795	Fee-for-Service	1225375116	1225375116	1	1	BRENNEMAN, JANEL L CCC-SLP	8/17/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1660 WEST LINNE ROAD	SUITE J-9	TRACY	CA	95377	8105	39	06077	37.69589443	-121.4467076	San Joaquin County
287809	Fee-for-Service	1689909608	1689909608	1	1	BRIM, SUSAN MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110171	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
287813	Fee-for-Service	1336745967	1336745967	1	1	BLESSED HOSPICE CALIFORNIA,	6/20/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	4540 KEARNY VILLA RD	STE 105	SAN DIEGO	CA	92123	1564	37	06073	32.82260734	-117.144126	San Diego County
287831	Fee-for-Service	1427477355	1427477355	1	1	BAQAI, ZAR MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142253	05	Anesthesiology	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
287854	Fee-for-Service	1144304130	1144304130	1	1	BRABANT, ENOCH C MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42179	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 ARMY ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
287903	Fee-for-Service	1073553756	1073553756	1	4	BEAR VALLEY COMMUNITY HEALTH	5/16/2023	261QR1300X	NA	Rural Health Center	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
287923	Fee-for-Service	1659348621	1659348621	1	1	BAST, STEVE C MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55098	20	Orthopedic Surgery	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
287927	Fee-for-Service	1821245952	1821245952	1	1	BAURMANN, AMELIA G CNM	9/2/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
287946	Fee-for-Service	1871122630	1871122630	1	1	BUI, PHOEBE P DO	3/17/2024	390200000X	NA	Other	026	PHYSICIANS	19387	None	None	0	In state provider	None	8900 BOLSA AVE	STE B	WESTMINSTER	CA	92683	5475	30	06059	33.74480556	-117.9740439	Orange County
287947	Fee-for-Service	1760670798	1760670798	1	1	BONES, JAMIE V DC	12/16/2008	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	8010 WAYLAND LN	STE 1B	GILROY	CA	95020	4158	43	06085	37.01414531	-121.5818293	Santa Clara County
287981	Fee-for-Service	1144304130	1144304130	1	1	BRABANT, ENOCH C MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42179	40	Pediatrics	0	In state provider	None	3555 ARMY ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
288006	Fee-for-Service	1730418146	1730418146	1	1	BULLAIN, SZOFIA S MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112882	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
288027	Fee-for-Service	1013907377	1013907377	1	1	BAKER, MARNIE MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77478	40	Pediatrics	0	In state provider	None	250 E YALE LOOP	STE 200	IRVINE	CA	92604	4697	30	06059	33.67473753	-117.7880547	Orange County
288042	Fee-for-Service	1316489651	1316489651	1	1	BRENSON, ANNA M	5/11/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
288103	Fee-for-Service	1033596168	1033596168	1	1	BRICK, JONATHAN DO MD	8/7/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15087	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
288188	Fee-for-Service	1730911157	1730911157	1	1	BARRIOS, PABLO R PT	3/13/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
288241	Fee-for-Service	1497781348	1497781348	1	1	BRODSKY, MICHAEL A MD	4/10/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	21623	30	Radiology	0	In state provider	NORTH BAY MRI CENTER	2149 APPIAN WAY	None	PINOLE	CA	94564	2514	07	06013	37.99738125	-122.3013414	Contra Costa County
288328	Fee-for-Service	1164483699	1164483699	1	1	BERNABE, VICENTE R DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7405	20	Orthopedic Surgery	0	In state provider	None	9191 WESTMINISTER BLVD	None	GARDEN GROVE	CA	92844	2751	30	06059	33.75950574	-117.9684615	Orange County
288349	Fee-for-Service	1417966763	1417966763	1	1	BRAVO, FRANK CNP	8/23/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
288393	Fee-for-Service	1013412543	1013412543	1	1	BLOOM, LAURA MD	8/15/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	185593	02	General Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
288398	Fee-for-Service	1972978252	1972978252	1	1	BARTON, ANTHONY P	4/4/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
288428	Fee-for-Service	1972627081	1972627081	1	1	BAZIKYAN, ADRINE MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	83028	-	NOT APPLICABLE	0	In state provider	None	5628 EAST SLAUSON AVENUE	None	COMMERCE	CA	90040	2922	19	06037	33.98593459	-118.163681	Los Angeles County
288435	Fee-for-Service	1497067573	1497067573	1	1	BEAUMONT, THOMAS L MD	4/8/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	159281	14	Neurological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288449	Fee-for-Service	1972802130	1972802130	1	1	BRUNET, BARBARA A	12/27/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	138808	None	None	0	In state provider	None	14550 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	2200	19	06037	34.43539863	-118.39023	Los Angeles County
288475	Fee-for-Service	1295870475	1295870475	1	1	BURKE, THOMAS F OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	HOLLISTER OPTOMETRIC CT	6831 HOLLISTER AVE	STE F	GOLETA	CA	93117	3015	42	06083	34.4301627	-119.8669185	Santa Barbara County
288493	Fee-for-Service	1861433526	1861433526	1	2	BRYAN H TRAN MD INC	10/22/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	27800 MEDICAL CENTER ROA	SUITE 144	MISSION VIEJO	CA	92691	6447	30	06059	33.55952733	-117.6645199	Orange County
288502	Fee-for-Service	1881856995	1881856995	1	1	BAKMAN, IRENE MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102072	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
288512	Fee-for-Service	1013412543	1013412543	1	1	BLOOM, LAURA MD	8/15/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	185593	89	Surgery-Traumatic	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
288527	Fee-for-Service	1427664002	1427664002	1	1	BAUSS, CHRISTOPHER J LMFT	11/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2009 PALO VERDE AVE	SUITE A	LONG BEACH	CA	90815	3322	19	06037	33.792597	-118.1080155	Los Angeles County
288539	Fee-for-Service	1740787555	1740787555	1	1	BILUGAN, ROMEO S MD	9/8/2021	207P00000X	NA	Other	026	PHYSICIANS	165769	None	None	0	In state provider	None	14135 MAIN ST	301	HESPERIA	CA	92345	8092	36	06071	34.42669852	-117.354483	San Bernardino County
288543	Fee-for-Service	1104271816	1104271816	1	1	BALLE, KRISTIAN	3/13/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	23133	07	Dermatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
288577	Fee-for-Service	1861068934	1861068934	1	1	BELZA, DANIELLE E CNP	11/24/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
288594	Fee-for-Service	1932313483	1932313483	1	1	BUI, DON T MD	9/9/2022	208800000X	NA	Other	026	PHYSICIANS	127053	None	None	0	In state provider	None	23961 CALLE DE LA MAGDAL	500	LAGUNA HILLS	CA	92653	7622	30	06059	33.60999658	-117.7126577	Orange County
288633	Fee-for-Service	1467530535	1467530535	1	1	BAVYKINA, ANNA Y MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65400	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
288634	Fee-for-Service	1255332318	1255332318	1	1	BARNHART, CHARLES R MD	7/28/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	29994	20	Orthopedic Surgery	0	In state provider	INC	51 N 5TH AVE	STE 301	ARCADIA	CA	91006	3739	19	06037	34.1412293	-118.0205477	Los Angeles County
288637	Fee-for-Service	1548229743	1548229743	1	1	BEAUVAIS, JOHN P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4600 38TH ST	None	COLUMBUS	NE	68601	1664	00	None	41.455224	-97.384752	Platte County
288643	Fee-for-Service	1184657231	1184657231	1	1	BARIGIAN, JEFFREY MD INC	7/2/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	36952	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	48677 VICTORIA LN	None	OAKHURST	CA	93644	9216	20	06039	37.32772782	-119.6601883	Madera County
288703	Fee-for-Service	1356100051	1356100051	1	1	BARSOTTI, ALEXANDRA N	4/9/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288754	Fee-for-Service	1851356612	1851356612	1	1	BAUER, DOUGLAS C MD	4/30/1985	207R00000X	NA	Other	026	PHYSICIANS	52442	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	# 405M	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
288768	Fee-for-Service	1255921557	1255921557	1	1	BUSCH, CHRISTINA LCSW	1/11/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	103553	-	NOT APPLICABLE	0	In state provider	None	8 CRESTWOOD RD	None	BOULEVARD	CA	91905	9725	37	06073	32.7075769	-116.3623755	San Diego County
288771	Fee-for-Service	1558370023	1558370023	1	2	BEVERLY ORTHOPEDIC LABORATOR	3/24/2022	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	Y INC	2625 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2309	19	06037	34.02107979	-118.1317682	Los Angeles County
288809	Fee-for-Service	1952863052	1952863052	1	1	BO, CHRISTOPHER MD	9/25/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
288811	Fee-for-Service	1942797873	1942797873	1	1	BALANCED HEALTH AND WELLNESS	2/21/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	A NURSING CORPORATION	26400 LA ALAMEDA	STE 208	MISSION VIEJO	CA	92691	6307	30	06059	33.5637103	-117.669431	Orange County
288868	Fee-for-Service	1497979926	1497979926	1	1	BASTIAN, ERIN B LCSW	7/1/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21720	-	NOT APPLICABLE	0	In state provider	None	212 N STEVENSON ST	None	VISALIA	CA	93291	6024	54	06107	36.331569	-119.299635	Tulare County
288877	Fee-for-Service	1982049052	1982049052	1	1	BEROOKIM, JASMINE A MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135598	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
288878	Fee-for-Service	1992860639	1992860639	1	1	BRESLIN, PAMELA A	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	40	Pediatrics	0	In state provider	None	23845 HOLMAN HWY	STE 203	MONTEREY	CA	93940	5901	27	06053	36.57594044	-121.9132944	Monterey County
288884	Fee-for-Service	1710198262	1710198262	1	1	BEHNAM, MARCELINA B MD	2/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109776	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
288917	Fee-for-Service	1821415365	1821415365	1	1	BIELINSKI, CLIFFORD M MD	9/27/2020	207L00000X	NA	Other	026	PHYSICIANS	142655	05	Anesthesiology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
288919	Fee-for-Service	1447758552	1447758552	1	1	BELTRAN, BRIAN PT	10/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1280 CORONA POINTE CT	STE 118	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
288945	Fee-for-Service	1215100417	1215100417	1	1	BANTA, DANTE A MD INC	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	44079	None	None	0	In state provider	None	875 N WESTERN AVE	None	LOS ANGELES	CA	90029	3759	19	06037	34.086141	-118.3091865	Los Angeles County
288970	Fee-for-Service	1467763300	1467763300	1	1	BARRY, NORAN MD	10/24/2022	208600000X	NA	General Surgery	026	PHYSICIANS	169254	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
288972	Fee-for-Service	1104950310	1104950310	1	1	BROWN, HEATHER R LCSW	7/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
288991	Fee-for-Service	1295962900	1295962900	1	1	BOWMAN, PRENTICE L MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
288992	Fee-for-Service	1750584686	1750584686	1	1	BRITT, D GARDNER MD	2/28/1991	207P00000X	NA	Other	026	PHYSICIANS	42306	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39674221	-122.8201502	Sonoma County
288999	Fee-for-Service	1013919133	1013919133	1	1	BRACKETT JEFFREY C	6/13/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60080	None	None	0	In state provider	None	168 N BRENT ST	STE 503	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
289005	Fee-for-Service	1649447491	1649447491	1	1	BERRY, JESSE L MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109638	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO STREET	None	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
289018	Fee-for-Service	1699754135	1699754135	1	1	BECK, CLIFFORD K MD	1/31/1982	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	42510	41	Internal Medicine	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
289038	Fee-for-Service	1083975874	1083975874	1	1	BAUGH, AARON D MD	7/25/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	155615	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
289062	Fee-for-Service	1053762005	1053762005	1	1	BROWN, CHARLES NP	2/7/2025	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10538 MISSION GORGE RD	100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
289065	Fee-for-Service	1972819977	1972819977	1	1	BLESA, MARTA MD A	2/7/2011	193400000X	NA	Other	026	PHYSICIANS	31530	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	5821 TEMPLE CITY BLVD	None	TEMPLE CITY	CA	91780	1837	19	06037	34.10555463	-118.0607065	Los Angeles County
289117	Fee-for-Service	1902135577	1902135577	1	1	BUSTAMANTE DAYANGHIRANG, ALM	4/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167406	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RANG MD	2760 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700542	-119.790868	Fresno County
289133	Fee-for-Service	1023377231	1023377231	1	1	BANKS, LA KEDIA C CNP	3/25/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2331 A MONTPELIER DR	STE 20	SAN JOSE	CA	95116	1688	43	06085	37.3649965	-121.8479359	Santa Clara County
289177	Fee-for-Service	1770594749	1770594749	1	1	BROWN, LORENZO S MD	12/11/2011	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	30457	04	Otology, Laryngology, Rhinology	0	In state provider	None	103 S LOCUST ST	None	INGLEWOOD	CA	90301	1812	19	06037	33.962814	-118.3504055	Los Angeles County
289203	Fee-for-Service	1952399800	1952399800	1	1	BENNETT,LEE D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
289240	Fee-for-Service	1972034841	1972034841	1	1	BLAIR, DAVID R MD	8/16/2022	207SG0201X	NA	Other	026	PHYSICIANS	159073	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
289263	Fee-for-Service	1598384901	1598384901	1	1	BAE, JUNUN DO	3/13/2025	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	21275	38	Geriatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
289279	Fee-for-Service	1740695824	1740695824	1	1	BOURLAND, BRYAN DO	1/23/2024	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	20885	None	None	0	In state provider	None	9850 GENESEE AVE	510	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
289295	Fee-for-Service	1528027455	1528027455	1	1	BROWN, KEVIN A DO	12/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89521	3861	00	None	39.52483792	-119.7968314	Washoe County
289317	Fee-for-Service	1982233326	1982233326	1	1	BOAZ, ALEXANDER M MD	5/22/2024	208M00000X	NA	Other	026	PHYSICIANS	191717	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
289352	Fee-for-Service	1194099754	1194099754	1	1	BAJWA, RAVNEET MD	9/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122408	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.0696407	-118.3836988	Los Angeles County
289355	Fee-for-Service	1083698237	1083698237	1	1	BERON, PHILLIP J MD	5/3/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81089	78	Neoplastic Diseases/Oncology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
289358	Fee-for-Service	1790816171	1790816171	1	1	BERWALD, ROSEMARY R CCC-SLP	11/1/1999	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4340 STEVENS CREEK BLVD	STE 107	SAN JOSE	CA	95129	1147	43	06085	37.3231065	-121.979493	Santa Clara County
289361	Fee-for-Service	1184633745	1184633745	1	1	BOCIAN, ROBERT C MD	7/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65716	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
289372	Fee-for-Service	1174575476	1174575476	1	1	BOROVAY, MICHAEL ALAN MD	12/31/1991	207R00000X	NA	Other	026	PHYSICIANS	63874	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1251 W LAMBERT RD	None	LA HABRA	CA	90631	6614	30	06059	33.9247203	-117.9597086	Orange County
289373	Fee-for-Service	1457701641	1457701641	1	1	BOZIGIAN, MARY E LMFT	5/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
289375	Fee-for-Service	1891808804	1891808804	1	1	BUI, RAU VAN MD	6/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	35749	08	Family Practice	0	In state provider	None	27 S 13TH ST	None	SAN JOSE	CA	95112	2022	43	06085	37.34154726	-121.8777509	Santa Clara County
289382	Fee-for-Service	1700170867	1700170867	1	1	BIJU B. MATHEW M.D	4/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
289427	Fee-for-Service	1548333040	1548333040	1	1	BANNACH, MICHAEL C MD	9/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60021	08	Family Practice	0	In state provider	None	145 THUNDER DR	None	VISTA	CA	92083	6010	37	06073	33.18535652	-117.288201	San Diego County
289441	Fee-for-Service	1902008956	1902008956	1	1	BOYACK, BRYANT A DO	12/15/2009	390200000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
289449	Fee-for-Service	1083698237	1083698237	1	1	BERON, PHILLIP J MD	5/3/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81089	30	Radiology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
289460	Fee-for-Service	1508820366	1508820366	1	1	BUFFUM, JAMES T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	759 CHESTNUT ST	None	SPRINGFIELD	MA	01199	1001	00	None	42.122601	-72.602856	Hampden County
289467	Fee-for-Service	1174575476	1174575476	1	1	BOROVAY, MICHAEL ALAN MD	12/31/1991	207R00000X	NA	Other	026	PHYSICIANS	63874	41	Internal Medicine	0	In state provider	None	1251 W LAMBERT RD	None	LA HABRA	CA	90631	6614	30	06059	33.9247203	-117.9597086	Orange County
289470	Fee-for-Service	1194031005	1194031005	1	1	BOELEN, AMBER S LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
289488	Fee-for-Service	1154355188	1154355188	1	1	BANNER THUNDERBIRD	10/19/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
289502	Fee-for-Service	1457870966	1457870966	1	1	BENGSTON, LOGAN C LMFT	10/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	327 E REDWOOD AVE	C	FORT BRAGG	CA	95437	3550	23	06045	39.4442763	-123.80293	Mendocino County
289511	Fee-for-Service	1962788463	1962788463	1	1	BURBANK OCCUPATIONAL HEALTH	9/4/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER INC	3413 PACIFIC AVE	STE 102	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
289532	Fee-for-Service	1346479177	1346479177	1	1	BROWN, GALE D LMFT	8/15/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1620 OAK PARK AVE	None	CHICO	CA	95928	4882	04	06007	39.72460853	-121.8540643	Butte County
289561	Fee-for-Service	1699351791	1699351791	1	1	BORDEN, LAURA B MD	6/10/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
289572	Fee-for-Service	1154355188	1154355188	1	1	BANNER THUNDERBIRD	10/19/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
289582	Fee-for-Service	1619493749	1619493749	1	1	BUDD-VIZCAINO, ALLI CCC-SLP	9/16/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
289597	Fee-for-Service	1831198860	1831198860	1	1	BURNETT, BRUCE T MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	6130 ELTON AVE	None	LAS VEGAS	NV	89107	2538	00	None	36.17198653	-115.225452	Clark County
289634	Fee-for-Service	1497789499	1497789499	1	1	BECKLEY, OLAWUNMI A MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69200	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
289636	Fee-for-Service	1518077650	1518077650	1	1	BRESSINGTON, GEOFFREY S LMFT	4/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
289688	Fee-for-Service	1467545467	1467545467	1	1	BARNES, ROBERT J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31954	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
289767	Fee-for-Service	1104884337	1104884337	1	1	BOIES, EYLA G MD	3/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74394	40	Pediatrics	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
289828	Fee-for-Service	1356411268	1356411268	1	1	BATES, CHARLES C MD	9/30/1981	207R00000X	NA	Other	026	PHYSICIANS	47018	41	Internal Medicine	0	In state provider	None	980 CASS ST	None	MONTEREY	CA	93940	4548	27	06053	36.59233374	-121.896488	Monterey County
289847	Fee-for-Service	1134233521	1134233521	1	1	BARNES, LOIS MD	8/31/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	58467	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 S SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	6814	19	06037	33.87583364	-118.3958985	Los Angeles County
289870	Fee-for-Service	1518029800	1518029800	1	1	BULLEN, SHELLEY L LMFT	10/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	274 COHASSET RD	130	CHICO	CA	95926	2236	04	06007	39.75169866	-121.851622	Butte County
289945	Fee-for-Service	1144526773	1144526773	1	1	BRYAN X LEE MD A PROF MEDICA	5/23/2011	207LP2900X	NA	Other	026	PHYSICIANS	91137	05	Anesthesiology	0	In state provider	OR PAIN MANAGEMENT	250 W BONITA AVE	160	POMONA	CA	91767	1863	19	06037	34.09664881	-117.751261	Los Angeles County
289957	Fee-for-Service	1326365362	1326365362	1	1	BUI, DAVID K A MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118580	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
289997	Fee-for-Service	1114305539	1114305539	1	2	BURNS, LORIANNE MD	10/22/2018	2080P0204X	NA	Other	026	PHYSICIANS	145874	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
290068	Fee-for-Service	1972194165	1972194165	1	1	BLUE PACIFIC HOME HEALTH	6/26/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5658 SEPULVEDA BLVD	STE 210	VAN NUYS	CA	91411	2951	19	06037	34.173774	-118.466123	Los Angeles County
290101	Fee-for-Service	1801880745	1801880745	1	1	BOLDREY, EDWIN E MD	12/31/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	17069	18	Ophthalmology	0	In state provider	None	50 S SAN MATEO DR	STE 125	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
290117	Fee-for-Service	1891461711	1891461711	1	1	BRODY, MELODY W PT	9/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
290125	Fee-for-Service	1841338944	1841338944	1	1	BELTONE OF RIVERSIDE	3/24/2004	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	BELTONE OF RIVERSIDE	5908 MAGNOLIA AVE	None	RIVERSIDE	CA	92506	1884	33	06065	33.96167634	-117.3912477	Riverside County
290164	Fee-for-Service	1073553756	1073553756	1	3	BEAR VALLEY COMMUNITY HEALTH	10/16/2000	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1649	370 SUMMIT BLVD	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24579572	-116.8883656	San Bernardino County
290172	Fee-for-Service	1760424824	1760424824	1	1	BRODHEAD, JOHN MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40682	41	Internal Medicine	0	In state provider	None	2025 ZONAL AVE	BLDG GNH7900	LOS ANGELES	CA	90089	0264	19	06037	34.05998665	-118.2058023	Los Angeles County
290190	Fee-for-Service	1184887069	1184887069	1	1	BECK, JENNIFER J MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126736	20	Orthopedic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
290198	Fee-for-Service	1306181375	1306181375	1	1	BANIPAL, SIMPLEDEEP K MD	2/21/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	154251	70	Clinic (mixed specialty)	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
290242	Fee-for-Service	1023210242	1023210242	1	1	BEAN, TRACI M	4/14/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 WEST 6TH STREET	STE 111	LOS ANGELES	CA	90017	1823	19	06037	34.05416748	-118.2622848	Los Angeles County
290243	Fee-for-Service	1871676759	1871676759	1	1	BORGHEI, KARIMEH	7/8/2008	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
290250	Fee-for-Service	1164478855	1164478855	1	1	BAQAI, REHANA S MD	1/1/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	48182	None	None	0	In state provider	None	15651 IMPERIAL HWY	STE 105	LA MIRADA	CA	90638	1600	19	06037	33.91736136	-117.9972197	Los Angeles County
290282	Fee-for-Service	1295237139	1295237139	1	1	BEAUPRE, MICHELLE J LCSW	5/13/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16950 VIA DE SANTA FE	5060-118	RANCHO SANTA FE	CA	92067	9519	37	06073	33.01890695	-117.2022723	San Diego County
290299	Fee-for-Service	1336198746	1336198746	1	1	BRADY, JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9330 S UNIVERSITY BLVD	None	HGHLNDS RANCH	CO	80126	5065	00	None	39.5463094	-104.9463379	Douglas County
290307	Fee-for-Service	1437458999	1437458999	1	1	BURGIN, ARIK MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114850	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
290326	Fee-for-Service	1356105837	1356105837	1	1	BLUE JET ACCESS TRANSPORTATI	2/25/2024	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON LLC	4836 HOLLOW CORNER RD	308	CULVER CITY	CA	90230	7545	19	06037	34.00641245	-118.3890552	Los Angeles County
290353	Fee-for-Service	1295758688	1295758688	1	2	BRADEN PARTNERS LP	7/19/2019	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3101 SILLECT AVE	106	BAKERSFIELD	CA	93308	6348	15	06029	35.38769515	-119.0376071	Kern County
290367	Fee-for-Service	1043313257	1043313257	1	1	BLAIR, STEVEN D MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70395	08	Family Practice	0	In state provider	None	414 G ST	STE 120	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
290396	Fee-for-Service	1679968705	1679968705	1	2	BODDU, SUCHARITA MD	5/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	151938	07	Dermatology	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
290398	Fee-for-Service	1972557064	1972557064	1	1	BILOXI HMA LLC	10/17/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	150 REYNOIR STREET	None	BILOXI	MS	39530	4130	00	None	30.39593624	-88.89038741	Harrison County
290402	Fee-for-Service	1124192489	1124192489	1	1	BROWN, GORDON A DO	8/4/2021	208800000X	NA	Other	026	PHYSICIANS	18706	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
290409	Fee-for-Service	1568583458	1568583458	1	1	BEST BUY HEALTH INC	6/3/2020	No Taxonomy Provided	NA	None	068	HCBC BENEFIT PROVIDER	-	-	NOT APPLICABLE	2	Out of state provider	None	27475 MEADOWBROOK RD	None	NOVI	MI	48377	3532	00	None	42.492393	-83.457882	Oakland County
290413	Fee-for-Service	1184493827	1184493827	1	1	BUI, SANG KIM	1/10/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	32913 GELDER CIR	None	MENIFEE	CA	92584	2903	33	06065	0	0	None
290443	Fee-for-Service	1972557064	1972557064	1	1	BILOXI HMA LLC	10/17/2018	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	150 REYNOIR STREET	None	BILOXI	MS	39530	4130	00	None	30.39593624	-88.89038741	Harrison County
290444	Fee-for-Service	1174611107	1174611107	1	1	BOTTARI, BRENDAN MD	6/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81922	None	None	0	In state provider	None	652 PETALUMA AVE	STE I	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
290456	Fee-for-Service	1184493827	1184493827	1	1	BUI, SANG KIM	1/10/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	32913 GELDER CIR	None	MENIFEE	CA	92584	2903	33	06065	0	0	None
290478	Fee-for-Service	1699336370	1699336370	1	1	BASICAL, KYLE MD	11/18/2022	390200000X	NA	Other	026	PHYSICIANS	182287	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
290507	Fee-for-Service	1407191984	1407191984	1	1	BSA HOSPITAL LLC	12/3/2018	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1600 WALLACE BLVD	None	AMARILLO	TX	79106	1799	00	None	35.19634143	-101.9178866	Potter County
290511	Fee-for-Service	1366776205	1366776205	1	1	BAIROS, JOHNNY CRNA	1/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	12567 HESPERIA RD	None	VICTORVILLE	CA	92395	5847	36	06071	34.47951846	-117.290868	San Bernardino County
290536	Fee-for-Service	1477510097	1477510097	1	1	BLANCO-BUMATAY, BETALINA	3/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50060	40	Pediatrics	0	In state provider	None	1262 E NORTH ST	None	MANTECA	CA	95336	4962	39	06077	37.80103784	-121.1964105	San Joaquin County
290544	Fee-for-Service	1689873184	1689873184	1	1	BECK HOLDER, KAMBRIA K MD	7/15/2014	390200000X	NA	Other	026	PHYSICIANS	101959	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
290546	Fee-for-Service	1407191984	1407191984	1	1	BSA HOSPITAL LLC	12/3/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1600 WALLACE BLVD	None	AMARILLO	TX	79106	1799	00	None	35.19634143	-101.9178866	Potter County
290551	Fee-for-Service	1336156769	1336156769	1	1	BLAND, HOWARD K MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	61709	01	General Practice	0	In state provider	None	1198 PACIFIC COAST HWY	STE I	SEAL BEACH	CA	90740	6278	30	06059	33.74325823	-118.1004531	Orange County
290582	Fee-for-Service	1689873184	1689873184	1	1	BECK HOLDER, KAMBRIA K MD	7/15/2014	390200000X	NA	Other	026	PHYSICIANS	101959	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
290605	Fee-for-Service	1861256547	1861256547	1	1	BONNET, CLEMENCE P MD	10/2/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
290700	Fee-for-Service	1992278089	1992278089	1	1	BROWN, SARENA N LCSW	4/25/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
290708	Fee-for-Service	1477925485	1477925485	1	1	BARBOZA, MARIA	10/9/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2675 FLETCHER PKWY	#205	SAN DIEGO	CA	92020	2126	37	06073	32.8014058	-117.0008513	San Diego
290733	Fee-for-Service	1053392365	1053392365	1	1	BANNYKH, SERGUEI I MD	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72353	22	Pathology (M.D. only)	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
290736	Fee-for-Service	1205846037	1205846037	1	1	BAILEY MEDICAL CENTER LLC	12/10/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10502 N 110TH EAST AVE	None	OWASSO	OK	74055	6655	00	None	36.30449291	-95.85182807	Tulsa County
290750	Fee-for-Service	1073157764	1073157764	1	1	BOYZO, JORGE LCSW	4/27/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	121890	-	NOT APPLICABLE	0	In state provider	None	2801 BRISTOL STREET	STE 200	COSTA MESA	CA	92626	5996	30	06059	33.67474907	-117.889122	Orange County
290754	Fee-for-Service	1407851108	1407851108	1	1	BURNETT, JOHN F MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	45980	24	Plastic Surgery	0	In state provider	None	6153 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82548093	-119.7831422	Fresno County
290757	Fee-for-Service	1477925485	1477925485	1	1	BARBOZA, MARIA	10/9/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2675 FLETCHER PKWY	#205	SAN DIEGO	CA	92020	2126	37	06073	32.8014058	-117.0008513	San Diego
290771	Fee-for-Service	1326133109	1326133109	1	1	BAMGBOSE, ELIZABETH B CRNA	6/7/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
290787	Fee-for-Service	1295146173	1295146173	1	1	BEDELL, VICTORIA MD	3/14/2025	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
290789	Fee-for-Service	1922179407	1922179407	1	1	BERENDES, SHANNON L	10/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
290800	Fee-for-Service	1437872322	1437872322	1	1	BAKER, BETHANY PT	10/10/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
290822	Fee-for-Service	1548540933	1548540933	1	1	BEAL, ELIZABETH C H DO	7/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12780	01	General Practice	0	In state provider	None	2130 HERITAGE LOOP RD	BLDG 5	PASO ROBLES	CA	93446	7800	40	06079	35.74251645	-120.8773689	San Luis Obispo County
290840	Fee-for-Service	1629340989	1629340989	1	1	BRODSKY, GENNA B LCSW	3/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	3641	01	06001	37.82397231	-122.2578822	Alameda County
290874	Fee-for-Service	1548349004	1548349004	1	1	BICHAI, WILLIAM N	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92564	None	None	0	In state provider	None	620 34TH ST	None	BAKERSFIELD	CA	93301	2208	15	06029	35.39051352	-119.0091465	Kern County
290883	Fee-for-Service	1306473004	1306473004	1	1	BURGHART, VICTORIA	10/31/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180154	36	Psychiatry	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
290885	Fee-for-Service	1225410582	1225410582	1	1	BRETHOUWER, DAVID A DO	4/5/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	15035	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
290936	Fee-for-Service	1225065667	1225065667	2	1	BHARDWAJ, MANICK MD	1/14/2016	207R00000X	NA	Other	026	PHYSICIANS	45855	41	Internal Medicine	0	In state provider	None	4817 CENTENNIAL PLAZA WY	STE A	BAKERSFIELD	CA	93312	1957	15	06029	35.40389036	-119.093518	Kern County
290951	Fee-for-Service	1669566097	1669566097	1	1	BRODY, ALAN S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
291072	Fee-for-Service	1992181176	1992181176	1	1	BESSERT, AMY I NP	4/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
291105	Fee-for-Service	1285644112	1285644112	1	1	BINDEL, DONNA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41555	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1052 CASS ST	None	MONTEREY	CA	93940	4509	27	06053	36.59145624	-121.8969886	Monterey County
291125	Fee-for-Service	1285644112	1285644112	1	1	BINDEL, DONNA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1052 CASS ST	None	MONTEREY	CA	93940	4509	27	06053	36.59145624	-121.8969886	Monterey County
291134	Fee-for-Service	1053185173	1053185173	1	1	BABE BIRTHER LLC	12/15/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
291144	Fee-for-Service	1730320763	1730320763	1	1	BUTT, OLIVIA MD	11/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106483	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27225 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63194474	-122.0897225	Alameda County
291169	Fee-for-Service	1518457704	1518457704	1	1	BAGINSKI, LEON MD INC	6/18/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64918	None	None	0	In state provider	None	27800 MEDICAL CENTER RD	#310	MISSION VIEJO	CA	92691	6461	30	06059	33.55952733	-117.6645199	Orange County
291175	Fee-for-Service	1811089717	1811089717	1	1	BERTOLLI, THOMAS A MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	38824	01	General Practice	0	In state provider	None	46900 OCEAN DR	None	GUALALA	CA	95445	9999	23	06045	38.80460137	-123.5780677	Mendocino County
291185	Fee-for-Service	1871859611	1871859611	1	1	BROCK, JAMES P DO MD	7/1/2018	2080P0214X	NA	Pulmonology	026	PHYSICIANS	13058	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
291191	Fee-for-Service	1437618774	1437618774	1	1	BARNHART, CAROLINE E MD	11/16/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181568	None	None	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
291206	Fee-for-Service	1548208069	1548208069	1	1	BALANON S SYNYA K MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53743	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
291208	Fee-for-Service	1780885368	1780885368	1	1	BIGELOW, BRIGITTE K MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112437	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
291220	Fee-for-Service	1194974717	1194974717	1	1	BUNKLEY, RONNIE LCSW	9/27/2024	103TC0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
291252	Fee-for-Service	1538103411	1538103411	1	1	BENOWITZ, NEAL L MD	7/30/1981	207R00000X	NA	Other	026	PHYSICIANS	21334	47	Miscellaneous	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
291283	Fee-for-Service	1619960655	1619960655	1	1	BROWN, STEVEN MD	4/24/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	88266	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
291284	Fee-for-Service	1124864749	1124864749	1	1	BLR SERVICES LLC	8/9/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
291286	Fee-for-Service	1215025465	1215025465	1	1	BASSI, RICKY MD	3/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125244	67	Endocrinology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4423	50	06099	37.666863	-120.9962775	Stanislaus County
291309	Fee-for-Service	1548528037	1548528037	1	1	BERDUGO, RAYMOND A MD	8/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120091	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
291315	Fee-for-Service	1629343033	1629343033	1	1	BRADSHAW, CHRISTINA L MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135533	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
291332	Fee-for-Service	1083636260	1083636260	1	1	BALLI, KEVIN C MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70833	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
291333	Fee-for-Service	1760490031	1760490031	1	1	BESSER, STANLEY M MD	3/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42115	47	Miscellaneous	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
291339	Fee-for-Service	1760490031	1760490031	1	1	BESSER, STANLEY M MD	3/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42115	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
291346	Fee-for-Service	1760490031	1760490031	1	1	BESSER, STANLEY M MD	3/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42115	01	General Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
291386	Fee-for-Service	1801232822	1801232822	1	1	BREWER, SARAH N MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141759	None	None	0	In state provider	None	30131 TOWN CENTER DR	SUITE 315	LAGUNA NIGUEL	CA	92677	2010	30	06059	33.52530096	-117.7148334	Orange County
291444	Fee-for-Service	1962559039	1962559039	1	1	BOWENS, NINA	10/30/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	143901	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
291448	Fee-for-Service	1235386731	1235386731	1	1	BUJAK, NICHOLAS K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13677 W MCDOWELL RD	None	GOODYEAR	AZ	85395	2635	00	None	33.461982	-112.3535475	Maricopa County
291458	Fee-for-Service	1144308875	1144308875	1	1	BROADHURST, ROBERT B MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85384	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
291483	Fee-for-Service	1932171121	1932171121	1	1	BALCOS, ENRICO U MD	6/19/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	63363	36	Psychiatry	0	In state provider	None	1125 E 17TH ST	SUITE N153	SANTA ANA	CA	92701	2201	30	06059	33.76004145	-117.854838	Orange County
291515	Non-Physician Medical Practitioner	None	1104177849	0	0	BRAVO, NANCY E	3/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	952 WEST F STREET	None	ONTARIO	CA	91762	2614	00	06000	34.06986	-117.667161	San Bernardino County
291531	Non-Physician Medical Practitioner	None	1154691665	0	0	BINOYA, CYNTHIA E	9/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10230 ARTESIA BLVD	SUITE 118	BELLFLOWER	CA	90706	6763	00	06000	33.8728276	-118.1160403	Los Angeles County
291553	Non-Physician Medical Practitioner	None	1558991844	0	0	BAJAMUNDI, KEITH W NP	1/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12507 ALONDRA BLVD	None	NORWALK	CA	90650	7351	00	06000	33.88780847	-118.0660905	Los Angeles County
291562	Non-Physician Medical Practitioner	None	1265093926	0	0	BOKTOR, DIANA PA-C	10/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	00	06000	34.0653985	-118.3769177	Los Angeles County
291592	Non-Physician Medical Practitioner	None	1346591104	0	0	BLACK, LAURA ANN	10/24/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	717 CENTER ST	None	HEALDSBURG	CA	95448	3604	00	06000	38.61783	-122.8707965	Sonoma County
291597	Non-Physician Medical Practitioner	None	1508408808	0	0	BASHIR, SHAZIA NP	6/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 SAN DIMAS STREET	STE A200	BAKERSFIELD	CA	93301	2284	00	06000	35.3946385	-119.008203	Kern County
291626	Non-Physician Medical Practitioner	None	1386040129	0	0	BENENHALEY, LEESA E NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
291634	Non-Physician Medical Practitioner	None	1124140124	0	0	BRISTOL, HEATHER E	12/21/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	331 LA CUESTA DR	None	SCOTTS VALLEY	CA	95066	4714	00	06000	37.03835531	-122.0256848	Santa Cruz County
291641	Non-Physician Medical Practitioner	None	1376966192	0	0	BARTMUS, TERRY L NP	11/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4915 BUCKHORN BUTTE CT	None	LAS VEGAS	NV	89149	5259	00	06000	36.250074	-115.2667855	Clark County
291652	Non-Physician Medical Practitioner	None	1245803584	0	0	BLEGEN, MATTHEW PA	6/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
291665	Non-Physician Medical Practitioner	None	1245968676	0	0	BAYONA, FRANCIS	3/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
291794	Non-Physician Medical Practitioner	None	1285062505	0	0	BAHNE, EMILY B NP	11/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6410 S EAST AVE	None	FRESNO	CA	93725	9424	00	06000	36.64296858	-119.7727565	Fresno County
291827	Non-Physician Medical Practitioner	None	1811456213	0	0	BROCK, JORI L NP	12/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7920 FROST STREET	SUITE 200	SAN DIEGO	CA	92123	4289	00	06000	32.80027449	-117.153846	San Diego County
291843	Non-Physician Medical Practitioner	None	1023248457	0	0	BROWN, KALEY MICHELLE	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	ORTHOPEDICS DEPARTMENT	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
291859	Non-Physician Medical Practitioner	None	1629523394	0	0	BENEDICTO, RYAN M NP	10/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27022 MOUNTAIN WILLOW LN	None	CANYON COUNTY	CA	91387	3991	00	06000	34.4062818	-118.4360596	Los Angeles County
291876	Non-Physician Medical Practitioner	None	1861253346	0	0	BIRONDO, MARDELLA PA-C	2/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
291885	Non-Physician Medical Practitioner	None	1548689649	0	0	BAECKER, JENNIFER S NP	10/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1926 VIENTO VERANO DRIVE	None	DIAMOND BAR	CA	91765	2706	00	06000	33.98679255	-117.8378759	Los Angeles County
291886	Non-Physician Medical Practitioner	None	1265893317	0	0	BURGESS, LESLIE A NP	1/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11760 CRYSTAL AVENUE	None	CHINO	CA	91710	1713	00	06000	34.03971168	-117.6991484	San Bernardino County
291889	Non-Physician Medical Practitioner	None	1164983375	0	0	BALLARD, AMANDA PA-C	6/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 E ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	00	06000	34.07556833	-117.7507835	Los Angeles County
291911	Non-Physician Medical Practitioner	None	1568002863	0	0	BOYLE, ANGELA R	1/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	631 COOPER RD	None	OXNARD	CA	93030	5427	00	06000	34.20454837	-119.1719737	Ventura County
291951	Non-Physician Medical Practitioner	None	1285795021	0	0	BOUTTE, TEMICA D PA-C	10/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	780 ATLANTIC AVE	None	LONG BEACH	CA	90813	4565	00	06000	33.776325	-118.1850235	Los Angeles County
291952	Non-Physician Medical Practitioner	None	1811367261	0	0	BARIEL, JEFFREY B	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1480 10TH STREET	None	LOS OSOS	CA	93402	3751	00	06000	35.32468676	-120.8320896	San Luis Obispo County
291965	Non-Physician Medical Practitioner	None	1669615985	0	0	BACHRACH, ARI MAX	12/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	00	06000	37.48892015	-122.218747	San Mateo County
291972	Non-Physician Medical Practitioner	None	1457924235	0	0	BEATTIE, BRIDGETTE M PA	9/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	00	06000	32.72663119	-117.1611714	San Diego County
292004	Non-Physician Medical Practitioner	None	1164930228	0	0	BENSOUSSAN, MICHELLE N PA-C	3/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	309 WEST BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	00	06000	34.01597577	-118.1003516	Los Angeles County
292020	Non-Physician Medical Practitioner	None	1285792432	0	0	BLOOM, JOAN D	6/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
292032	Non-Physician Medical Practitioner	None	1215286976	0	0	BROCK, DANNA M	6/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3536 ELMHURST AVENUE	None	ROYAL OAK	MI	48073	2345	00	06000	42.5208003	-83.17210113	Oakland County
292050	Non-Physician Medical Practitioner	None	1083998959	0	0	BAITY, ELIZABETH G PA-C	3/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
292060	Non-Physician Medical Practitioner	None	1346207388	0	0	BLOK-KALNASY, LAURA	5/25/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5665 PEACHTREE DUNWOODY	None	ATLANTA	GA	30342	1764	00	06000	33.908526	-84.349593	Fulton County
292071	Non-Physician Medical Practitioner	None	1598846099	0	0	BAUMGARTEN, GREGORY A NP	5/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
292092	Non-Physician Medical Practitioner	None	1598823742	0	0	BARNETT, MATHEW B NP	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7915 E ROSE AVE	None	SELMA	CA	93662	9424	00	06000	36.56868382	-119.6497848	Fresno County
292105	Non-Physician Medical Practitioner	None	1225770563	0	0	BUTHORNE, RACHEL PA-C	12/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 SHERMAN DR	STE 7	RIVERSIDE	CA	92503	4001	00	06000	33.92678822	-117.4368632	Riverside County
292115	Non-Physician Medical Practitioner	None	1558682195	0	0	BEKELE, METASEBIA	6/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 ELM LANE	None	WILLITS	CA	95490	4402	00	06000	39.38918847	-123.3473278	Mendocino County
292118	Non-Physician Medical Practitioner	None	1013081439	0	0	BRIARE, FRANCES EILEEN	11/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
292121	Non-Physician Medical Practitioner	None	1336467133	0	0	BOYD, DARCY GERMAINE	5/18/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	770 WELCH RD STE 100	None	PALO ALTO	CA	94304	1505	00	06000	37.43748087	-122.1759625	Santa Clara County
292142	Non-Physician Medical Practitioner	None	1780202473	0	0	BERMAN, JULIA F	7/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14662 NEWPORT AVENUE	None	TUSTIN	CA	92780	6064	00	06000	33.73088521	-117.8293385	Orange County
292145	Non-Physician Medical Practitioner	None	1518460435	0	0	BAUTISTA GARCIA, JOSE LUIS NP	8/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	00	06000	33.78003775	-118.1866604	Los Angeles County
292218	Non-Physician Medical Practitioner	None	1891217204	0	0	BELL, ERIC J	8/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3663 SOLANO AVENUE	APT 95	NAPA	CA	94558	2771	00	06000	38.32629936	-122.3139391	Napa County
292223	Non-Physician Medical Practitioner	None	1922271238	0	0	BAKER, RACHEL MARY	3/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
292226	Non-Physician Medical Practitioner	None	1316545239	0	0	BOGHOZIAN, DIANA NP	1/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1737 W GLENOAKS BLVD	None	GLENDALE	CA	91201	1542	00	06000	34.17214599	-118.2908947	Los Angeles County
292230	Non-Physician Medical Practitioner	None	1619307154	0	0	BARBA, ARACIEL NP	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11150 GLENOAKS BLVD	APT 264	PACOIMA	CA	91331	6666	00	06000	34.2729632	-118.410921	Los Angeles County
292235	Non-Physician Medical Practitioner	None	1578904439	0	0	BARNES, LALIA G PA-C	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
292285	Non-Physician Medical Practitioner	None	1164891289	0	0	BENITEZ, TANYA NP	1/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 E ROMIE LN	A	SALINAS	CA	93901	4031	00	06000	36.65998191	-121.6461895	Monterey County
292303	Non-Physician Medical Practitioner	None	1730473836	0	0	BALLINGHAM, ZACKARY B NP	9/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1245 HEYBOURNE DR	None	GARDNERVILLE	NV	89410	6146	00	06000	38.94846574	-119.7488664	Douglas County
292311	Non-Physician Medical Practitioner	None	1770892895	0	0	BORRELLI, SCOTT RYAN	11/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
292343	Non-Physician Medical Practitioner	None	1871928135	0	0	BUDNEVSKA-SIRA, VIRA	1/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7752 JUAN WAY	None	FAIR OAKS	CA	95628	3414	00	06000	38.662029	-121.279437	Sacramento County
292344	Non-Physician Medical Practitioner	None	1255613402	0	0	BEDFORD, RONALD M JR NP	1/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	567 W CHANNEL ISLANDS BL	STE 145	PORT HUENEME	CA	93041	2133	00	06000	34.17609238	-119.214086	Ventura County
292367	Non-Physician Medical Practitioner	None	1134166614	0	0	BOUGHEY, JOAN NP	8/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	00	06000	33.67620851	-117.7948348	Orange County
292369	Non-Physician Medical Practitioner	None	1154164820	0	0	BHANGOO, DAVINDER-DEEP PA	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	00	06000	37.79964	-121.246425	San Joaquin County
292372	Non-Physician Medical Practitioner	None	1386665271	0	0	BREBNER, TRACEY PA-C	5/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	00	06000	33.1857	-117.290538	San Diego County
292404	Non-Physician Medical Practitioner	None	1992112874	0	0	BARR, LINDSAY H NP	12/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5225 BLAKESLEE AVE	STE 318	NORTH HOLLYWOOD	CA	91601	3245	00	06000	34.16546273	-118.372504	Los Angeles County
292405	Non-Physician Medical Practitioner	None	1043649304	0	0	BERGMAN, BRETT A	2/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	00	06000	33.6242782	-117.9284249	Orange County
292415	Non-Physician Medical Practitioner	None	1720598808	0	0	BUSCHING, MICHELLE M PA-C	1/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
292418	Non-Physician Medical Practitioner	None	1427155571	0	0	BRANHAM, JODY V CNM	1/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 DRAKES LANDING RD #	SUITE 225	GREENBRAE	CA	94904	2404	00	06000	37.94376589	-122.5180749	Marin County
292420	Non-Physician Medical Practitioner	None	1114399953	0	0	BAL, HARKIRAT S NP	2/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2351 S BUSH AVE	None	FRESNO	CA	93727	5274	00	06000	36.71704557	-119.7168717	Fresno County
292441	Non-Physician Medical Practitioner	None	1013759042	0	0	BANGAH, HARACE NP	11/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 ALHAMBRA BLVD	STE 300 & 230	SACRAMENTO	CA	95816	5238	00	06000	38.570076	-121.4657145	Sacramento County
292497	Non-Physician Medical Practitioner	None	1699073916	0	0	BOYNTON, ELLEN M	10/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	114 CASEY ST	None	SAN CLEMENTE	CA	92672	2612	00	06000	33.39339613	-117.5936876	San Diego County
292521	Non-Physician Medical Practitioner	None	1619126273	0	0	BROOME, DANIELLE M	12/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	435 MONROVISTA AVE	None	MONROVIA	CA	91016	4611	00	06000	34.13130452	-117.993537	Los Angeles County
292523	Non-Physician Medical Practitioner	None	1861716045	0	0	BISHOP, CLARK	5/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	245 UNION AVE APT A1001	None	CAMPBELL	CA	95008	3524	00	06000	37.28296947	-121.9356794	Santa Clara County
292546	Non-Physician Medical Practitioner	None	1134637192	0	0	BARNARD, REBECCA L	2/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19764 MT WASATCH DR	None	RIVERSIDE	CA	92508	3281	00	06000	33.89015124	-117.3187934	Riverside County
292579	Non-Physician Medical Practitioner	None	1982251773	0	0	BATRA, SHRADDHA C PA	12/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	00	06000	38.602089	-121.3925895	Sacramento County
292586	Non-Physician Medical Practitioner	None	1487312534	0	0	BERNSTEIN, LAI-LING	12/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
292616	Non-Physician Medical Practitioner	None	1417961442	0	0	BROOKS, GEMMA A NP	8/5/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3389 SIERRA OAKS BLVD	None	SACRAMENTO	CA	95864	5739	00	06000	38.570292	-121.388184	Sacramento County
292626	Non-Physician Medical Practitioner	None	1225260078	0	0	BAFUMA, PATRICK J PA	12/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	00	06000	34.95203385	-120.4131707	Santa Barbara County
292641	Non-Physician Medical Practitioner	None	1063969293	0	0	BEST, ALLISON S	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	308 ALVARADO STREET	None	REDLANDS	CA	92373	5123	00	06000	34.04960454	-117.1835738	San Bernardino County
292642	Non-Physician Medical Practitioner	None	1518302124	0	0	BUSALACCHI, ANTOINETTE F PA	5/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9665 LUTHERAN WY	None	SANTEE	CA	92071	1508	00	06000	32.85447894	-116.9889218	San Diego County
292649	Non-Physician Medical Practitioner	None	1710054564	0	0	BARTON-SERAFINI, ROSARY A	3/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6290 SUNNY MEADOW LANE	None	CHINO HILLS	CA	91709	3268	00	06000	33.93289761	-117.6675033	San Bernardino County
292657	Non-Physician Medical Practitioner	None	1912023144	0	0	BARRERA, JEANETTE M	9/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10618 PANGBORN AVE	None	DOWNEY	CA	90241	2940	00	06000	33.9357707	-118.1101652	Los Angeles County
292702	Non-Physician Medical Practitioner	None	1871873869	0	0	BUSHMAN, LEAH A NP	3/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
292737	Non-Physician Medical Practitioner	None	1164634176	0	0	BERNSTEIN, IVAN PRANIL	5/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	00	06000	37.48948529	-122.2232468	San Mateo County
292744	Non-Physician Medical Practitioner	None	1891214763	0	0	BRANDSMEIER, CHARLES R NP	8/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 GELLERT BLVD	None	DALY CITY	CA	94015	2613	00	06000	37.66753085	-122.4686194	San Mateo County
292747	Non-Physician Medical Practitioner	None	1982964417	0	0	BIALKA, KATHERINE L PA	4/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 SIERRA COLLEGE DR	SUITE 207	GRASS VALLEY	CA	95945	5763	00	06000	39.23410746	-121.0515391	Nevada County
292818	Non-Physician Medical Practitioner	None	1962957506	0	0	BELL, SUSAN J	7/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	06000	42.318801	-122.831728	Jackson County
292822	Non-Physician Medical Practitioner	None	1104124999	0	0	BRZOZKA, MELANIE LYNN	8/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD # 100	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
292834	Non-Physician Medical Practitioner	None	1760194666	0	0	BARZAGA, LOVELY M NP	1/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1317 OAKDALE RD	SUITE 440	MODESTO	CA	95355	3364	00	06000	37.662489	-120.957588	Stanislaus County
292852	Non-Physician Medical Practitioner	None	1396117800	0	0	BRENNAN, STEFANIE L NP	4/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 E THIRD ST	APT 120	LONG BEACH	CA	90802	3189	00	06000	33.77047149	-118.190574	Los Angeles County
292867	Non-Physician Medical Practitioner	None	1023193562	0	0	BROWN, RIKKY R	8/14/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13905 MERITAGE COURT	None	BAKERSFIELD	CA	93314	4715	00	06000	35.36729619	-119.1571769	Kern County
292871	Non-Physician Medical Practitioner	None	1952546103	0	0	BROWN, KORTNEY M NP	9/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
292873	Non-Physician Medical Practitioner	None	1902022494	0	0	BAKER, PATRICIA LOUISE	3/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	141 LYNCH CREEK WAY STE	None	PETALUMA	CA	94954	2390	00	06000	38.25192092	-122.6341929	Sonoma County
292883	Non-Physician Medical Practitioner	None	1679584445	0	0	BROUSSARD, LINDA C PA	7/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E FLORIDA AVE	None	HEMET	CA	92544	4632	00	06000	33.74755247	-116.9539875	Riverside County
292888	Non-Physician Medical Practitioner	None	1578094330	0	0	BRASSEL, LAUREN G NP	4/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	716 5TH STREET	None	HERMOSA BEACH	CA	90254	4738	00	06000	33.85855749	-118.3918831	Los Angeles County
292896	Non-Physician Medical Practitioner	None	1336992825	0	0	BROTHERS, BRITTANI	9/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6620 COYLE AVE	STE 303	CARMICHAEL	CA	95608	6333	00	06000	38.66751	-121.310028	Sacramento County
292914	Non-Physician Medical Practitioner	None	1649436577	0	0	BROOKS, SUSAN LYNN	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3639 HARBOR BLVD STE 106	None	VENTURA	CA	93001	4276	00	06000	34.24323572	-119.2569406	Ventura County
292939	Non-Physician Medical Practitioner	None	1194409979	0	0	BATISTA, MARLENE	6/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
292951	Non-Physician Medical Practitioner	None	1568425239	0	0	BAKER, ROBERT	11/30/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	72057 HIGHWAY 111	None	RANCHO MIRAGE	CA	92270	4927	00	06000	33.7347649	-116.4074389	Riverside County
292953	Non-Physician Medical Practitioner	None	1639914294	0	0	BROWN, BIANCA NP	8/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1444 EAST HOLT AVE	RM 301	POMONA	CA	91767	5865	00	06000	34.06297235	-117.7228495	Los Angeles County
292959	Non-Physician Medical Practitioner	None	1134518962	0	0	BLANK, ALEXANDER J	3/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1653 HACIENDA COURT	None	YUBA CITY	CA	95993	7704	00	06000	39.15147068	-121.6746554	Sutter County
292970	Non-Physician Medical Practitioner	None	1710529805	0	0	BELL, WENDY L NP	2/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
292987	Non-Physician Medical Practitioner	None	1033150685	0	0	BONDI, TRACY LYNNE	10/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
292997	Non-Physician Medical Practitioner	None	1801879879	0	0	BLACK, COLLEEN R	12/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 712	None	LEMOORE	CA	93245	0712	00	06000	0	0	None
293000	Non-Physician Medical Practitioner	None	1932583150	0	0	BOSLEY, JAZMYNE A NP	3/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10251 SORRENTO VISTA PAR	SUITE 280	SAN DIEGO	CA	92121	3776	00	06000	32.89524013	-117.2142063	San Diego County
293008	Non-Physician Medical Practitioner	None	1255851119	0	0	BAUM, ARON R PA	7/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	750 REDWOOD HWY	SUITE 1204	MILL VALLEY	CA	94941	2483	00	06000	37.89525674	-122.5158838	Marin County
293025	Non-Physician Medical Practitioner	None	1003204504	0	0	BANDY, ALEXANDER J NP	5/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	530 W BONITA AVE	None	CLAREMONT	CA	91711	4625	00	06000	34.09648238	-117.7213962	Los Angeles County
293044	Non-Physician Medical Practitioner	None	1699485664	0	0	BROWN, LYNDSEY NP	9/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7830 CLAIREMONT MESA BLV	STE 100	SAN DIEGO	CA	92111	1619	00	06000	32.83285853	-117.1522755	San Diego County
293047	Non-Physician Medical Practitioner	None	1518985142	0	0	BOUCHARD, MARIA CHRISTINA	5/1/1993	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	00	06000	34.21700406	-119.1582582	Ventura County
293060	Non-Physician Medical Practitioner	None	1043362296	0	0	BRIDWELL, LARRY JOE	4/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	00	06000	37.8242017	-122.2578306	Alameda County
293086	Non-Physician Medical Practitioner	None	1205489903	0	0	BAKER, LISA A NP	6/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	00	06000	37.50033166	-119.9769163	Mariposa County
293097	Non-Physician Medical Practitioner	None	1265737175	0	0	BURROUGHS, SWEENA A	7/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
293114	Non-Physician Medical Practitioner	None	1891447843	0	0	BELL, JACQUELINE NP	2/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
293160	Non-Physician Medical Practitioner	None	1659856177	0	0	BRADY, BREIANA A PA	10/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
293166	Non-Physician Medical Practitioner	None	1508878133	0	0	BELZER, KATHLEEN M	6/23/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 SUTTER PL	SUITE 203	DAVIS	CA	95616	6201	00	06000	38.56287659	-121.7715536	Yolo County
293170	Non-Physician Medical Practitioner	None	1770326944	0	0	BRINTLEY, KAJUANA	1/31/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
293179	Non-Physician Medical Practitioner	None	1053084061	0	0	BROWN, RACHEL R PA-C	6/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
293190	Non-Physician Medical Practitioner	None	1952111965	0	0	BOVEE, REED PA-C	2/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
293194	Non-Physician Medical Practitioner	None	1144468299	0	0	BORUKHOVA, ELONA A	9/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3830 ELIJAH CT	#421	SAN DIEGO	CA	92130	6020	00	06000	32.94619237	-117.2339009	San Diego County
293203	Non-Physician Medical Practitioner	None	1851470868	0	0	BUCKLEY, CHRISTOPHER J	6/28/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2581 CALIFORNIA PARK DR	APT. 284	CHICO	CA	95928	4012	00	06000	39.75181262	-121.7921218	Butte County
293204	Non-Physician Medical Practitioner	None	1013091594	0	0	BRECKENRIDGE, LAURA	4/2/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 SNEATH LN	SUITE 104	SAN BRUNO	CA	94066	2308	00	06000	37.63462925	-122.4259247	San Mateo County
293210	Non-Physician Medical Practitioner	None	1447314828	0	0	BAHUGUNA, CHARU	3/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 HOSPITAL PKWY	SUITE C	SAN JOSE	CA	95119	1103	00	06000	37.23931375	-121.8014189	Santa Clara County
293244	Non-Physician Medical Practitioner	None	1326829862	0	0	BEINSCHROTH, GABRIELLE NP	12/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16143 KOKANEE RD	STE C	APPLE VALLEY	CA	92307	1355	00	06000	34.54439055	-117.2678905	San Bernardino County
293255	Non-Physician Medical Practitioner	None	1891740007	0	0	BAILEY, KEVIN JAN	12/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	0000	00	06000	37.66508443	-120.9962589	Stanislaus County
293286	Non-Physician Medical Practitioner	None	1609567098	0	0	BABCHANIK, LYUDMILA I PA-C	9/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	00	06000	38.74953449	-121.2601832	Placer County
293311	Non-Physician Medical Practitioner	None	1063587368	0	0	BASILE, GAIL ANN	9/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7373 WEST LN	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
293332	Non-Physician Medical Practitioner	None	1811446214	0	0	BLACKWILL, HALEY C NP	6/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
293342	Non-Physician Medical Practitioner	None	1043019581	0	0	BALBUENA, YOVANY	4/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
293343	Non-Physician Medical Practitioner	None	1457897258	0	0	BAXTER, SCOTT B	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	22 MALLARD CREEK TRAIL	None	HENDERSON	NV	89052	6700	00	06000	35.95974429	-115.0772177	Clark County
293356	Non-Physician Medical Practitioner	None	1205281540	0	0	BOOM, LINNINEA A NP	7/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6350 EMERALD RIDGE WAY	None	MIRA LOMA	CA	91752	3492	00	06000	33.9723149	-117.5413409	Riverside County
293365	Non-Physician Medical Practitioner	None	1063169696	0	0	BODA, EMMA C PA	7/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	00	06000	34.13805177	-117.4457839	San Bernardino County
293387	Non-Physician Medical Practitioner	None	1497347975	0	0	BOWEN, RICHARD B	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
293431	Non-Physician Medical Practitioner	None	1295915825	0	0	BELLFIELD, BARBARA L NP	2/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	661 LIONS DRIVE	None	OXNARD	CA	93030	4716	00	06000	34.20938634	-119.2005013	Ventura County
293438	Non-Physician Medical Practitioner	None	1639541022	0	0	BOULES, FADY S NP	5/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	435 MONDALE ST	None	CORONA	CA	92879	5887	00	06000	33.89088098	-117.5134105	Riverside County
293440	Non-Physician Medical Practitioner	None	1780611715	0	0	BRACKEN, PETER MATTHEW	5/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1828 S WESTERN AVE	SUITE 10	LOS ANGELES	CA	90006	5808	00	06000	34.04079509	-118.3089792	Los Angeles County
293444	Non-Physician Medical Practitioner	None	1427389238	0	0	BROWN, JAFARI K	9/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13150 OILNUT CT	None	MORENO VALLEY	CA	92553	6869	00	06000	33.92961308	-117.2140321	Riverside County
293450	Non-Physician Medical Practitioner	None	1669888574	0	0	BASHARDOUST, NUSHA	7/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2125 SPECK LANE	None	NEWBURY PARK	CA	91320	4519	00	06000	34.17278837	-118.9240983	Ventura County
293467	Non-Physician Medical Practitioner	None	1609628395	0	0	BLOCH, JOSHUA M PA-C	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
293473	Non-Physician Medical Practitioner	None	1487057931	0	0	BIRCH, SHIRLEY F NP	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 SCRIPPS DRIVE	STE 102	SACRAMENTO	CA	95825	6206	00	06000	38.573181	-121.4118135	Sacramento County
293487	Non-Physician Medical Practitioner	None	1669946687	0	0	BLAISE, ERIN E NP	11/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	00	06000	32.77510996	-117.1277427	San Diego County
293488	Non-Physician Medical Practitioner	None	1255765723	0	0	BOYLE, REBECCA A	8/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1705 MACKENZIE DR	None	SUNNYVALE	CA	94087	5239	00	06000	37.33726022	-122.052333	Santa Clara County
293491	Non-Physician Medical Practitioner	None	1578972543	0	0	BURSCH, LISA K NP	7/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41162 MESA ROBLES CIR	None	TEMECULA	CA	92592	9326	00	06000	33.51153602	-117.0864789	Riverside County
293494	Non-Physician Medical Practitioner	None	1629067053	0	0	BOSWORTH, ABHA M	10/26/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4060 4TH AVE	240	SAN DIEGO	CA	92103	2120	00	06000	32.75053673	-117.1616539	San Diego County
293507	Non-Physician Medical Practitioner	None	1073990859	0	0	BHALLA, MANJU NP	1/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4900 COMMERCE DR	None	BAKERSFIELD	CA	93309	0418	00	06000	35.3696013	-119.0558857	Kern County
293514	Non-Physician Medical Practitioner	None	1013126044	0	0	BAWA, CHRISTIN R	5/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1064 DIAMOND STREET	None	SAN DIEGO	CA	92109	2605	00	06000	32.80043864	-117.2513382	San Diego County
293523	Non-Physician Medical Practitioner	None	1346254216	0	0	BANTEA, VIORICA PA	7/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3441 MARYSVILLE BLVD	None	SACRAMENTO	CA	95838	4512	00	06000	38.631231	-121.431402	Sacramento County
293558	Non-Physician Medical Practitioner	None	1437617164	0	0	BABAEI, FARAHNAZ NP	9/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5601 NORRIS CANYON RD	SUITE 200	SAN RAMON	CA	94583	5407	00	06000	37.77772182	-121.9579459	Contra Costa County
293564	Non-Physician Medical Practitioner	None	1033512868	0	0	BERMUDEZ, MARIETTA M NP	5/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
293570	Non-Physician Medical Practitioner	None	1902984057	0	0	BACA, MARGARITA	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	00	06000	37.97209412	-122.5280013	Marin County
293595	Non-Physician Medical Practitioner	None	1891205159	0	0	BRANNEN, MANDY M NP	1/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	245 CEDAR ST	None	EL CAJON	CA	92021	4544	00	06000	32.80584053	-116.9594775	San Diego County
293605	Non-Physician Medical Practitioner	None	1841774486	0	0	BAIN, RANDALL E	2/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2201 SHORELINE DR	None	ALAMEDA	CA	94501	6450	00	06000	37.75589256	-122.254394	Alameda County
293607	Non-Physician Medical Practitioner	None	1891765632	0	0	BORBA, DAVID	8/6/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
293639	Non-Physician Medical Practitioner	None	1710046198	0	0	BOW, RICHARD KEMP	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
293676	Non-Physician Medical Practitioner	None	1790433910	0	0	BYUN, HYOJEONG NP	8/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 N 3RD ST	None	LOMPOC	CA	93436	7002	00	06000	34.64013944	-120.4451768	Santa Barbara County
293690	Non-Physician Medical Practitioner	None	1053427732	0	0	BROWN, SCOTT M	11/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	878 OSO DR	None	CORONA	CA	92879	8854	00	06000	33.89490249	-117.5440712	Riverside County
293700	Non-Physician Medical Practitioner	None	1134883309	0	0	BRONKEMA, NOLAN A PA-C	12/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
293701	Non-Physician Medical Practitioner	None	1336817287	0	0	BURNS, LISA N NP	10/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
293706	Non-Physician Medical Practitioner	None	1578584223	0	0	BRADLEY, MARIA ELIZABETH B PA-C	11/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 SAN DIMAS ST	101	BAKERSFIELD	CA	93301	5711	00	06000	35.39552345	-119.0082184	Kern County
293707	Non-Physician Medical Practitioner	None	1821742735	0	0	BRECK, JENNIFER R PA	8/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1114 6TH ST	None	MODESTO	CA	95354	2203	00	06000	37.63901905	-121.0057149	Stanislaus County
293717	Non-Physician Medical Practitioner	None	1407145477	0	0	BARRETTO, NAYABEI NP	1/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5800 MATHILDE DRIVE	None	SANTA ROSA	CA	95492	8622	00	06000	38.52590981	-122.7748285	Sonoma County
293719	Non-Physician Medical Practitioner	None	1174681563	0	0	BAKKE, PAUL A	3/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	ORTHOPEDICS 1	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
293726	Non-Physician Medical Practitioner	None	1275127664	0	0	BHANDARI, YASHODA NP	3/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
293729	Non-Physician Medical Practitioner	None	1316297740	0	0	BLACKBURN, JOSEPH K	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3525 W KINGS AVE	None	PHOENIX	AZ	85053	2969	00	06000	33.635052	-112.135158	Maricopa County
293761	Non-Physician Medical Practitioner	None	1326660572	0	0	BROACH, MADELYN R NP	1/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	00	06000	36.74333844	-119.7831874	Fresno County
293782	Non-Physician Medical Practitioner	None	1154333201	0	0	BISSON, ANNE M M	12/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2320 HOLMAN COURT	None	WOODLAND	CA	95776	5383	00	06000	38.64672454	-121.7388619	Yolo County
293786	Non-Physician Medical Practitioner	None	1881142891	0	0	BOY, PAUL R NP	5/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
293797	Non-Physician Medical Practitioner	None	1770564270	0	0	BAER, CYNTHIA L NP	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2541 E PORTLAND AVE	None	FRESNO	CA	93720	4907	00	06000	36.85614305	-119.7378869	Fresno County
293821	Non-Physician Medical Practitioner	None	1396141008	0	0	BEDELIAN, TALINE S NP	3/5/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15140 RIVERSIDE LANE	None	APPLE VALLEY	CA	92307	4865	00	06000	34.52656841	-117.2702587	San Bernardino County
293826	Non-Physician Medical Practitioner	None	1841757598	0	0	BEBERO, MA MILDRED NP	11/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3349 G ST STE C	None	MERCED	CA	95340	0978	00	06000	37.32464815	-120.4692963	Merced County
293837	Non-Physician Medical Practitioner	None	1992014443	0	0	BOWE, MICHAEL A	2/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1235 E MARY LANE	None	GILBERT	AZ	85295	1736	00	06000	33.295437	-111.763143	Maricopa County
293844	Non-Physician Medical Practitioner	None	1013530039	0	0	BREWSTER, APRIL NP	10/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	#357	LA MESA	CA	91942	3027	00	06000	32.77978322	-117.0094766	San Diego County
293856	Non-Physician Medical Practitioner	None	1598771669	0	0	BELL, BARBARA NP	3/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	00	06000	39.74473059	-121.8488381	Butte County
293865	Non-Physician Medical Practitioner	None	1457688616	0	0	BALIAN, CHELSEA M NP	12/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1126 N SPARKS STREET	None	BURBANK	CA	91506	1339	00	06000	34.18359769	-118.3285561	Los Angeles County
293871	Non-Physician Medical Practitioner	None	1194575217	0	0	BUI, MICHELLE T PA-C	5/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17100 NORWALK BLVD	STE 101	CERRITOS	CA	90703	2750	00	06000	33.87557796	-118.0725386	Los Angeles County
293889	Non-Physician Medical Practitioner	None	1497814206	0	0	BURROUGHS, JENNIFER DAY	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
293900	Non-Physician Medical Practitioner	None	1467802934	0	0	BERRYHILL, BETHANY M NP	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1410 LORIMER WY	None	ROSEVILLE	CA	95747	6036	00	06000	38.75903816	-121.3219442	Placer County
293908	Non-Physician Medical Practitioner	None	1700269933	0	0	BANATTE-GARCON, ROLDINE NP	3/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10312 WALNUT CREEK DRIVE	None	BAKERSFIELD	CA	93311	2761	00	06000	35.32229425	-119.1171168	Kern County
293911	Non-Physician Medical Practitioner	None	1881242782	0	0	BALAYAN, SHAINA-JILL NP	10/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39500 FREMONT BLVD	100	FREMONT	CA	94538	2101	00	06000	37.5448266	-121.9802588	Alameda County
293936	Non-Physician Medical Practitioner	None	1942827092	0	0	BYRNES, SHANNON M PA-C	7/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
293941	Non-Physician Medical Practitioner	None	1174052898	0	0	BUNKER, DANIEL P	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	826 COLUMBIA ST	None	REDLANDS	CA	92374	3110	00	06000	34.06366336	-117.1879231	San Bernardino County
293949	Non-Physician Medical Practitioner	None	1548872591	0	0	BOLLIN, EMILY A NP	10/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2980 EL RANCHO DR	None	SCOTTS VALLEY	CA	95060	1103	00	06000	37.0337706	-122.0213553	Santa Cruz County
293966	Non-Physician Medical Practitioner	None	1730547639	0	0	BEDOLIDO, CHRISELYN C NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
293974	Non-Physician Medical Practitioner	None	1285393181	0	0	BANTUGAN, LEONORA B NP	5/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
293976	Non-Physician Medical Practitioner	None	1902262231	0	0	BONILLA, GLENN J NP	1/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10314 STONEHAM ST	None	BAKERSFIELD	CA	93314	8032	00	06000	35.43374958	-119.1173091	Kern County
293977	Non-Physician Medical Practitioner	None	1891270385	0	0	BARNES, JONATHAN D	10/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4221 5TH STREET	None	RIVERSIDE	CA	92501	2611	00	06000	33.98775014	-117.3786518	Riverside County
293979	Non-Physician Medical Practitioner	None	1669827192	0	0	BROUSSARD, DANIELLE M	2/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5520 WILSHIRE BLVD	APT 623	LOS ANGELES	CA	90036	5786	00	06000	34.06228347	-118.3489335	Los Angeles County
293994	Non-Physician Medical Practitioner	None	1720052418	0	0	BUENROSTRO, ANGELICA	10/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31 E MACARTHUR CRES	SUITE F305	SANTA ANA	CA	92707	5932	00	06000	33.70094119	-117.8665178	Orange County
294003	Non-Physician Medical Practitioner	None	1861724353	0	0	BRUST, CRYSTAL ANNE	3/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
294006	Non-Physician Medical Practitioner	None	1609172303	0	0	BAUTISTA, ELIZABETH G NP	1/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6901 CATAWBA AVE	None	FONTANA	CA	92336	5030	00	06000	34.12817611	-117.45908	San Bernardino County
294011	Non-Physician Medical Practitioner	None	1871239616	0	0	BOLLER, ELLEN M PA	6/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
294020	Non-Physician Medical Practitioner	None	1013681717	0	0	BRUBAKER, CHELSEE J PA-C	9/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3430 GARFIELD AVE	None	COMMERCE	CA	90040	3104	00	06000	33.98408703	-118.1403554	Los Angeles County
294023	Non-Physician Medical Practitioner	None	1366812273	0	0	BIBLE, JAMIE J	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9615 PILLITERI WY	None	ELK GROVE	CA	95757	4615	00	06000	38.407761	-121.4449155	Sacramento County
294031	Non-Physician Medical Practitioner	None	1952739021	0	0	BULANDOS, MARIA JONAH C NP	12/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17822 BEACH BLVD	STE 300	HUNTINGTON BEACH	CA	92647	7172	00	06000	33.70331388	-117.9890471	Orange County
294036	Non-Physician Medical Practitioner	None	1679012041	0	0	BURRIS, MICHAEL L NP	4/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	00	06000	33.67620851	-117.7948348	Orange County
294054	Non-Physician Medical Practitioner	None	1750759692	0	0	BRATTON, KAYLA C	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	620 MYRTLEWOOD COURT	None	OCEANSIDE	CA	92058	5896	00	06000	33.23586298	-117.3333401	San Diego County
294060	Non-Physician Medical Practitioner	None	1932358553	0	0	BARYLSKI, CHAD R NP	8/26/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2800 OLYMPIC PKWY	None	CHULA VISTA	CA	91915	6007	00	06000	32.62833	-116.937792	San Diego County
294061	Non-Physician Medical Practitioner	None	1326805789	0	0	BUI, JULIE	1/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6430 SOUTH ST	None	LAKEWOOD	CA	90713	1713	00	06000	33.85826253	-118.107441	Los Angeles County
294078	Non-Physician Medical Practitioner	None	1740338656	0	0	BRUMMETT, MAX H	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 PEMBROKE AVE	None	HEMET	CA	92545	5335	00	06000	33.73394558	-117.0035303	Riverside County
294088	Non-Physician Medical Practitioner	None	1760667240	0	0	BOND, SHAWN MICHAEL	1/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15728 WARM SPRINGS DR	None	CANYON COUNTRY	CA	91387	4029	00	06000	34.3878397	-118.4107963	Los Angeles County
294092	Non-Physician Medical Practitioner	None	1114060258	0	0	BROWN, MICHELLE L NP	5/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	00	06000	39.74352822	-121.8495394	Butte County
294108	Non-Physician Medical Practitioner	None	1891164745	0	0	BARR, RYAN S PA	4/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
294110	Non-Physician Medical Practitioner	None	1174996839	0	0	BLANCHET, NICCOLE M NP	5/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
294140	Non-Physician Medical Practitioner	None	1306020623	0	0	BOWEN, NARAI MARIE	12/31/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5850 S MAIN ST	None	LOS ANGELES	CA	90003	0000	00	06000	33.988536	-118.2739135	Los Angeles County
294143	Non-Physician Medical Practitioner	None	1962946293	0	0	BOCHENEK, VALARIE A	10/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1490 PIEDRA DR	None	WALNUT CREEK	CA	94597	2334	00	06000	37.92063333	-122.0837654	Contra Costa County
294172	Non-Physician Medical Practitioner	None	1578156402	0	0	BLECHA, TAMI NP	4/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
294207	Non-Physician Medical Practitioner	None	1043047509	0	0	BOYLE, SCOTT PA-C	4/1/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
294222	Non-Physician Medical Practitioner	None	1215546833	0	0	BORDENKECHER, LANA L NP	11/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 SPANOS COURT	SUITE 108	MODESTO	CA	95355	2812	00	06000	37.66975543	-120.9724048	Stanislaus County
294228	Non-Physician Medical Practitioner	None	1578076675	0	0	BITTNER, CAROLINE M PA-C	9/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
294246	Non-Physician Medical Practitioner	None	1710500434	0	0	BERGUS, LYNDSAY M PA-C	10/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
294256	Non-Physician Medical Practitioner	None	1427549773	0	0	BROOKINS, MICOLE A NP	8/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
294264	Non-Physician Medical Practitioner	None	1861806424	0	0	BROWN, MEGAN C	4/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	91 VALLEY FALLS PLACE	None	FOLSOM	CA	95630	7176	00	06000	38.706777	-121.1907645	Sacramento County
294267	Non-Physician Medical Practitioner	None	1407965478	0	0	BARRETO, PATRICIA L	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	483 W PRESCOTT	None	CLOVIS	CA	93619	0434	00	06000	36.86466596	-119.7220778	Fresno County
294268	Non-Physician Medical Practitioner	None	1417966763	0	0	BRAVO, FRANK NP	11/1/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6217 WEST ALLUVIAL AVE	None	FRESNO	CA	93722	2627	00	06000	36.84379382	-119.9042578	Fresno County
294269	Non-Physician Medical Practitioner	None	1568865657	0	0	BATDORF, BRYAN S	10/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	119 SPRUCE AVENUE	None	KERNVILLE	CA	93238	6020	00	06000	35.7659154	-118.4376733	Kern County
294287	Non-Physician Medical Practitioner	None	1255578183	0	0	BANDY, ALEXANDER J NP	7/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	530 W BONITA AVE	None	CLAREMONT	CA	91711	4625	00	06000	34.09648238	-117.7213962	Los Angeles County
294303	Non-Physician Medical Practitioner	None	1437869765	0	0	BERMAN, TYLER M PA	5/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11800 WILSHIRE BLVD	None	LOS ANGELES	CA	90025	6606	00	06000	34.0475456	-118.4632671	Los Angeles County
294325	Non-Physician Medical Practitioner	None	1285171751	0	0	BADHESHA, UPKAR K NP	5/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	00	06000	37.662489	-120.957588	Stanislaus County
294327	Non-Physician Medical Practitioner	None	1972688703	0	0	BLAKE, SINCLAIR E PA	4/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
294337	Non-Physician Medical Practitioner	None	1467104455	0	0	BELLEVILLE, LAUREN PA	5/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	00	06000	37.48948529	-122.2232468	San Mateo County
294348	Non-Physician Medical Practitioner	None	1518452283	0	0	BOARD, DARREN R NP	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	00	06000	35.36196445	-119.0749413	Kern County
294352	Non-Physician Medical Practitioner	None	1649692369	0	0	BALDWIN, DONNA J	5/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1526 GLASGOW LN	None	ESCONDIDO	CA	92027	1285	00	06000	33.1591037	-117.0571349	San Diego County
294377	Non-Physician Medical Practitioner	None	1063523843	0	0	BALASSONE, LAURA ANNE	5/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	00	06000	37.69013379	-121.9265243	Alameda County
294383	Non-Physician Medical Practitioner	None	1992480578	0	0	BAIRD, RYAN PA	9/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
294393	Non-Physician Medical Practitioner	None	1245460187	0	0	BOWMAN, CINDY PA	5/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	00	06000	32.83133206	-117.1252363	San Diego County
294397	Non-Physician Medical Practitioner	None	1033410550	0	0	BRUCE, AMY M	3/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	514 SAPPHIRE STREET	None	REDWOOD CITY	CA	94062	2932	00	06000	37.47190198	-122.245623	San Mateo County
294418	Non-Physician Medical Practitioner	None	1740482405	0	0	BURT, MARLENE DIANE	12/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE RM A80	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
294473	Non-Physician Medical Practitioner	None	1710450721	0	0	BILLINGS, STEPHANIE	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3288 BELL RD	None	AUBURN	CA	95603	9243	00	06000	38.94193048	-121.1046075	Placer County
294486	Non-Physician Medical Practitioner	None	1649621954	0	0	BABARAN, NICOLE M	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2245 W BROADWAY	APT N-115	ANAHEIM	CA	92804	1319	00	06000	33.82886852	-117.961713	Orange County
294494	Non-Physician Medical Practitioner	None	1285671180	0	0	BERSTOCK, AVI J	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4241 MOORE ST	None	LOS ANGELES	CA	90066	5725	00	06000	33.99217534	-118.4334205	Los Angeles County
294518	Non-Physician Medical Practitioner	None	1407018468	0	0	BERGGREN, TRACY A	12/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	109 SHORELINE CT	None	RICHMOND	CA	94804	4588	00	06000	37.911294	-122.3448435	Contra Costa County
294519	Non-Physician Medical Practitioner	None	1841758018	0	0	BANGERTER, STEPHANIE C NP	3/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1141 ROSE AVE	None	SELMA	CA	93662	3241	00	06000	36.56881144	-119.5985344	Fresno County
294522	Non-Physician Medical Practitioner	None	1679975981	0	0	BUI, THUY-LINH N	12/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3160 VERDUGO PL	None	LOS ANGELES	CA	90065	2032	00	06000	34.10818868	-118.2364243	Los Angeles County
294533	Non-Physician Medical Practitioner	None	1558575076	0	0	BENNETT, REBECCA L NP	3/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4512 MAX D	None	SAN DIEGO	CA	92115	3113	00	06000	32.75954158	-117.096775	San Diego County
294546	Non-Physician Medical Practitioner	None	1104483783	0	0	BECK, BLAKE J PA	7/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
294564	Non-Physician Medical Practitioner	None	1255000493	0	0	BHATT, RISHMA V NP	11/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
294578	Non-Physician Medical Practitioner	None	1265187017	0	0	BINA, ARIEL PA-C	6/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18226 VENTURA BLVD	102	TARZANA	CA	91356	4246	00	06000	34.16628399	-118.5299288	Los Angeles County
294622	Non-Physician Medical Practitioner	None	1841590726	0	0	BEJARANO, VERENISSE G	7/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3066 HORTALEZA PL	None	DAVIS	CA	95618	6533	00	06000	38.5584655	-121.7109565	Yolo County
294642	Non-Physician Medical Practitioner	None	1700208527	0	0	BHANDARI, KEERA D PA	10/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
294650	Non-Physician Medical Practitioner	None	1992339477	0	0	BAE, BIANCA PA-C	7/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
294665	Non-Physician Medical Practitioner	None	1861748154	0	0	BAI, NICHOLAS J	1/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2028 31ST STREET	None	SAN DIEGO	CA	92104	5632	00	06000	32.72711093	-117.1275317	San Diego County
294667	Non-Physician Medical Practitioner	None	1700600129	0	0	BRAUNSTEIN, CASSANDRA PA-C	3/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24411 HEALTH CENTER DR	SUITE 350	LAGUNA HILLS	CA	92653	3687	00	06000	33.6087201	-117.7076948	Orange County
294669	Non-Physician Medical Practitioner	None	1790953222	0	0	BAUTISTA, ELAINE R PA	7/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
294671	Non-Physician Medical Practitioner	None	1679978951	0	0	BROWN, BRANDON	8/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
294681	Non-Physician Medical Practitioner	None	1114406519	0	0	BARRA, JESSICA B NP	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4546 EL CAMINO REAL	SUITE B2	LOS ALTOS	CA	94022	1099	00	06000	37.40151623	-122.1143075	Santa Clara County
294687	Non-Physician Medical Practitioner	None	1164034419	0	0	BAILEY, MEGAN E PA-C	11/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
294690	Non-Physician Medical Practitioner	None	1124451240	0	0	BUECHLER, JOY	10/21/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	535 E 70TH ST	None	NEW YORK	NY	10021	4823	00	06000	40.764906	-73.9529055	New York County
294698	Non-Physician Medical Practitioner	None	1679856348	0	0	BALATERO, JOELENE S	11/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16323 CLARK AVE	None	BELLFLOWER	CA	90706	5209	00	06000	33.885693	-118.1339975	Los Angeles County
294701	Non-Physician Medical Practitioner	None	1023782067	0	0	BARAN, VICTORIA M PA-C	11/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
294723	Non-Physician Medical Practitioner	None	1326047499	0	0	BAVIN, ROBERTA A NP	10/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1190 N DEWITT	None	CLOVIS	CA	93611	7029	00	06000	36.85176137	-119.7061281	Fresno County
294728	Non-Physician Medical Practitioner	None	1548620578	0	0	BEHNAM HICKS, JESSICA NP	10/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	00	06000	37.84779018	-122.2868874	Alameda County
294737	Non-Physician Medical Practitioner	None	1790071587	0	0	BABCOCK, TRACI V NP	7/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	843 N CURSON AVE	None	LOS ANGELES	CA	90046	7401	00	06000	34.08660984	-118.3553745	Los Angeles County
294756	Non-Physician Medical Practitioner	None	1578780235	0	0	BELMONTE, MICHELLE	6/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	861 MAGNOLIA AVE	MAIN APARTMENT	LARKSPUR	CA	94939	1132	00	06000	37.94418044	-122.5424875	Marin County
294778	Non-Physician Medical Practitioner	None	1154677219	0	0	BUHLER, JEANNIE A	12/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1105 E SPRUCE AVE STE 20	None	FRESNO	CA	93720	3313	00	06000	36.839466	-119.762685	Fresno County
294805	Non-Physician Medical Practitioner	None	1912555079	0	0	BUSH, CHRISTINA PA-C	9/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	00	06000	34.27904453	-118.459944	Los Angeles County
294809	Non-Physician Medical Practitioner	None	1851669782	0	0	BATES, FAYE M CNM	7/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2658 E ALLUVIAL AVE	STE 102	FRESNO	CA	93720	9109	00	06000	36.84480547	-119.7365625	Fresno County
294824	Non-Physician Medical Practitioner	None	1659859510	0	0	BAGHUMYAN, LIANA NP	10/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1509 WILSON TER	None	GLENDALE	CA	91206	4007	00	06000	34.14950866	-118.2311155	Los Angeles County
294900	Non-Physician Medical Practitioner	None	1497895049	0	0	BROWN, JERRY LAMONT	8/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12021 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	00	06000	33.922863	-118.2431655	Los Angeles County
294904	Non-Physician Medical Practitioner	None	1912533670	0	0	BEST, ALLISON NP	2/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19333 BEAR VALLEY RD	STE 201	APPLE VALLEY	CA	92308	5150	00	06000	34.47104148	-117.2413863	San Bernardino County
294955	Non-Physician Medical Practitioner	None	1396313557	0	0	BIFFARETTI, VIRGINIA NP	4/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
294956	Non-Physician Medical Practitioner	None	1992860639	0	0	BRESLIN, PAMELA ANN	12/1/1998	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 UPPER RAGSDALE DR	SUITE B-210	MONTEREY	CA	93940	5736	00	06000	36.57940327	-121.8142876	Monterey County
294981	Non-Physician Medical Practitioner	None	1386254001	0	0	BUCEY, NANCY NP	8/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
294992	Non-Physician Medical Practitioner	None	1265717565	0	0	BEDOLLA, STEPHANIE L NP	3/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 MANOR CT	None	HEALDSBURG	CA	95448	3761	00	06000	38.6200185	-122.8616073	Sonoma County
295015	Non-Physician Medical Practitioner	None	1710596663	0	0	BARELA, SHARI A NP	1/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
295018	Non-Physician Medical Practitioner	None	1306311956	0	0	BESERRA, AMBER R PA-C	2/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
295028	Non-Physician Medical Practitioner	None	1942402847	0	0	BAINBRIDGE, TROY M	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7112 NORTH OLD STAGE RD	None	WEED	CA	96094	7112	00	06000	41.38199088	-122.3942606	Siskiyou County
295051	Non-Physician Medical Practitioner	None	1508181959	0	0	BUGBEE, DEBRA ANNE	4/22/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1004 FOWLER WAY	SUITE 4	PLACERVILLE	CA	95667	5746	00	06000	38.72683597	-120.7921028	El Dorado County
295057	Non-Physician Medical Practitioner	None	1821192568	0	0	BARR, MEGAN V	10/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	134 GRANDVIEW ST	None	ENCINITAS	CA	92024	1009	00	06000	33.07614421	-117.3071065	San Diego County
295064	Non-Physician Medical Practitioner	None	1316679822	0	0	BOROM, AKEEM R	7/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	00	06000	33.78236048	-117.8664975	Orange County
295073	Non-Physician Medical Practitioner	None	1063815850	0	0	BU, LIMING	8/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	518 RIVERVIEW DR	None	REDLANDS	CA	92374	1716	00	06000	34.08386595	-117.176022	San Bernardino County
295084	Non-Physician Medical Practitioner	None	1083924583	0	0	BRADFIELD, ERIC	6/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7440 MEANY AVE	SUITE B	BAKERSFIELD	CA	93308	5183	00	06000	35.39429147	-119.084391	Kern County
295091	Non-Physician Medical Practitioner	None	1588208698	0	0	BURNS, MICHAEL P PA	2/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	00	06000	36.98863619	-121.9830754	Santa Cruz County
295095	Non-Physician Medical Practitioner	None	1457641961	0	0	BOYER, JODY PA-C	9/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	00	06000	34.02308948	-118.3972101	Los Angeles County
295099	Non-Physician Medical Practitioner	None	1205977790	0	0	BALL, MONICA A	12/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 SHULER CIR	None	MARINA	CA	93933	2725	00	06000	36.6851093	-121.7916848	Monterey County
295107	Non-Physician Medical Practitioner	None	1568975829	0	0	BECKER, BRYCE W PA-C	11/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	00	06000	35.27851417	-120.6501092	San Luis Obispo County
295108	Non-Physician Medical Practitioner	None	1306033071	0	0	BEEMER, JOHN M	3/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	621 PARK VIEW TERRACE	None	GLENDORA	CA	91741	2450	00	06000	34.13841402	-117.8761458	Los Angeles County
295124	Non-Physician Medical Practitioner	None	1487026050	0	0	BARTLETT, GRACE A L NP	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2820 S SULTANA AVE	None	ONTARIO	CA	91761	3411	00	06000	34.0236	-117.6459975	San Bernardino County
295130	Non-Physician Medical Practitioner	None	1972029866	0	0	BOYER, PAUL D PA-C	5/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10605 SCRIPPS POWAY PKWY	SUITE B AND C	SAN DIEGO	CA	92131	3925	00	06000	32.93714729	-117.0990446	San Diego County
295137	Non-Physician Medical Practitioner	None	1326471863	0	0	BAROCIO, REYMUNDO	8/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2841 FOWLER RD	SPC 150	CERES	CA	95307	2841	00	06000	37.60398	-120.941883	Stanislaus County
295148	Non-Physician Medical Practitioner	None	1578828117	0	0	BARTLETT, KRISTA K PA	8/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	00	06000	37.48948529	-122.2232468	San Mateo County
295149	Non-Physician Medical Practitioner	None	1861895278	0	0	BOONE, DAVID R PA	8/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
295159	Non-Physician Medical Practitioner	None	1407171135	0	0	BARNETT, JESSICA MONIQUE-SEABURY	9/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
295205	Non-Physician Medical Practitioner	None	1003850637	0	0	BRATT, BETH L	9/11/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	0000	00	06000	37.25111017	-121.9465891	Santa Clara County
295266	Non-Physician Medical Practitioner	None	1679827117	0	0	BALI, AMI D PA-C	6/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10913 DRACO ROAD	UNIT 22	SAN DIEGO	CA	92126	4834	00	06000	32.918706	-117.1270705	San Diego County
295281	Non-Physician Medical Practitioner	None	1639974728	0	0	BARUELA, JOYCE	3/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
295325	Non-Physician Medical Practitioner	None	1730398850	0	0	BRISENO-TOOMEY, DEBBIE ANN	12/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
295360	Non-Physician Medical Practitioner	None	1336625524	0	0	BRACEYASIEDU, ALEKSANDRYA C NP	9/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
295366	Non-Physician Medical Practitioner	None	1285057174	0	0	BROOKING, ESTHER M PA-C	7/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	830 JEFFERSON AVE	STE M	REDWOOD CITY	CA	94063	1804	00	06000	37.48599384	-122.2282125	San Mateo County
295379	Non-Physician Medical Practitioner	None	1508416207	0	0	BRUNKAN, SHELLEY M PA-C	12/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	00	06000	37.688107	-121.8861427	Alameda County
295389	Non-Physician Medical Practitioner	None	1720318892	0	0	BILBAO, MARY S	10/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	610 GILBERT AVE	APT 8	MENLO PARK	CA	94025	2734	00	06000	37.46054878	-122.1620075	San Mateo County
295406	Non-Physician Medical Practitioner	None	1558916106	0	0	BANIHASHEMI, YASAMIN NP	12/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	00	06000	34.069509	-118.383743	Los Angeles County
295411	Non-Physician Medical Practitioner	None	1578233037	0	0	BROWN, KAYLYNN K PA-C	11/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
295436	Non-Physician Medical Practitioner	None	1922872621	0	0	BRADSHAW-TERRY, PAIGE CNP	4/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 N 3RD ST	None	LOMPOC	CA	93436	7002	00	06000	34.64013944	-120.4451768	Santa Barbara County
295437	Non-Physician Medical Practitioner	None	1326544347	0	0	BUIS, WILLIAM NP	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	00	06000	37.92643968	-122.0521822	Contra Costa County
295443	Non-Physician Medical Practitioner	None	1134654965	0	0	BOUTROS, DANA M PA-C	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	289 W. HUNTINGTON DR.	STE 103	ARCADIA	CA	91007	3492	00	06000	34.13549119	-118.0419175	Los Angeles County
295453	Non-Physician Medical Practitioner	None	1215505854	0	0	BELZA, JUSTIN N NP	11/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
295455	Non-Physician Medical Practitioner	None	1306493267	0	0	BATARSEH, ZADE N PA-C	6/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3331	00	06000	33.85291987	-117.5664344	Riverside County
295478	Non-Physician Medical Practitioner	None	1609896869	0	0	BERGLUND, CAROLYN A NP	7/3/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	00	06000	36.327888	-119.294919	Tulare County
295489	Non-Physician Medical Practitioner	None	1811346901	0	0	BRIGGS, RODNEY J	3/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1275 LISTON AVE	None	LOGANDALE	NV	89021	1205	00	06000	36.59726878	-114.4694335	Clark County
295515	Non-Physician Medical Practitioner	None	1245372473	0	0	BELSHAW, DAVID A	9/13/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14240 SPRINGER AVE	None	SARATOGA	CA	95070	5824	00	06000	37.26044334	-122.0354347	Santa Clara County
295516	Non-Physician Medical Practitioner	None	1063771806	0	0	BUENSTRO, MICHELLE M NP	3/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2111 BREWSTER AVE	None	REDWOOD	CA	94062	1909	00	06000	37.48011577	-122.2448903	San Mateo County
295530	Non-Physician Medical Practitioner	None	1437242856	0	0	BOUTROS, LETICIA RODRIGUEZ	12/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	MS# 113	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
295532	Non-Physician Medical Practitioner	None	1093933251	0	0	BERNATSKY, VANIA E NP	1/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	105 RANCHO RIO AVE	None	BEN LOMOND	CA	95005	9414	00	06000	37.08798542	-122.0778414	Santa Cruz County
295539	Non-Physician Medical Practitioner	None	1558074120	0	0	BUI, DANNY	12/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2077 HARBOR BLVD	A	COSTA MESA	CA	92627	9384	00	06000	33.64990963	-117.9190918	Orange County
295551	Non-Physician Medical Practitioner	None	1942623657	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	6/9/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	58581 US HIGHWAY 371	SUITES F, G, & H	ANZA	CA	92539	0000	00	06000	33.5569201	-116.6397862	Riverside County
295553	Non-Physician Medical Practitioner	None	1801575543	0	0	BUTZ, KENDALL PA-C	10/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 N WIGET LANE	STE 210	WALNUT CREEK	CA	94598	2452	00	06000	37.92948925	-122.0275099	Contra Costa County
295556	Non-Physician Medical Practitioner	None	1114226370	0	0	BERNHARD, SARAH M NP	10/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
295570	Non-Physician Medical Practitioner	None	1295162576	0	0	BALL, KELLY NP	12/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
295587	Non-Physician Medical Practitioner	None	1093238909	0	0	BEANE, KATHRYN J PA	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 N WIGET LANE	STE 210	WALNUT CREEK	CA	94598	2452	00	06000	37.92948925	-122.0275099	Contra Costa County
295592	Non-Physician Medical Practitioner	None	1598775173	0	0	BAKER, KALANI	5/15/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	500 5TH ST	None	BROOKINGS	OR	97415	9702	00	06000	42.056721	-124.2879845	Curry County
295603	Non-Physician Medical Practitioner	None	1437248572	0	0	BURNS, MICHELE I PA-C	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1101 BRYAN AVE	STE E	TUSTIN	CA	92780	4401	00	06000	33.74272355	-117.8149529	Orange County
295612	Non-Physician Medical Practitioner	None	1770987281	0	0	BRADLEY, KATHRYN PA	9/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
295625	Non-Physician Medical Practitioner	None	1386155299	0	0	BRISTOL, ERICA L NP	9/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7868 MILLIKEN AVE	APT 437	RANCHO CUCAMONGA	CA	91730	8390	00	06000	34.11255348	-117.5585907	San Bernardino County
295626	Non-Physician Medical Practitioner	None	1912324138	0	0	BARNETT, KRISTEN S NP	11/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 EXPOSITION BLVD	BLDG 200 STE 2000	SACRAMENTO	CA	95815	4314	00	06000	38.598876	-121.4502885	Sacramento County
295632	Non-Physician Medical Practitioner	None	1700293339	0	0	BERTOLI, MARA M NP	1/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1058 WICKFIELD WAY	None	SANTA ROSA	CA	95401	4981	00	06000	38.444355	-122.76621	Sonoma County
295643	Non-Physician Medical Practitioner	None	1467603159	0	0	BUSTOS, KELLY J NP	6/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	37725 HIGH RIDGE DRIVE	None	BEAUMONT	CA	92223	8068	00	06000	33.94641415	-117.0134125	Riverside County
295649	Non-Physician Medical Practitioner	None	1144567264	0	0	BALOGUN, MOJISOLA	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
295658	Non-Physician Medical Practitioner	None	1649574427	0	0	BARNETT, JEREMY	2/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 K STREET	SUITE 210	SACRAMENTO	CA	95816	5118	00	06000	38.572947	-121.46904	Sacramento County
295662	Non-Physician Medical Practitioner	None	1063882975	0	0	BIBLE, SONIA E PA	1/22/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	00	06000	38.570076	-121.4657145	Sacramento County
295693	Non-Physician Medical Practitioner	None	1629210364	0	0	BESEL, CHRISTINE ACORNLEY	12/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12462 PUTNAM ST	SUITE 303	WHITTIER	CA	90602	1048	00	06000	33.9709236	-118.0460596	Los Angeles County
295706	Non-Physician Medical Practitioner	None	1902553878	0	0	BERNAL, IRMA NP	9/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
295722	Non-Physician Medical Practitioner	None	1679684906	0	0	BAER, SUSAN DENISE	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19000 HOMESTEAD RD	CDRP, 1ST FLOOR	CUPERTINO	CA	95014	0712	00	06000	37.33773494	-122.0043395	Santa Clara County
295735	Non-Physician Medical Practitioner	None	1629529557	0	0	BARNES, ROBIN L NP	7/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	00	06000	34.65803329	-120.4576446	Santa Barbara County
295742	Non-Physician Medical Practitioner	None	1316623317	0	0	BAINS, KANWALDIP K NP	7/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 HERNDON	210 AND 230	FRESNO	CA	93720	3303	00	06000	36.83756048	-119.7609525	Fresno County
295743	Non-Physician Medical Practitioner	None	1568414969	0	0	BURWELL, NICOLE B	10/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 KIPLING STREET	None	PALO ALTO	CA	94301	1527	00	06000	37.44899078	-122.161828	Santa Clara County
295748	Non-Physician Medical Practitioner	None	1508267428	0	0	BRITT, SANDRA NP	4/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	00	06000	33.736257	-117.995535	Orange County
295756	Non-Physician Medical Practitioner	None	1740861541	0	0	BUEZIS, GRACE S CNM	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1423 MAGNOLIA	None	CHICO	CA	95926	3226	00	06000	39.74063551	-121.8499048	Butte County
295768	Non-Physician Medical Practitioner	None	1831295963	0	0	BRUHN, NANCY P NP	7/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
295832	Non-Physician Medical Practitioner	None	1013127877	0	0	BUSTAMANTE, ANGEL R	5/9/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	941 S ATLANTIC BLVD	SUITE 101	MONTEREY PARK	CA	91754	4722	00	06000	34.04918291	-118.1391218	Los Angeles County
295845	Non-Physician Medical Practitioner	None	1679154207	0	0	BRAVO, ANGELINA NP	6/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2339 W CLEVELAND AVE	STE 101	MADERA	CA	93637	8753	00	06000	36.97466548	-120.085749	Madera County
295848	Non-Physician Medical Practitioner	None	1194261099	0	0	BRECK, JOEL	4/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5227 DENNY AVENUE	APT 304	NORTH HOLLYWOOD	CA	91601	3547	00	06000	34.165809	-118.3643185	Los Angeles County
295859	Non-Physician Medical Practitioner	None	1942671920	0	0	BRYSON, ALYSSE M	4/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	694 63RD ST	None	OAKLAND	CA	94609	1267	00	06000	37.84838169	-122.2686436	Alameda County
295880	Non-Physician Medical Practitioner	None	1003180191	0	0	BAUM, MANIVANHM M	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2090 N NAPA CRT	None	HANFORD	CA	93230	8932	00	06000	36.34927502	-119.6781954	Kings County
295889	Non-Physician Medical Practitioner	None	1568953578	0	0	BENTON, MIA N PA-C	1/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
295925	Non-Physician Medical Practitioner	None	1669014742	0	0	BRADLEY, ANNA O CNP	12/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
295926	Non-Physician Medical Practitioner	None	1518069343	0	0	BRADSHAW, LAURIE B NP	2/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	00	06000	39.71601447	-121.790817	Butte County
295942	Non-Physician Medical Practitioner	None	1194073312	0	0	BROWN, BRENDA T PA-C	1/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
295954	Non-Physician Medical Practitioner	None	1548853625	0	0	BERNOTAS, JACOB J PA-C	10/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29955 TECHNOLOGY DR	SUITE 111	MURRIETA	CA	92563	2637	00	06000	33.56063993	-117.1379703	Riverside County
295967	Non-Physician Medical Practitioner	None	1114746088	0	0	BAUGH, JULIENNE M NP	1/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
295978	Non-Physician Medical Practitioner	None	1861010969	0	0	BROWN, WYATT R PA-C	3/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
296002	Non-Physician Medical Practitioner	None	1659043768	0	0	BANALES, VANESSA A PA-C	1/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
296028	Non-Physician Medical Practitioner	None	1538206875	0	0	BERMAN, MELODY A PA	7/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
296089	Non-Physician Medical Practitioner	None	1497107890	0	0	BIGA, LISA C NP	8/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5679 DRESSLAR CIRCLE	None	LIVERMORE	CA	94550	7194	00	06000	37.67848053	-121.723488	Alameda County
296092	Non-Physician Medical Practitioner	None	1528528072	0	0	BOWERS, KATHERINE D NP	4/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	00	06000	38.7257686	-120.7910663	El Dorado County
296138	Non-Physician Medical Practitioner	None	1457806424	0	0	BARRIER, ADRIANA A	10/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1361 MANDRAKE WAY	None	BEAUMONT	CA	92223	8467	00	06000	33.93872597	-116.9613676	Riverside County
296169	Non-Physician Medical Practitioner	None	1386658326	0	0	BARON, STEPHANIE D PA-C	7/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	00	06000	34.06215064	-117.9453997	Los Angeles County
296176	Non-Physician Medical Practitioner	None	1437776283	0	0	BULGARELLI, CODY E PA-C	12/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	00	06000	35.63564004	-118.407037	Kern County
296198	Non-Physician Medical Practitioner	None	1093989949	0	0	BALLARD, NATALYA Y	11/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	442 SONORA CIRCLE	None	REDLANDS	CA	92373	8509	00	06000	34.05030374	-117.175605	San Bernardino County
296202	Non-Physician Medical Practitioner	None	1881700599	0	0	BROOKES, LYNN	10/13/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6300 E. HWY 20	None	LUCERNE	CA	95458	0000	00	06000	39.08645757	-122.7925572	Lake County
296248	Non-Physician Medical Practitioner	None	1912032681	0	0	BRESSAN, JOHN W NP	10/5/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6372 OAKCREEK WAY	None	CITRUS HEIGHTS	CA	95621	6104	00	06000	38.676285	-121.317498	Sacramento County
296256	Non-Physician Medical Practitioner	None	1578176475	0	0	BALTAZAR, SAMANTHA PA-C	12/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7172 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	3804	00	06000	33.94477707	-117.4034127	Riverside County
296257	Non-Physician Medical Practitioner	None	1457633091	0	0	BARIENBROCK, VANESSA NP	8/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33 CREEK RD	STE 270	IRVINE	CA	92604	7707	00	06000	33.67506955	-117.796973	Orange County
296261	Non-Physician Medical Practitioner	None	1285415141	0	0	BENITEZ, MARA NP	12/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3349 G STREET	SUITE F	MERCED	CA	95340	0978	00	06000	37.32432497	-120.4693064	Merced County
296271	Non-Physician Medical Practitioner	None	1043471519	0	0	BRALEY, JASON T PA-C	12/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296285	Non-Physician Medical Practitioner	None	1629680673	0	0	BOBB, FRANCISCA P NP	2/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1332 NATIVIDAD RD	C	SALINAS	CA	93906	3133	00	06000	36.69909137	-121.635247	Monterey County
296295	Non-Physician Medical Practitioner	None	1386069995	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	6/9/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 N INDIAN CANYON DR	SUITE W-300	PALM SPRINGS	CA	92262	4800	00	06000	33.839505	-116.5455735	Riverside County
296323	Non-Physician Medical Practitioner	None	1689603128	0	0	BROWN, JENNIFER K	10/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6121 KAHILIHOLA ROAD	None	KALAUEA	HI	96754	5117	00	06000	22.18001172	-159.4341188	Kauai County
296413	Non-Physician Medical Practitioner	None	1831332030	0	0	BRIAN, SUZANE K	4/28/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296416	Non-Physician Medical Practitioner	None	1154722031	0	0	BOOTH, SARAH NP	12/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	740 EVERETT AVE	None	PALO ALTO	CA	94301	1315	00	06000	37.45275488	-122.1588436	Santa Clara County
296442	Non-Physician Medical Practitioner	None	1528267010	0	0	BELABIN, JEFFREY H	4/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7543 GRANVILLE DR	None	TAMARAC	FL	33321	8730	00	06000	26.220843	-80.29163901	Broward County
296450	Non-Physician Medical Practitioner	None	1720850829	0	0	BRACKEN, ALEXIS J PA-C	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
296510	Non-Physician Medical Practitioner	None	1922009067	0	0	BANH, LISA K	9/27/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14305 AUTUMN HILL LANE	None	CHINO HILLS	CA	91709	1012	00	06000	33.99315001	-117.7570298	San Bernardino County
296531	Non-Physician Medical Practitioner	None	1780278440	0	0	BORCHARD, DOMINIQUE C PA	1/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
296551	Non-Physician Medical Practitioner	None	1912443003	0	0	BIANES, LILIBETH T NP	3/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	37110 DEWBERRY TER	None	PALMDALE	CA	93551	6180	00	06000	34.55847379	-118.1740485	Los Angeles County
296553	Non-Physician Medical Practitioner	None	1609831114	0	0	BASSILIOS, MIRANDA N	1/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4800 VALERIO STREET	None	DUBLIN	CA	94568	4856	00	06000	37.71744688	-121.8459264	Alameda County
296603	Non-Physician Medical Practitioner	None	1679163349	0	0	BURNEY, BRITTANY C NP	2/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	00	06000	34.52471945	-117.3042336	San Bernardino County
296617	Non-Physician Medical Practitioner	None	1093319915	0	0	BOWDEN, DESTINEE PA-C	10/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1374 E ALLUVIAL AVE	None	FRESNO	CA	93720	2608	00	06000	36.84475352	-119.758806	Fresno County
296622	Non-Physician Medical Practitioner	None	1710691928	0	0	BATES, SABRINA S NP	12/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
296634	Non-Physician Medical Practitioner	None	1619305265	0	0	BARO, DAVID R PA-C	10/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
296653	Non-Physician Medical Practitioner	None	1497739585	0	0	BREAULT, GRACE	3/20/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
296655	Non-Physician Medical Practitioner	None	1932354321	0	0	BAJADA, DIANE ELIZABETH	3/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4001 J ST	None	SACRAMENTO	CA	95819	3626	00	06000	38.570526	-121.4521695	Sacramento County
296711	Non-Physician Medical Practitioner	None	1962845750	0	0	BENSON, VERDALE N	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2674 SHADOW MOUNTAIN DR	None	SAN RAMON	CA	94583	1828	00	06000	37.77117463	-121.9787204	Contra Costa County
296715	Non-Physician Medical Practitioner	None	1700099645	0	0	BARBA, LAURA A NP	7/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5772 CALVIN WAY	None	SAN DIEGO	CA	92120	4718	00	06000	32.78401578	-117.0579146	San Diego County
296721	Non-Physician Medical Practitioner	None	1790886737	0	0	BONNELL, SUSAN MARIE	6/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4305 UNIVERSITY AVENUE	SUITE 150	SAN DIEGO	CA	92105	0000	00	06000	32.74957853	-117.101439	San Diego County
296730	Non-Physician Medical Practitioner	None	1689204018	0	0	BALLARD, JULIE A PA	7/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11150 HIGHWAY 1	None	POINT REYES STATI	CA	94956	9756	00	06000	38.06731086	-122.8046644	Marin County
296758	Non-Physician Medical Practitioner	None	1023538139	0	0	BENKO, DARRELL NP	10/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	517 3RD STREET	22	EUREKA	CA	95501	3203	00	06000	40.80367671	-124.166036	Humboldt County
296776	Non-Physician Medical Practitioner	None	1497286082	0	0	BOLDA, LAUREN M PA	8/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
296796	Non-Physician Medical Practitioner	None	1528215993	0	0	BRAND, KELLY R PA	2/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDRENS WAY	STE 202	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
296799	Non-Physician Medical Practitioner	None	1386006468	0	0	BUITRAGO, JOANNA K NP	10/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
296821	Non-Physician Medical Practitioner	None	1114038379	0	0	BENNETT, CIARA E	9/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10535 HOSPITAL WAY	None	MATHER	CA	95655	4200	00	06000	38.572443	-121.2965235	Sacramento County
296823	Non-Physician Medical Practitioner	None	1033776109	0	0	BONAMICI, CHRISTINE M PA-C	11/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
296826	Non-Physician Medical Practitioner	None	1194434498	0	0	BLUME, MADISON S PA	2/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1920 N GAREY AVE	None	POMONA	CA	91767	2708	00	06000	34.08095869	-117.7526975	Los Angeles County
296834	Non-Physician Medical Practitioner	None	1538790605	0	0	BALINGIT, KAT T NP	10/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
296845	Non-Physician Medical Practitioner	None	1518027473	0	0	BEALL, KATHRYN MARY	9/18/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	550 PEACHTREE ST NE	None	ATLANTA	GA	30308	2247	00	06000	33.76888979	-84.38524145	Fulton County
296859	Non-Physician Medical Practitioner	None	1053468298	0	0	BERGULA, ARNIE	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14934 AMSO ST	None	POWAY	CA	92064	2635	00	06000	32.98421064	-117.0606407	San Diego County
296865	Non-Physician Medical Practitioner	None	1871295048	0	0	BUTORINA, IRINA V NP	5/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	00	06000	38.29871411	-122.4751509	Sonoma County
296882	Non-Physician Medical Practitioner	None	1598267726	0	0	BINGULA, BRIGIT N NP	11/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1161 CIRBY WAY	None	ROSEVILLE	CA	95661	4421	00	06000	38.72953129	-121.2740134	Placer County
296891	Non-Physician Medical Practitioner	None	1891293338	0	0	BRADLEY, RACHEL R PA	10/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
296893	Non-Physician Medical Practitioner	None	1962977140	0	0	BEKALO-QUINLAN, KRYSTLE S B	2/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24920 MOUND ST	None	LOMA LINDA	CA	92350	0202	00	06000	34.05170856	-117.260438	San Bernardino County
296897	Non-Physician Medical Practitioner	None	1225791312	0	0	BRAS, SANDY JANE T NP	7/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
296902	Non-Physician Medical Practitioner	None	1366884017	0	0	BENNETT, AMY L NP	2/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	950 CRANE AVENUE	None	FOSTER CITY	CA	94404	1450	00	06000	37.56671704	-122.2541041	San Mateo County
296915	Non-Physician Medical Practitioner	None	1285898999	0	0	BASULTO, RACHEL S	4/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5208 BLOSSOM RANCH DR	None	ELK GROVE	CA	95757	3307	00	06000	38.399247	-121.443642	Sacramento County
296920	Non-Physician Medical Practitioner	None	1306487061	0	0	BEDOLLA, SILVIA N NP	2/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
296926	Non-Physician Medical Practitioner	None	1194273862	0	0	BIASCA, MATTHEW R	10/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2209 GATEWAY PLACE	None	RANCHO MISSION VI	CA	92694	1851	00	06000	33.52188746	-117.6185659	Orange County
296928	Non-Physician Medical Practitioner	None	1467856989	0	0	BIFONE, CASEY M	8/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1845 1ST AVE	None	NEW YORK CITY	NY	10128	3893	00	06000	40.782879	-73.9452195	New York County
296954	Non-Physician Medical Practitioner	None	1306257324	0	0	BENEVOLENCE INDUSTRIES INC	10/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	934 ATLANTIC AVE	None	LONG BEACH	CA	90813	4515	00	06000	33.778395	-118.1850225	Los Angeles County
296964	Non-Physician Medical Practitioner	None	1750015095	0	0	BUI, VIVIAN M PA-C	5/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	00	06000	33.84718298	-117.933758	Orange County
296968	Non-Physician Medical Practitioner	None	1477607463	0	0	BON, JAMES NP	3/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	00	06000	34.09054375	-118.392295	Los Angeles County
296975	Non-Physician Medical Practitioner	None	1326316241	0	0	BECKER, LAUREN K NP	5/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
296996	Non-Physician Medical Practitioner	None	1346407293	0	0	BECK, JULIE D NP	1/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	303 ZORRO VISTA	None	SAN CLEMENTE	CA	92672	7510	00	06000	33.44115398	-117.5908775	Orange County
296999	Non-Physician Medical Practitioner	None	1043402324	0	0	BAILEY, AZIZI R	11/30/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17760 LOG HILL RD	None	RIVERSIDE	CA	92504	8845	00	06000	33.86143788	-117.3538795	Riverside County
297026	Non-Physician Medical Practitioner	None	1942684493	0	0	BAKER, ABIGAIL E NP	9/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13023 BERMUDA AVE	None	CHINO	CA	91710	4563	00	06000	34.016958	-117.6681335	San Bernardino County
297036	Non-Physician Medical Practitioner	None	1629332341	0	0	BEY, LOVEVASIA NP	12/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12225 SHALE RIDGE LN	None	AUBURN	CA	95602	8870	00	06000	38.95301533	-121.0957807	Placer County
297059	Non-Physician Medical Practitioner	None	1750564605	0	0	BUGOS, KELLY	12/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	875 BLAKE WILBUR DRIVE	None	STANFORD	CA	94305	5826	00	06000	37.43562782	-122.1766097	Santa Clara County
297063	Non-Physician Medical Practitioner	None	1366119547	0	0	BRAR, GURPREET S NP	5/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1921 18TH ST	None	BAKERSFIELD	CA	93301	4205	00	06000	35.37525954	-119.024586	Kern County
297087	Non-Physician Medical Practitioner	None	1700546132	0	0	BUCKLAND, IAN NP	12/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	151 CLAYDELLE AVE	None	EL CAJON	CA	92020	4505	00	06000	32.794155	-116.958763	San Diego County
297105	Non-Physician Medical Practitioner	None	1801507439	0	0	BRAR, SATWINDER K NP	3/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
297108	Non-Physician Medical Practitioner	None	1750704482	0	0	BARLAS, NELOFAR PA-C	11/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3155 KEARNEY ST	100	FREMONT	CA	94538	2268	00	06000	37.5490951	-121.974815	Alameda County
297149	Non-Physician Medical Practitioner	None	1174295687	0	0	BASU, SAGARIKA PA-C	1/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9481 PITTSBURGH AVE	200	RANCHO CUCAMONGA	CA	91730	9021	00	06000	34.08094188	-117.5559944	San Bernardino County
297155	Non-Physician Medical Practitioner	None	1922022086	0	0	BANDY DENTON, JUDY NP	10/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5952 N GOLDENROD WAY	None	PRESCOTT	AZ	86301	3798	00	06000	34.627797	-112.445712	Yavapai County
297170	Non-Physician Medical Practitioner	None	1629528245	0	0	BOLEY, CAROLYN B NP	10/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 2130	None	MCKINLEYVILLE	CA	95519	2130	00	06000	0	0	None
297179	Non-Physician Medical Practitioner	None	1275877599	0	0	BHAVSAR, JESSICA M PA-C	10/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	00	06000	37.88758326	-122.1181419	Contra Costa County
297205	Non-Physician Medical Practitioner	None	1609383827	0	0	BUTTERS, JANELLE NP	9/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	509 GRESHAM CT	None	ROSEVILLE	CA	95747	5011	00	06000	38.80363129	-121.3339042	Placer County
297209	Non-Physician Medical Practitioner	None	1578683843	0	0	BRADY, VIVIAN M PA-C	12/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	00	06000	33.78003775	-118.1866604	Los Angeles County
297211	Non-Physician Medical Practitioner	None	1215306196	0	0	BARKER, EMILY PA	7/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
297236	Non-Physician Medical Practitioner	None	1720555352	0	0	BYRD, KEITH B	2/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4785 DANDELION LOOP	None	TRACY	CA	99537	8773	00	06000	37.69741014	-121.4277221	San Joaquin County
297242	Non-Physician Medical Practitioner	None	1841607314	0	0	BIVAS, ARIELLE S NP	1/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	248 VENTURA AVE	None	PALO ALTO	CA	94306	3443	00	06000	37.41910953	-122.1281999	Santa Clara County
297243	Non-Physician Medical Practitioner	None	1649722760	0	0	BASCO, CLAIRE T	2/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	311 HEBRON CIRCLE	None	SACRAMENTO	CA	95835	2061	00	06000	38.666493	-121.546251	Sacramento County
297277	Non-Physician Medical Practitioner	None	1558690677	0	0	BRINCKHAUS, LOIDA L NP	2/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 ENCANTO LANE	None	COLTON	CA	92324	9737	00	06000	34.04137547	-117.2801119	San Bernardino County
297284	Non-Physician Medical Practitioner	None	1619272523	0	0	BERNAZZOLI, ZACHARY PA	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
297323	Non-Physician Medical Practitioner	None	1467187203	0	0	BROWN, KAYNEN D PA	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
297326	Non-Physician Medical Practitioner	None	1780176958	0	0	BERGMAN, DEBORAH M PA	10/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE STREET	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
297327	Non-Physician Medical Practitioner	None	1154846012	0	0	BARKER, ALEXANDRA E PA-C	1/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
297341	Non-Physician Medical Practitioner	None	1255680039	0	0	BELTRAN, EVELYN A	6/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6404 CATARATA ST	None	BAKERSFIELD	CA	93311	9639	00	06000	35.297343	-119.128873	Kern County
297342	Non-Physician Medical Practitioner	None	1336254705	0	0	BAUTISTA, JORGE O	5/8/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	427 CENTRAL AVE	None	FILLMORE	CA	93015	1329	00	06000	34.40149146	-118.9139494	Ventura County
297380	Non-Physician Medical Practitioner	None	1942657937	0	0	BATAC, NADINE NP	4/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	00	06000	32.77677653	-117.1592911	San Diego County
297404	Non-Physician Medical Practitioner	None	1871661207	0	0	BUNCH, ALLISON VIRGINIA	3/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 SACRAMENTO ST	SUITE 100	SAN FRANCISCO	CA	94118	1625	00	06000	37.78707021	-122.4555217	San Francisco County
297413	Non-Physician Medical Practitioner	None	1043036429	0	0	BADUA, PETER P NP	4/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10621 CHURCH ST	STE 120	RANCHO CUCAMONGA	CA	91730	6862	00	06000	34.11289206	-117.5715772	San Bernardino County
297451	Non-Physician Medical Practitioner	None	1497047377	0	0	BIGBEE, KORIE M NP	4/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16236 NAVIGATOR AVE	None	CHINO	CA	91708	7680	00	06000	33.95891764	-117.6289494	San Bernardino County
297456	Non-Physician Medical Practitioner	None	1457310245	0	0	BROMLEY, SUSAN E	1/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 PORTER DR	None	SAN RAMON	CA	94583	1524	00	06000	37.77372204	-121.9911155	Contra Costa County
297463	Non-Physician Medical Practitioner	None	1801309455	0	0	BURKE-CRAVENS, AMBER D NP	2/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
297478	Non-Physician Medical Practitioner	None	1033783147	0	0	BARATH, MAYANKA PA	1/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	00	06000	37.7802547	-122.4642049	San Francisco County
297499	Non-Physician Medical Practitioner	None	1184145278	0	0	BARANGAN, MICHELLE A	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10075 WONDERFUL DAY DR	None	LAS VEGAS	NV	89148	4574	00	06000	36.08022136	-115.3130524	Clark County
297504	Non-Physician Medical Practitioner	None	1750037552	0	0	BOLANOS, JOE PA-C	3/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S BROOKHURST ST.	None	ANAHEIM	CA	92804	4302	00	06000	33.821568	-117.9589665	Orange County
297517	Non-Physician Medical Practitioner	None	1578223483	0	0	BAIDA, CYNDLE A NP	11/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 S MAIN ST	STE 108	CORONA	CA	92882	3401	00	06000	33.87190191	-117.5669613	Riverside County
297527	Non-Physician Medical Practitioner	None	1164415501	0	0	BOLYANATZ, MARYA M NP	12/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2142 KING ST	None	SAN LUIS OBISPO	CA	93401	5138	00	06000	35.27049424	-120.6624172	San Luis Obispo County
297558	Non-Physician Medical Practitioner	None	1457796427	0	0	BANKS, CHRISTOPHER P	6/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 WESTMINSTER CT	None	CHICO	CA	95928	7634	00	06000	39.72629119	-121.7990178	Butte County
297559	Non-Physician Medical Practitioner	None	1245903616	0	0	BRAY, STEPHANIE NP	1/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
297570	Non-Physician Medical Practitioner	None	1134893365	0	0	BALDWIN, MORGAN B NP	11/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
297611	Non-Physician Medical Practitioner	None	1790023620	0	0	BUZIN, VIKTOR	6/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
297628	Non-Physician Medical Practitioner	None	1790075315	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	1/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1970 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	5202	00	06000	33.97555819	-117.3545428	Riverside County
297636	Non-Physician Medical Practitioner	None	1699287995	0	0	BRUHNKE, STEPHANIE E NP	7/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
297650	Non-Physician Medical Practitioner	None	1518180702	0	0	BARNES, SARA ELIZABETH	8/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	229 W 7TH ST	None	SAN JACINTO	CA	92583	4662	00	06000	33.78027368	-116.9601627	Riverside County
297658	Non-Physician Medical Practitioner	None	1306329438	0	0	BAZAN, MARLON S PA	6/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
297662	Non-Physician Medical Practitioner	None	1043547953	0	0	BUCCI, AIMEE NP	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	06000	33.478749	-112.0426515	Maricopa County
297670	Non-Physician Medical Practitioner	None	1982627881	0	0	BLOCK, BRYAN J	3/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1133 HIDDEN SPRINGS LANE	None	GLENDORA	CA	91741	2329	00	06000	34.1488902	-117.8448775	Los Angeles County
297688	Non-Physician Medical Practitioner	None	1114561990	0	0	BERKOWITZ, KHRISTER-NIKKA A NP	4/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
297690	Non-Physician Medical Practitioner	None	1235380080	0	0	BATRA, ASHWANI NP	5/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43811 59TH ST WEST	None	LANCASTER	CA	93536	7151	00	06000	34.67879653	-118.2358915	Los Angeles County
297713	Non-Physician Medical Practitioner	None	1891276770	0	0	BASSETT, CAROLINE E PA	9/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
297714	Non-Physician Medical Practitioner	None	1649533530	0	0	BARRAGAR, CHRISTINA L	9/24/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	855 WILCOX AVE	204	LOS ANGELES	CA	90038	4610	00	06000	34.0868901	-118.3309958	Los Angeles County
297722	Non-Physician Medical Practitioner	None	1205900792	0	0	BOWMAN, JENNIFER L	8/11/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1859 DYSART WAY	None	FOLSOM	CA	95630	6105	00	06000	38.677761	-121.1058675	Sacramento County
297741	Non-Physician Medical Practitioner	None	1033696315	0	0	BRENTON, THEODORE W C NP	8/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2440 4TH AVE	None	SACRAMENTO	CA	95818	3235	00	06000	38.55243571	-121.4825036	Sacramento County
297746	Non-Physician Medical Practitioner	None	1033594536	0	0	BOUCHER, COURTNEY M	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29945 COMPANIA DRIVE	None	TEMECULA	CA	92591	3625	00	06000	33.51079932	-117.1357243	Riverside County
297768	Non-Physician Medical Practitioner	None	1699968826	0	0	BELLAMY, ROGER T PA	3/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
297793	Non-Physician Medical Practitioner	None	1427555218	0	0	BAYOH, FANTA M NP	11/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	00	06000	34.06269295	-118.2030006	Los Angeles County
297805	Non-Physician Medical Practitioner	None	1609502723	0	0	BETTIR, KHEIRA C PA-C	6/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	315 N THIRD AVE	SUITE 303A	COVINA	CA	91723	1916	00	06000	34.08873786	-117.8923869	Los Angeles County
297807	Non-Physician Medical Practitioner	None	1396184438	0	0	BENT, GERALDINE G NP	11/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5426 FAWN CHASE WAY	None	LAS VEGAS	NV	89135	4005	00	06000	36.08977895	-115.3186532	Clark County
297812	Non-Physician Medical Practitioner	None	1326057092	0	0	BLANCHARD, LAUREN B NP	2/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3706 MAPLE AVE	None	OAKLAND	CA	94602	3340	00	06000	37.79859163	-122.2036671	Alameda County
297821	Non-Physician Medical Practitioner	None	1326346669	0	0	BALLARD, KELLY ELYSE	4/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
297839	Non-Physician Medical Practitioner	None	1629400999	0	0	BATES, LAUREN E NP	10/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
297843	Non-Physician Medical Practitioner	None	1306116298	0	0	BARJESTEH, RAMELLA E NP	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 BENNINGTON	None	TURLOCK	CA	95382	0365	00	06000	37.52781707	-120.8430884	Stanislaus County
297845	Non-Physician Medical Practitioner	None	1396886941	0	0	BERTAO, TERESA IRMA	6/7/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6912 AJAX AVE	None	BELL GARDENS	CA	90201	4057	00	06000	33.96992365	-118.1629712	Los Angeles County
297874	Non-Physician Medical Practitioner	None	1902290778	0	0	BAUMANN, ALISON NP	8/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	00	06000	33.98867148	-118.3837334	Los Angeles County
297879	Non-Physician Medical Practitioner	None	1982065165	0	0	BOUSHAKRA, RIMA S	9/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1841 BAHIA STREET	None	SAN MATEO	CA	94403	2068	00	06000	37.54276915	-122.2806149	San Mateo County
297894	Non-Physician Medical Practitioner	None	1609492123	0	0	BACHMAN, CHANTEL NP	7/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 N PALM CANYON DR	STE 212	PALM SPRINGS	CA	92262	4426	00	06000	33.838182	-116.546744	Riverside County
297912	Non-Physician Medical Practitioner	None	1801306097	0	0	BYFIELD, KAILY M NP	7/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
297913	Non-Physician Medical Practitioner	None	1851680078	0	0	BUCK, KIMBERLY JOY	8/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4440 BROCKTON AVE STE 42	None	RIVERSIDE	CA	92501	4026	00	06000	33.97764104	-117.3838896	Riverside County
297930	Non-Physician Medical Practitioner	None	1164013132	0	0	BRAR, SUKHDEEP K NP	1/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 N GILBERT ST	BLDG B, STE A	HEMET	CA	92543	4066	00	06000	33.75067797	-116.976072	Riverside County
297933	Non-Physician Medical Practitioner	None	1013959121	0	0	BISHOP, JUDITH T	1/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
297938	Non-Physician Medical Practitioner	None	1295086163	0	0	BUDAGYAN, ELENA JAKLIN	10/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10050 GARVEY AVE	#111	EL MONTE	CA	91733	2088	00	06000	34.06270952	-118.049481	Los Angeles County
297945	Non-Physician Medical Practitioner	None	1013223379	0	0	BARLOW, JULIE A NP	5/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	649 SOUTHWOOD DR	None	SANTA ROSA	CA	95407	7490	00	06000	38.417904	-122.726817	Sonoma County
297948	Non-Physician Medical Practitioner	None	1699137067	0	0	BIMANAND, NAREK Z	3/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26727 SANDBURN PLACE	None	STEVENSON RANCH	CA	91381	1464	00	06000	34.38752771	-118.6021307	Los Angeles County
297950	Non-Physician Medical Practitioner	None	1467428359	0	0	BECK, TANA	9/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7515 DE LONGPRE AVE APT	None	LOS ANGELES	CA	90046	8501	00	06000	34.09620648	-118.353501	Los Angeles County
297954	Non-Physician Medical Practitioner	None	1255054789	0	0	BARRO, AARON I PA-C	4/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1214	00	06000	34.131303	-117.3225325	San Bernardino County
297958	Non-Physician Medical Practitioner	None	1083071484	0	0	BRALOCK, ANITA R CNM	2/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4136 W 62ND STREET	None	LOS ANGELES	CA	90043	3613	00	06000	33.98349682	-118.3472518	Los Angeles County
297959	Non-Physician Medical Practitioner	None	1508570250	0	0	BUI, ANDY	6/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	345 N RIVERSIDE AVE	None	RIALTO	CA	92376	5925	00	06000	34.10524305	-117.3702612	San Bernardino County
297968	Non-Physician Medical Practitioner	None	1881390854	0	0	BODDY, NATHANIEL PA	10/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	00	06000	39.71601447	-121.790817	Butte County
297969	Non-Physician Medical Practitioner	None	1104182195	0	0	BONAVENTURE, MATTHEW E	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25320 THE OLD ROAD	None	SANTA CLARITA	CA	91381	1638	00	06000	34.3782912	-118.5689396	Los Angeles County
297970	Non-Physician Medical Practitioner	None	1487144747	0	0	BLAUSTEIN, KRISTA B PA	7/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	00	06000	34.24435917	-119.0191975	Ventura County
297975	Non-Physician Medical Practitioner	None	1467237016	0	0	BATEMAN, LINDSEY PA-C	2/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1711 ORANGE ST	None	REDLANDS	CA	92374	2254	00	06000	34.0796409	-117.1824145	San Bernardino County
297984	Non-Physician Medical Practitioner	None	1831794023	0	0	BRAUNWORTH, CHRISTINA NP	7/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
297998	Non-Physician Medical Practitioner	None	1275287021	0	0	BOWEN, SARA NP	1/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2901 SILLECT AVE	SUITE 100	BAKERSFIELD	CA	93308	6371	00	06000	35.38611256	-119.0393796	Kern County
298006	Non-Physician Medical Practitioner	None	1033564109	0	0	BALDIVIA, PAMELA SUE C NP	2/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
298011	Non-Physician Medical Practitioner	None	1386490233	0	0	BRIDGER, KELSEY G PA-C	10/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
298035	Non-Physician Medical Practitioner	None	1881373785	0	0	BROWN, ALLISON PA	11/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVE	310	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
298040	Non-Physician Medical Practitioner	None	1649608324	0	0	BALISTRERI, MARISOL NP	1/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7744 VOLCLAY DR	None	SAN DIEGO	CA	92119	1222	00	06000	32.81506369	-117.0451202	San Diego County
298044	Non-Physician Medical Practitioner	None	1801335534	0	0	BAYARAS, ELIZABETH M	7/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2640 ADRIATIC AVE	None	LONG BEACH	CA	90810	3125	00	06000	33.80517	-118.2143605	Los Angeles County
298075	Non-Physician Medical Practitioner	None	1679192561	0	0	BOLTON, LEIGH S CNP	9/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
298077	Non-Physician Medical Practitioner	None	1801097704	0	0	BERGERON-DESIMONE, VALERY	10/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25941 CORDILLERA DR	None	MISSION VIEJO	CA	92691	4011	00	06000	33.61013764	-117.6775432	Orange County
298079	Non-Physician Medical Practitioner	None	1902447055	0	0	BOEHLKE, KYLAN CNP	11/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
298085	Non-Physician Medical Practitioner	None	1598220881	0	0	BROZ, JOHN J PA-C	4/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 ROSCOE BLVD	None	NORTHRIGE	CA	91325	4105	00	06000	34.22073847	-118.532988	Los Angeles County
298090	Non-Physician Medical Practitioner	None	1225434798	0	0	BEEDLES, MOLLY PA	11/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	00	06000	32.99706	-117.05544	San Diego County
298091	Non-Physician Medical Practitioner	None	1164534368	0	0	BAKER, ERIN LEE	9/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22921 TRITON WAY	SUITE 125	LAGUNA HILLS	CA	92653	1236	00	06000	33.62929998	-117.7328734	Orange County
298114	Non-Physician Medical Practitioner	None	1700943107	0	0	BENSON, BRIAN S	3/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1249 EAST DEODAR DR	None	BEAUMONT	CA	92223	8583	00	06000	33.95624064	-117.0150935	Riverside County
298131	Non-Physician Medical Practitioner	None	1063468338	0	0	BOSMA, CECILY F PA	4/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	00	06000	34.44257521	-119.7584538	Santa Barbara County
298143	Non-Physician Medical Practitioner	None	1831224070	0	0	BAGGOTT, CHRISTINA R NP	11/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 CARSON ST	None	SUNNYVALE	CA	94086	5804	00	06000	37.3808618	-122.0464069	Santa Clara County
298157	Non-Physician Medical Practitioner	None	1841597911	0	0	BERKICH, GARRET J	4/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	555 N ARLINGTON AVE	None	RENO	NV	89503	4723	00	06000	39.53124039	-119.8188498	Washoe County
298159	Non-Physician Medical Practitioner	None	1922614411	0	0	BENJAMIN, ALICE LEE A NP	4/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	00	06000	33.98921547	-118.2242565	Los Angeles County
298165	Non-Physician Medical Practitioner	None	1033362645	0	0	BAREIS, STEPHANIE L	7/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3351 DUCKHORN DR	APT 811	SACRAMENTO	CA	95834	2633	00	06000	38.628585	-121.523697	Sacramento County
298192	Non-Physician Medical Practitioner	None	1356548069	0	0	BODZIO, LISA M	3/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26956 CALAMINE DRIVE	None	CALABASAS	CA	91301	2335	00	06000	34.14158765	-118.7132009	Los Angeles County
298201	Non-Physician Medical Practitioner	None	1790455160	0	0	BOWKER, SHAUN B PA-C	5/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
298209	Non-Physician Medical Practitioner	None	1265813315	0	0	BACENA-MIANO, CHARISSA G NP	1/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4000 PHYSICIANS BLVD	BLD E STE 101	BAKERSFIELD	CA	93301	1284	00	06000	35.39685986	-119.0093834	Kern County
298217	Non-Physician Medical Practitioner	None	1235899931	0	0	BRONIEC, HEATHER M PA	5/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	00	06000	36.84225164	-119.7833937	Fresno County
298250	Non-Physician Medical Practitioner	None	1336179852	0	0	BENAK, JONATHAN JAMES	11/17/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7811 LAGUNA BLVD	SUITE 601	ELK GROVE	CA	95758	7941	00	06000	38.423259	-121.4118945	Sacramento County
298288	Non-Physician Medical Practitioner	None	1073150025	0	0	BENNETT, CARL E NP	1/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE STREET	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
298291	Non-Physician Medical Practitioner	None	1598807117	0	0	BOLIN, LUCRETIA	9/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
298293	Non-Physician Medical Practitioner	None	1881018067	0	0	BARMACK, KIMBERLY	8/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3022 CIELO PLACE	None	CARLSBAD	CA	92009	7535	00	06000	33.08813438	-117.2425488	San Diego County
298298	Non-Physician Medical Practitioner	None	1477233765	0	0	BELOTE, BRANDYN M PA	1/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	SUITE 7100	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
298303	Non-Physician Medical Practitioner	None	1669638193	0	0	BUCCAT, MARRIANNE	2/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
298330	Non-Physician Medical Practitioner	None	1306499421	0	0	BELL, LYNDSEY NP	8/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	BLDG 55	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
298344	Non-Physician Medical Practitioner	None	1073951877	0	0	BATTE, SARAH R	11/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1552 BERRYESSA AVE	None	VENTURA	CA	93004	3076	00	06000	34.27074817	-119.161923	Ventura County
298368	Non-Physician Medical Practitioner	None	1528428273	0	0	BORG, DEBORAH S NP	8/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
298374	Non-Physician Medical Practitioner	None	1275717506	0	0	BECERRA, ALFONSO JR	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28980 AVALON AVE	None	MORENO VALLEY	CA	92555	7055	00	06000	33.90944202	-117.1560631	Riverside County
298382	Non-Physician Medical Practitioner	None	1285763987	0	0	BROWN-RAMIREZ, BARBARA ANNE	9/25/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S MILLER ST STE B	None	SANTA MARIA	CA	93454	6960	00	06000	34.936479	-120.4315845	Santa Barbara County
298389	Non-Physician Medical Practitioner	None	1285291955	0	0	BOYCE, LAUREN T PA	1/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
298396	Non-Physician Medical Practitioner	None	1902314933	0	0	BRADNI, SHARON R NP	3/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45 RIVER PARK PLACE WEST	STE 104	FRESNO	CA	93720	1565	00	06000	36.85901695	-119.7893872	Fresno County
298399	Non-Physician Medical Practitioner	None	1962835876	0	0	BERDY, SARA E RN	8/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 POTRERO AVE	3A20	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
298433	Non-Physician Medical Practitioner	None	1205924222	0	0	BAKER, GREGORY S	6/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11698 SNOW RD	None	BAKERSFIELD	CA	93301	4201	00	06000	35.4270093	-119.1320444	Kern County
298436	Non-Physician Medical Practitioner	None	1114657160	0	0	BOYD, DAVID LESTER NP	1/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	2142	00	06000	34.06812722	-118.3837146	Los Angeles County
298466	Non-Physician Medical Practitioner	None	1134732704	0	0	BARNES, NATALIE N NP	2/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
298470	Non-Physician Medical Practitioner	None	1336277441	0	0	BURACZYNSKI, MARK J	4/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30250 LOMA CHIQUITA RD	None	LOS GATOS	CA	95033	8062	00	06000	37.10281881	-121.8077392	Santa Clara County
298474	Non-Physician Medical Practitioner	None	1043364896	0	0	BUDKA, KENDRA REA	8/23/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11807 WHITTIER BLVD	None	WHITTIER	CA	90601	3941	00	06000	33.98063769	-118.0503687	Los Angeles County
298486	Non-Physician Medical Practitioner	None	1275144313	0	0	BUSTILLO, SOFIA C PA-C	5/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
298509	Non-Physician Medical Practitioner	None	1851017305	0	0	BILBAO, SOPHIA PA-C	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	905 CALLE AMANECER	STE 115	SAN CLEMENTE	CA	92673	6255	00	06000	33.44951265	-117.6075825	Orange County
298542	Non-Physician Medical Practitioner	None	1972818227	0	0	BATTAGLIA, MATTHEW E	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2624 E ST	None	SACRAMENTO	CA	95816	3123	00	06000	38.579553	-121.4686125	Sacramento County
298560	Non-Physician Medical Practitioner	None	1114485067	0	0	BUCKEY, CARISSA C NP	8/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	892 AEROVISTA PL	SUITE 130	SAN LUIS OBISPO	CA	93401	8054	00	06000	35.24277125	-120.6405941	San Luis Obispo County
298572	Non-Physician Medical Practitioner	None	1437636313	0	0	BECKSTROM, LEANNE T PA	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	00	06000	37.25111017	-121.9465891	Santa Clara County
298585	Non-Physician Medical Practitioner	None	1467546515	0	0	BUECHEL, JULIE A NP	2/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1416 FENWICK DR	None	BAKERSFIELD	CA	93312	4646	00	06000	35.37198631	-119.1423614	Kern County
298586	Non-Physician Medical Practitioner	None	1013105501	0	0	BAKER, CATHERINE L NP	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	837 BONITA DR	None	VISTA	CA	92083	4720	00	06000	33.203556	-117.264356	San Diego County
298602	Non-Physician Medical Practitioner	None	1306993092	0	0	BOOKS, AMALIA ELENA	7/20/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	00	06000	38.39008977	-121.9378499	Solano County
298622	Non-Physician Medical Practitioner	None	1528747128	0	0	BARROWS, HANNAH R PA	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	00	06000	34.95203385	-120.4131707	Santa Barbara County
298623	Non-Physician Medical Practitioner	None	1275301525	0	0	BRAICOVICH, MARISA NP	6/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
298629	Non-Physician Medical Practitioner	None	1326467804	0	0	BROTHERTON, ANNE N NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
298633	Non-Physician Medical Practitioner	None	1861660664	0	0	BERROS, RACHEL L	6/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	136 MALTESE ROAD	None	EFFORT	PA	18330	7974	00	06000	40.96612006	-75.44053464	Monroe County
298638	Non-Physician Medical Practitioner	None	1740269026	0	0	BOUASY, THOMAS	6/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6789 N BLACKSTONE AVE	None	FRESNO	CA	93710	3530	00	06000	36.83695148	-119.7904013	Fresno County
298643	Non-Physician Medical Practitioner	None	1871554592	0	0	BROWNSBERGER, RICHARD N	4/7/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	488 E VALLEY PKWY	SUITE 404	ESCONDIDO	CA	92025	3363	00	06000	33.12523814	-117.0769715	San Diego County
298649	Non-Physician Medical Practitioner	None	1720369895	0	0	BRISTOW, LAUREN B NP	9/13/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2439 OAK ST	APT D	SANTA MONICA	CA	90405	5135	00	06000	34.01595238	-118.4588688	Los Angeles County
298651	Non-Physician Medical Practitioner	None	1700378460	0	0	BOLA, AMRIT K NP	10/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
298658	Non-Physician Medical Practitioner	None	1396496477	0	0	BRYANT, BRITTNEY NP	8/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13132 STUDEBAKER RD	10	NORWALK	CA	90650	2562	00	06000	33.911874	-118.099151	Los Angeles County
298660	Non-Physician Medical Practitioner	None	1306159918	0	0	BROOKS, MATTHEW J NP	8/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1454 27TH AVE	None	SACRAMENTO	CA	95822	2652	00	06000	38.528397	-121.5032175	Sacramento County
298664	Non-Physician Medical Practitioner	None	1184391112	0	0	BENITEZ, EDGAR NP	10/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298665	Non-Physician Medical Practitioner	None	1194312041	0	0	BUTCHER, KATHERINE M NP	2/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
298671	Non-Physician Medical Practitioner	None	1407238942	0	0	BRICK, JEANELLE L	9/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 WHITECLOUD	None	IRVINE	CA	92614	2926	00	06000	33.67333782	-117.8074563	Orange County
298694	Non-Physician Medical Practitioner	None	1770038424	0	0	BLACKWELL, RACHAEL R NP	11/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	620 BERMUDA ST	None	BAKERSFIELD	CA	93309	2904	00	06000	35.34881522	-119.0625167	Kern County
298696	Non-Physician Medical Practitioner	None	1871277335	0	0	BARANGAN, TERRIE	5/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298738	Non-Physician Medical Practitioner	None	1629652441	0	0	BENARON, MICHAEL R PA-C	8/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
298752	Non-Physician Medical Practitioner	None	1508035270	0	0	BRYANT, TAWANNA J	5/5/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11660 CHURCH ST	397	RANCHO CUCAMONGA	CA	91730	8940	00	06000	34.11103112	-117.5511706	San Bernardino County
298754	Non-Physician Medical Practitioner	None	1205265964	0	0	BAKER, CAMERON A A	2/19/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2591 E CHRISTOPHER DR	None	FRESNO	CA	93720	4447	00	06000	36.86956514	-119.7372581	Fresno County
298758	Non-Physician Medical Practitioner	None	1619290483	0	0	BLAU, BRANDY M NP	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8704 ELFIN COURT	None	ELK GROVE	CA	95758	6796	00	06000	38.441223	-121.439502	Sacramento County
298788	Non-Physician Medical Practitioner	None	1508193640	0	0	BERHANE, AMAN PA	2/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10251 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6719	00	06000	33.87290452	-118.1154735	Los Angeles County
298789	Non-Physician Medical Practitioner	None	1467980243	0	0	BARRIO, AMANDA Y NP	8/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2650 S BRISTOL ST	STE 101-103	SANTA ANA	CA	92704	5751	00	06000	33.71118647	-117.885452	Orange County
298805	Non-Physician Medical Practitioner	None	1518248970	0	0	BARBER, RACHEL	10/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	00	06000	39.15305697	-123.2037774	Mendocino County
298818	Non-Physician Medical Practitioner	None	1154729648	0	0	BELWAY, REBECCA PA-C	12/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 SHRADER ST	SUITE 650	SAN FRANCISCO	CA	94117	1036	00	06000	37.77467326	-122.4529451	San Francisco County
298821	Non-Physician Medical Practitioner	None	1699171843	0	0	BEYAH, SHANNA R	4/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1355 CHEETAH WAY	None	PALMDALE	CA	93551	4351	00	06000	34.58257847	-118.1556671	Los Angeles County
298826	Non-Physician Medical Practitioner	None	1518549054	0	0	BOUCHARD, DANIELLE NP	10/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18345 VENTURA BLVD.	STE 510	TARZANA	CA	91356	4245	00	06000	34.16738049	-118.5325057	Los Angeles County
298840	Non-Physician Medical Practitioner	None	1669219259	0	0	BOZORG, HANNA NP	10/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
298851	Non-Physician Medical Practitioner	None	1083169296	0	0	BOLIVAR, NATALIE A NP	11/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3745 SCENIC WAY	None	OCEANSIDE	CA	92056	5402	00	06000	33.17113549	-117.2667028	San Diego County
298855	Non-Physician Medical Practitioner	None	1558077263	0	0	BENEDICKTUS, CYNTHIA J NP	8/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
298874	Non-Physician Medical Practitioner	None	1619141710	0	0	BULANIN, VLADIMIR	5/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	777 CAMPUS COMMONS RD	SUITE 120	SACRAMENTO	CA	95825	8309	00	06000	38.571021	-121.416786	Sacramento County
298882	Non-Physician Medical Practitioner	None	1013083120	0	0	BOTELLO, ALVARO G	1/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	STE 713	GARDEN GROVE	CA	92843	1921	00	06000	33.77450141	-117.9123364	Orange County
298889	Non-Physician Medical Practitioner	None	1710932967	0	0	BEEMAN, VANESSA D	3/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2488 N CALIFORNIA ST	ALPINE ORTHOPAEDIC MEDIC	STOCKTON	CA	95204	5508	00	06000	37.97587328	-121.2911856	San Joaquin County
298903	Non-Physician Medical Practitioner	None	1568487908	0	0	BARBERE, STEVEN E NP	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	779 OCEAN VIEW BLVD	None	GROVER BEACH	CA	93433	1329	00	06000	35.12898098	-120.6211543	San Luis Obispo County
298908	Non-Physician Medical Practitioner	None	1700569886	0	0	BLONSKY, NATASHA PA-C	10/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	00	06000	34.2064445	-118.8824085	Ventura County
298967	Non-Physician Medical Practitioner	None	1548659105	0	0	BEHAVIORAL HEALTH SERVICES I	4/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 W EL SEGUNDO BLVD	SUITE B	HAWTHORNE	CA	90250	3317	00	06000	33.91648148	-118.3206645	Los Angeles County
299003	Non-Physician Medical Practitioner	None	1861502007	0	0	BELL, KATHERINE ELIZABETH	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 POTRERO AVE	UCSF DEPARTMENT OF PSYCH	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
299004	Non-Physician Medical Practitioner	None	1659469229	0	0	BENT, DEBORAH L	9/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6742 SHETLAND CIRCLE	None	HUNTINGTON BEACH	CA	92648	4865	00	06000	33.69066004	-118.0114228	Orange County
299011	Non-Physician Medical Practitioner	None	1043560972	0	0	BERTOZZI, JULIA C	1/31/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18537 VINA DRIVE	None	LOS GATOS	CA	95031	9103	00	06000	37.19974599	-121.9951555	Santa Clara County
299027	Non-Physician Medical Practitioner	None	1295289262	0	0	BRUNEAU, SUSANNE E	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2126 E HOOVER	None	ORANGE	CA	92867	6111	00	06000	33.80801838	-117.8303074	Orange County
299029	Non-Physician Medical Practitioner	None	1316293723	0	0	BUSWELL, NICHOLE M	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	16 WILTAN DRIVE	None	MONROE	CT	06468	1059	00	06000	41.34437884	-73.26356469	Greater Bridgeport Planning Region
299047	Non-Physician Medical Practitioner	None	1184928012	0	0	BURRIS, TRACY L NP	6/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	460 EASTLICK STREET	None	UKIAH	CA	95482	4613	00	06000	39.14521825	-123.2175478	Mendocino County
299090	Non-Physician Medical Practitioner	None	1386889624	0	0	BRUNET, WENDY S NP	10/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
299092	Non-Physician Medical Practitioner	None	1124408422	0	0	BRIMBERRY, LAURA NP	11/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	00	06000	38.572803	-121.4685	Sacramento County
299110	Non-Physician Medical Practitioner	None	1902454002	0	0	BARAJAS, TIFFANY L NP	1/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	00	06000	33.89242734	-118.2947128	Los Angeles County
299138	Non-Physician Medical Practitioner	None	1558612804	0	0	BAI, YAN NP	6/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4807 CHERYL AVENUE	None	GLENDALE	CA	91214	1224	00	06000	34.235802	-118.249768	Los Angeles County
299145	Non-Physician Medical Practitioner	None	1497166672	0	0	BENEVOLENCE INDUSTRIES INC	6/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	805 W LA VETA AVE	110	ORANGE	CA	92868	3901	00	06000	33.78064152	-117.8606475	Orange County
299151	Non-Physician Medical Practitioner	None	1972676922	0	0	BONNENFANT, ANDREA M NP	3/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1686 HACIENDA CT	None	YUBA CITY	CA	95993	7704	00	06000	39.1518234	-121.6746892	Sutter County
299158	Non-Physician Medical Practitioner	None	1740629047	0	0	BANSIL, DENNIS J	10/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5211 DEL SUR CIRCLE	None	LA PALMA	CA	90623	2211	00	06000	33.84015136	-118.0421765	Orange County
299160	Non-Physician Medical Practitioner	None	1083015887	0	0	BUTLER, EUGENE	12/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	840 CLIFTON CT	None	BENICIA	CA	94510	3639	00	06000	38.09193478	-122.1847642	Solano County
299188	Non-Physician Medical Practitioner	None	1750531265	0	0	BARTOLOZZI, JOHN N	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10748 RIVERSIDE DRIVE	UNIT 8	TOULUCA LAKE	CA	91602	2313	00	06000	34.15223026	-118.3652637	Los Angeles County
299190	Non-Physician Medical Practitioner	None	1275206252	0	0	BAO, SILIN NP	10/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
299205	Non-Physician Medical Practitioner	None	1871902411	0	0	BYRNE, MARGARET M	8/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2039 BACON ST	None	SAN DIEGO	CA	92107	2505	00	06000	32.74917321	-117.2489422	San Diego County
299210	Non-Physician Medical Practitioner	None	1265716542	0	0	BHANGOO, SANDEEP K NP	7/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6427 REFLECTION DRIVE	102	SAN DIEGO	CA	92124	3488	00	06000	32.79177145	-117.1093235	San Diego County
299220	Non-Physician Medical Practitioner	None	1578763207	0	0	BENEVOLENCE INDUSTRIES INCORPORATED	6/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3631 CRENSHAW BLVD	109	LOS ANGELES	CA	90016	4869	00	06000	34.023177	-118.3351475	Los Angeles County
299224	Non-Physician Medical Practitioner	None	1528119237	0	0	BARRON, RITA SUSAN	6/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 S COURT ST STE B	None	VISALIA	CA	93277	4931	00	06000	36.314937	-119.291679	Tulare County
299244	Non-Physician Medical Practitioner	None	1184664070	0	0	BRICE, JULEE ANN	4/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	00	06000	34.131303	-117.3225325	San Bernardino County
299270	Non-Physician Medical Practitioner	None	1891835781	0	0	BROWN, JOAN PAMELA	9/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	06000	36.1590063	-115.1674415	Clark County
299275	Non-Physician Medical Practitioner	None	1417681248	0	0	BARNETT, ALISON NP	11/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
299291	Non-Physician Medical Practitioner	None	1851867766	0	0	BAPTISTE, CHANTAL P	10/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	811 W 7TH ST	SUITE 1200, OFFICE 1048	LOS ANGELES	CA	90017	3423	00	06000	34.0489635	-118.2591312	Los Angeles County
299295	Non-Physician Medical Practitioner	None	1972080455	0	0	BRONSON, TRACY M NP	6/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
299297	Non-Physician Medical Practitioner	None	1245406800	0	0	BUDD, ROSANA M NP	1/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41179 RIMFIELD DR	None	PALMDALE	CA	93551	1212	00	06000	34.63030768	-118.2130602	Los Angeles County
299317	Non-Physician Medical Practitioner	None	1295317709	0	0	BUTLER, REGINA M NP	6/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	126 AVOCADO AVE	102	PERRIS	CA	92571	2605	00	06000	33.8102395	-117.2244465	Riverside County
299319	Non-Physician Medical Practitioner	None	1134874761	0	0	BIMBH, JASPREET K PA	3/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
299332	Non-Physician Medical Practitioner	None	1932499225	0	0	BARNES, PAUL T	6/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	553 CHERRY AVE	None	SAN BRUNO	CA	94066	4121	00	06000	37.62132029	-122.421479	San Mateo County
299344	Non-Physician Medical Practitioner	None	1689440711	0	0	BONILLA, JESSE A NP	1/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	00	06000	33.67718578	-117.9887516	Orange County
299355	Non-Physician Medical Practitioner	None	1356455026	0	0	BOWMAN-HARVEY, CRIS A NP	5/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5391 W KENT PL	None	DENVER	CO	80238	2928	00	06000	39.64936635	-105.0547956	Denver County
299372	Non-Physician Medical Practitioner	None	1578990230	0	0	BARNARD, MARGARET NP	8/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31720 TEMECULA PKWY	203	TEMECULA	CA	92592	5895	00	06000	33.4799323	-117.1033702	Riverside County
299378	Non-Physician Medical Practitioner	None	1659620052	0	0	BECKS, MONICA A	8/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1555 RIVIERA AVE	APT 416	WALNUT CREEK	CA	94596	3592	00	06000	37.91085278	-122.066735	Contra Costa County
299397	Non-Physician Medical Practitioner	None	1760620983	0	0	BAETA, LOIS CORINA	3/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 HOSPITAL DR	None	VALLEJO	CA	94589	2580	00	06000	38.13100118	-122.2403008	Solano County
299418	Non-Physician Medical Practitioner	None	1154803310	0	0	BHATTARAI, SHRADA PA	11/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20101 LAKE CHABOT RD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	00	06000	37.69819004	-122.0873124	Alameda County
299426	Non-Physician Medical Practitioner	None	1457874893	0	0	BASRA, RAMNEET K	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 INDER LN	None	YUBA CITY	CA	95993	5154	00	06000	39.11616699	-121.6482197	Sutter County
299428	Non-Physician Medical Practitioner	None	1801344288	0	0	BRADEN, DEVEN D	10/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	931 LEISHA LN	None	REDDING	CA	96001	6203	00	06000	40.58464526	-122.4292576	Shasta County
299432	Non-Physician Medical Practitioner	None	1104414101	0	0	BUNAG, MICHAEL JOHN P NP	2/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
299451	Non-Physician Medical Practitioner	None	1699980896	0	0	BERNARDI, ELIZABETH	7/9/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3000	00	06000	34.129683	-117.970857	Los Angeles County
299461	Non-Physician Medical Practitioner	None	1447337779	0	0	BURKHART, VIVIAN NP	11/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
299495	Non-Physician Medical Practitioner	None	1073587440	0	0	BRANDT, JARED ROBERT	11/28/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	75 PRINGLE WAY	SUITE 1002	RENO	NV	89502	1464	00	06000	39.52621891	-119.7944075	Washoe County
299520	Non-Physician Medical Practitioner	None	1780875005	0	0	BEDIA, ANNAMARIE	4/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	INFUSION CENTER D12	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
299524	Non-Physician Medical Practitioner	None	1548850134	0	0	BENTZ, MARIE E NP	3/31/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1444 S MAIN ST	None	SANTA ANA	CA	92707	1717	00	06000	33.727401	-117.8678195	Orange County
299528	Non-Physician Medical Practitioner	None	1285695445	0	0	BILELLO, JACLYN R PA-C	6/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
299555	Non-Physician Medical Practitioner	None	1871859421	0	0	BOYD, LISA N PA	5/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
299556	Non-Physician Medical Practitioner	None	1427203264	0	0	BERMAN-GREENSTEIN, ANNE RACHEL	6/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
299567	Non-Physician Medical Practitioner	None	1992931729	0	0	BROOME, AMETRA	8/19/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	742 W GARDENA BLVD	None	GARDENA	CA	90247	5024	00	06000	33.88165193	-118.2885204	Los Angeles County
299595	Non-Physician Medical Practitioner	None	1184065088	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	10/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11750 CHOLLA DR	SUITE B	DESERT HOT SPRING	CA	92240	3064	00	06000	33.96386115	-116.5144878	Riverside County
299600	Non-Physician Medical Practitioner	None	1053919985	0	0	BART, AMBER L NP	8/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
299623	Non-Physician Medical Practitioner	None	1366844318	0	0	BARRON, JULIE C	3/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 SHERWOOD AVE	None	ALHAMBRA	CA	91801	2923	00	06000	34.0938302	-118.1579934	Los Angeles County
299627	Non-Physician Medical Practitioner	None	1811407109	0	0	BLOMBERG, BROOKE L PA-C	12/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25405 HANCOCK AVENUE	STE. 105	MURRIETA	CA	92562	5978	00	06000	33.5580833	-117.1850127	Riverside County
299672	Non-Physician Medical Practitioner	None	1194412668	0	0	BRANIECKI, AMANDA J PA	9/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
299677	Non-Physician Medical Practitioner	None	1700979127	0	0	BOTTCHER, MARGARET S NP	6/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	226 1/2 S JUANITA AVENUE	None	REDONDO BEACH	CA	90277	3438	00	06000	33.83901785	-118.3789522	Los Angeles County
299695	Non-Physician Medical Practitioner	None	1467130435	0	0	BAILEY, PAUL NP	11/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE ST	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
299696	Non-Physician Medical Practitioner	None	1528837564	0	0	BERKEY, BRITTNEY PA-C	8/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	00	06000	37.79071145	-122.4308506	San Francisco County
299701	Non-Physician Medical Practitioner	None	1891709119	0	0	BANION, CAROLYN	7/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1775 AURORA CT	None	AURORA	CO	80045	2536	00	06000	39.744243	-104.8382955	Adams County
299739	Non-Physician Medical Practitioner	None	1679293013	0	0	BALTAZAR, MIKI D NP	4/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4821 PANAMA LN	STE A-C	BAKERSFIELD	CA	93313	3480	00	06000	35.29587848	-119.056005	Kern County
299751	Non-Physician Medical Practitioner	None	1831810696	0	0	BUSSER, DEAN	8/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
299776	Non-Physician Medical Practitioner	None	1760746242	0	0	BACHOURA, GEORGINA NP	7/31/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15782 MIDWOOD DR	#3	GRANADA HILLS	CA	91344	3223	00	06000	34.2795393	-118.4735354	Los Angeles County
299787	Non-Physician Medical Practitioner	None	1700259181	0	0	BRADBURY, ELIZABETH A	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4495 DIAMOND ST	STE 2	CAPITOLA	CA	95010	3046	00	06000	36.97255891	-121.9599928	Santa Cruz County
299789	Non-Physician Medical Practitioner	None	1326577552	0	0	BOOMGARDEN, KATI NP	1/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1531 ESPLANADE	None	CHICO	CA	95926	3310	00	06000	39.74248474	-121.8493369	Butte County
299797	Non-Physician Medical Practitioner	None	1497205678	0	0	BEACH, APRIL M NP	9/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6063 DOLORES DR	None	ROHNERT PARK	CA	94928	1708	00	06000	38.35323012	-122.7025311	Sonoma County
299820	Non-Physician Medical Practitioner	None	1598253338	0	0	BOLANOS, SARAH LEE	4/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
299837	Non-Physician Medical Practitioner	None	1841962180	0	0	BAHR, MIKHAIL PA-C	5/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
299856	Non-Physician Medical Practitioner	None	1962752006	0	0	BILLINGSLEA-YOON, EMMA NP	10/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 MEDICAL PLZ	SUITE 200	LOS ANGELES	CA	90095	0001	00	06000	34.06473399	-118.445865	Los Angeles County
299858	Non-Physician Medical Practitioner	None	1104549856	0	0	BAGHAEI, POUYA PA-C	1/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
299863	Non-Physician Medical Practitioner	None	1881736692	0	0	BANKS, WANDA F NP	9/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2234 W 31ST ST	None	LOS ANGELES	CA	90018	2951	00	06000	34.02642303	-118.316276	Los Angeles County
299886	Non-Physician Medical Practitioner	None	1427010784	0	0	BUAN, DEANA MICHELLE DODD	3/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST. SUITE 1	None	MURRIETA	CA	92562	0000	00	06000	33.55740114	-117.2157733	Riverside County
299891	Non-Physician Medical Practitioner	None	1407178775	0	0	BARON NELSON, MARY C NP	7/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5272 LA CANADA BLVD	None	LA CANADA	CA	91011	1722	00	06000	34.22164463	-118.2043626	Los Angeles County
299908	Non-Physician Medical Practitioner	None	1336219443	0	0	BARZOTTINI, CHERI	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
299923	Non-Physician Medical Practitioner	None	1356704043	0	0	BARBAS, ADRIEN F NP	5/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3293 MADERA AVE	None	OAKLAND	CA	94619	3412	00	06000	37.78109572	-122.190768	Alameda County
299925	Non-Physician Medical Practitioner	None	1265282446	0	0	BRISTOW, ANNA CNM	5/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
299935	Non-Physician Medical Practitioner	None	1477852424	0	0	BRITO-NADJMABADI, AIDE	4/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10300 FINCHLEY DR	None	BAKERSFIELD	CA	93311	3506	00	06000	35.34179969	-119.1167075	Kern County
299936	Non-Physician Medical Practitioner	None	1477830057	0	0	BLACK, JAMIE PA	11/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
299955	Non-Physician Medical Practitioner	None	1578975751	0	0	BYRAM, JINAH N NP	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7600 OLD DOMINION CT	None	APTOS	CA	95003	3821	00	06000	36.97913818	-121.9099818	Santa Cruz County
299986	Non-Physician Medical Practitioner	None	1710947874	0	0	BARRY, SCOTT W	4/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 W ORANGEBURG	None	MODESTO	CA	95350	3741	00	06000	37.66550529	-121.0289629	Stanislaus County
299999	Non-Physician Medical Practitioner	None	1295176394	0	0	BABIKIAN, RAZMIG V NP	8/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
300000	Non-Physician Medical Practitioner	None	1437607041	0	0	BEHMARDIAN, ANAHITA NP	11/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	00	06000	33.73793948	-118.3036095	Los Angeles County
300027	Non-Physician Medical Practitioner	None	1104412543	0	0	BARKLEY, VANESSA J PA-C	4/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
300035	Non-Physician Medical Practitioner	None	1891419073	0	0	BALL, AMANDA NP	6/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4550 VAN NUYS BLVD	STE A4	SHERMAN OAKS	CA	91403	2844	00	06000	34.154658	-118.4486715	Los Angeles County
300061	Non-Physician Medical Practitioner	None	1649685397	0	0	BRADLEY, ALBERT B	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	404 BALLINDINE DRIVE	None	VACAVILLE	CA	95688	9236	00	06000	38.38564204	-121.9826081	Solano County
300109	Non-Physician Medical Practitioner	None	1700050200	0	0	BROWN, LAURENCE J	3/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	PROVIDER RELATIONS- ZC 3	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
300138	Non-Physician Medical Practitioner	None	1902408875	0	0	BARLAAN, MAFE A NP	1/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
300171	Non-Physician Medical Practitioner	None	1457010001	0	0	BERULYTE, DOMANTE PA-C	1/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4700 SOQUEL DR	None	SOQUEL	CA	95073	2427	00	06000	36.98815433	-121.9571695	Santa Cruz County
300178	Non-Physician Medical Practitioner	None	1205028982	0	0	BAE, MELISSA H	9/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2125 CRESCENT DRIVE	None	SIGNAL HILL	CA	90755	5622	00	06000	33.79573297	-118.1584684	Los Angeles County
300191	Non-Physician Medical Practitioner	None	1669919577	0	0	BOHN, NATALIE	12/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
300206	Non-Physician Medical Practitioner	None	1740804665	0	0	BARNWELL, KEVIN J PA-C	10/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
300207	Non-Physician Medical Practitioner	None	1033499215	0	0	BOITANO, APRIL MICHELLE	10/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 MISSION BLVD	SUITE 2800	JACKSON	CA	95642	2536	00	06000	38.35163001	-120.7670107	Amador County
300216	Non-Physician Medical Practitioner	None	1548605587	0	0	BALUYUT, VIRGILIO Y	5/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 4TH ST	SUITE 1	BERKELEY	CA	94710	1717	00	06000	37.87435655	-122.302076	Alameda County
300240	Non-Physician Medical Practitioner	None	1427578376	0	0	BURTON, ANTHONY PA	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
300260	Non-Physician Medical Practitioner	None	1952696957	0	0	BELLETTO, JANNA LYNN	5/23/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1040 N MAIN ST	None	MANTECA	CA	95336	3745	00	06000	37.81164418	-121.216958	San Joaquin County
300300	Non-Physician Medical Practitioner	None	1245351485	0	0	BAUTISTA, AMY B NP	11/5/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24051 WILLOW CREEK RD	None	DIAMOND BAR	CA	91765	1431	00	06000	34.02914092	-117.7997003	Los Angeles County
300305	Non-Physician Medical Practitioner	None	1205472115	0	0	BLAKE, CATRINA P NP	3/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
300313	Non-Physician Medical Practitioner	None	1265531354	0	0	BROMS, THERESA L NP	6/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 WALES ST	None	THOUSAND OAKS	CA	93160	3544	00	06000	34.19470314	-118.8774092	Ventura County
300329	Non-Physician Medical Practitioner	None	1659736775	0	0	BRETT, AUSTIN M PA	8/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1628 PALM AVE	None	SAN DIEGO	CA	92154	1027	00	06000	32.58396546	-117.098649	San Diego County
300350	Non-Physician Medical Practitioner	None	1558880807	0	0	BOWYER, BERNADETTE	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
300351	Non-Physician Medical Practitioner	None	1992181176	0	0	BESSERT, AMY	12/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3670 DEGNAN BLVD	None	LOS ANGELES	CA	90018	4015	00	06000	34.02110503	-118.329693	Los Angeles County
300355	Non-Physician Medical Practitioner	None	1760408959	0	0	BREED, CHERYL D	11/4/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4501 X ST	SUITE 3016	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
300367	Non-Physician Medical Practitioner	None	1871255315	0	0	BECK, CHARLEY	12/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 S OAK AVE	None	OAKDALE	CA	95361	3519	00	06000	37.75764557	-120.8600743	Stanislaus County
300368	Non-Physician Medical Practitioner	None	1104176999	0	0	BUHLER, ELIZABETH NP	12/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	830 SCENIC DRIVE	None	MODESTO	CA	95350	6131	00	06000	37.64720049	-120.982338	Stanislaus County
300375	Non-Physician Medical Practitioner	None	1538642459	0	0	BARTON, JORDAN L PA-C	8/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 GELLERT BLVD	None	DALY CITY	CA	94015	2613	00	06000	37.66753085	-122.4686194	San Mateo County
300389	Non-Physician Medical Practitioner	None	1235771197	0	0	BOTELHO, COURTNEY-RAE P PA	1/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
300400	Non-Physician Medical Practitioner	None	1912142225	0	0	BROWN, REBECCA ELLEN NP	9/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	21991 N 91ST DRIVE	None	SUPRISE	AZ	85383	3548	00	06000	33.683364	-112.255713	Maricopa County
300407	Non-Physician Medical Practitioner	None	1376164996	0	0	BRASHER, DANIELLE R PA-C	7/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
300410	Non-Physician Medical Practitioner	None	1902416332	0	0	BRYDEN, ALLISON D NP	3/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8910 VILLA LA JOLLA DR	STE 110	LA JOLLA	CA	92037	1701	00	06000	32.87058261	-117.2338797	San Diego County
300420	Non-Physician Medical Practitioner	None	1588960694	0	0	BEARD, KENNARD D	9/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 LILAC ST	None	LODI	CA	95242	9127	00	06000	38.14929135	-121.3048383	San Joaquin County
300421	Non-Physician Medical Practitioner	None	1861150807	0	0	BERGER, BROOKE A	1/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 EAST REDLANDS BLVD	SUITE 106	REDLANDS	CA	92373	0000	00	06000	34.05731952	-117.181197	San Bernardino County
300428	Non-Physician Medical Practitioner	None	1477912442	0	0	BROWN, CHRISTINA E PA	7/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 E OCEAN BLVD	110	LONG BEACH	CA	90802	5003	00	06000	33.76653325	-118.185777	Los Angeles County
300446	Non-Physician Medical Practitioner	None	1912529272	0	0	BATTLE, SHALA	8/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
300452	Non-Physician Medical Practitioner	None	1629425566	0	0	BARBIN, MARK	6/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	00	06000	38.72453536	-120.7921649	El Dorado County
300485	Non-Physician Medical Practitioner	None	1497099832	0	0	BOYICH, JENNIFER MARIE	1/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S CHEVY CHASE DR	#105	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
300488	Non-Physician Medical Practitioner	None	1831608090	0	0	BALURAN, JONATHAN D NP	3/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
300510	Non-Physician Medical Practitioner	None	1043849276	0	0	BENAVIDES, JANCY D PA	12/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
300515	Non-Physician Medical Practitioner	None	1689098832	0	0	BRADY, ANGELA M NP	7/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9396 AVENIDA ALTURA	BELLA	CHERRY VALLEY	CA	92223	3816	00	06000	33.98432619	-116.959942	Riverside County
300521	Non-Physician Medical Practitioner	None	1659900389	0	0	BEATTIE, ALEXANDRA M NP	6/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	00	06000	32.80027449	-117.153846	San Diego County
300534	Non-Physician Medical Practitioner	None	1417432147	0	0	BAJO, JANETTE NP	8/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
300548	Non-Physician Medical Practitioner	None	1396172557	0	0	BEATY, AMANDA E	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12000 CHILDRESS STREET	None	BAKERSFIELD	CA	93312	8237	00	06000	35.41104422	-119.1358129	Kern County
300550	Non-Physician Medical Practitioner	None	1043428501	0	0	BEIM, KELLY	11/13/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
300596	Non-Physician Medical Practitioner	None	1497032130	0	0	BETCO, MARIA VERONICA	3/23/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8710 MONROE CT	SUITE 200	RANCHO CUCAMONGA	CA	91730	4883	00	06000	34.09544496	-117.5747968	San Bernardino County
300605	Non-Physician Medical Practitioner	None	1295327112	0	0	BARKER, EMILY S NP	6/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	#357	LA MESA	CA	91942	3027	00	06000	32.77978322	-117.0094766	San Diego County
300621	Non-Physician Medical Practitioner	None	1124730403	0	0	BARNETT, NATALIE PA-C	10/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7600 HOSPITAL DR	J1	SACRAMENTO	CA	95823	5406	00	06000	38.463876	-121.414698	Sacramento County
300625	Non-Physician Medical Practitioner	None	1588035067	0	0	BERG, ASHLEY L NP	6/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
300634	Non-Physician Medical Practitioner	None	1699978528	0	0	BLUM, DANIELLE	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	00	06000	34.06736471	-118.3763201	Los Angeles County
300642	Non-Physician Medical Practitioner	None	1225494834	0	0	BREED, FRANCES E NP	1/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	06000	34.480224	-114.3390555	Mohave County
300670	Non-Physician Medical Practitioner	None	1487725693	0	0	BACANI, REDENTOR C	4/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1029 TABOR HILL AVE	None	HENDERSON	NV	89074	8032	00	06000	36.04681749	-115.0328006	Clark County
300682	Non-Physician Medical Practitioner	None	1386956571	0	0	BENDLER, REGINA M	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1041 BOULDER PLACE	None	OCEANSIDE	CA	92057	1957	00	06000	33.27280743	-117.2952378	San Diego County
300691	Non-Physician Medical Practitioner	None	1740604495	0	0	BRAHEN, JOSHUA L	10/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1311 HUMBOLDT STREET	None	RENO	NV	89509	2733	00	06000	39.51119876	-119.8138943	Washoe County
300711	Non-Physician Medical Practitioner	None	1174083984	0	0	BROMLEY, WINDY L	1/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
300713	Non-Physician Medical Practitioner	None	1588341242	0	0	BLISS, SOPHIE M PA-C	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
300723	Non-Physician Medical Practitioner	None	1639363328	0	0	BALLARD, MELISSA ANN	12/27/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	RM S076 M/C 5101	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
300729	Non-Physician Medical Practitioner	None	1205561008	0	0	BANUELAS, VICTORIA PA-C	9/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	00	06000	33.4799323	-117.1033702	Riverside County
300741	Non-Physician Medical Practitioner	None	1679923783	0	0	BROCKMAN, ERIN K PA	5/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
300755	Non-Physician Medical Practitioner	None	1750794202	0	0	BURNS, KATHLEEN D NP	9/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 S MYRTLE	APT 302	MONROVIA	CA	91016	8413	00	06000	34.14445684	-118.0009036	Los Angeles County
300772	Non-Physician Medical Practitioner	None	1952036048	0	0	BENITEZ-CEBALLOS, ANA M NP	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5504 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4104	00	06000	34.01907641	-118.1513095	Los Angeles County
300779	Non-Physician Medical Practitioner	None	1558534685	0	0	BOGDANOV, HEATHER D NP	4/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
300811	Non-Physician Medical Practitioner	None	1841364742	0	0	BAILEY, MELISSA ANNE	2/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	4TH FLOOR	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
300817	Non-Physician Medical Practitioner	None	1891358016	0	0	BEECH, LEEANNA A PA	4/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
300827	Non-Physician Medical Practitioner	None	1285944769	0	0	BOUCHARD, DARCIE	7/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	06000	36.163269	-115.1654465	Clark County
300840	Non-Physician Medical Practitioner	None	1134366180	0	0	BURNETT-BATTLE, YOLANDA M NP	6/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12171 FARMINGTON ST	None	OAK HILLS	CA	92344	9232	00	06000	34.37584091	-117.396938	San Bernardino County
300855	Non-Physician Medical Practitioner	None	1215421102	0	0	BARAJAS, GABRIEL G NP	9/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9601 STAFFORDSHIRE WAY	None	BAKERSFIELD	CA	93312	4304	00	06000	35.36467399	-119.1084447	Kern County
300861	Non-Physician Medical Practitioner	None	1750033155	0	0	BALCITA, GEMMA D NP	4/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
300863	Non-Physician Medical Practitioner	None	1326821067	0	0	BOLDT, CELINA PA-C	11/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
300891	Non-Physician Medical Practitioner	None	1093225211	0	0	BZDEL, BIANCA PA-C	4/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70554251	-121.873005	Alameda County
300892	Non-Physician Medical Practitioner	None	1841449840	0	0	BARTH, MARY E NP	5/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81767 DR CARREON BLVDD	STE 100	INDIO	CA	92201	5590	00	06000	33.70738112	-116.237755	Riverside County
300895	Non-Physician Medical Practitioner	None	1760894547	0	0	BAJADA, ADA P NP	1/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 ESCANYO DR	None	S SAN FRANCISCO	CA	94080	4133	00	06000	37.64957402	-122.4458963	San Mateo County
300896	Non-Physician Medical Practitioner	None	1346470275	0	0	BERG, CAROLINA SUE	4/26/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 DIVISADERO ST.,	3RD FLOOR UROLOGY DEPART	SAN FRANCISCO	CA	94115	0000	00	06000	37.78475261	-122.43973	San Francisco County
300897	Non-Physician Medical Practitioner	None	1285939553	0	0	BERGE, KARINA MANAYAN	10/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	SUITE 6220	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
300914	Non-Physician Medical Practitioner	None	1609030683	0	0	BURANDAY, JASON A	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5311 ARDEN DR	None	TEMPLE CITY	CA	91780	3320	00	06000	34.09871361	-118.043729	Los Angeles County
300919	Non-Physician Medical Practitioner	None	1922035989	0	0	BOYD, GABRIEL MANUEL	8/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1630 E HERNDON AVE	None	FRESNO	CA	93720	3305	00	06000	36.83756049	-119.7583515	Fresno County
300925	Non-Physician Medical Practitioner	None	1578243051	0	0	BURGESS, GLORIA J PA-C	9/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	00	06000	36.74333844	-119.7831874	Fresno County
300939	Non-Physician Medical Practitioner	None	1922715747	0	0	BAYAOA, KATHLEEN K NP	12/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	00	06000	36.359649	-119.331567	Tulare County
300963	Non-Physician Medical Practitioner	None	1043836679	0	0	BRIDENSTINE, MARIAN A MD	4/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
300992	Non-Physician Medical Practitioner	None	1306499272	0	0	BYRNE, KEVIN PA	6/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	00	06000	37.89281357	-122.0598728	Contra Costa County
301004	Non-Physician Medical Practitioner	None	1720467491	0	0	BARNEY, ADELINE M NP	12/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	61 REMINGTON	None	IRVINE	CA	92620	5731	00	06000	33.69905019	-117.770631	Orange County
301016	Non-Physician Medical Practitioner	None	1538615125	0	0	BONSOL, ALTHEA	4/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18133 VENTURA BLVD	300 3RD FLOOR	TARZANA	CA	91356	3612	00	06000	34.1657808	-118.5283188	Los Angeles County
301045	Non-Physician Medical Practitioner	None	1912219213	0	0	BOHN, LORILEE NP	10/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 SUPERIOR AVE	SUITE 300	NEWPORT BEACH	CA	92663	3600	00	06000	33.62918676	-117.9305675	Orange County
301052	Non-Physician Medical Practitioner	None	1801412325	0	0	BEHZIZ, ARIAN A NP	6/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
301053	Non-Physician Medical Practitioner	None	1306913793	0	0	BULLARD, MONICA J.	10/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	SUITE 205	OAKLAND	CA	94609	3424	00	06000	37.81892183	-122.2640154	Alameda County
301063	Non-Physician Medical Practitioner	None	1578039665	0	0	BAINS, PARMVEER S PA	11/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
301076	Non-Physician Medical Practitioner	None	1457006017	0	0	BARILLA, ARAZ NP	4/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4955 VAN NUYS BLVD	STE 301	SHERMAN OAKS	CA	91403	1815	00	06000	34.160805	-118.4487295	Los Angeles County
301091	Non-Physician Medical Practitioner	None	1659681278	0	0	BEDEROV, VADIM I	4/29/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 SAN ANSELMO AVE S	None	SAN BRUNO	CA	94066	5519	00	06000	37.61707204	-122.4054087	San Mateo County
301094	Non-Physician Medical Practitioner	None	1295390672	0	0	BAGHERPOUR, ARMEGHAN PA	1/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8120 TIMBERLAKE WAY	STE 210B	SACRAMENTO	CA	95823	5414	00	06000	38.461023	-121.41414	Sacramento County
301095	Non-Physician Medical Practitioner	None	1164952578	0	0	BARRY, AMY B	12/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1592 STILLWELL ROAD	APT A	SAN FRANCISCO	CA	94129	1035	00	06000	37.7930934	-122.4795676	San Francisco County
301108	Non-Physician Medical Practitioner	None	1467975953	0	0	BURNS, KATHERINE M PA	5/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
301128	Non-Physician Medical Practitioner	None	1538897947	0	0	BAKER, SERENA N	11/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 E DEVONSHIRE AVE	STE 201	HEMET	CA	92543	3033	00	06000	33.75118151	-116.9615025	Riverside County
301159	Non-Physician Medical Practitioner	None	1528599867	0	0	BONIFACIO, MARK GERALD M	6/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2727 N PECK RD	None	EL MONTE	CA	91733	2434	00	06000	34.060311	-118.0306097	Los Angeles County
301160	Non-Physician Medical Practitioner	None	1386755759	0	0	BUSTAMANTE, VIOLKYS	5/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1217 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4642	00	06000	34.0111325	-118.1136867	Los Angeles County
301171	Non-Physician Medical Practitioner	None	1497066286	0	0	BENNETT, VICTORIA I	7/27/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2059 WOOD MAR DR	None	FOLSOM	CA	95762	3718	00	06000	38.71633289	-121.0872406	El Dorado County
301180	Non-Physician Medical Practitioner	None	1205320496	0	0	BEDDOR, ANNA C PA-C	12/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
301184	Non-Physician Medical Practitioner	None	1356606693	0	0	BEZANSON, HANNAH J NP	11/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1726 PORTALS AVE	None	CLOVIS	CA	93611	2036	00	06000	36.81657201	-119.6842747	Fresno County
301218	Non-Physician Medical Practitioner	None	1871088393	0	0	BURIANI, JESSICA A PA	10/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
301225	Non-Physician Medical Practitioner	None	1497880934	0	0	BRODERICK, VICKY L	1/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	800 E 21ST ST	NEONATAL INTENSIVE CARE	SIOUX FALLS	SD	57105	1016	00	06000	43.534251	-96.7157055	Minnehaha County
301233	Non-Physician Medical Practitioner	None	1083636401	0	0	BLANDINO, RAYLENE PA	6/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S HAM LN	STE A	LODI	CA	95242	2317	00	06000	38.124495	-121.2882875	San Joaquin County
301236	Non-Physician Medical Practitioner	None	1508065111	0	0	BROWN, ERICA RUTMAN	10/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	550 DEEP VALLEY DR	SUITE 287	ROLLING HILLS EST	CA	90274	3664	00	06000	33.77200208	-118.3735856	Los Angeles County
301238	Non-Physician Medical Practitioner	None	1114342417	0	0	BRILEE, MICHELLE M	1/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1347 HUCKLEBERRY LANE	None	SAN JACINTO	CA	92582	4219	00	06000	33.77379871	-116.9854943	Riverside County
301261	Non-Physician Medical Practitioner	None	1881210029	0	0	BIRCH, JEREMY N PA-C	3/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301269	Non-Physician Medical Practitioner	None	1154419117	0	0	BRAZIL, LISA E NP	5/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 CASA ST	SUITE 320	SAN LUIS OBISPO	CA	93405	1894	00	06000	35.29359615	-120.6654304	San Luis Obispo County
301290	Non-Physician Medical Practitioner	None	1033139225	0	0	BERES, KIMBERLY	9/22/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4150 V STREET, PSSB STE	DEPT OF ANESTHESIOLOGY A	SACRAMENTO	CA	95817	1460	00	06000	38.556081	-121.4570475	Sacramento County
301297	Non-Physician Medical Practitioner	None	1275696064	0	0	BOWER, LORI ANN	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	00	06000	37.60573981	-122.0835989	Alameda County
301316	Non-Physician Medical Practitioner	None	1285024083	0	0	BAUTISTA, ERICKSON C NP	9/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
301327	Non-Physician Medical Practitioner	None	1023137403	0	0	BAGIU, KRISTIN L NP	8/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	00	06000	33.71114199	-117.8853958	Orange County
301334	Non-Physician Medical Practitioner	None	1174731640	0	0	BRILEY, DENNIS WAYNE	12/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 E VALENCIA MESA DR	SUITE 105	FULLERTON	CA	92835	3813	00	06000	33.89343304	-117.9279349	Orange County
301346	Non-Physician Medical Practitioner	None	1366093486	0	0	BRUMFIELD, SAMANTHA J	6/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	00	06000	33.01539521	-117.0824934	San Diego County
301355	Non-Physician Medical Practitioner	None	1699437467	0	0	BERNARTE, CHARLENE L PA-C	8/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301406	Non-Physician Medical Practitioner	None	1881421493	0	0	BLACK, JORDAN D PA-C	9/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
301424	Non-Physician Medical Practitioner	None	1841419793	0	0	BLACK, ROBIN	12/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2077 HARBOR BLVD	A	COSTA MESA	CA	92627	9384	00	06000	33.64990963	-117.9190918	Orange County
301475	Non-Physician Medical Practitioner	None	1639459720	0	0	BRIONES, ERIC R	5/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1590 STARGAZE DR	None	CHULA VISTA	CA	91915	1819	00	06000	32.62706137	-116.9526018	San Diego County
301485	Non-Physician Medical Practitioner	None	1891151023	0	0	BRISENO, DAISY NP	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2256 COVER CT	None	DISCOVERY BAY	CA	94505	1316	00	06000	37.89348135	-121.6049135	Contra Costa County
301489	Non-Physician Medical Practitioner	None	1154913309	0	0	BEANE, ERIC PA-C	10/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
301491	Non-Physician Medical Practitioner	None	1932714896	0	0	BROOKS, SAMANTHA N PA-C	8/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301515	Non-Physician Medical Practitioner	None	1154033538	0	0	BUI, NANCY T NP	3/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
301516	Non-Physician Medical Practitioner	None	1639256159	0	0	BUI, MINH THI	10/19/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13309 VAN NUYS BLVD	None	PACOIMA	CA	91331	3006	00	06000	34.2652134	-118.423365	Los Angeles County
301524	Non-Physician Medical Practitioner	None	1477833465	0	0	BUELL, CASSANDRA C	2/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3014 MOJAVE DR	None	W SACRAMENTO	CA	95691	5247	00	06000	38.54302312	-121.5330879	Yolo County
301539	Non-Physician Medical Practitioner	None	1720509193	0	0	BHANDARKAR, APARNA NP	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1185 JOHNSON AVE	None	SAN JOSE	CA	95128	3125	00	06000	37.30337824	-122.005613	Santa Clara County
301558	Non-Physician Medical Practitioner	None	1396083713	0	0	BRADFORD, BRITTANY R NP	5/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2140 EAST 7TH PLACE	D103	LOS ANGELES	CA	90021	1749	00	06000	34.03351155	-118.2284325	Los Angeles County
301576	Non-Physician Medical Practitioner	None	1316136906	0	0	BARDEN, LAWRENCE PA-C	6/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
301583	Non-Physician Medical Practitioner	None	1376761940	0	0	BENEVOLENCE INDUSTRIES INCORPORATED	2/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3533 W. PICO BOULEVARD	None	LOS ANGELES	CA	90019	0000	00	06000	34.04721925	-118.3197384	Los Angeles County
301588	Non-Physician Medical Practitioner	None	1578651279	0	0	BOYKIN-MOWREY, TINA M	6/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 E HAVEN AVE	None	ARCADIA	CA	91006	2902	00	06000	34.14742976	-118.0251011	Los Angeles County
301636	Non-Physician Medical Practitioner	None	1013386754	0	0	BRINTON, TALIA M	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 1/2 OXFORD ST	None	BERKELEY	CA	94709	1426	00	06000	37.88162786	-122.2671474	Alameda County
301647	Non-Physician Medical Practitioner	None	1205820537	0	0	BELLOMY-MUTH, MELINDA M NP	5/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4236 PACIFIC AVE LOWER	None	LONG BEACH	CA	90807	1924	00	06000	33.83284714	-118.1953446	Los Angeles County
301656	Non-Physician Medical Practitioner	None	1427776269	0	0	BERKABILE, JONATHAN	8/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
301670	Non-Physician Medical Practitioner	None	1659427292	0	0	BOLD, JAMES E	1/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2925 CANONITA DR	None	FALLBROOK	CA	92028	8771	00	06000	33.35153961	-117.193759	San Diego County
301689	Non-Physician Medical Practitioner	None	1003997248	0	0	BROWN, LINDA ROSE	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	WOMEN'S HEALTH , PERMANE	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
301752	Non-Physician Medical Practitioner	None	1336176114	0	0	BRANSON, DEBRA C NP	12/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4454 EASTGATE MALL	2	SAN DIEGO	CA	92121	1959	00	06000	32.87874137	-117.2098877	San Diego County
301766	Non-Physician Medical Practitioner	None	1518126804	0	0	BULMER, JOHANNA C	4/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23900 RANCHO CT	None	VALENCIA	CA	91354	1556	00	06000	34.46360777	-118.5587551	Los Angeles County
301777	Non-Physician Medical Practitioner	None	1467449975	0	0	BROAD, MICHELE R NP	7/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24910 LAS BRISAS ROAD	STE 106	MURRIETA	CA	92562	4010	00	06000	33.57522424	-117.1828078	Riverside County
301789	Non-Physician Medical Practitioner	None	1013468149	0	0	BATALHA, JASON NP	10/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
301792	Non-Physician Medical Practitioner	None	1992741755	0	0	BUTLER, MARVIN R	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1071 LAKE DEESON WOODS	None	LAKELAND	FL	33805	7643	00	06000	28.10852364	-81.93793666	Polk County
301823	Non-Physician Medical Practitioner	None	1306836507	0	0	BLEHM, ROBERT L PA-C	7/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	415 KNOLLCREST DR STE 10	None	REDDING	CA	96002	0181	00	06000	40.57267376	-122.3643496	Shasta County
301833	Non-Physician Medical Practitioner	None	1851588222	0	0	BARRERA, GABRIEL C	11/5/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3250 WHITE CLOUD DR	None	HACIENDA HEIGHTS	CA	91745	6325	00	06000	33.9802888	-117.9764475	Los Angeles County
301866	Non-Physician Medical Practitioner	None	1801088240	0	0	BELLOWS, BRITTANY PA	10/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1387 E 2ND ST	None	BENICIA	CA	94510	2836	00	06000	38.05445908	-122.1525476	Solano County
301899	Non-Physician Medical Practitioner	None	1932824679	0	0	BOHAN, DANIELLE PA	3/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	00	06000	37.89281357	-122.0598728	Contra Costa County
301916	Non-Physician Medical Practitioner	None	1295730935	0	0	BUNKER-ALBERTS, MICHELE VIVIENE	1/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
301924	Non-Physician Medical Practitioner	None	1659755791	0	0	BROWN, ALICIA K PA	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2323 DE LA VINA ST	STE 201	SANTA BARBARA	CA	93105	3879	00	06000	34.43202913	-119.7212339	Santa Barbara County
301973	Non-Physician Medical Practitioner	None	1730538216	0	0	BALYAN, RITA	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 N CENTRAL AVE	UNIT 308	GLENDALE	CA	91203	2964	00	06000	34.15066916	-118.2578713	Los Angeles County
301981	Non-Physician Medical Practitioner	None	1154954915	0	0	BRADLEY, SHAWNEE S NP	11/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	00	06000	33.82736911	-116.5109632	Riverside County
301990	Non-Physician Medical Practitioner	None	1790020147	0	0	BLAU, LAURA PA	1/8/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
302000	Non-Physician Medical Practitioner	None	1104998103	0	0	BON, ROBIN A	5/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
302014	Non-Physician Medical Practitioner	None	1073925160	0	0	BLACKMON, WILL R III	7/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3233 CALIFORNIA STREET	None	BERKELEY	CA	94703	2670	00	06000	37.84882803	-122.2759173	Alameda County
302027	Non-Physician Medical Practitioner	None	1205292133	0	0	BERNAL, HOLLY J NP	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	235 EDGEWOOD DR	None	PACIFICA	CA	94044	1110	00	06000	37.66266445	-122.4821715	San Mateo County
302043	Non-Physician Medical Practitioner	None	1326683350	0	0	BLECK, JENNIFER D PA-C	1/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 MENDOCINO AVE	None	SANTA ROSA	CA	95403	2805	00	06000	38.46672	-122.720724	Sonoma County
302053	Non-Physician Medical Practitioner	None	1821483025	0	0	BENNETT, JESSICA L NP	11/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
302059	Non-Physician Medical Practitioner	None	1750321972	0	0	BASNER, LILLIAN F NP	1/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	561 TEHUACAN RD	None	UKIAH	CA	95842	4197	00	06000	39.16418991	-123.1610954	Mendocino County
302096	Non-Physician Medical Practitioner	None	1720557473	0	0	BUTTERWORTH, MEGAN A PA-C	1/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
302102	Non-Physician Medical Practitioner	None	1821104506	0	0	BRUMMOND, JONATHAN W	11/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22241 FALENICA	None	MISSION VIEJO	CA	92691	1555	00	06000	33.63957853	-117.6639417	Orange County
302138	Non-Physician Medical Practitioner	None	1568747137	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	9/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8851 CENTER DR	SUITE 100	LA MESA	CA	91942	3017	00	06000	32.78189749	-117.0075062	San Diego County
302141	Non-Physician Medical Practitioner	None	1255804365	0	0	BUSCHO, LEAH NP	9/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1267 N VIRGIL AVE	None	LOS ANGELES	CA	90029	2017	00	06000	34.09544056	-118.2866442	Los Angeles County
302147	Non-Physician Medical Practitioner	None	1003385287	0	0	BOJKA, RACHEL	11/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	236 SAN JOSE	None	SALINAS	CA	93901	3901	00	06000	36.6582359	-121.6463252	Monterey County
302171	Non-Physician Medical Practitioner	None	1225496086	0	0	BRUGMAN, JANE L NP	3/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7846 E HAMPSHIRE ROAD	None	ORANGE	CA	92867	1504	00	06000	33.82958737	-117.7697254	Orange County
302176	Non-Physician Medical Practitioner	None	1467846147	0	0	BEAUSOLEIL, COREY M	8/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	402 TREYBROOKE CIRCLE	APT 33	GREENVILLE	NC	27834	7744	00	06000	35.616555	-77.4013815	Pitt County
302191	Non-Physician Medical Practitioner	None	1982752887	0	0	BALL, CAROLYN J	3/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 S KIHRIDGE LANE	None	ENCINITAS	CA	92024	4238	00	06000	33.0377885	-117.2435908	San Diego County
302199	Non-Physician Medical Practitioner	None	1063840601	0	0	BARDEN, MARGARET D NP	11/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21902 LASSENT ST	None	CHATSWORTH	CA	91311	3627	00	06000	34.24994171	-118.6044734	Los Angeles County
302213	Non-Physician Medical Practitioner	None	1831433119	0	0	BOUCKE, COURTNEY L NP	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	164 HOLBROOKE WAY	None	GRASS VALLEY	CA	95945	9700	00	06000	39.23875406	-121.0621824	Nevada County
302221	Non-Physician Medical Practitioner	None	1255671186	0	0	BELL, ROBERT E PA	6/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	00	06000	37.78824776	-122.4311213	San Francisco County
302222	Non-Physician Medical Practitioner	None	1326477423	0	0	BARTLEY, JENNIFER	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
302263	Non-Physician Medical Practitioner	None	1841267622	0	0	BUCHANAN, LESLIE	7/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2925 SYCAMORE DR	SUITE 204-205	SIMI VALLEY	CA	93065	1207	00	06000	34.288398	-118.7439175	Ventura County
302265	Non-Physician Medical Practitioner	None	1407456288	0	0	BRANT, MARIA B NP	5/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
302266	Non-Physician Medical Practitioner	None	1669911640	0	0	BERRIOS, ARIEL M PA	10/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
302282	Non-Physician Medical Practitioner	None	1255859948	0	0	BUI, JIMMYHAI D	1/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2305 STRAWBERRY LANE	None	SANTA ANA	CA	92706	2240	00	06000	33.76262707	-117.9006999	Orange County
302286	Non-Physician Medical Practitioner	None	1033381181	0	0	BROWN, DAVID A PA	11/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	00	06000	33.82736911	-116.5109632	Riverside County
302290	Non-Physician Medical Practitioner	None	1104349869	0	0	BELTRAN, AARON NP	2/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	00	06000	34.15729818	-118.3277073	Los Angeles County
302311	Non-Physician Medical Practitioner	None	1376914846	0	0	BAKER, ADAM J	2/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26025 CALMHILL DRIVE	None	TORRANCE	CA	90505	7301	00	06000	33.78577261	-118.3364907	Los Angeles County
302330	Non-Physician Medical Practitioner	None	1235389826	0	0	BRENNAN, LAURA ANNE	8/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4501 X ST	2 ND FLOOR	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
302333	Non-Physician Medical Practitioner	None	1952627663	0	0	BROWER, RYAN W	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4249 E ODESSA DR	None	SAN TAN VALLEY	AZ	85140	4497	00	06000	33.227001	-111.5201295	Pinal County
302344	Non-Physician Medical Practitioner	None	1124579149	0	0	BITHER, KRISTINA A M	4/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3305 GUIDO ST	None	OAKLAND	CA	94602	3524	00	06000	37.80235282	-122.1923367	Alameda County
302359	Non-Physician Medical Practitioner	None	1801268636	0	0	BERARDINO, ALISON M NP	8/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2618 GLACIER DR	None	KLAMATH FALLS	OR	97603	8573	00	06000	42.2023587	-121.6946337	Klamath County
302364	Non-Physician Medical Practitioner	None	1710034210	0	0	BROWN, RAENA LYNN	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPARTMENT 148	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
302369	Non-Physician Medical Practitioner	None	1184749715	0	0	BRISKIN, PATRICIA	11/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
302374	Non-Physician Medical Practitioner	None	1467970988	0	0	BENNETT, ANTHONY	12/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	06000	33.786909	-112.129047	Maricopa County
302437	Non-Physician Medical Practitioner	None	1184876872	0	0	BROWNE, AMANDA EM	8/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1959 NE PACIFIC ST	AA115, MS356310	SEATTLE	WA	98195	0000	00	06000	47.65080692	-122.3081828	King County
302488	Non-Physician Medical Practitioner	None	1477796688	0	0	BACA-ASHER, JOSEFINA S	4/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 BROADWAY STREET	None	REDWOOD CITY	CA	94063	3132	00	06000	37.48523183	-122.2025998	San Mateo County
302504	Non-Physician Medical Practitioner	None	1801882055	0	0	BROCKMAN, JOE B JR	9/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2140 RAMADA DR	None	OCEANSIDE	CA	92056	6333	00	06000	33.19539643	-117.306954	San Diego County
302520	Non-Physician Medical Practitioner	None	1720311012	0	0	BERKLEY, HUGH K PA-C	11/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
302526	Non-Physician Medical Practitioner	None	1780613943	0	0	BARZEGAR, SEDA PA	4/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
302527	Non-Physician Medical Practitioner	None	1447703731	0	0	BREWER, JESSICA L PA-C	1/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	00	06000	34.02980528	-118.4786605	Los Angeles County
302529	Non-Physician Medical Practitioner	None	1821461435	0	0	BENGEL, NICOLE PA-C	6/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1031 W CHAPMAN AVENUE	SUITE 101	ORANGE	CA	92868	2872	00	06000	33.78791049	-117.8632755	Orange County
302554	Non-Physician Medical Practitioner	None	1699128686	0	0	BASHAM, ALLISON J PA	2/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
302563	Non-Physician Medical Practitioner	None	1366164576	0	0	BARCLIFF, JENNIFER A	1/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	00	06000	33.94354395	-117.394926	Riverside County
302574	Non-Physician Medical Practitioner	None	1699487108	0	0	BARTON, LAUREN A CNM	1/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
302576	Non-Physician Medical Practitioner	None	1619373826	0	0	BER, SARAH R NP	1/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6029 TOPEKA DRIVE	None	TARZANA	CA	91356	1321	00	06000	34.18002	-118.546166	Los Angeles County
302593	Non-Physician Medical Practitioner	None	1710534359	0	0	BROSAMER, ERIN N PA-C	7/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18682 BEACH BLVD	120	HUNTINGTON BEACH	CA	92648	2049	00	06000	33.69152695	-117.9887007	Orange County
302604	Non-Physician Medical Practitioner	None	1326862616	0	0	BOURBON, BRIANA L PA	2/19/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 COFFEE RD	None	MODESTO	CA	95355	2803	00	06000	37.668645	-120.9756715	Stanislaus County
302615	Non-Physician Medical Practitioner	None	1497159818	0	0	BELL, KEVIN F	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1545 ELIZABETH ST	None	REDLANDS	CA	92373	7018	00	06000	34.03169417	-117.1669446	San Bernardino County
302637	Non-Physician Medical Practitioner	None	1235864133	0	0	BERTOLI, GRACE C PA	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
302641	Non-Physician Medical Practitioner	None	1629203609	0	0	BAYLON, NANCY C	6/6/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5953 ATLANTIC BLVD	None	MAYWOOD	CA	90270	3133	00	06000	33.98590138	-118.1858597	Los Angeles County
302646	Non-Physician Medical Practitioner	None	1134368087	0	0	BLANKINSHIP, TAWNY N	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5959 TANUS CIR	None	ROCKLIN	CA	95677	4303	00	06000	38.77918874	-121.2036041	Placer County
302709	Non-Physician Medical Practitioner	None	1356050355	0	0	BORDINHAO, KRISTINA	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
302739	Non-Physician Medical Practitioner	None	1124511464	0	0	BUI, HIEP P NP	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	539 COLORADO AVE	None	TURLOCK	CA	95380	4110	00	06000	37.49757401	-120.8333219	Stanislaus County
302749	Non-Physician Medical Practitioner	None	1962483412	0	0	BINDER, KEVIN LEE	1/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
302758	Non-Physician Medical Practitioner	None	1699167940	0	0	BEAN, MICHELE N NP	2/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1213 FOREST DR	None	SANTA PAULA	CA	93060	1207	00	06000	34.37241002	-119.0626728	Ventura County
302768	Non-Physician Medical Practitioner	None	1811323710	0	0	BORIACK, EMILY RENEE	9/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	SUITE 2112	SACRAMENTO	CA	95817	0000	00	06000	38.556288	-121.458474	Sacramento County
302824	Non-Physician Medical Practitioner	None	1033190418	0	0	BRYAN, JO	12/21/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
302861	Non-Physician Medical Practitioner	None	1902056062	0	0	BAU, SHERONA N	10/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
302884	Non-Physician Medical Practitioner	None	1477581668	0	0	BOLAND, DEBRA E NP	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1987 BEACH BLVD	None	PACIFICA	CA	94044	2510	00	06000	37.634184	-122.4942135	San Mateo County
302893	Non-Physician Medical Practitioner	None	1841617529	0	0	BOOHER, CHIP NP	5/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
302902	Non-Physician Medical Practitioner	None	1760816763	0	0	BRYAN, HEATHER M NP	5/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40 WEST 20TH STREET	None	MERCED	CA	95340	3903	00	06000	37.30195837	-120.4749608	Merced County
302921	Non-Physician Medical Practitioner	None	1306355441	0	0	BASSI, CHRISTIAN NP	12/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2755 HERNDON	None	CLOVIS	CA	93611	6800	00	06000	36.83745149	-119.6604315	Fresno County
302931	Non-Physician Medical Practitioner	None	1992270698	0	0	BAHRAMZI, NOORSABA NP	10/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	#357	LA MESA	CA	91942	3027	00	06000	32.77978322	-117.0094766	San Diego County
302936	Non-Physician Medical Practitioner	None	1396805479	0	0	BUONAVITA, GRACIELA A	3/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	145 W WINSLOW ST	None	UPLAND	CA	91786	1006	00	06000	34.11567504	-117.6532382	San Bernardino County
302942	Non-Physician Medical Practitioner	None	1043769342	0	0	BARRAZA, BERTHA NP	12/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1605 GLACIER WAY	None	WASCO	CA	93280	3106	00	06000	35.58438679	-119.3566627	Kern County
302961	Non-Physician Medical Practitioner	None	1043959968	0	0	BRIARD, BRETT PA	8/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	00	06000	39.74473059	-121.8488381	Butte County
302980	Non-Physician Medical Practitioner	None	1770971418	0	0	BOWMAN, BRIAN C NP	4/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
302984	Non-Physician Medical Practitioner	None	1750896502	0	0	BAYER, STEVEN R PA-C	7/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2401 REO DR	None	SAN DIEGO	CA	92139	3025	00	06000	32.67512422	-117.064198	San Diego County
303030	Non-Physician Medical Practitioner	None	1265034912	0	0	BURNS, CHEYANNE K NP	4/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	00	06000	34.058745	-117.2000975	San Bernardino County
303042	Non-Physician Medical Practitioner	None	1477129302	0	0	BEITTER, KEERSTIN N PA-C	9/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	340 FOURTH AVE	SUITE 19	CHULA VISTA	CA	91910	3813	00	06000	32.63831293	-117.0833536	San Diego County
303052	Non-Physician Medical Practitioner	None	1679593727	0	0	BOLDING, DAWN RENE	11/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	00	06000	38.55204	-121.455387	Sacramento County
303077	Non-Physician Medical Practitioner	None	1144812843	0	0	BUONDELMONTE, NICOLE PA-C	3/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4857	00	06000	33.839505	-116.5455735	Riverside County
303084	Non-Physician Medical Practitioner	None	1992368419	0	0	BUI, HUONG L PA	7/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
303092	Non-Physician Medical Practitioner	None	1003412339	0	0	BHATIA, SHARUTI D NP	2/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	703 MAGNOLIA AVE	None	CORONA	CA	92879	3118	00	06000	33.85828352	-117.5557208	Riverside County
303118	Non-Physician Medical Practitioner	None	1205549052	0	0	BARNETT, CAITLIN R PA-C	2/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303120	Non-Physician Medical Practitioner	None	1265839708	0	0	BALAYAN, KONSTANTIN W PA	9/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	00	06000	34.03833368	-118.3726622	Los Angeles County
303135	Non-Physician Medical Practitioner	None	1205107216	0	0	BLAUFARB, ALEXANDRA ALLYNE	8/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 SAN PABLO AVE	None	ALBANY	CA	94706	1103	00	06000	37.89781848	-122.3014067	Alameda County
303170	Non-Physician Medical Practitioner	None	1326626979	0	0	BLACK, KATHERINE A PA-C	10/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
303198	Non-Physician Medical Practitioner	None	1508115841	0	0	BURNS, AILEEN M	7/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1332 CHAPARRAL AVENUE	None	MCKINEYVILLE	CA	95519	8805	00	06000	40.96231154	-124.106832	Humboldt County
303201	Non-Physician Medical Practitioner	None	1659396760	0	0	BULAON, REYNALDO M PA-C	11/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
303223	Non-Physician Medical Practitioner	None	1124192893	0	0	BRODIE, BARBARA J NP	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 SUSSEX CT	None	BELMONT	CA	94002	2536	00	06000	37.52830477	-122.282118	San Mateo County
303245	Non-Physician Medical Practitioner	None	1780928812	0	0	BLOCK, JENNIFER MARTIN	1/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
303261	Non-Physician Medical Practitioner	None	1679833206	0	0	BERCK, BECQUIE A	7/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5956 RUTHWOOD DRIVE	None	CALABASAS	CA	91302	1076	00	06000	34.16533506	-118.6994219	Los Angeles County
303272	Non-Physician Medical Practitioner	None	1417040825	0	0	BAUTISTA, ANGELI ARREGLADO	11/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16323 CLARK AVE	None	BELLFLOWER	CA	90706	5209	00	06000	33.885693	-118.1339975	Los Angeles County
303282	Non-Physician Medical Practitioner	None	1508452244	0	0	BUI, AMANDA T NP	3/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
303283	Non-Physician Medical Practitioner	None	1689174146	0	0	BEALE, EVAN J PA-C	5/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
303296	Non-Physician Medical Practitioner	None	1366956476	0	0	BARRAGAN, NINA MARIE NP	12/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
303335	Non-Physician Medical Practitioner	None	1033865654	0	0	BRADLEY, HANNAH NP	11/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5525 GROSSMONT CENTER DR	SUITE 609	LA MESA	CA	91942	3009	00	06000	32.781195	-117.0070695	San Diego County
303339	Non-Physician Medical Practitioner	None	1427782432	0	0	BRADY, MELANIE	12/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	00	06000	33.715035	-117.936993	Orange County
303340	Non-Physician Medical Practitioner	None	1245665884	0	0	BLOOM, ANDREW J PA-C	10/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
303355	Non-Physician Medical Practitioner	None	1104163484	0	0	BUCKLEY, GENEVIEVE T NP	8/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	00	06000	39.23410746	-121.0515391	Nevada County
303357	Non-Physician Medical Practitioner	None	1497001226	0	0	BIENVENIDOS COMMUNITY HEALTH CENTER	6/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	507 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	2621	00	06000	34.0269721	-118.1553658	Los Angeles County
303379	Non-Physician Medical Practitioner	None	1194065847	0	0	BRIMMO, TASHA N NP	12/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	868 TOULOUSE LN	None	CLOVIS	CA	93619	7686	00	06000	36.8632384	-119.7005112	Fresno County
303399	Non-Physician Medical Practitioner	None	1316248115	0	0	BRANTLEY, ANTRINA DENISE	1/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
303400	Non-Physician Medical Practitioner	None	1700220407	0	0	BABY BUDDIES BIRTH CENTER	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1908 N BEALE RD	SUITE C	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
303405	Non-Physician Medical Practitioner	None	1457125346	0	0	BANH, EVELYN NP	2/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
303410	Non-Physician Medical Practitioner	None	1093282576	0	0	BROWN, COURTNEY PA-C	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 WEBSTER ST	416	SAN FRANCISCO	CA	94115	2379	00	06000	37.7904826	-122.4324477	San Francisco County
303413	Non-Physician Medical Practitioner	None	1750353512	0	0	BELKNAP, STEVEN M	3/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29962 CORTE TOLANO	None	TEMECULA	CA	92591	5329	00	06000	33.5164738	-117.136993	Riverside County
303423	Non-Physician Medical Practitioner	None	1821852203	0	0	BLISS, ANDREW C NP	9/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	00	06000	33.94909549	-118.3481595	Los Angeles County
303425	Non-Physician Medical Practitioner	None	1073162012	0	0	BAHRAMI, YASMIN NP	1/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18751 VENTURA BLVD	SUITE 100	TARZANA	CA	91356	3372	00	06000	34.17098024	-118.5414492	Los Angeles County
303435	Non-Physician Medical Practitioner	None	1013445691	0	0	BENAVIDEZ, RICHARD A PA	4/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
303439	Non-Physician Medical Practitioner	None	1710311337	0	0	BRADLEY, MARINA N NP	4/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7544 STAGECOACH LANE	None	VACAVILLE	CA	95688	9745	00	06000	38.42895418	-122.0203136	Solano County
303484	Non-Physician Medical Practitioner	None	1629258447	0	0	BURKETT, CHRISTOPHER	6/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
303498	Non-Physician Medical Practitioner	None	1225671845	0	0	BARADARAN, KIMYA PA	4/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	00	06000	37.7634502	-122.4579779	San Francisco County
303509	Non-Physician Medical Practitioner	None	1174061410	0	0	BAGGAO, MARIA CONCEPCION M NP	10/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N LA CUMBRE RD	M	SANTA BARBARA	CA	93110	1577	00	06000	34.44255908	-119.7510269	Santa Barbara County
303516	Non-Physician Medical Practitioner	None	1790861516	0	0	BREWER, CYNDI PA	7/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
303523	Non-Physician Medical Practitioner	None	1346736907	0	0	BUTLER, CAROLINE PA-C	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	06000	43.383456	-124.2330435	Coos County
303550	Non-Physician Medical Practitioner	None	1104105691	0	0	BUSSMANN, STEPHANIE MARIE	10/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	425 W 59TH ST	SUITE4B	NEW YORK	NY	10019	8022	00	06000	40.769928	-73.9859625	New York County
303551	Non-Physician Medical Practitioner	None	1770091621	0	0	BEAL, RANE N NP	4/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	00	06000	38.572803	-121.4685	Sacramento County
303580	Non-Physician Medical Practitioner	None	1528246907	0	0	BRADY, CHRISTINA L	4/26/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	105 COUNTRY ESTATES DR	None	SANTA CRUZ	CA	95060	9724	00	06000	37.05056705	-122.1584802	Santa Cruz County
303594	Non-Physician Medical Practitioner	None	1033691670	0	0	BURRES, NATALIE G PA	11/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	825 DELBON AVE	None	TURLOCK	CA	95382	2016	00	06000	37.51052943	-120.8386573	Stanislaus County
303605	Non-Physician Medical Practitioner	None	1225438294	0	0	BYRD, JANET K NP	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	00	06000	38.29871411	-122.4751509	Sonoma County
303628	Non-Physician Medical Practitioner	None	1053969766	0	0	BEHIMEHR, SHEILA NP	5/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
303650	Non-Physician Medical Practitioner	None	1801332671	0	0	BREGANTE, MELISSA D NP	9/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
303651	Non-Physician Medical Practitioner	None	1417234360	0	0	BERGER, TERRI DENISE	12/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1122 'S' STREET	SUITE B	FRESNO	CA	93721	0000	00	06000	36.74185388	-119.7823667	Fresno County
303664	Non-Physician Medical Practitioner	None	1932825569	0	0	BURROWS, KATHRYN PA	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
303665	Non-Physician Medical Practitioner	None	1316318942	0	0	BERGER, KERIN PA	12/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
303686	Non-Physician Medical Practitioner	None	1679014773	0	0	BRODIE, NKECHINYERE A CNM	7/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	00	06000	34.02891163	-118.4797466	Los Angeles County
303687	Non-Physician Medical Practitioner	None	1174602734	0	0	BAILS, IRINA	7/29/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 JEFFERSON BLVD STE B	None	WEST SACRAMENTO	CA	95605	2394	00	06000	38.58786311	-121.5270236	Yolo County
303702	Non-Physician Medical Practitioner	None	1275849283	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	1/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	66675 PIERSON BLVD	None	DESERT HOT SPRING	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
303717	Non-Physician Medical Practitioner	None	1912241258	0	0	BANJ HEALTH CENTER, INC.	9/11/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12954 HAWTHORNE BLVD STE	None	HAWTHORNE	CA	90250	4418	00	06000	33.91447388	-118.3523875	Los Angeles County
303746	Non-Physician Medical Practitioner	None	1518340751	0	0	BALDONADO, JEANETTE F NP	7/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	72 MONSERRAT AVE	None	FOOTHILL RANCH	CA	92610	1903	00	06000	33.68521311	-117.6558676	Orange County
303755	Non-Physician Medical Practitioner	None	1922667500	0	0	BENNETT, HOLLY E NP	10/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	00	06000	37.92643968	-122.0521822	Contra Costa County
303767	Non-Physician Medical Practitioner	None	1659105476	0	0	BIBEE, MORGAN NP	9/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
303804	Non-Physician Medical Practitioner	None	1346748555	0	0	BURRIS, KAYLI A	8/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1069 CRYER CT	#102	HENDERSON	NV	89002	1082	00	06000	35.99028408	-114.9290732	Clark County
303813	Non-Physician Medical Practitioner	None	1326704016	0	0	BARNES, ASHLYN E NP	2/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	00	06000	33.82736911	-116.5109632	Riverside County
303822	Non-Physician Medical Practitioner	None	1275295479	0	0	BOPARAI, SUNITA K NP	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
303825	Non-Physician Medical Practitioner	None	1063819944	0	0	BARRACK, KRISTINA R	1/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1739 SUNSET CLIFFS BLVD	APT 11	SAN DIEGO	CA	92107	3249	00	06000	32.74200211	-117.249931	San Diego County
303847	Non-Physician Medical Practitioner	None	1871679613	0	0	BRIBIESCA, ROSA M NP	5/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25108 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2400	00	06000	33.59796909	-117.6575322	Orange County
303853	Non-Physician Medical Practitioner	None	1780605048	0	0	BLOMENKAMP, MELAINA Z	7/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	309 CORAL DRIVE	None	LAKE HAVASU CITY	AZ	86403	4781	00	06000	34.486119	-114.3413595	Mohave County
303870	Non-Physician Medical Practitioner	None	1144564527	0	0	BANJ HEALTH CENTER, INC.	8/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3620 MLK JR BLVD	None	LYNWOOD	CA	90262	2607	00	06000	33.93169754	-118.2033151	Los Angeles County
303875	Non-Physician Medical Practitioner	None	1194208405	0	0	BALAKRISHNAN, VIDYA PA-C	3/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1675 ALHAMBRA	STE B	SACRAMENTO	CA	95816	7047	00	06000	38.563983	-121.4679915	Sacramento County
303889	Non-Physician Medical Practitioner	None	1871159673	0	0	BORGHEI, SIMONE N NP	10/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
303896	Non-Physician Medical Practitioner	None	1174210355	0	0	BRIDGEFORTH, ANNISSA M NP	2/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
303898	Non-Physician Medical Practitioner	None	1114087145	0	0	BELLOWS, KIM PA-C	8/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3434 VILLA LANE	STE 150	NAPA	CA	94558	6405	00	06000	38.32515937	-122.2938358	Napa County
303903	Non-Physician Medical Practitioner	None	1043621220	0	0	BENEVOLENCE INDUSTRIES INC	6/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	303 N EAST ST	None	ANAHEIM	CA	92805	3341	00	06000	33.84042094	-117.9034309	Orange County
303921	Non-Physician Medical Practitioner	None	1265684633	0	0	BOERSMA, ELLEN M NP	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3279 SCOTTS VALLEY RD	None	LAKEPORT	CA	95453	9436	00	06000	39.07976003	-122.9497924	Lake County
303925	Non-Physician Medical Practitioner	None	1194741603	0	0	BULMAN, LINDA D PA-C	8/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
303932	Non-Physician Medical Practitioner	None	1154872539	0	0	BORRELLI, TILLIE	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
303939	Non-Physician Medical Practitioner	None	1720506744	0	0	BERWALD, KATHERINE R	9/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	00	06000	33.80318353	-118.0666665	Orange County
303970	Non-Physician Medical Practitioner	None	1639800527	0	0	BRITTON, MICHAEL A NP	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	199 WEST PORTAL AVE	None	SAN FRANCISCO	CA	94127	1305	00	06000	37.73890204	-122.467945	San Francisco County
303986	Non-Physician Medical Practitioner	None	1386422855	0	0	BRANDMEYER, KATHERINE NP	1/9/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
304006	Non-Physician Medical Practitioner	None	1740849363	0	0	BERMAN, DANNIELLA A PA	8/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
304038	Non-Physician Medical Practitioner	None	1255168340	0	0	BARRAGAN, ILEANA V NP	10/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	00	06000	33.77450141	-117.9123364	Orange County
304044	Non-Physician Medical Practitioner	None	1093260622	0	0	BEDASSA, BERHANU K NP	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1427 S POINT VIEW ST	APT 17	LOS ANGELES	CA	90035	3933	00	06000	34.05137936	-118.3701781	Los Angeles County
304047	Non-Physician Medical Practitioner	None	1275086464	0	0	BEYER, MARK PA-C	12/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	00	06000	33.03623896	-117.2837308	San Diego County
304054	Non-Physician Medical Practitioner	None	1396051637	0	0	BETHONEY, JUSTIN N NP	10/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	138 35TH STREET	None	HERMOSA BEACH	CA	90254	2020	00	06000	33.87728843	-118.4072193	Los Angeles County
304071	Non-Physician Medical Practitioner	None	1295061695	0	0	BERRYHILL, MARION L NP	9/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	00	06000	33.52069117	-117.1653103	Riverside County
304088	Non-Physician Medical Practitioner	None	1972278653	0	0	BRAY, KIRSTIN L	10/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	00	06000	37.52910755	-120.8840959	Stanislaus County
304111	Non-Physician Medical Practitioner	None	1740588771	0	0	BOERTJE, ROBYN J NP	7/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	938 N CHERRY ST	None	VISALIA	CA	93274	2210	00	06000	36.221211	-119.337643	Tulare County
304120	Non-Physician Medical Practitioner	None	1982894937	0	0	BALDING, SYLVIA	8/28/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	00	06000	37.78614008	-122.4556866	San Francisco County
304122	Non-Physician Medical Practitioner	None	1992733141	0	0	BENNETT, KIM E	3/18/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	347 CAMPBELL AVE	None	REDLANDS	CA	92373	6800	00	06000	34.04027521	-117.1613627	San Bernardino County
304126	Non-Physician Medical Practitioner	None	1851811244	0	0	BRYON, JILL NP	7/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
304147	Non-Physician Medical Practitioner	None	1205083425	0	0	BERVID, CATHEY R NP	4/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8841 DOLLY VARDEN AVE	None	KINGS BEACH	CA	96143	0000	00	06000	39.24163659	-120.0173415	Placer County
304150	Non-Physician Medical Practitioner	None	1861484685	0	0	BREEN-MCDONOUGH, PATRICIA PA-C	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1135 S SUNSET AVENUE	SUITE 401	WEST COVINA	CA	91790	3921	00	06000	34.06215064	-117.9453997	Los Angeles County
304159	Non-Physician Medical Practitioner	None	1942919675	0	0	BACK, EUNJI PA-C	1/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24331 EL TORO ROAD	SUITE 200	LAGUNA WOODS	CA	92637	3116	00	06000	33.60928782	-117.7295058	Orange County
304189	Non-Physician Medical Practitioner	None	1700450566	0	0	BONTEMPO-HERNANDEZ, AMY E NP	10/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19042 SOLEDAD CANYON RD	A	SANTA CLARITA	CA	91351	3362	00	06000	34.4156522	-118.46848	Los Angeles County
304193	Non-Physician Medical Practitioner	None	1114013026	0	0	BLACK-WILLIAMS, MARY L NP	9/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1230 DUXBURY CIR	None	CORONA	CA	92882	8391	00	06000	33.84155877	-117.5932838	Riverside County
304194	Non-Physician Medical Practitioner	None	1225258445	0	0	BAUTISTA, MARIE ANGELA PA	4/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
304196	Non-Physician Medical Practitioner	None	1881606713	0	0	BOLT, LAURIE A	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 GREENFIELD AVE	None	HANFORD	CA	93230	3513	00	06000	36.328968	-119.6582195	Kings County
304218	Non-Physician Medical Practitioner	None	1770182388	0	0	BAHRANI, YALDA NP	12/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
304228	Non-Physician Medical Practitioner	None	1407165251	0	0	BRAVO, JANET E NP	8/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12942 MAGNOLIA BLVD	None	SHERMAN OAKS	CA	91423	1619	00	06000	34.16484049	-118.415358	Los Angeles County
304286	Non-Physician Medical Practitioner	None	1801064407	0	0	BAIR, ELLEN ELIZABETH	9/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
304288	Non-Physician Medical Practitioner	None	1407108939	0	0	BLACKER, KATRINA L NP	3/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
304318	Non-Physician Medical Practitioner	None	1477126365	0	0	BREWER, ADRIANA NP	11/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	707 W VALLEY BLVD	None	TEHACHAPI	CA	93561	2119	00	06000	35.12433846	-118.4591228	Kern County
304337	Non-Physician Medical Practitioner	None	1629081138	0	0	BROWN-SIENKO, TERISA M NP	10/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5250 AVENIDA DE DESPACIO	None	YORBA LINDA	CA	92887	4000	00	06000	33.88340777	-117.7241931	Orange County
304344	Non-Physician Medical Practitioner	None	1114694635	0	0	BELL, OLAJUMOKE NP	4/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	00	06000	34.16480359	-118.8299997	Ventura County
304362	Non-Physician Medical Practitioner	None	1285037614	0	0	BOSMA, HEATHER M NP	5/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4856 CEBRIAN AVENUE	None	NEW CUYAMA	CA	93254	8159	00	06000	34.9443738	-119.6897339	Santa Barbara County
304389	Non-Physician Medical Practitioner	None	1487833679	0	0	BEN-NUN, KAREN R	6/3/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 CHATTANOOGA STREET	APARTMENT 2	SAN FRANCISCO	CA	94114	3423	00	06000	37.75483492	-122.4266449	San Francisco County
304416	Non-Physician Medical Practitioner	None	1164157913	0	0	BACTAD, MARA NP	1/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	921 W 7TH ST	None	OXNARD	CA	93030	6755	00	06000	34.19516476	-119.1890959	Ventura County
304418	Non-Physician Medical Practitioner	None	1699182832	0	0	BLACKMON, JUSTIN T PA	4/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	400 N MCCLURG CT	APT 3305	CHICAGO	IL	60611	4387	00	06000	41.889195	-87.61770851	Cook County
304421	Non-Physician Medical Practitioner	None	1699906891	0	0	BEY, GINA E V NP	12/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3539 CYPRESS WAY	None	SANTA ROSA	CA	95405	7605	00	06000	38.435706	-122.6763045	Sonoma County
304431	Non-Physician Medical Practitioner	None	1902017700	0	0	BATIN, JOHN	3/4/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7180 MOHAWK TRL	None	YUCCA VALLEY	CA	92284	2633	00	06000	34.12302392	-116.4400684	San Bernardino County
304434	Non-Physician Medical Practitioner	None	1780148544	0	0	BASCO, MARIE CLAIRE S NP	8/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	00	06000	38.65086	-121.531833	Sacramento County
304484	Non-Physician Medical Practitioner	None	1033262746	0	0	BEASLEY, PUSHPINDER SINGH	2/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	4TH FLOOR OPERATING ROOM	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
304497	Non-Physician Medical Practitioner	None	1831236520	0	0	BARSKY, DAVID ALEXANDER	1/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7791 JENNA DRIVE	None	GOLETA	CA	93117	1074	00	06000	34.43695224	-119.8990078	Santa Barbara County
304504	Non-Physician Medical Practitioner	None	1477890242	0	0	BRETCHES, LISA R NP	8/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1064 SMOKETREE DR	None	CORONA	CA	92882	8783	00	06000	33.87643766	-117.6291579	Riverside County
304510	Non-Physician Medical Practitioner	None	1922087253	0	0	BAZA-VARGAS, ARMANDO PA-C	5/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1070 S SANTA FE AVE	None	VISTA	CA	92084	7010	00	06000	33.19120588	-117.2283618	San Diego County
304521	Non-Physician Medical Practitioner	None	1518097450	0	0	BROWN, MINETTE PLAZA	8/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14445 OLIVE VIEW DRIVE	NORTH ANNEX	SYLMAR	CA	91342	0000	00	06000	34.32450186	-118.4456317	Los Angeles County
304523	Non-Physician Medical Practitioner	None	1366689358	0	0	BROOKS, KELLY L	9/25/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4484 COFFEETREE LN	None	MOORPARK	CA	93021	3533	00	06000	34.27192779	-118.8601394	Ventura County
304524	Non-Physician Medical Practitioner	None	1497299184	0	0	BERK, CORRIE T NP	6/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1350 SPRUCE PARK DR	STE 332	LAS VEGAS	NV	89135	1469	00	06000	36.15612769	-115.324765	Clark County
304530	Non-Physician Medical Practitioner	None	1205466687	0	0	BUIE, JESSICA S PA-C	11/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
304533	Non-Physician Medical Practitioner	None	1275972655	0	0	BANEZ, FRANCISCO	12/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
304540	Non-Physician Medical Practitioner	None	1942245857	0	0	BULGER, JEFFREY E	3/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15 GLEN ECHO	None	DOVE CANYON	CA	92679	4926	00	06000	33.64094193	-117.5630572	Orange County
304584	Non-Physician Medical Practitioner	None	1215007661	0	0	BRAYSAHW, ALICE E	2/20/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1996 SALZBURG TRAIL	None	REDDING	CA	96003	9334	00	06000	40.57700944	-122.3255498	Shasta County
304613	Non-Physician Medical Practitioner	None	1346469756	0	0	BIESENTHAL, TAMI NP	2/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	782 MEDICAL CENTER DRIVE	STE 212	CLOVIS	CA	93611	6889	00	06000	36.84379626	-119.6609117	Fresno County
304676	Non-Physician Medical Practitioner	None	1699326371	0	0	BARRAGAN, BRIAN PA-C	6/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	00	06000	33.89356031	-117.9271656	Orange County
304686	Non-Physician Medical Practitioner	None	1235916396	0	0	BAKHTMAND, ARMITA PA-C	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	00	06000	38.1206163	-121.2858323	San Joaquin County
304721	Non-Physician Medical Practitioner	None	1699738229	0	0	BERG, CHRISTOPHER J	7/13/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	06000	36.21499805	-115.2504953	Clark County
304736	Non-Physician Medical Practitioner	None	1770174609	0	0	BEAUDET, HALEY A NP	2/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1704 W MANCHESTER AVE	# 109	LOS ANGELES	CA	90047	3034	00	06000	33.9599425	-118.307079	Los Angeles County
304747	Non-Physician Medical Practitioner	None	1447920475	0	0	BACUS, DAVID NP	11/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
304768	Non-Physician Medical Practitioner	None	1235641382	0	0	BROBY, NICOLETTE	2/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
304780	Non-Physician Medical Practitioner	None	1093292294	0	0	BADHESHA, PRABHJOT K NP	9/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	743 E ARETHA AVE	None	FOWLER	CA	93625	0000	00	06000	36.640125	-119.6720595	Fresno County
304793	Non-Physician Medical Practitioner	None	1861884256	0	0	BLANKENHEIM, RHONDA S	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5832 W 2ND ST	None	RIO LINDA	CA	95673	4816	00	06000	38.674404	-121.4633745	Sacramento County
304803	Non-Physician Medical Practitioner	None	1194586198	0	0	BURNAM-TORRENTE, DANIELLA	9/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	00	06000	36.61275747	-121.9010674	Monterey County
304808	Non-Physician Medical Practitioner	None	1457655938	0	0	BOOTH, JAMIE L	5/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	42126 SWEETSHADE LANE	None	TEMECULA	CA	92591	3821	00	06000	33.51211553	-117.1244193	Riverside County
304835	Non-Physician Medical Practitioner	None	1083852206	0	0	BETTS, BONNIE S NP	9/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11306 PEARL ST	STE 101	LOS ANGELES	CA	90064	3047	00	06000	34.03256225	-118.4370575	Los Angeles County
304903	Non-Physician Medical Practitioner	None	1003257338	0	0	BRADY, JAMIE E	12/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2468 LEXINGTON DR	None	VENTURA	CA	93003	2817	00	06000	34.2766464	-119.2633966	Ventura County
304923	Non-Physician Medical Practitioner	None	1982285052	0	0	BALASBAS, JANINE NP	11/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	685 N 13TH AVE	STE 7,8,9	UPLAND	CA	91786	4963	00	06000	34.10202219	-117.6339091	San Bernardino County
304942	Non-Physician Medical Practitioner	None	1811397177	0	0	BRYANT, KATHRYN A NP	11/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2495 RIO ALAYNE CT	None	SPARKS	NV	89436	0682	00	06000	39.56778957	-119.7329263	Washoe County
304990	Non-Physician Medical Practitioner	None	1003679291	0	0	BAUTISTA, MAREYNAL	2/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
305026	Non-Physician Medical Practitioner	None	1568963809	0	0	BYERS, RACHEL W NP	2/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2160 CENTURY PARK E	204	LOS ANGELES	CA	90067	2206	00	06000	34.05756059	-118.4107445	Los Angeles County
305031	Non-Physician Medical Practitioner	None	1770821217	0	0	BALOGH, KIRSTEN A NP	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1655 GREENFIELD AVE	UNIT 20	LOS ANGELES	CA	90025	7543	00	06000	34.04937782	-118.441992	Los Angeles County
305054	Non-Physician Medical Practitioner	None	1831380161	0	0	BALDWIN, GARY T	9/11/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28894 GOLDEN DAWN DR	None	MENIFEE	CA	92584	5896	00	06000	33.66908027	-117.1564839	Riverside County
305066	Non-Physician Medical Practitioner	None	1346498474	0	0	BAEK, SOO PA-C	8/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8150 HAGEMAN RD	None	BAKERSFIELD	CA	93312	1959	00	06000	35.40166449	-119.0933415	Kern County
305082	Non-Physician Medical Practitioner	None	1609156868	0	0	BAPTISTE YOUNGSTON, TRACY NP	1/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1320 TRAVIS BLVD	STE C	FAIRFIELD	CA	94533	4654	00	06000	38.25825918	-122.0515475	Solano County
305083	Non-Physician Medical Practitioner	None	1851374821	0	0	BIANCHI, STEPHANIE L NP	5/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5906 LAGUNA VALE WAY	None	ELK GROVE	CA	95758	4860	00	06000	38.419497	-121.4357625	Sacramento County
305090	Non-Physician Medical Practitioner	None	1578823647	0	0	BANNING FAMILY COMMUNITY HEALTH CENTER	5/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1070 E. RAMSEY STEET	None	BANNING	CA	92220	0998	00	06000	33.92534349	-116.8644555	Riverside County
305091	Non-Physician Medical Practitioner	None	1588728422	0	0	BOLAJI, ELIZABETH J	6/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1177 N PARK AVE	None	POMONA	CA	91768	3028	00	06000	34.06950662	-117.7549507	Los Angeles County
305110	Non-Physician Medical Practitioner	None	1730703281	0	0	BRODHEAD, RACHEL B PA-C	10/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
305129	Non-Physician Medical Practitioner	None	1609038587	0	0	BULJAN, MICHAEL MARION	9/13/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 DIVISADERO ST	4TH FLOOR MELANOMA CLINI	SAN FRANCISCO	CA	94115	3010	00	06000	37.78475261	-122.43973	San Francisco County
305131	Non-Physician Medical Practitioner	None	1760696488	0	0	BELDEN, WENDY N	9/13/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3401 W. SUNFLOWER AVE.	SUITE 250	SANTA ANA	CA	92704	0000	00	06000	33.69575566	-117.9144503	Orange County
305141	Non-Physician Medical Practitioner	None	1518505197	0	0	BABAKHANYAN, ARMEN E NP	3/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2975 N SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	00	06000	34.28924598	-118.7439214	Ventura County
305143	Non-Physician Medical Practitioner	None	1427350859	0	0	BENASSI, KARI BENET	3/26/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DRIVE	G 313	STANFORD	CA	94305	5208	00	06000	37.43304542	-122.1759654	Santa Clara County
305162	Non-Physician Medical Practitioner	None	1235470360	0	0	BERNARDO, RIA K B NP	10/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11531 RIVERSIDE DRIVE	SUITE 205	N HOLLYWOOD	CA	91602	1088	00	06000	34.15766646	-118.3830345	Los Angeles County
305164	Non-Physician Medical Practitioner	None	1760625123	0	0	BLECHER, MICHELE	10/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305189	Non-Physician Medical Practitioner	None	1073961835	0	0	BARBERO, AUTUMN N NP	9/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
305218	Non-Physician Medical Practitioner	None	1023455706	0	0	BEN REFAEL, LISA M	9/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17419 COVELLO ST	None	LAKE BALBOA	CA	91406	2414	00	06000	34.20758449	-118.512558	Los Angeles County
305239	Non-Physician Medical Practitioner	None	1477286540	0	0	BRONNER, NIKI I PA-C	12/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
305254	Non-Physician Medical Practitioner	None	1831542620	0	0	BROYLES, KATHERINE ALYSIA	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1711 ORANGE ST	None	REDLANDS	CA	92374	2254	00	06000	34.0796409	-117.1824145	San Bernardino County
305278	Non-Physician Medical Practitioner	None	1962023028	0	0	BOSNICH, JAMIE G NP	8/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305290	Non-Physician Medical Practitioner	None	1740828615	0	0	BRUNN, ANNA T NP	2/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	652 PETALUMA AVE	SUITE B	SEBASTOPOL	CA	95472	4266	00	06000	38.39662494	-122.8201368	Sonoma County
305298	Non-Physician Medical Practitioner	None	1720287170	0	0	BLODGETT, STEPHANIE D	10/4/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21185 VIA TEODOCIO	None	YORBA LINDA	CA	92887	1820	00	06000	33.89223694	-117.7632095	Orange County
305306	Non-Physician Medical Practitioner	None	1194479436	0	0	BOUSMAIL, LEANNE PA-C	3/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	00	06000	33.66214655	-117.6532809	Orange County
305328	Non-Physician Medical Practitioner	None	1366717803	0	0	BOWMAN, ALEXANDRA ZANABRIA	7/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10050 GARVEY AVE	None	EL MONTE	CA	91733	2088	00	06000	34.06270952	-118.049481	Los Angeles County
305331	Non-Physician Medical Practitioner	None	1043363765	0	0	BRAVATE, CRYSTAL M	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1890 WASHINGTON STREET	APT 203	SAN FRANCISCO	CA	94109	2937	00	06000	37.79290507	-122.4242742	San Francisco County
305340	Non-Physician Medical Practitioner	None	1205347341	0	0	BACON, CHRISTOPHER J NP	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11938 PARAMOUNT BLVD.	None	DOWNEY	CA	90242	2306	00	06000	33.93385032	-118.1444253	Los Angeles County
305390	Non-Physician Medical Practitioner	None	1467961599	0	0	BRZESKI, CLAIRE M PA	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
305429	Non-Physician Medical Practitioner	None	1811505092	0	0	BRIGGS, NICOLE E PA-C	9/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
305441	Non-Physician Medical Practitioner	None	1538456926	0	0	BESHAI, GEORGINA R	9/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16245 TISBURY CIR	None	HUNTINGTON BEACH	CA	92649	2142	00	06000	33.72600535	-118.0602289	Orange County
305465	Non-Physician Medical Practitioner	None	1144995465	0	0	BARAJAS, LILI M PA-C	11/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	00	06000	34.137603	-118.101464	Los Angeles County
305476	Non-Physician Medical Practitioner	None	1891188702	0	0	BASHAM, TIFFANY S NP	2/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	460 N GREENFIELD AVE	SUITE 3	HANFORD	CA	93230	3500	00	06000	36.3296463	-119.6581535	Kings County
305546	Non-Physician Medical Practitioner	None	1295132199	0	0	BRITTON, ALYSSA C PA	7/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	00	06000	33.02257788	-117.0856332	San Diego County
305573	Non-Physician Medical Practitioner	None	1699705574	0	0	BANKS, DAWN O	7/12/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	SUITE 204B	LOMA LINDA	CA	92354	3128	00	06000	34.04805253	-117.249534	San Bernardino County
305576	Non-Physician Medical Practitioner	None	1063690931	0	0	BOURNE, KENRICK C PA	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
305601	Non-Physician Medical Practitioner	None	1376912311	0	0	BLONDEK, CHRISTIE M	11/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 GLENWOOD CIR	APT 16B	MONTEREY	CA	93940	4415	00	06000	36.5855504	-121.8885457	Monterey County
305635	Non-Physician Medical Practitioner	None	1104328152	0	0	BUTTAR, RASVIN NP	5/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
305640	Non-Physician Medical Practitioner	None	1164998886	0	0	BASTANI, ASHKAN NP	4/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5153 HOLT BLVD	STE B1	MONTCLAIR	CA	91763	4837	00	06000	34.0631015	-117.692694	San Bernardino County
305667	Non-Physician Medical Practitioner	None	1306014436	0	0	BOYD, DEBORAH D	7/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2760 N. BALLS FERRY RD.	None	ANDERSON	CA	96007	3537	00	06000	40.45489921	-122.2878254	Shasta County
305707	Non-Physician Medical Practitioner	None	1952461659	0	0	BRUMMOND, TRIA E	10/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22241 FALENCIA	None	MISSION VIEJO	CA	92691	6528	00	06000	33.63957853	-117.6639417	Orange County
305726	Non-Physician Medical Practitioner	None	1821245952	0	0	BAURMANN, AMELIA	10/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
305750	Non-Physician Medical Practitioner	None	1164632287	0	0	BRANDON, MARY GRACE	9/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9090 WILSHIRE BLVD	200	BEVERLY HILLS	CA	90211	1848	00	06000	34.06702873	-118.3894057	Los Angeles County
305764	Non-Physician Medical Practitioner	None	1083217780	0	0	BARLOW, HANNAH PA-C	8/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
305782	Non-Physician Medical Practitioner	None	1770605008	0	0	BELL, SUSANA PA	6/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	00	06000	35.36196445	-119.0749413	Kern County
305784	Non-Physician Medical Practitioner	None	1639898059	0	0	BLACK, ALIX N PA	1/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	00	06000	33.89552551	-117.186021	Riverside County
305825	Non-Physician Medical Practitioner	None	1801211180	0	0	BAILEY, JENNIFER A NP	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6980 ANTELL CIR	None	LAS VEGAS	NV	89119	0405	00	06000	36.063387	-115.130744	Clark County
305849	Non-Physician Medical Practitioner	None	1679392567	0	0	BARLAAN, CHERYL LYN CNM	1/9/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
305850	Non-Physician Medical Practitioner	None	1922142595	0	0	BELETE, ASTER	10/19/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7232 VAN NUYS BLVD STE 1	None	VAN NUYS	CA	91405	2231	00	06000	34.202241	-118.4487235	Los Angeles County
305872	Non-Physician Medical Practitioner	None	1700027372	0	0	BEHAR, CHEYENNE R NP	12/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
305884	Non-Physician Medical Practitioner	None	1326682717	0	0	BAUTISTA, CATALINA PA-C	1/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
305885	Non-Physician Medical Practitioner	None	1922524495	0	0	BRUCE, RICHARD D PA-C	12/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
305886	Non-Physician Medical Practitioner	None	1174880793	0	0	BUDHAN, MARSHA N PA	4/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2220 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2514	00	06000	33.9598587	-118.318258	Los Angeles County
305896	Non-Physician Medical Practitioner	None	1801837836	0	0	BECKHAM, TINA JEAN	5/10/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	00	06000	34.21700406	-119.1582582	Ventura County
305903	Non-Physician Medical Practitioner	None	1629315114	0	0	BILTZ, JOHN H	12/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8275 N 10TH ST	None	FRESNO	CA	93720	2251	00	06000	36.856116	-119.760857	Fresno County
305918	Non-Physician Medical Practitioner	None	1164723987	0	0	BURCHETT, PATRICK THOMAS	4/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13123 E 16TH AVE	THE CHILDRENS HOSPITAL	AURORA	CO	80045	7106	00	06000	39.742164	-104.8350375	Adams County
305941	Non-Physician Medical Practitioner	None	1164517850	0	0	BUNZEL, MARY	3/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 SAN PABLO AVE	SUITE 300	ALBANY	CA	94706	1127	00	06000	37.89781848	-122.3014067	Alameda County
305942	Non-Physician Medical Practitioner	None	1760671200	0	0	BURKUM, DEREK	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3944 E BART ST	None	GILBERT	AZ	85095	0262	00	06000	33.315813	-111.705399	Maricopa County
305964	Non-Physician Medical Practitioner	None	1962977561	0	0	BUX, MICHAEL Y PA	3/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	00	06000	32.95809	-115.5537045	Imperial County
305967	Non-Physician Medical Practitioner	None	1548344948	0	0	BUTLER, LUCY F	10/3/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2125 HEAVENLY CT	None	LODI	CA	95242	4408	00	06000	38.10677146	-121.3005284	San Joaquin County
305996	Non-Physician Medical Practitioner	None	1083633150	0	0	BOROSKI, MICHELLE R	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	245 TULANE	None	VENTURA	CA	93003	1936	00	06000	34.27926819	-119.2375846	Ventura County
306023	Non-Physician Medical Practitioner	None	1659880706	0	0	BATCHELDER, RYAN P PA	6/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
306040	Non-Physician Medical Practitioner	None	1003280934	0	0	BOYLE, BRENDA J NP	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	408 GOODRICH ROCK	None	BEAUMONT	CA	92223	7380	00	06000	33.90646922	-116.96098	Riverside County
306041	Non-Physician Medical Practitioner	None	1427474949	0	0	BRADY, TAMARA M PA	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4000 INNOVATOR DRIVE	UNIT 25102	SACRAMENTO	CA	95834	3897	00	06000	38.641581	-121.5093735	Sacramento County
306071	Non-Physician Medical Practitioner	None	1912443086	0	0	BACH, THUY P	2/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	712 S SIERRA VISTA AVE	APT G	ALHAMBRA	CA	91801	4547	00	06000	34.08878842	-118.1182229	Los Angeles County
306126	Non-Physician Medical Practitioner	None	1962971788	0	0	BOEKELHEIDE, PHILIP G PA-C	10/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4640 ADMIRALTY WAY	718	MARINA DEL REY	CA	90292	6621	00	06000	33.98120707	-118.4409729	Los Angeles County
306129	Non-Physician Medical Practitioner	None	1104550425	0	0	BLAUSER, CANDACE	4/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	00	06000	37.72851602	-122.4296638	San Francisco County
306142	Non-Physician Medical Practitioner	None	1881283299	0	0	BERTSCH, LAURA	7/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	00	06000	33.89356031	-117.9271656	Orange County
306155	Non-Physician Medical Practitioner	None	1568917540	0	0	BLAIR, SLOANE R NP	11/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20101 LAKE CHABOT RD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	00	06000	37.69819004	-122.0873124	Alameda County
306157	Non-Physician Medical Practitioner	None	1902631583	0	0	BUND, DANIELLE NP	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8670 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	2930	00	06000	34.06629779	-118.3807407	Los Angeles County
306161	Non-Physician Medical Practitioner	None	1740538891	0	0	BAUER, MICHELLE L PA-C	5/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7100 REDWOOD BLVD	STE 200	NOVATO	CA	94945	4100	00	06000	38.10057107	-122.5678339	Marin County
306167	Non-Physician Medical Practitioner	None	1609159854	0	0	BERNSTEIN, GAIL ELAINE	10/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	120 EDDIE DOWLING HWY	None	N SMITHFIELD	RI	02896	8214	00	06000	41.97986333	-71.51327854	Providence County
306172	Non-Physician Medical Practitioner	None	1689136749	0	0	BANDARANAYAKE, DINUSHA I PA-C	2/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3660 PARK SIERRA DR	STE 202	RIVERSIDE	CA	92505	3071	00	06000	33.90330693	-117.4707039	Riverside County
306200	Non-Physician Medical Practitioner	None	1366719569	0	0	BUDA, ZOE	11/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
306205	Non-Physician Medical Practitioner	None	1811279763	0	0	BARTZ-ALTADONNA COMMUNITY HEALTH CENTER	1/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43322 GINGHAM AVE	STE 104&105	LANCASTER	CA	93535	4569	00	06000	34.67013731	-118.1222748	Los Angeles County
306208	Non-Physician Medical Practitioner	None	1689838716	0	0	BRAMMELL, CRAIG A PA-C	1/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
306246	Non-Physician Medical Practitioner	None	1235554510	0	0	BAGNASCO, SHANNON NP	7/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27720 JEFFERSON	SUITE 200	TEMECULA	CA	92590	2610	00	06000	33.51188961	-117.1586219	Riverside County
306262	Non-Physician Medical Practitioner	None	1881970572	0	0	BURDICK, RYAN	5/18/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	143 N CLARK ST STE B	None	FRESNO	CA	93701	2182	00	06000	36.744102	-119.7860465	Fresno County
306288	Non-Physician Medical Practitioner	None	1992035513	0	0	BILLINGS, HAROLD EDWARD	12/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 S SPALDING DR	SUITE 400	BEVERLY HILLS	CA	90212	1800	00	06000	34.06625419	-118.4088854	Los Angeles County
306304	Non-Physician Medical Practitioner	None	1043991888	0	0	BLEDSOE, ALLISON M PA-C	12/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
306308	Non-Physician Medical Practitioner	None	1275980492	0	0	BECKER, NEISHA D CNP	9/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 DALE AVE	APT 31	MOUNTAIN VIEW	CA	94040	3358	00	06000	37.37236473	-122.0644108	Santa Clara County
306311	Non-Physician Medical Practitioner	None	1891008587	0	0	BORGHESE, KIMBERLY MARIE	8/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	06000	36.163269	-115.1654465	Clark County
306312	Non-Physician Medical Practitioner	None	1376043133	0	0	BUMGARDNER, ALLESA R PA	9/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
306318	Non-Physician Medical Practitioner	None	1821393166	0	0	BRODBELT, SHARON L	1/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1161 TOMAHAWK LANE	None	SOUTH LAKE TAHOE	CA	96150	5274	00	06000	38.85928801	-120.0171883	El Dorado County
306328	Non-Physician Medical Practitioner	None	1619417060	0	0	BOWMAN, BRYAN NP	11/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	00	06000	33.73793948	-118.3036095	Los Angeles County
306360	Non-Physician Medical Practitioner	None	1699401414	0	0	BADRELDIN, DINA NP	1/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
306365	Non-Physician Medical Practitioner	None	1538688650	0	0	BALEWSKI, NANCY PA	2/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
306378	Non-Physician Medical Practitioner	None	1013104629	0	0	BILAUCA, FLORIN F	8/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4451 MANZANITA WAY	None	TURLOCK	CA	95382	7460	00	06000	37.53379772	-120.8332544	Stanislaus County
306395	Non-Physician Medical Practitioner	None	1740722461	0	0	BARNES, GREGORY	11/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
306398	Non-Physician Medical Practitioner	None	1811358880	0	0	BARNES, KATIE NP	1/23/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3780 MASSACHUSETTS AVE	None	LA MESA	CA	91941	7638	00	06000	32.745816	-117.042827	San Diego County
306408	Non-Physician Medical Practitioner	None	1396716783	0	0	BREGMAN, STEVEN M	7/7/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2606 MALLORY LANE	None	SANTA CRUZ	CA	95065	1663	00	06000	36.991624	-121.9724525	Santa Cruz County
306411	Non-Physician Medical Practitioner	None	1528724838	0	0	BURON KEERS, CATHERINE E NP	4/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
306413	Non-Physician Medical Practitioner	None	1679817019	0	0	BANJ HEALTH CENTER, INC.	8/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3624 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	2607	00	06000	33.93146164	-118.2031117	Los Angeles County
306450	Non-Physician Medical Practitioner	None	1649646803	0	0	BRITTON, KATRINA L NP	1/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 E 3RD ST	None	LONG BEACH	CA	90802	3190	00	06000	33.77047149	-118.190574	Los Angeles County
306453	Non-Physician Medical Practitioner	None	1689923088	0	0	BERUMEN, JEAN C NP	11/15/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36640 CHERRYWOOD DR	None	YUCAIPA	CA	92399	5707	00	06000	34.01597991	-117.0051739	San Bernardino County
306455	Non-Physician Medical Practitioner	None	1366724650	0	0	BLEDSOE, AARON PA-C	11/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
306466	Non-Physician Medical Practitioner	None	1922163914	0	0	BRILLO, JUSTIN ERICH	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33842 WHITEHEAD LANE	None	FREMONT	CA	94555	1431	00	06000	37.58533882	-122.0379296	Alameda County
306470	Non-Physician Medical Practitioner	None	1053830851	0	0	BOOTH, KELLEY C NP	12/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 TELEGRAPH AVE	120	BERKELEY	CA	94705	1159	00	06000	37.85808554	-122.2594469	Alameda County
306476	Non-Physician Medical Practitioner	None	1568135366	0	0	BATTH, GURSIMRAN NP	2/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1801 COLORADO AVE	STE 250	TURLOCK	CA	95382	2710	00	06000	37.50941613	-120.8353105	Stanislaus County
306511	Non-Physician Medical Practitioner	None	1083193486	0	0	BARROS, RACHEL	4/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1380 WHITTON AVE	None	SAN JOSE	CA	95116	2357	00	06000	37.34654106	-121.8618483	Santa Clara County
306524	Non-Physician Medical Practitioner	None	1184970006	0	0	BENEKOS, ERIN K NP	4/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 20TH STREET	None	HUNTINGTON BEACH	CA	92648	3830	00	06000	33.67010208	-118.0112275	Orange County
306575	Non-Physician Medical Practitioner	None	1730774944	0	0	BRINCKERHOFF, KIMBERLY F NP	5/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2888 COCHRAN STREET	None	SIMI VALLEY	CA	93065	2782	00	06000	34.27898255	-118.7378325	Ventura County
306635	Non-Physician Medical Practitioner	None	1720579980	0	0	BHALARU, SUNEET NP	5/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 J STREET	STE 350	SACRAMENTO	CA	95819	3633	00	06000	38.570652	-121.4535465	Sacramento County
306681	Non-Physician Medical Practitioner	None	1639114069	0	0	BAYUK, KAREN E	11/1/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
306711	Non-Physician Medical Practitioner	None	1457443368	0	0	BLAINE, DENNIS P	5/4/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	759 DAVENPORT WAY	None	LINCOLN	CA	95648	2922	00	06000	38.87822353	-121.3148492	Placer County
306716	Non-Physician Medical Practitioner	None	1609517937	0	0	BERGANTZ, KYLE J PA-C	7/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
306749	Non-Physician Medical Practitioner	None	1699704858	0	0	BRYLEWSKI, PAUL	3/30/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 GRAND AVE	None	SAN LUIS OBISPO	CA	93407	0210	00	06000	35.30048884	-120.6580985	San Luis Obispo County
306757	Non-Physician Medical Practitioner	None	1831568013	0	0	BEUTNER, KATHERINE R NP	11/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2520 RYAN RD	APT 38	CONCORD	CA	94518	2640	00	06000	37.94096975	-122.0258025	Contra Costa County
306761	Non-Physician Medical Practitioner	None	1598258659	0	0	BHATIA, LAURA K PA-C	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	00	06000	34.2202663	-119.1484221	Ventura County
306765	Non-Physician Medical Practitioner	None	1609545458	0	0	BELDEN, ALICIA W NP	10/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 H ST,	None	SACRAMENTO	CA	95816	4611	00	06000	38.572137	-121.4562375	Sacramento County
306798	Non-Physician Medical Practitioner	None	1841358959	0	0	BERRY, JILL MARIE	10/6/1997	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 GOVERNORS LN	None	CHICO	CA	95926	1991	00	06000	39.75506817	-121.858057	Butte County
306809	Non-Physician Medical Practitioner	None	1205076361	0	0	B, MARTORANA E	9/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2975 WOODCREST DRIVE	None	NAPA	CA	94559	2043	00	06000	38.31516501	-122.3262057	Napa County
306814	Non-Physician Medical Practitioner	None	1255469334	0	0	BHATIA, JERAMIE	5/26/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	00	06000	33.84861872	-118.3488958	Los Angeles County
306828	Non-Physician Medical Practitioner	None	1215173653	0	0	BLUFF, KIMBERLY A NP	4/6/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6968 MISSION GROVE PKWY	None	RIVERSIDE	CA	92506	6259	00	06000	33.92452798	-117.3244861	Riverside County
306835	Non-Physician Medical Practitioner	None	1629646286	0	0	BARCARSE, VICTOR JOHN	2/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	00	06000	34.09054375	-118.392295	Los Angeles County
306845	Non-Physician Medical Practitioner	None	1437648466	0	0	BHAKTA, JAI S PA-C	10/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
306847	Non-Physician Medical Practitioner	None	1497911929	0	0	BROWN, LORENA	3/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	920 2ND AVE S	SUITE 400	MINNEAPOLIS	MN	55402	3318	00	06000	44.97310912	-93.27171852	Hennepin County
306876	Non-Physician Medical Practitioner	None	1336599042	0	0	BAINBRIDGE, ELYSE R	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	165 HYANNIS CT	None	APTOS	CA	95003	5818	00	06000	36.95092685	-121.8718455	Santa Cruz County
306894	Non-Physician Medical Practitioner	None	1548775257	0	0	BIVANS, PETER G NP	10/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
306897	Non-Physician Medical Practitioner	None	1417538554	0	0	BUI, MADELINE B PA	12/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
306928	Non-Physician Medical Practitioner	None	1023349883	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	4/14/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1151 E WASHINGTON AVE ST	None	ESCONDIDO	CA	92025	2254	00	06000	33.13266323	-117.0686597	San Diego County
306961	Non-Physician Medical Practitioner	None	1194923581	0	0	BENDER, LAUREN C	10/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	533 GEORGIAN ROAD	None	LA CANADA	CA	91011	3547	00	06000	34.1971611	-118.1903045	Los Angeles County
306977	Non-Physician Medical Practitioner	None	1982633400	0	0	BOND, JOYCE M	5/9/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
306997	Non-Physician Medical Practitioner	None	1760265599	0	0	BEN-ZVI, MERAV PA-C	12/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	00	06000	37.36893518	-122.0779448	Santa Clara County
307002	Non-Physician Medical Practitioner	None	1679122394	0	0	BOWER, MARIAH PA-C	7/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
307008	Non-Physician Medical Practitioner	None	1457021149	0	0	BAJWA, GURKARAN PA	11/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	00	06000	37.32710433	-121.9386474	Santa Clara County
307030	Non-Physician Medical Practitioner	None	1407212376	0	0	BRUECKNER, TAMMIE N NP	2/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
307085	Non-Physician Medical Practitioner	None	1902179013	0	0	BRUBAKER, BRITTANY C NP	2/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5 HARRIS CT	BLDG T 2ND FL	MONTEREY	CA	93940	5750	00	06000	36.58051622	-121.8198331	Monterey County
307087	Non-Physician Medical Practitioner	None	1114567922	0	0	BRATAN, IRINA S NP	8/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	00	06000	40.78355148	-124.1420294	Humboldt County
307096	Non-Physician Medical Practitioner	None	1083634117	0	0	BARNES, JULIE A	6/25/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	MOB 206	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
307137	Non-Physician Medical Practitioner	None	1619792306	0	0	BAEZ-SMITH, CAMILA NP	12/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4440 BROCKTON AVE	STE 410, 420 & 430	RIVERSIDE	CA	92501	4068	00	06000	33.97764104	-117.3838896	Riverside County
307148	Non-Physician Medical Practitioner	None	1831647387	0	0	BALKCOM, SEAN PA	9/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	101B 102B 104B 106B 108B	LOMA LINDA	CA	92354	3128	00	06000	34.04805253	-117.249534	San Bernardino County
307157	Non-Physician Medical Practitioner	None	1356938617	0	0	BRUSH, LINDSAY R PA-C	5/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	00	06000	36.83939464	-119.6661479	Fresno County
307168	Non-Physician Medical Practitioner	None	1063268365	0	0	BURRIS, BRITTANY A CNM	7/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS AVE	SUITE 408	FRESNO	CA	93701	2168	00	06000	36.74500687	-119.7846885	Fresno County
307181	Non-Physician Medical Practitioner	None	1720642812	0	0	BIANCHI-WILBERDING, BRITTANY T PA-C	2/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
307193	Non-Physician Medical Practitioner	None	1154882348	0	0	BUSTOS, MADELAINE CLAIRE S PA-C	10/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
307204	Non-Physician Medical Practitioner	None	1134123672	0	0	BOGGS, HELAINE M	6/2/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3196	00	06000	35.64171	-117.669847	Kern County
307205	Non-Physician Medical Practitioner	None	1861144727	0	0	BORCHENKO, BIANA NP	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4849 VAN NUYS BLVD	211	SHERMAN OAKS	CA	91403	2110	00	06000	34.159113	-118.4487465	Los Angeles County
307209	Non-Physician Medical Practitioner	None	1861565012	0	0	BASSHAM, MARY E	8/13/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 S HARBOR BLVD	250	SANTA ANA	CA	92704	6824	00	06000	33.70467057	-117.919705	Orange County
307211	Non-Physician Medical Practitioner	None	1235726274	0	0	BECKER, GRACE E NP	4/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
307212	Non-Physician Medical Practitioner	None	1205484318	0	0	BONNELLO, COURTNI N NP	10/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
307217	Non-Physician Medical Practitioner	None	1235459827	0	0	BROWN, ANTONIO R PA	12/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
307268	Non-Physician Medical Practitioner	None	1023799863	0	0	BRAGA, ANGELICA M NP	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
307269	Non-Physician Medical Practitioner	None	1568035756	0	0	BYRD, ASHA P PA	6/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
307296	Non-Physician Medical Practitioner	None	1538796370	0	0	BEHERA, SUJATA PA-C	10/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2433 CENTRAL AVENUE	SUITE A	ALAMEDA	CA	94501	4564	00	06000	37.76358675	-122.2413153	Alameda County
307317	Non-Physician Medical Practitioner	None	1962775288	0	0	BANH-HASENSTEIN, KYLE A PA-C	6/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
307326	Non-Physician Medical Practitioner	None	1679893531	0	0	BURBOA, JAVIER C	3/15/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1301 W LINCON AVE	STE 102	MONTEBELLO	CA	90640	3240	00	06000	34.02197439	-118.110931	Los Angeles County
307330	Non-Physician Medical Practitioner	None	1336574425	0	0	BAKER, MADISON L	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	236 EUCALYPTUS DR	None	REDLANDS	CA	92373	7132	00	06000	34.03113324	-117.1580007	San Bernardino County
307335	Non-Physician Medical Practitioner	None	1811333883	0	0	BENSON, CHRISTINE M NP	2/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	158 MAR VISTA DR	None	MONTEREY	CA	93940	6032	00	06000	36.58269856	-121.904622	Monterey County
307344	Non-Physician Medical Practitioner	None	1972124626	0	0	BELLAMY, APRIL E NP	8/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N WESTERN AVE	STE 305	SAN BERNARDINO	CA	92411	1354	00	06000	34.1315778	-117.3182453	San Bernardino County
307349	Non-Physician Medical Practitioner	None	1821338260	0	0	BARNES, BRETT H PA	8/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
307350	Non-Physician Medical Practitioner	None	1770106007	0	0	BURIEL, MILISSA NP	11/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	00	06000	37.95521179	-122.0898401	Contra Costa County
307356	Non-Physician Medical Practitioner	None	1043387897	0	0	BLANCHFIELD, CHRISTOPHER C	10/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7684 CALLE BASTIA	None	HIGHLAND	CA	92346	5897	00	06000	34.11399811	-117.1723319	San Bernardino County
307378	Non-Physician Medical Practitioner	None	1932549573	0	0	BUENAFLOR, VALERIE M NP	11/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	608 G ST	SUITE 2 A	BRAWLEY	CA	92227	2568	00	06000	32.97749255	-115.5318435	Imperial County
307379	Non-Physician Medical Practitioner	None	1134456379	0	0	BUSH, CARLA D NP	4/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	249 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3700	00	06000	34.13591253	-117.280809	San Bernardino County
307381	Non-Physician Medical Practitioner	None	1770027831	0	0	BIJAYAYOTHIN, PANUJEE NP	8/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 VALVERDE AVE	None	BREA	CA	92821	5958	00	06000	33.91752582	-117.8765651	Orange County
307387	Non-Physician Medical Practitioner	None	1346421328	0	0	BERNARD, MARCIA E NP	2/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2372 STERLING AVE	None	SAN BERNARDINO	CA	92404	4624	00	06000	34.13682	-117.243687	San Bernardino County
307388	Non-Physician Medical Practitioner	None	1962830174	0	0	BORREGO COMMUNITY HEATH FOUNDATION	4/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29490 LAKEVIEW AVE	None	NUEVO	CA	92567	9705	00	06000	33.81758755	-117.1322999	Riverside County
307391	Non-Physician Medical Practitioner	None	1184903270	0	0	BACON, COLLEEN M NP	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 W JUNIPERO AVE	None	SAN CLEMENTE	CA	92672	4338	00	06000	33.41283418	-117.6039448	Orange County
307400	Non-Physician Medical Practitioner	None	1184044844	0	0	BROMAGE, LAURA M NP	3/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6161 GLEN HARBOR DRIVE	None	SAN JOSE	CA	95123	4916	00	06000	37.23616153	-121.818483	Santa Clara County
307410	Non-Physician Medical Practitioner	None	1215289780	0	0	BERMUDEZ LOCANO, ROSEANN NP	6/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 S OAK AVE	None	OAKDALE	CA	95361	3519	00	06000	37.75764557	-120.8600743	Stanislaus County
307413	Non-Physician Medical Practitioner	None	1891794657	0	0	BALLOU, LEIGH ANN	5/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	RM 2562B	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
307415	Non-Physician Medical Practitioner	None	1851761381	0	0	BROWN, EMILY E	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	395 FRANKLIN DR	None	PISMO BEACH	CA	93449	2200	00	06000	35.14790524	-120.647631	San Luis Obispo County
307417	Non-Physician Medical Practitioner	None	1831686831	0	0	BROOKS, ALLI K PA	2/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	00	06000	41.31798759	-122.3218165	Siskiyou County
307429	Non-Physician Medical Practitioner	None	1588287676	0	0	BACHU, MEGHANA NP	1/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6236 THORNTON AVE	None	NEWARK	CA	94560	3732	00	06000	37.53514287	-122.0319492	Alameda County
307494	Non-Physician Medical Practitioner	None	1275698623	0	0	BURMEISTER, GAIL E NP	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	00	06000	33.6526055	-117.910746	Orange County
307495	Non-Physician Medical Practitioner	None	1740229269	0	0	BIRKNER, BELINDA B PA-C	4/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
307497	Non-Physician Medical Practitioner	None	1619465697	0	0	BELL, AMBER C CNM	11/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
307503	Non-Physician Medical Practitioner	None	1821293713	0	0	BAUER, JENNIFER	10/29/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
307526	Non-Physician Medical Practitioner	None	1184678245	0	0	BENITEZ, GILBERT	10/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5726 BEVERLY HILLS DR	None	WHITTIER	CA	90631	3411	00	06000	33.99083491	-118.0294318	Los Angeles County
307535	Non-Physician Medical Practitioner	None	1356816029	0	0	BIDWELL, STEVEN PA-C	12/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 WARNER	None	SANTA ANA	CA	92704	5331	00	06000	33.715124	-117.9105585	Orange County
307536	Non-Physician Medical Practitioner	None	1740372366	0	0	BLANCO, DEBRA A	5/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	912 S LA SERENA DR	None	WEST COVINA	CA	91791	3422	00	06000	34.05854609	-117.8778912	Los Angeles County
307543	Non-Physician Medical Practitioner	None	1255613451	0	0	BATISTE, LINDEN M	9/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26187 STALLION RD	None	MORENO VALLEY	CA	92555	5700	00	06000	33.87927905	-117.2072166	Riverside County
307561	Non-Physician Medical Practitioner	None	1497202121	0	0	BALDWIN, ANDREA M NP	4/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2150 PINEWOOD DRIVE	None	SOUTH LAKE TAHOE	CA	96150	5144	00	06000	38.85005345	-120.0166752	El Dorado County
307562	Non-Physician Medical Practitioner	None	1184285371	0	0	BOURELLE, TAYLOR PA-C	11/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2901 SILLECT AVE	SUITE 100	BAKERSFIELD	CA	93308	6371	00	06000	35.38611256	-119.0393796	Kern County
307638	Non-Physician Medical Practitioner	None	1497814107	0	0	BAILEY, BRENDA R	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2924 ALLENTON AVE	None	HACIENDA HEIGHTS	CA	91745	5407	00	06000	33.98284538	-117.9654628	Los Angeles County
307660	Non-Physician Medical Practitioner	None	1649890831	0	0	BONTIGAO, MARIE ANGELA G NP	6/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	00	06000	33.92617009	-117.4404151	Riverside County
307662	Non-Physician Medical Practitioner	None	1790161529	0	0	BAHAR, YASMIN NP	7/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 ADOBE ST	None	CONCORD	CA	94520	2313	00	06000	37.97700068	-122.0381159	Contra Costa County
307685	Non-Physician Medical Practitioner	None	1497747596	0	0	BEATY, RODNEY PA	4/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	00	06000	35.36196445	-119.0749413	Kern County
307694	Non-Physician Medical Practitioner	None	1760268882	0	0	BENITEZ, MARTHA NP	9/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12998 HESPERIA RD	101	VICTORVILLE	CA	92395	8316	00	06000	34.48789715	-117.2906992	San Bernardino County
307700	Non-Physician Medical Practitioner	None	1275197501	0	0	BOVE, NATASHA K PA-C	2/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	832 S GREVILLEA AVE	None	INGLEWOOD	CA	90301	3312	00	06000	33.9529004	-118.3548473	Los Angeles County
307701	Non-Physician Medical Practitioner	None	1316353022	0	0	BALDRIAS, APRIL L M NP	7/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14602 BAYLOR AVE	None	CHINO	CA	91710	6980	00	06000	33.98715243	-117.6549264	San Bernardino County
307706	Non-Physician Medical Practitioner	None	1104974013	0	0	BURNS, JACQUELYN T	3/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5198 WINONA COURT	None	OCEANSIDE	CA	92057	6358	00	06000	33.24104324	-117.2852396	San Diego County
307714	Non-Physician Medical Practitioner	None	1306408505	0	0	BIERMAN, ANDREW NP	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
307715	Non-Physician Medical Practitioner	None	1942588561	0	0	BAHMANABADI, HODA PA	4/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	00	06000	37.48948529	-122.2232468	San Mateo County
307718	Non-Physician Medical Practitioner	None	1861770083	0	0	BOWLES, CHRISTINA M NP	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22 DOWNING STREET	None	LADERA RANCH	CA	92694	0933	00	06000	33.55793844	-117.640874	Orange County
307728	Non-Physician Medical Practitioner	None	1356995344	0	0	BELLON, SHANE S PA	1/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
307757	Non-Physician Medical Practitioner	None	1801145321	0	0	BRANUM, FAYE PA-C	11/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
307758	Non-Physician Medical Practitioner	None	1649368861	0	0	BOYLE, KRISTINE BARBARA	10/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	NEONATOLOGY DEPT	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
307761	Non-Physician Medical Practitioner	None	1851071229	0	0	BOWERS, ASHLEY S NP	10/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 N MEDICAL CENTER DRI	223	CLOVIS	CA	93611	6879	00	06000	36.84152435	-119.6624818	Fresno County
307791	Non-Physician Medical Practitioner	None	1609448257	0	0	BROWN, NOHORA NP	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2110 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3703	00	06000	35.37344851	-119.0261655	Kern County
307806	Non-Physician Medical Practitioner	None	1598121170	0	0	BINELLI, DANIEL PA-C	7/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
307820	Non-Physician Medical Practitioner	None	1083673313	0	0	BLACK, JAMES M	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2971 DRUID LN	None	ROSSMOOR	CA	90720	4948	00	06000	33.77618357	-118.0816795	Orange County
307825	Non-Physician Medical Practitioner	None	1093124703	0	0	BACANI, GRACE C	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13553 LONGFELLOW LANE	None	SAN DIEGO	CA	92129	2860	00	06000	32.96028133	-117.1188121	San Diego County
307833	Non-Physician Medical Practitioner	None	1144809393	0	0	BILOTTA, NATALIE NP	2/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4500 BROCKTON AVE	STE 319	RIVERSIDE	CA	92501	4090	00	06000	33.97785263	-117.3836152	Riverside County
307835	Non-Physician Medical Practitioner	None	1386941029	0	0	BEAZLEY, DOUGLAS NP	5/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
307839	Non-Physician Medical Practitioner	None	1184640740	0	0	B, ROURKE B	12/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2609 SAGEBRUSH DR	STE. 101	FLOWER MOUND	TX	75028	2733	00	06000	33.02996625	-97.06845627	Denton County
307848	Non-Physician Medical Practitioner	None	1730522764	0	0	BUCU, ANGELINA D	3/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	620 N KENWOOD ST	#211	GLENDALE	CA	91206	2369	00	06000	34.15586547	-118.2508515	Los Angeles County
307850	Non-Physician Medical Practitioner	None	1871676759	0	0	BORGHEI, KARIMEH	7/8/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	00	06000	38.664027	-121.7933505	Yolo County
307864	Non-Physician Medical Practitioner	None	1639507411	0	0	BOLLINGER, BRENDA J NP	12/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	240 NICE LN	117	NEWPORT BEACH	CA	92663	2652	00	06000	33.6247035	-117.9345054	Orange County
307884	Non-Physician Medical Practitioner	None	1831665553	0	0	BRAL, CHANEL PA	2/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
307914	Non-Physician Medical Practitioner	None	1629813944	0	0	BIRRUETA, GIOVANNI	8/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1704 WEST MANCHESTER AVE	SUITE 106	LOS ANGELES	CA	90047	3056	00	06000	33.9599425	-118.307079	Los Angeles County
307926	Non-Physician Medical Practitioner	None	1467483685	0	0	BOYLE, VICTORIA L NP	3/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18023 SENCILLO DR	None	SAN DIEGO	CA	92128	1322	00	06000	33.03893027	-117.0629531	San Diego County
307930	Non-Physician Medical Practitioner	None	1033511910	0	0	BHATTESSA, TANUJA NP	9/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	594 EL CAMINO REAL	None	SANTA CLARA	CA	95050	4345	00	06000	37.35293214	-121.9385135	Santa Clara County
307938	Non-Physician Medical Practitioner	None	1790768240	0	0	BORAMANAND, NICOLE K CNP	10/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
307939	Non-Physician Medical Practitioner	None	1003433236	0	0	BABAKHANIAN, GAYANE NP	10/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
307982	Non-Physician Medical Practitioner	None	1720685795	0	0	BELL, ANDREA G NP	3/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	00	06000	32.802147	-117.151371	San Diego County
307996	Non-Physician Medical Practitioner	None	1801051529	0	0	BRUCE, DIANA MICHELLE	7/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 VETERANS BLVD	NEUROSURGERY DEPT.	REDWOOD CITY	CA	94063	2037	00	06000	37.48948529	-122.2232468	San Mateo County
307997	Non-Physician Medical Practitioner	None	1760972400	0	0	BLANCO, RYAN G	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1545 N LAS PALMAS	UNIT 12	LOS ANGELES	CA	90028	1726	00	06000	34.09914454	-118.3363594	Los Angeles County
308002	Non-Physician Medical Practitioner	None	1437798782	0	0	BRYNER, AMANDA NP	4/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 COMMERCIAL CROSSING	None	SANTA CRUZ	CA	95065	1816	00	06000	36.98796413	-121.9825327	Santa Cruz County
308009	Non-Physician Medical Practitioner	None	1043466246	0	0	BLUE, OPHELIA I	5/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4616 25TH AVE NE # 475	None	SEATTLE	WA	98105	4183	00	06000	47.662281	-122.3009145	King County
308010	Non-Physician Medical Practitioner	None	1346602604	0	0	BALDONADO, MEG CAMILLE NP	10/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
308013	Non-Physician Medical Practitioner	None	1760497697	0	0	BUSH, CASSANDRA RENEE	4/4/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3525 RICHARD ARRINGTON J	None	BIRMINGHAM	AL	35234	2307	00	06000	33.53483573	-86.7902109	Jefferson County
308026	Non-Physician Medical Practitioner	None	1740808526	0	0	BINLEY, ANDREA PA-C	7/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1640 NEWPORT BLVD	SUITE 210	COSTA MESA	CA	92627	3786	00	06000	33.63437128	-117.9221659	Orange County
308030	Non-Physician Medical Practitioner	None	1356585640	0	0	BARRERA, MARCIA	9/22/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3050 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5742	00	06000	33.9453691	-118.2169795	Los Angeles County
308036	Non-Physician Medical Practitioner	None	1588322770	0	0	BAIN, ILYSSA NP	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	06000	33.478749	-112.0426515	Maricopa County
308044	Non-Physician Medical Practitioner	None	1427575232	0	0	BUNNEY, JILL A NP	12/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
308093	Non-Physician Medical Practitioner	None	1720784184	0	0	BALAJADIA, QUEENNIE	1/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	06000	36.28701289	-115.2877045	Clark County
308144	Non-Physician Medical Practitioner	None	1780944280	0	0	BEHNAM, STEPHANIE E NP	7/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	950 CRANE ST	APT 5	MENLO PARK	CA	94025	4726	00	06000	37.44991974	-122.1834989	San Mateo County
308147	Non-Physician Medical Practitioner	None	1083091326	0	0	BURTON, NOELLE PA-C	4/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	584 N. SUNRISE AVE	100	ROSEVILLE	CA	95661	2862	00	06000	38.75842021	-121.2528302	Placer County
308163	Non-Physician Medical Practitioner	None	1891830998	0	0	BERGER, VELVA JANE	3/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30300 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	0000	00	06000	33.5230101	-117.6683028	Orange County
308171	Non-Physician Medical Practitioner	None	1356615421	0	0	BENAVIDEZ, VICENTE PA-C	8/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2145 NILES ST	None	BAKERSFIELD	CA	93305	5007	00	06000	35.37652092	-118.9682408	Kern County
308178	Non-Physician Medical Practitioner	None	1336772730	0	0	BERGLUND, LUKE W PA-C	12/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	00	06000	36.9282117	-121.7937089	Santa Cruz County
308184	Non-Physician Medical Practitioner	None	1134132483	0	0	BELTZ, STEPHANIE L NP	4/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 SAN JOSE STREET	None	SALINAS	CA	93901	3901	00	06000	36.65817286	-121.6460674	Monterey County
308227	Non-Physician Medical Practitioner	None	1679919138	0	0	BOGGS, JOHN B NP	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1008 SEGRE PLACE	None	SANTA CRUZ	CA	95060	3159	00	06000	36.972162	-122.0542985	Santa Cruz County
308257	Non-Physician Medical Practitioner	None	1518345180	0	0	BERBERIAN, JOHN NP	2/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1334 E TUJUNGA AVE	None	BURBANK	CA	91501	0001	00	06000	34.19397479	-118.2911587	Los Angeles County
308299	Non-Physician Medical Practitioner	None	1922294891	0	0	BROWN-LECHNER, MINDY R NP	6/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
308302	Non-Physician Medical Practitioner	None	1902228711	0	0	BLAKESLEY, TRISHA E NP	1/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1865 MORNING VIEW DR	None	VISTA	CA	92084	3350	00	06000	33.22791785	-117.2312743	San Diego County
308351	Non-Physician Medical Practitioner	None	1417942616	0	0	BERON, ILINA	3/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1059 S HOLT AVE	None	LOS ANGELES	CA	90035	2009	00	06000	34.05757056	-118.3783562	Los Angeles County
308355	Non-Physician Medical Practitioner	None	1427454438	0	0	BROWN, MELINDA	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19785 COASTLINE LN	None	HUNTINGTON BEACH	CA	92648	3001	00	06000	33.67292739	-118.0071526	Orange County
308383	Non-Physician Medical Practitioner	None	1891119020	0	0	BHULLAR, GURPREET K PA-C	6/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2516 E WHITMORE AVE	None	CERES	CA	95307	2645	00	06000	37.59473849	-120.9489745	Stanislaus County
308397	Non-Physician Medical Practitioner	None	1063842920	0	0	BERTRAND, BRAD D NP	3/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	830 JEFFERSON AVE	STE M	REDWOOD CITY	CA	94063	1804	00	06000	37.48599384	-122.2282125	San Mateo County
308410	Non-Physician Medical Practitioner	None	1053770008	0	0	BREWAH, LLOYDETTE H NP	3/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	00	06000	33.6526055	-117.910746	Orange County
308450	Non-Physician Medical Practitioner	None	1700902012	0	0	BURNS, CHRISTINE K PA	8/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	670 SIERRA ROSE DR	None	RENO	NV	89511	2072	00	06000	39.4735137	-119.7995156	Washoe County
308458	Non-Physician Medical Practitioner	None	1043248263	0	0	BARNES, MICHAEL W PA	8/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	00	06000	37.23931375	-121.8014189	Santa Clara County
308461	Non-Physician Medical Practitioner	None	1316116932	0	0	BIRCH, JENNIFER ALICE	9/11/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	630 S RAYMOND AVE UNIT 3	None	PASADENA	CA	91105	3206	00	06000	34.13505223	-118.1487761	Los Angeles County
308514	Non-Physician Medical Practitioner	None	1265452809	0	0	BATES, KIN D	4/1/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3330 CHURN CREEK RD STE	None	REDDING	CA	96002	2532	00	06000	40.55890497	-122.3530646	Shasta County
308520	Non-Physician Medical Practitioner	None	1760696728	0	0	BRITT, WILLIAM J PA-C	5/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
308533	Non-Physician Medical Practitioner	None	1134340201	0	0	BARRETT, ROGER O PA-C	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34633 BOROS BLVD	None	BEAUMONT	CA	92223	7465	00	06000	33.96304697	-117.0591581	Riverside County
308537	Non-Physician Medical Practitioner	None	1417321928	0	0	BRIA, MARIANA	3/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20601 W PAOLI LN	None	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
308549	Non-Physician Medical Practitioner	None	1114179611	0	0	BINDER, KELLIE ANH HUE	1/29/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DRIVE SOUTH	UC IRVINE MEDICAL CENTER	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
308550	Non-Physician Medical Practitioner	None	1518191014	0	0	BAKER, SHANNON NP	9/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2375 S MELROSE DR	None	VISTA	CA	92081	8788	00	06000	33.14409946	-117.2417711	San Diego County
308590	Non-Physician Medical Practitioner	None	1811328792	0	0	BICKNELL, JOSEPHINE I NP	8/31/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4340 GRAND VIEW BLVD	UNIT 39	LOS ANGELES	CA	90066	0000	00	06000	33.99518688	-118.4227481	Los Angeles County
308613	Non-Physician Medical Practitioner	None	1841626322	0	0	BORGERDING, DANIELLE A PA	7/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
308640	Non-Physician Medical Practitioner	None	1619216009	0	0	BISSONNETTE, CRIS NP	6/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
308655	Non-Physician Medical Practitioner	None	1821354564	0	0	BRAGG, PEONY C NP	2/21/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
308693	Non-Physician Medical Practitioner	None	1396256525	0	0	BI, SHELLEY PA	9/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	170 COLUMBUS AVE	SUITE 110	SAN FRANCISCO	CA	94133	5160	00	06000	37.79680499	-122.4050031	San Francisco County
308698	Non-Physician Medical Practitioner	None	1932478641	0	0	BENNETT, ANGELA	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
308707	Non-Physician Medical Practitioner	None	1134548605	0	0	BERNAL, DANILO C NP	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3051 THAMES RIVER DR	None	OXNARD	CA	93036	5338	00	06000	34.24296479	-119.1692581	Ventura County
308719	Non-Physician Medical Practitioner	None	1205267549	0	0	BANNER HEALTH	8/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1680 PAUL BUNYAN ROAD	None	SUSANVILLE	CA	96130	3159	00	06000	40.42141164	-120.6468171	Lassen County
308756	Non-Physician Medical Practitioner	None	1609803907	0	0	BESSLER, ROBERT ALAN	5/9/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	00	06000	33.92617009	-117.4404151	Riverside County
308768	Non-Physician Medical Practitioner	None	1437567153	0	0	BURKE, COURTNEY L NP	2/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8357 CATENDULA DR	None	BUENA PARK	CA	90620	2009	00	06000	33.85404309	-117.9875013	Orange County
308782	Non-Physician Medical Practitioner	None	1306333794	0	0	BLANCHARD, MARY V NP	5/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15803 COBALT ST	None	SYLMAR	CA	91342	4783	00	06000	34.30277733	-118.4743927	Los Angeles County
308790	Non-Physician Medical Practitioner	None	1972654879	0	0	BERRIOS, ALVARO NP	6/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	593 E ELDER ST	B	FALLBROOK	CA	92028	5000	00	06000	33.3801147	-117.2453962	San Diego County
308791	Non-Physician Medical Practitioner	None	1922443167	0	0	BOLICK, ALICE N	1/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3917 PARK BLVD	None	OAKLAND	CA	94602	1115	00	06000	37.8054523	-122.2266789	Alameda County
308815	Non-Physician Medical Practitioner	None	1366077323	0	0	BOERE, NICOLE K NP	4/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 COFFEE RD	None	MODESTO	CA	95355	2803	00	06000	37.668645	-120.9756715	Stanislaus County
308816	Non-Physician Medical Practitioner	None	1689717829	0	0	BOYD-MORRISON, SHAWNNA NP	5/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 RUE VERTE	None	NEWPORT BEACH	CA	92660	5205	00	06000	33.61817786	-117.8653727	Orange County
308825	Non-Physician Medical Practitioner	None	1114682291	0	0	BLASI, JACOB D PA-C	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11795 EDUCATION ST	STE 100	AUBURN	CA	95602	2469	00	06000	38.94433757	-121.098912	Placer County
308827	Non-Physician Medical Practitioner	None	1205928140	0	0	BAQUET, RENE P PA	2/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	00	06000	34.06215064	-117.9453997	Los Angeles County
308834	Non-Physician Medical Practitioner	None	1598337487	0	0	BALLIN, JACLYN I PA-C	2/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 PARK PL	SUITE 200	SAN RAMON	CA	94583	1761	00	06000	37.7730841	-121.9883297	Contra Costa County
308838	Non-Physician Medical Practitioner	None	1356026132	0	0	BOTTLE, ANDREW A PA	9/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
308846	Non-Physician Medical Practitioner	None	1821074550	0	0	BRANDT, KAREN RENEE	2/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1509 WILSON TER	None	GLENDALE	CA	91206	4007	00	06000	34.14950866	-118.2311155	Los Angeles County
308849	Non-Physician Medical Practitioner	None	1821653783	0	0	BELAY, ADRIANA I NP	2/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
308851	Non-Physician Medical Practitioner	None	1053866418	0	0	BHANGOO, RUPINDER NP	2/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3152 N MILLBROOK AVE	STE. B	FRESNO	CA	93703	1400	00	06000	36.779166	-119.7634925	Fresno County
308853	Non-Physician Medical Practitioner	None	1386260842	0	0	BURNEY, MELISSA A PA	1/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
308886	Non-Physician Medical Practitioner	None	1518615277	0	0	BARRIGA, STEFANY M NP	7/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
308894	Non-Physician Medical Practitioner	None	1528655610	0	0	BALTAZAR, ILIANA	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
308896	Non-Physician Medical Practitioner	None	1770202186	0	0	BAZA, THEODORE PA-C	4/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 S OAK AVE	None	OAKDALE	CA	95361	3519	00	06000	37.75764557	-120.8600743	Stanislaus County
308906	Non-Physician Medical Practitioner	None	1760922603	0	0	BUTLER, MARISTELA M NP	5/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	305 SAN BRUNO AVE W	None	SAN BRUNO	CA	94066	3526	00	06000	37.62988304	-122.4137582	San Mateo County
308918	Non-Physician Medical Practitioner	None	1578869855	0	0	BELL, JUSTINA M	9/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	402 E 78TH STREET	APT 16	NEW YORK	NY	10075	8406	00	06000	40.771377	-73.952748	New York County
308926	Non-Physician Medical Practitioner	None	1144731134	0	0	BAUZON, VERNICE M A NP	3/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3626 BURLY AVE	None	ORANGE	CA	92869	3809	00	06000	33.78563448	-117.8146575	Orange County
308933	Non-Physician Medical Practitioner	None	1861993164	0	0	BECKER, PAUL E NP	8/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15610 OUTER BEAR VALLEY	None	VICTORVILLE	CA	92395	8822	00	06000	34.470875	-117.3231568	San Bernardino County
308940	Non-Physician Medical Practitioner	None	1336378702	0	0	BAKHDA, KRISTIN A	5/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	530 DRY CREEK RD	None	MONTEREY	CA	93940	4204	00	06000	36.59347363	-121.9138651	Monterey County
308949	Non-Physician Medical Practitioner	None	1295345064	0	0	BONNETT-PHILLIPS, KALEN P PA	10/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
308962	Non-Physician Medical Practitioner	None	1134704463	0	0	BLACKSTONE, JOSEPH M NP	8/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1212 S MAIN ST	None	SALINAS	CA	93901	2260	00	06000	36.65759539	-121.6594973	Monterey County
308965	Non-Physician Medical Practitioner	None	1780947572	0	0	BENDER, AMBER K	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19500 BERRY STREET	None	PINE GROVE	CA	95665	9519	00	06000	38.41809575	-120.664562	Amador County
309007	Non-Physician Medical Practitioner	None	1912780925	0	0	BANAN, MARYAM NP	9/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
309015	Non-Physician Medical Practitioner	None	1699823591	0	0	BENTON, LAURIE K	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1445 HIDDEN MESA CT	None	EL CAJON	CA	92019	3665	00	06000	32.77234821	-116.9217603	San Diego County
309023	Non-Physician Medical Practitioner	None	1295117331	0	0	BEARD, BEE L NP	1/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
309027	Non-Physician Medical Practitioner	None	1790384279	0	0	BROWN, DANIELL NP	9/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
309031	Non-Physician Medical Practitioner	None	1407904329	0	0	BYOUS, ROSSLYNN N	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5620 STONE VIEW RD	None	RANCHO CUCAMONGA	CA	91739	8936	00	06000	34.15183198	-117.534865	San Bernardino County
309046	Non-Physician Medical Practitioner	None	1649812090	0	0	BARRACLOUGH, JENNA L PA	1/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4300 GOLDEN CENTER DRIVE	SUITE C	PLACERVILLE	CA	95667	6278	00	06000	38.70657265	-120.82856	El Dorado County
309048	Non-Physician Medical Practitioner	None	1225431869	0	0	BANTIGUE, JESSICA C NP	10/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9362 TWIN TRAILS DR	201	SAN DIEGO	CA	92129	2665	00	06000	32.95628991	-117.1263211	San Diego County
309053	Non-Physician Medical Practitioner	None	1518980374	0	0	BOCK, CHERYL L	10/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
309065	Non-Physician Medical Practitioner	None	1528488087	0	0	BRODHEAD, SARAH E NP	4/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 AVENUE F	UNIT A	REDONDO BEACH	CA	90277	5150	00	06000	33.81884381	-118.3791773	Los Angeles County
309076	Non-Physician Medical Practitioner	None	1952739708	0	0	BACON, ANINA D PA-C	5/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	00	06000	36.74333844	-119.7831874	Fresno County
309110	Non-Physician Medical Practitioner	None	1679260814	0	0	BAROY, RONALD M NP	8/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	# B10	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
309144	Non-Physician Medical Practitioner	None	1629598305	0	0	BENNETT, VICTORIA L	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11100 4TH ST	APT L308	RANCHO CUCAMONGA	CA	91730	5926	00	06000	34.079346	-117.5628465	San Bernardino County
309152	Non-Physician Medical Practitioner	None	1639309768	0	0	BIELAS-FLYNN, BARBARA A NP	3/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	327 QUEBRADA DEL MAR RD	None	MARINA	CA	93933	4315	00	06000	36.68757275	-121.7854189	Monterey County
309185	Non-Physician Medical Practitioner	None	1306618954	0	0	BYRD, TATUM M NP	3/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3883 AIRWAY DR	SUITE 320	SANTA ROSA	CA	95403	1670	00	06000	38.483226	-122.739705	Sonoma County
309189	Non-Physician Medical Practitioner	None	1962742890	0	0	BONDS, RANDY J PA-C	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16478 SPIRIT ROAD	None	MORENO VALLEY	CA	92555	3322	00	06000	33.879061	-117.2044069	Riverside County
309197	Non-Physician Medical Practitioner	None	1952771370	0	0	BROCK, WHITNEY W NP	6/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
309211	Non-Physician Medical Practitioner	None	1598856726	0	0	BULLARD, TERRY L	2/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6814 LA PRESA DR	None	SAN GABRIEL	CA	91775	1110	00	06000	34.12351653	-118.0827058	Los Angeles County
309244	Non-Physician Medical Practitioner	None	1467497719	0	0	BEH, SHERRYL A	3/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1328 TWENTY SECOND STREE	None	SANTA MONICA	CA	90404	0000	00	06000	34.03122319	-118.4797185	Los Angeles County
309292	Non-Physician Medical Practitioner	None	1265780332	0	0	BERESFORD, BRANDI N NP	2/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2909 CORAL ST	None	CORONA	CA	92882	6169	00	06000	33.8488438	-117.590876	Riverside County
309301	Non-Physician Medical Practitioner	None	1750589149	0	0	BROWN, EMEM E	6/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 1/2 E SANTA PAULA ST	None	SANTA PAULA	CA	93060	4181	00	06000	34.35420664	-119.0713353	Ventura County
309320	Non-Physician Medical Practitioner	None	1699423541	0	0	BARRERAS, MEGAN A PA	8/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47111 MONROE ST	None	INDIO	CA	92201	6739	00	06000	33.70620698	-116.2339008	Riverside County
309335	Non-Physician Medical Practitioner	None	1720520182	0	0	BEYAOJU, ANDREA L NP	6/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10283 JENNY LYNN WAY	None	ELK GROVE	CA	95757	5969	00	06000	38.384199	-121.430142	Sacramento County
309342	Non-Physician Medical Practitioner	None	1073886289	0	0	BARKER, SCOTT H PA	1/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
309346	Non-Physician Medical Practitioner	None	1841677705	0	0	BARTON, BRITTA M	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29465 SIDERITE CIRCLE	None	MENIFEE	CA	92584	8239	00	06000	33.64008514	-117.1462579	Riverside County
309361	Non-Physician Medical Practitioner	None	1104478981	0	0	BATTAGLIA, TAYLOR C PA-C	9/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
309384	Non-Physician Medical Practitioner	None	1831872225	0	0	BAKER, KRYSTEL NP	9/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1665 ESPLANADE	None	CHICO	CA	95926	3312	00	06000	39.74388808	-121.8503372	Butte County
309389	Non-Physician Medical Practitioner	None	1992158687	0	0	BAY, SARAH L NP	12/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5023E WINCHCOMB DRIVE	None	SCOTTSDALE	AZ	85254	2860	00	06000	33.615756	-111.971943	Maricopa County
309400	Non-Physician Medical Practitioner	None	1588353320	0	0	BURKE, LAUREN N PA	6/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
309425	Non-Physician Medical Practitioner	None	1699374785	0	0	BERRY, MEGHAN E PA	10/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
309431	Non-Physician Medical Practitioner	None	1396093738	0	0	BROWN, ALISON OWEN	10/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2141 N HARBOR BLVD	SUITE 25000	FULLERTON	CA	92835	3827	00	06000	33.89443025	-117.9288328	Orange County
309436	Non-Physician Medical Practitioner	None	1962681536	0	0	BRIGHT, STACY L NP	6/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	650 ALAMEDA BLVD	None	CORONADO	CA	92118	2012	00	06000	32.69430239	-117.1861208	San Diego County
309439	Non-Physician Medical Practitioner	None	1790178440	0	0	BLANKENSHIP, CLAYTON D NP	3/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8329 BRIMHALL RD	SUITE 801	BAKERSFIELD	CA	93312	2243	00	06000	35.366706	-119.0959425	Kern County
309444	Non-Physician Medical Practitioner	None	1205245560	0	0	BERETA, STEVEN C NP	9/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	425 E AFTON LANE	None	ANAHEIM	CA	92805	3008	00	06000	33.83909191	-117.9104028	Orange County
309461	Non-Physician Medical Practitioner	None	1457402174	0	0	BEYAN, LORPU G	10/1/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1663 E 68TH ST	STE 20	LONG BEACH	CA	90805	1698	00	06000	33.87828457	-118.1723026	Los Angeles County
309462	Non-Physician Medical Practitioner	None	1871843375	0	0	B, AUSTIN R	10/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
309470	Non-Physician Medical Practitioner	None	1689006512	0	0	BAUER, MICHELLE A	11/8/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
309475	Non-Physician Medical Practitioner	None	1093327744	0	0	BATTERSON, JESSICA NP	4/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
309509	Non-Physician Medical Practitioner	None	1528124716	0	0	BAHM, JENNIFER L	4/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
309527	Non-Physician Medical Practitioner	None	1477321073	0	0	BECK, CHRISTA M CNM	1/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4560 ADMIRALTY WAY	SUITE 105	MARINA DEL REY	CA	90292	5423	00	06000	33.98364904	-118.4449069	Los Angeles County
309528	Non-Physician Medical Practitioner	None	1396070702	0	0	BALL, DARLENE NP	12/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36243 INLAND VALLEY DR	STE 80	WILDOMAR	CA	92595	9547	00	06000	33.591528	-117.2393325	Riverside County
309546	Non-Physician Medical Practitioner	None	1073060943	0	0	BERRY, CHRISTINA R NP	2/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
309559	Non-Physician Medical Practitioner	None	1568980589	0	0	BRAND, MITCHELL NP	9/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	00	06000	34.27623479	-119.2520218	Ventura County
309595	Non-Physician Medical Practitioner	None	1326110693	0	0	BALLARD, CLAIRE JANINE	10/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
309599	Non-Physician Medical Practitioner	None	1689782831	0	0	BARNES, BRIAN NP	4/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3412 ALMA AVE	UNIT A	MANHATTAN BEACH	CA	90266	3329	00	06000	33.89971362	-118.4162171	Los Angeles County
309625	Non-Physician Medical Practitioner	None	1851469092	0	0	BHAKTI, GINGER L CNM	10/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2066 GOLFCOURSE RD	None	BAYSIDE	CA	95524	9023	00	06000	40.84946588	-124.0581813	Humboldt County
309626	Non-Physician Medical Practitioner	None	1922535152	0	0	BROWN, CONOR PA	4/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
309636	Non-Physician Medical Practitioner	None	1629545835	0	0	BELK, DANA PA-C	2/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
309646	Non-Physician Medical Practitioner	None	1417074907	0	0	BLANCO, ROY L NP	4/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2333 W MARCH LANE	STE A1	STOCKTON	CA	95207	5263	00	06000	37.98543037	-121.3365306	San Joaquin County
309670	Non-Physician Medical Practitioner	None	1295841245	0	0	BIDDLE, KATHRYN KELLER	8/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 S MOORPARK RD	None	THOUSAND OAKS	CA	91361	1008	00	06000	34.17369227	-118.8765488	Ventura County
309686	Non-Physician Medical Practitioner	None	1245514512	0	0	BERNASCONI, ALEXANDRA M PA-C	6/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	00	06000	39.23410746	-121.0515391	Nevada County
309694	Non-Physician Medical Practitioner	None	1831782705	0	0	BROWNLEE, LATOYA	8/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	00	06000	37.66383747	-122.4671404	San Mateo County
309708	Non-Physician Medical Practitioner	None	1194074948	0	0	BOWLES, BRADEN MICHAEL	11/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9456 BRUNELLO CT	None	BAKERSFIELD	CA	93314	9754	00	06000	35.42896895	-119.1074768	Kern County
309741	Non-Physician Medical Practitioner	None	1760575682	0	0	BECK, LISA A	4/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11762 SILVER FIR DR	None	TRUCKEE	CA	96161	3207	00	06000	39.31571145	-120.1925622	Placer County
309742	Non-Physician Medical Practitioner	None	1033705744	0	0	BALOOCH, FATEMA NP	6/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
309751	Non-Physician Medical Practitioner	None	1376908145	0	0	BAILY, EVAN A PA-C	1/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 EL CAMINO REAL	STE J	SAN BRUNO	CA	94066	1310	00	06000	37.63997826	-122.4230745	San Mateo County
309758	Non-Physician Medical Practitioner	None	1942640214	0	0	BARKOFF, LYNSEY M NP	7/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26613 PURISSIMA RD	None	LOS ALTOS HILLS	CA	94022	3329	00	06000	37.37116115	-122.1392082	Santa Clara County
309778	Non-Physician Medical Practitioner	None	1386814499	0	0	BARTOLETTI, MARYN L NP	2/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1524 E ORANGE GROVE BLV	None	PASADENA	CA	91104	4726	00	06000	34.15781349	-118.1190735	Los Angeles County
309801	Non-Physician Medical Practitioner	None	1083048169	0	0	BARBER, MARISA N PA	5/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	892 AEROVISTA PL	SUITE 130	SAN LUIS OBISPO	CA	93401	8054	00	06000	35.24277125	-120.6405941	San Luis Obispo County
309847	Non-Physician Medical Practitioner	None	1275744252	0	0	BLANTZ, MERRY CHRISTINE	9/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	8409	00	06000	32.7537975	-117.1658298	San Diego County
309849	Non-Physician Medical Practitioner	None	1831156041	0	0	BRYANT, LIZA J PA	3/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	00	06000	37.666053	-120.996222	Stanislaus County
309877	Non-Physician Medical Practitioner	None	1649753427	0	0	BECK, ARIANE PA	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
309883	Non-Physician Medical Practitioner	None	1275748295	0	0	BRODNANSKY, NEYDA	5/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1360 W 6TH ST	#120	SAN PEDRO	CA	90732	3514	00	06000	33.73886546	-118.3075065	Los Angeles County
309884	Non-Physician Medical Practitioner	None	1710238811	0	0	BILLONES, ANN M	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2666 SIMI COURT	None	SAN DIEGO	CA	92139	3224	00	06000	32.67862142	-117.0421919	San Diego County
309907	Non-Physician Medical Practitioner	None	1235207143	0	0	BERGLUND, MEAGHAN M PA-C	7/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	547 HUMMINGBIRD DRIVE	None	BREA	CA	92823	1018	00	06000	33.92711533	-117.8473572	Orange County
309922	Non-Physician Medical Practitioner	None	1558387837	0	0	BARTON, CYNTHIA FEASTER	2/9/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4150 CLEMENT ST # 127	None	SAN FRANCISCO	CA	94121	1545	00	06000	37.78109398	-122.5051321	San Francisco County
309933	Non-Physician Medical Practitioner	None	1700297801	0	0	BARNAS, CHRISTI L NP	1/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	904 LIGHTHOUSE DR	None	WEST SACRAMENTO	CA	95605	2529	00	06000	38.59711689	-121.5237288	Yolo County
309934	Non-Physician Medical Practitioner	None	1083127088	0	0	BRASLEY, MANUEL R NP	5/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	292 EUCLID AVE	SUITE 210	SAN DIEGO	CA	92114	3629	00	06000	32.70706919	-117.0850896	San Diego County
309951	Non-Physician Medical Practitioner	None	1245874437	0	0	BUCHHOLZ, JUSTINE J NP	12/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
309957	Non-Physician Medical Practitioner	None	1306563754	0	0	BRADY, MEREDITH NP	3/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3814 AUBURN BLVD	SUITE 72	SACRAMENTO	CA	95821	2123	00	06000	38.639034	-121.375305	Sacramento County
309962	Non-Physician Medical Practitioner	None	1164895553	0	0	BEATTY, KIMBERLY D NP	10/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4097 HENSLEY CIR	None	EL DORADO HILLS	CA	95762	4272	00	06000	38.69029064	-121.0906054	El Dorado County
309977	Non-Physician Medical Practitioner	None	1184229668	0	0	BAKIR, MARAL NP	9/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	00	06000	34.06473399	-118.445865	Los Angeles County
309984	Non-Physician Medical Practitioner	None	1194901348	0	0	BAKER, JENNIFER	3/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6355 WALKER LN	SUITE 308	ALEXANDRIA	VA	22310	3245	00	06000	38.767563	-77.160852	City of Fairfax
309990	Non-Physician Medical Practitioner	None	1033489349	0	0	BARTLETT, DEBRA L	3/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6057 MOUNT RUSHMORE CIR	None	CASTRO VALLEY	CA	94552	1908	00	06000	37.7105183	-122.0362529	Alameda County
309991	Non-Physician Medical Practitioner	None	1326009630	0	0	BOJADO, LISA NP	10/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	00	06000	34.58364037	-118.1441012	Los Angeles County
309997	Non-Physician Medical Practitioner	None	1538150966	0	0	BENNER, DAVID CRISTOPHER	2/28/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1100 BALSAM AVE	None	BOULDER	CO	80304	3404	00	06000	40.02670649	-105.2833275	Boulder County
310015	Non-Physician Medical Practitioner	None	1043648140	0	0	BARNETT, ANDRIETTA NP	11/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 ADOBE ST	None	CONCORD	CA	94520	2313	00	06000	37.97700068	-122.0381159	Contra Costa County
310021	Non-Physician Medical Practitioner	None	1639835135	0	0	BAINS, PARAMJEET PA-C	9/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	00	06000	37.25111017	-121.9465891	Santa Clara County
310028	Non-Physician Medical Practitioner	None	1578661864	0	0	BARAJAS, ANA L	7/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17637 SAN FERNANDO MISS	None	GRANADA HILLS	CA	91344	4038	00	06000	34.27216747	-118.5188445	Los Angeles County
310037	Non-Physician Medical Practitioner	None	1588367668	0	0	BROWER, MICHELLE	5/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
310038	Non-Physician Medical Practitioner	None	1609418581	0	0	BRESNAHAN, MATTHEW W PA	2/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
310068	Non-Physician Medical Practitioner	None	1740665694	0	0	BIGBEE, JENNIFER M PA-C	7/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
310097	Non-Physician Medical Practitioner	None	1184958837	0	0	BROWN, BETH A	4/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5507 EMBER CT	None	AGOURA HILLS	CA	91301	2062	00	06000	34.15195112	-118.7851878	Los Angeles County
310102	Non-Physician Medical Practitioner	None	1780421198	0	0	BESERRA, LAUREN M CNM	9/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	00	06000	33.77450141	-117.9123364	Orange County
310128	Non-Physician Medical Practitioner	None	1972375079	0	0	BLACK, RYAN PA-C	11/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3655 RAMON RD	None	PALM SPRINGS	CA	92264	1150	00	06000	33.81585702	-116.5066057	Riverside County
310129	Non-Physician Medical Practitioner	None	1528783826	0	0	BROWN, BRIANNA PA-C	2/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 COFFEE RD	None	MODESTO	CA	95355	2803	00	06000	37.668645	-120.9756715	Stanislaus County
310152	Non-Physician Medical Practitioner	None	1457752842	0	0	BUTNER, LAURA PA-C	4/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
310183	Non-Physician Medical Practitioner	None	1386698520	0	0	BERRA, KATHLEEN A	5/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1825 WHITE OAK DRIVE	None	MENLO PARK	CA	94025	6128	00	06000	37.43306578	-122.1915583	San Mateo County
310196	Non-Physician Medical Practitioner	None	1073627196	0	0	BOUNDS, DAWN T NP	11/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	BLDG 53	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
310198	Non-Physician Medical Practitioner	None	1962932343	0	0	BRONSON, DEREK C PA	8/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
310214	Non-Physician Medical Practitioner	None	1487423455	0	0	BANG, SOO CHI PA-C	6/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	00	06000	33.78236048	-117.8664975	Orange County
310251	Non-Physician Medical Practitioner	None	1114236395	0	0	BALDWIN, STACY M NP	7/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 VIA CANERO	None	SAN CLEMENTE	CA	92673	7025	00	06000	33.47916844	-117.5969629	Orange County
310253	Non-Physician Medical Practitioner	None	1962652479	0	0	BROUILLETTE, LESLIE A	5/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	545 LEAFHAVEN LANE	None	WINDSOR	CA	95492	8159	00	06000	38.5459049	-122.7953162	Sonoma County
310277	Non-Physician Medical Practitioner	None	1639679822	0	0	BOLT, RYAN M	6/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5017 LONGBRANCH AVENUE	SUITE A	SAN DIEGO	CA	92107	2005	00	06000	32.75101644	-117.2480327	San Diego County
310280	Non-Physician Medical Practitioner	None	1598489049	0	0	BOYLE, KARINA M PA-C	5/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 WEBSTER ST	STE 500	OAKLAND	CA	94609	3149	00	06000	37.82132826	-122.2621843	Alameda County
310293	Non-Physician Medical Practitioner	None	1316008568	0	0	BRITO, NICOLE M NP	7/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2510 BUENA VISTA BLVD	None	ALAMEDA	CA	94501	1517	00	06000	37.76673937	-122.2374055	Alameda County
310307	Non-Physician Medical Practitioner	None	1700258472	0	0	BETTERS, CARLA D NP	8/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	00	06000	33.89326085	-117.9300987	Orange County
310321	Non-Physician Medical Practitioner	None	1215363379	0	0	BALIOUKOVA, ANNA	1/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	72-266 CHS	LOS ANGELES	CA	90095	1652	00	06000	34.06373445	-118.443537	Los Angeles County
310338	Non-Physician Medical Practitioner	None	1609365444	0	0	BEATTY, ANDREW E L	12/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4550 38TH AVE SW	APT 125	SEATTLE	WA	98126	2769	00	06000	47.56148866	-122.3800756	King County
310346	Non-Physician Medical Practitioner	None	1023564812	0	0	BROUSSARD, GINA L	3/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3349 G STREET	SUITE F	MERCED	CA	95340	0978	00	06000	37.32432497	-120.4693064	Merced County
310370	Non-Physician Medical Practitioner	None	1134550213	0	0	BROWN, VANESSA K NP	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 5TH STREET	APT 213	WEST SACRAMENTO	CA	95605	2823	00	06000	38.58264168	-121.5139652	Yolo County
310385	Non-Physician Medical Practitioner	None	1912012600	0	0	BORCHERT, JENNINE M	9/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44065 NORTHGATE AVE	None	TEMECULA	CA	92592	3000	00	06000	33.48908396	-117.1409153	Riverside County
310398	Non-Physician Medical Practitioner	None	1124100300	0	0	BLASKO, MICHAEL P PA-C	3/7/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
310417	Non-Physician Medical Practitioner	None	1942511480	0	0	BABALOLA, VICTOR NP	1/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	00	06000	37.92643968	-122.0521822	Contra Costa County
310445	Non-Physician Medical Practitioner	None	1225890122	0	0	BRETT, TIFFANY L PA-C	2/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	00	06000	33.67718578	-117.9887516	Orange County
310461	Non-Physician Medical Practitioner	None	1114942554	0	0	BROCKSMITH, DANIEL	1/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1890 OVERVIEW DRIVE NE	None	TACOMA	WA	98422	4246	00	06000	47.31087245	-122.4185903	Pierce County
310471	Non-Physician Medical Practitioner	None	1619249539	0	0	BARKER, JULIE ANN M PA-C	11/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
310484	Non-Physician Medical Practitioner	None	1336783562	0	0	BAZILE, ANICK PA	4/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	192 BEACON ST, SOUTH	None	SOUTH SAN FRANCIS	CA	94080	6913	00	06000	37.63966055	-122.4022905	San Mateo County
310485	Non-Physician Medical Practitioner	None	1194292458	0	0	BESA, PAULA PA-C	4/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
310492	Non-Physician Medical Practitioner	None	1205478328	0	0	BIRK, KELLY C NP	6/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12746 W JEFFERSON BLVD	FL 2-4	LOS ANGELES	CA	90094	2885	00	06000	33.97751255	-118.417598	Los Angeles County
310502	Non-Physician Medical Practitioner	None	1881477438	0	0	BHELLA, KHUSHBOO PA	11/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
310521	Non-Physician Medical Practitioner	None	1861702110	0	0	BELL, SHANNON M NP	6/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
310563	Non-Physician Medical Practitioner	None	1972047587	0	0	BELL, BRITTANY R	4/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2975 HAWK HILL LANE	None	SAN LUIS OBISPO	CA	93405	8328	00	06000	35.31393169	-120.6261071	San Luis Obispo County
310581	Non-Physician Medical Practitioner	None	1275048159	0	0	BANKE, LISA M	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6999 ARROYO RD	None	LIVERMORE	CA	94550	9642	00	06000	37.60553899	-121.7549418	Alameda County
310605	Non-Physician Medical Practitioner	None	1447769971	0	0	BELIN, CAROLINE L NP	7/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	00	06000	34.06704253	-118.3835029	Los Angeles County
310626	Non-Physician Medical Practitioner	None	1649864455	0	0	BRAVO-CUSTODIO, ANNA CATALINA M PA-C	8/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7172 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	3804	00	06000	33.94477707	-117.4034127	Riverside County
310629	Non-Physician Medical Practitioner	None	1871604819	0	0	BLINKINSOP, JUDITH CHRISTINE	1/2/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
310689	Non-Physician Medical Practitioner	None	1821671025	0	0	BURGUENO, ODELI M NP	12/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 EAST REDLANDS BLVD	SUITE 106	REDLANDS	CA	92373	0000	00	06000	34.05731952	-117.181197	San Bernardino County
310694	Non-Physician Medical Practitioner	None	1427672559	0	0	BANKS, GRACE E PA-C	9/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1199 BUSH ST	STE 620	SAN FRANCISCO	CA	94109	5999	00	06000	37.7891291	-122.4167087	San Francisco County
310702	Non-Physician Medical Practitioner	None	1619378411	0	0	BEKOE-SAKYI, MAVIS N	2/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2525 CARMICHAEL WAY	None	TURLOCK	CA	95382	9137	00	06000	37.51615741	-120.8289356	Stanislaus County
310717	Non-Physician Medical Practitioner	None	1942747951	0	0	BUI, ROCHELLE PA-C	5/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	00	06000	32.99706	-117.05544	San Diego County
310727	Non-Physician Medical Practitioner	None	1972665321	0	0	BUI, MYLINH P	7/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3334 PARK RIDGE DR	None	RICHMOND	CA	94806	5816	00	06000	37.98292342	-122.3460585	Contra Costa County
310729	Non-Physician Medical Practitioner	None	1174792030	0	0	BARSUN, ALURA LIN	4/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
310745	Non-Physician Medical Practitioner	None	1386068310	0	0	BOUCHER, MICHAEL D	10/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1087 EMMA LN	None	NIPOMA	CA	93444	6660	00	06000	35.03172759	-120.5418721	San Luis Obispo County
310762	Non-Physician Medical Practitioner	None	1073082210	0	0	BOLING, LESLIE E NP	8/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	296 H ST	303	CHULA VISTA	CA	91910	4779	00	06000	32.63445985	-117.0769184	San Diego County
310800	Non-Physician Medical Practitioner	None	1124577408	0	0	BEVAN, JORDAN S	10/31/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1469 MOSAIC WAY	None	CLOVIS	CA	93619	5158	00	06000	36.85743878	-119.6438504	Fresno County
310832	Non-Physician Medical Practitioner	None	1538541487	0	0	BAGLEY, ADRIANE M PA-C	8/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1943 NAPA AVE	None	BERKELEY	CA	94707	2607	00	06000	37.88736823	-122.274158	Alameda County
310841	Non-Physician Medical Practitioner	None	1942284906	0	0	BETZOLD, CHRISTINE MARIE	5/24/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	455 S MAIN ST	None	ORANGE	CA	92868	3835	00	06000	33.78077578	-117.8673468	Orange County
310842	Non-Physician Medical Practitioner	None	1811969371	0	0	BECERRA, AMY P.	7/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2005 17TH ST	None	BAKERSFIELD	CA	93301	4203	00	06000	35.37431347	-119.0249415	Kern County
310846	Non-Physician Medical Practitioner	None	1346008414	0	0	BANUELOS RAMIREZ, CARLOS PA	7/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	00	06000	33.9316595	-116.9468639	Riverside County
310871	Non-Physician Medical Practitioner	None	1467540096	0	0	BONJOUR, TIMOTHY JOHN	1/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7110 FM 78	None	SAN ANTONIO	TX	78244	1763	00	06000	29.48554939	-98.34839689	Bexar County
310926	Non-Physician Medical Practitioner	None	1609529833	0	0	BROWN, BRIGITTE D NP	10/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
310947	Non-Physician Medical Practitioner	None	1689075897	0	0	BUTLER, MATTHEW R PA-C	11/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	00	06000	40.57278686	-122.3958519	Shasta County
310965	Non-Physician Medical Practitioner	None	1932629862	0	0	BAISDEN, NICOLE A NP	4/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1779 DOMINICAN WAY	STE B	SANTA CRUZ	CA	95065	1526	00	06000	36.9902958	-121.9808957	Santa Cruz County
310993	Non-Physician Medical Practitioner	None	1558780296	0	0	BEADLE, JOHN E NP	4/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	00	06000	39.74352822	-121.8495394	Butte County
311005	Non-Physician Medical Practitioner	None	1275827511	0	0	BORDNER, MICHAEL PATRICK	4/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	360 DARDANELLI LN	SUITE 1-G	LOS GATOS	CA	95032	1421	00	06000	37.26304857	-121.9672608	Santa Clara County
311007	Non-Physician Medical Practitioner	None	1518316421	0	0	BELTRAN, NADINE PA-C	5/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	00	06000	34.29981583	-118.473722	Los Angeles County
311031	Non-Physician Medical Practitioner	None	1992573984	0	0	BAUTISTA, GERJEL A NP	5/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2455 SAND CREEK RD	STE 144	BRENTWOOD	CA	94513	7176	00	06000	37.94689155	-121.7370896	Contra Costa County
311040	Non-Physician Medical Practitioner	None	1992193320	0	0	BOY, CHRISTOPHER M PA	3/25/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	00	06000	37.666053	-120.996222	Stanislaus County
311047	Non-Physician Medical Practitioner	None	1821249376	0	0	BERNARDO, BELINDA LA MADRID	12/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14901 RINALDI ST	SUITE 110	MISSION HILLS	CA	91345	1204	00	06000	34.27903452	-118.457433	Los Angeles County
311057	Non-Physician Medical Practitioner	None	1275547085	0	0	BAUTISTA, JULIE ANNA	7/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	00	06000	36.94519024	-120.0420086	Madera County
311063	Non-Physician Medical Practitioner	None	1497155683	0	0	BENTLEY, JENNIFER L PA-C	7/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	170 COLUMBUS AVE	SUITE 110	SAN FRANCISCO	CA	94133	5160	00	06000	37.79680499	-122.4050031	San Francisco County
311065	Non-Physician Medical Practitioner	None	1851834410	0	0	BROWN, DANIELLE M CNP	1/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
311076	Non-Physician Medical Practitioner	None	1851811624	0	0	BANGALAN, CHRISTINE JOY P NP	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	00	06000	38.664027	-121.7933505	Yolo County
311087	Non-Physician Medical Practitioner	None	1144618349	0	0	BHARWANI, DINESH K	5/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	336 PERRY ELLIS DR	None	HENDERSON	NV	89014	6076	00	06000	36.05155286	-115.0495393	Clark County
311097	Non-Physician Medical Practitioner	None	1962539205	0	0	BENJAMIN, ZOYA	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 BROADWAY ST	None	REDWOOD CITY	CA	94063	3132	00	06000	37.48523183	-122.2025998	San Mateo County
311098	Non-Physician Medical Practitioner	None	1124193990	0	0	BLODGET, JILL	11/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2345 FAIR OAKS BOULEVARD	None	SACRAMENTO	CA	95825	0000	00	06000	38.57535	-121.407633	Sacramento County
311114	Non-Physician Medical Practitioner	None	1831188051	0	0	BERTHOLD, LAURIE	2/9/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2651 HIGHLAND AVE	KAISER PERMANENTE DEPT O	SELMA	CA	93662	3392	00	06000	36.57182292	-119.6287694	Fresno County
311123	Non-Physician Medical Practitioner	None	1750832143	0	0	BERMAN, SARI RACHELLE	1/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 NEILSON WAY	1434	SANTA MONICA	CA	90405	4021	00	06000	34.00008276	-118.4827116	Los Angeles County
311145	Non-Physician Medical Practitioner	None	1629289780	0	0	BURGA, DANTE ANIBAL	4/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4301 S FIGUEROA ST	# F	LOS ANGELES	CA	90037	2660	00	06000	34.005132	-118.282769	Los Angeles County
311155	Non-Physician Medical Practitioner	None	1245283464	0	0	BANDUCCI, CANDICE	10/31/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8501 BRIMHALL RD	BUILDING 100	BAKERSFIELD	CA	93312	2252	00	06000	35.36876784	-119.0971029	Kern County
311168	Non-Physician Medical Practitioner	None	1952707010	0	0	BATLA, KRISTA L	2/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22362 BLUE LUPINE CIR	None	GRAND TERRACE	CA	92313	5467	00	06000	34.03113359	-117.3179703	San Bernardino County
311189	Non-Physician Medical Practitioner	None	1043472988	0	0	BONNER, RHODELYNN D NP	4/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	960 EAST ADA AVE	None	GLENDALE	CA	91741	3647	00	06000	34.13192662	-117.8487579	Los Angeles County
311270	Non-Physician Medical Practitioner	None	1699156588	0	0	BURNETT, WHITNEY M	7/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2366 MONTE VISTA STREET	None	PASADENA	CA	91107	2518	00	06000	34.1553099	-118.101727	Los Angeles County
311281	Non-Physician Medical Practitioner	None	1932707114	0	0	BERUMEN, JACOB NP	2/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	00	06000	34.02648965	-118.4867439	Los Angeles County
311293	Non-Physician Medical Practitioner	None	1396890315	0	0	BAE, YONG	4/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	00	06000	37.24047903	-121.7998157	Santa Clara County
311308	Non-Physician Medical Practitioner	None	1487909321	0	0	BARATS, AMY M NP	4/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1200 RIVERSIDE DRIVE	None	RENO	NV	89503	5459	00	06000	39.52048896	-119.8269555	Washoe County
311327	Non-Physician Medical Practitioner	None	1366482259	0	0	BERNIER, CHRISTINE BETH	1/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N. PEPPER AVENUE	None	COLTON	CA	92324	0000	00	06000	34.073505	-117.3505995	San Bernardino County
311336	Non-Physician Medical Practitioner	None	1477902955	0	0	BLANCHARD, BRITTNEY N	11/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	126 N ELECTRIC AVE	APT H	ALHAMBRA	CA	91801	1927	00	06000	34.09386571	-118.1395861	Los Angeles County
311354	Non-Physician Medical Practitioner	None	1700831153	0	0	BALDWIN, ALICE T	9/1/1991	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1737	00	06000	33.808185	-118.1850575	Los Angeles County
311356	Non-Physician Medical Practitioner	None	1811404338	0	0	BORRMAN, ALISON E NP	3/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2166 35TH AVENUE	None	SAN FRANCISCO	CA	94116	1611	00	06000	37.74664971	-122.4930943	San Francisco County
311372	Non-Physician Medical Practitioner	None	1003470931	0	0	BARAJAS, GREGORIO PA-C	8/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	911 SUNSET DR	None	HOLLISTER	CA	95023	5695	00	06000	36.83504962	-121.3858245	San Benito County
311390	Non-Physician Medical Practitioner	None	1386119188	0	0	BRACKIN, CALEB NP	4/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
311392	Non-Physician Medical Practitioner	None	1205461613	0	0	BAL, NAVJOT NP	6/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	515 W GRANGEVILLE BLVD	B	HANFORD	CA	93230	2861	00	06000	36.3426505	-119.652795	Kings County
311396	Non-Physician Medical Practitioner	None	1649588005	0	0	BASTON, ANNA L C NP	7/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1463 CARACARA CIRCLE	None	EL CAJON	CA	92019	2552	00	06000	32.78701345	-116.929188	San Diego County
311405	Non-Physician Medical Practitioner	None	1952441297	0	0	BURNHAM, NICOLE S	8/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17600 BRUCE AVE	None	LOS GATOS	CA	95030	3207	00	06000	37.23736242	-121.9783923	Santa Clara County
311410	Non-Physician Medical Practitioner	None	1437129269	0	0	BINGHAM, JEANNETTE	8/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4663 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	4202	00	06000	37.04973619	-122.0157773	Santa Cruz County
311475	Non-Physician Medical Practitioner	None	1215083621	0	0	BEATTIE, JOANNE NP	10/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34601 HOPEWELL ROAD	None	SQUAW VALLEY	CA	93675	9675	00	06000	36.746505	-119.16792	Fresno County
311483	Non-Physician Medical Practitioner	None	1225497670	0	0	BANOLA, CESFE NP	8/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
311492	Non-Physician Medical Practitioner	None	1881005221	0	0	BETTISWORTH, LINDSEY R PA	4/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70554251	-121.873005	Alameda County
311496	Non-Physician Medical Practitioner	None	1124496203	0	0	BERRY, LAUREEN R NP	6/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	00	06000	34.44257521	-119.7584538	Santa Barbara County
311507	Non-Physician Medical Practitioner	None	1427577162	0	0	BAJWA, RAJWINDER K NP	5/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 F ST	100	BAKERSFIELD	CA	93301	1849	00	06000	35.384184	-119.023442	Kern County
311532	Non-Physician Medical Practitioner	None	1285931147	0	0	BORRUSO, ADAM R	3/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	SUITE 400	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
311535	Non-Physician Medical Practitioner	None	1871543397	0	0	BRIGANTI, REINA A NP	3/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	148436 SUNRISE HILL RD	None	RIVERSIDE	CA	92508	8989	00	06000	33.90373759	-117.3466378	Riverside County
311556	Non-Physician Medical Practitioner	None	1316014418	0	0	BAYLISS, KIM	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
311570	Non-Physician Medical Practitioner	None	1861051377	0	0	BRAZIL, WHITNEY S PA	1/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	416 W FOOTHILL BLVD	None	RIALTO	CA	92376	4953	00	06000	34.10677653	-117.3773835	San Bernardino County
311575	Non-Physician Medical Practitioner	None	1336201052	0	0	BAGLEY, CONNIE D NP	2/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
311595	Non-Physician Medical Practitioner	None	1972973329	0	0	BOW, LINDA D PA-C	3/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24331 EL TORO ROAD	SUITE 200	LAGUNA WOODS	CA	92637	3116	00	06000	33.60928782	-117.7295058	Orange County
311626	Non-Physician Medical Practitioner	None	1508464249	0	0	BIDWELL, JENNIFER D PA	12/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2880 ATLANTIC AVE	SUITE 170	LONG BEACH	CA	90806	1715	00	06000	33.809382	-118.185001	Los Angeles County
311635	Non-Physician Medical Practitioner	None	1164857488	0	0	BURGESS, MARIA L NP	11/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2744 SUNLIGHT CREEK ST	None	HENDERSON	NV	89052	3924	00	06000	35.99601947	-115.1082135	Clark County
311655	Non-Physician Medical Practitioner	None	1952845364	0	0	BRANDT, DAVID NP	3/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	00	06000	33.92617009	-117.4404151	Riverside County
311657	Non-Physician Medical Practitioner	None	1346738010	0	0	BASEBANG, SALOME	4/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
311680	Non-Physician Medical Practitioner	None	1215332184	0	0	BEHREND, JESSICA E NP	4/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1933 NERO CT	None	WALNUTT CREEK	CA	94598	2218	00	06000	37.92412775	-122.0413096	Contra Costa County
311716	Non-Physician Medical Practitioner	None	1457781676	0	0	BENEVOLENCE INDUSTRIES INCORPORATED	5/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	611 E IMPERIAL HWY	SUITE 107	LOS ANGELES	CA	90059	2358	00	06000	33.93106348	-118.264662	Los Angeles County
311726	Non-Physician Medical Practitioner	None	1124619580	0	0	BARROWS, BREANNA M PA-C	2/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2455 JEFFERSON BLVD	STE 100	WEST SACRAMENTO	CA	95691	5313	00	06000	38.55304251	-121.5367185	Yolo County
311759	Non-Physician Medical Practitioner	None	1124661913	0	0	BAELLO, MICHAEL J NP	10/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4849 VAN NUYS BLVD	STE 220	SHERMAN OAKS	CA	91403	2155	00	06000	34.159113	-118.4487465	Los Angeles County
311761	Non-Physician Medical Practitioner	None	1770603391	0	0	BECHTEL, JONATHAN PA-C	4/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 W LOS ANGELES	None	MOORPARK	CA	93021	1820	00	06000	34.27900253	-118.8824532	Ventura County
311764	Non-Physician Medical Practitioner	None	1447840608	0	0	BUI, VINCENT PA-C	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11190 WARNER AVE	STE 306	FOUNTAIN VALLEY	CA	92708	4054	00	06000	33.714	-117.9333585	Orange County
311820	Non-Physician Medical Practitioner	None	1154101343	0	0	BANGURA, CLARIS NP	5/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	00	06000	38.65716	-121.1738175	Sacramento County
311824	Non-Physician Medical Practitioner	None	1144732017	0	0	BERGEN, MICHELLE E NP	4/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	00	06000	36.83832032	-119.7632391	Fresno County
311837	Non-Physician Medical Practitioner	None	1063246528	0	0	BAUTISTA, MICHELLE NP	1/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
311866	Non-Physician Medical Practitioner	None	1215341730	0	0	BELMONT, MATTHEW J	9/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3531 E 2ND ST	None	TEMPLETON	CA	90803	5294	00	06000	33.76313354	-118.1506446	Los Angeles County
311867	Non-Physician Medical Practitioner	None	1881108058	0	0	BACA, JACQUELINE M NP	5/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12291 WASHINGTON BLVD	STE 102	WHITTIER	CA	90606	3817	00	06000	33.96734104	-118.0508773	Los Angeles County
311884	Non-Physician Medical Practitioner	None	1427413871	0	0	BITTNER, ALEXANDER PA-C	2/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	00	06000	34.02308948	-118.3972101	Los Angeles County
311889	Non-Physician Medical Practitioner	None	1083024699	0	0	BOBIS, SHEILA A P	7/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 311075	None	FONTANA	CA	92331	1075	00	06000	0	0	None
311908	Non-Physician Medical Practitioner	None	1932406717	0	0	BRADLEY, DENISE	10/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1321 COLBY AVE	None	EVERETT	WA	98201	1665	00	06000	47.99969831	-122.207987	Snohomish County
311917	Non-Physician Medical Practitioner	None	1306629423	0	0	BOJORQUES, VANESSA R PA-C	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	00	06000	37.9839146	-121.3516231	San Joaquin County
311922	Non-Physician Medical Practitioner	None	1053762005	0	0	BROWN, CHARLES M NP	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3410 FIR STREET	None	SAN DIEGO	CA	92104	5706	00	06000	32.72539775	-117.1192543	San Diego County
311933	Non-Physician Medical Practitioner	None	1134691215	0	0	BROULARD, ALAIN NP	3/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
311958	Non-Physician Medical Practitioner	None	1598779027	0	0	BARRETT, JAMES E PA-C	2/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
311960	Non-Physician Medical Practitioner	None	1851930168	0	0	BLAIS, LISA J NP	4/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
312003	Non-Physician Medical Practitioner	None	1225113293	0	0	BARADAR, MAHNAZ	11/15/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	700	ORANGE	CA	92868	4213	00	06000	33.78034779	-117.8655767	Orange County
312015	Non-Physician Medical Practitioner	None	1902391212	0	0	BORMANN, KRISTINA A	8/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	786 THIRD AVE	None	CHULA VISTA	CA	91910	5826	00	06000	32.62477162	-117.0734615	San Diego County
312016	Non-Physician Medical Practitioner	None	1871037010	0	0	BEDSWORTH BREWIS, STEPHANIE K NP	4/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
312026	Non-Physician Medical Practitioner	None	1548508930	0	0	BENGALI, TANYA NP	9/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 AIRWAY AVE	SUITE T-3	COSTA MESA	CA	92626	4627	00	06000	33.67783408	-117.8720921	Orange County
312037	Non-Physician Medical Practitioner	None	1710762091	0	0	BLAIR, KEITH L NP	10/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1317 OAKDALE RD	SUITE 440	MODESTO	CA	95355	3364	00	06000	37.662489	-120.957588	Stanislaus County
312056	Non-Physician Medical Practitioner	None	1720700503	0	0	BEDOLLA, DENISE NP	1/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
312068	Non-Physician Medical Practitioner	None	1669567251	0	0	BLUCHER, CORINNA L	1/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3905 BALTIC CIR	None	ROCKLIN	CA	95677	1964	00	06000	38.80405738	-121.2304004	Placer County
312077	Non-Physician Medical Practitioner	None	1700160546	0	0	BURN, ADRIENNE GONZALEZ	11/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8990 GARFIELD ST	SUITE 11	RIVERSIDE	CA	92503	3922	00	06000	33.92882844	-117.4396777	Riverside County
312088	Non-Physician Medical Practitioner	None	1538479753	0	0	BERGER, LYNN D	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1134 GAUCHO PLACE	None	ESCONDIDO	CA	92029	3038	00	06000	33.1080911	-117.1087242	San Diego County
312103	Non-Physician Medical Practitioner	None	1619480142	0	0	BLAS, VENUS CHRISTINE A PA-C	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
312107	Non-Physician Medical Practitioner	None	1538419601	0	0	BORDONARO, PAMELA MARIE	5/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	4300	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
312108	Non-Physician Medical Practitioner	None	1760013122	0	0	BAUM, ANDREW J PA-C	4/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
312137	Non-Physician Medical Practitioner	None	1336218734	0	0	BAUTISTA, JEFFERSON A NP	12/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	00	06000	33.84718298	-117.933758	Orange County
312147	Non-Physician Medical Practitioner	None	1194434183	0	0	BRINKERHOFF, CATALINA M PA	1/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2375 E PRATER WAY	None	SPARKS	NV	89434	9641	00	06000	39.54247495	-119.6975356	Washoe County
312166	Non-Physician Medical Practitioner	None	1003653932	0	0	BESKIND, HANNAH G	8/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
312176	Non-Physician Medical Practitioner	None	1508296724	0	0	BUCKLE, RAQUEL M	6/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3201 CHRISTMAS TREE LN	None	BAKERSFIELD	CA	93306	1106	00	06000	35.40946935	-118.9574915	Kern County
312193	Non-Physician Medical Practitioner	None	1962824532	0	0	BARRETO, NERISSA P NP	4/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	636 PACIFIC AVE	None	ALAMEDA	CA	94501	2127	00	06000	37.77624083	-122.277704	Alameda County
312208	Non-Physician Medical Practitioner	None	1548330285	0	0	BROCATO, MICHELE ANTHONY	12/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
312217	Non-Physician Medical Practitioner	None	1235211418	0	0	BARRESI, JOSEPH A JR	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14 DEERHILL DR	None	ROLLING HILLS EST	CA	90274	5110	00	06000	33.76773416	-118.3284516	Los Angeles County
312251	Non-Physician Medical Practitioner	None	1972210284	0	0	BOPARAI, NAVNEET NP	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19929 GREENLEY RD	None	SONORA	CA	95370	5996	00	06000	37.9837971	-120.366851	Tuolumne County
312290	Non-Physician Medical Practitioner	None	1609654755	0	0	BURNS, TYLER M PA-C	11/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	00	06000	33.78236048	-117.8664975	Orange County
312293	Non-Physician Medical Practitioner	None	1356757967	0	0	BERKOWITZ, LIANA M PA-C	1/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2826 HARRIS ST	None	EUREKA	CA	95503	4809	00	06000	40.78047614	-124.1355056	Humboldt County
312296	Non-Physician Medical Practitioner	None	1932608494	0	0	BRAR, TAMARA L NP	4/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
312309	Non-Physician Medical Practitioner	None	1174856603	0	0	BERONILLA, RICK G PA-C	11/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
312316	Non-Physician Medical Practitioner	None	1609975317	0	0	BROADBENT, JUSTIN M	4/10/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2288 AUBURN BLVD	SUITE 106	SACRAMENTO	CA	95821	1618	00	06000	38.625345	-121.4114985	Sacramento County
312322	Non-Physician Medical Practitioner	None	1508200452	0	0	BALOUGH, DENNIS T	4/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1841 39TH STREET	None	SACRAMENTO	CA	95816	6748	00	06000	38.55987	-121.4578935	Sacramento County
312327	Non-Physician Medical Practitioner	None	1497170286	0	0	BURKS, JANE M NP	7/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5630 FRESNO AVE	None	RICHMOND	CA	94804	5640	00	06000	37.9046468	-122.3102157	Contra Costa County
312385	Non-Physician Medical Practitioner	None	1821188103	0	0	BRUCE, JOANN MARY	9/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4125 BANGS AVE	None	MODESTO	CA	95356	8713	00	06000	37.70451024	-121.0709696	Stanislaus County
312388	Non-Physician Medical Practitioner	None	1932403615	0	0	BRADLEY, TRAVIS WAYNE	3/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD.	OFFICE 8S73	LOS ANGELES	CA	90048	0000	00	06000	34.07671715	-118.3799413	Los Angeles County
312402	Non-Physician Medical Practitioner	None	1356032478	0	0	BRIONES, ANGELA M PA-C	5/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8120 TIMBERLAKE WAY	STE 210B	SACRAMENTO	CA	95823	5414	00	06000	38.461023	-121.41414	Sacramento County
312423	Non-Physician Medical Practitioner	None	1518400183	0	0	BLACKMAN, JENNY T NP	3/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
312424	Non-Physician Medical Practitioner	None	1740665405	0	0	BURG, CHRISTINE F NP	6/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2840 CEDAR	None	MORRO BAY	CA	93442	1404	00	06000	35.39298406	-120.858473	San Luis Obispo County
312442	Non-Physician Medical Practitioner	None	1811308604	0	0	BELLER, PEGGY L NP	11/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	9170 PLATEAU CREEK CT	None	LAS VEGAS	NV	89149	0201	00	06000	36.27489999	-115.2963263	Clark County
312461	Non-Physician Medical Practitioner	None	1851884928	0	0	BABA, DENNIS M NP	11/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
312470	Non-Physician Medical Practitioner	None	1457901183	0	0	BORYS, ALEXANDRIA R NP	12/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
312474	Non-Physician Medical Practitioner	None	1902505464	0	0	BONILLA, JASMIN NP	7/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1557 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2597	00	06000	33.97477752	-118.246176	Los Angeles County
312509	Non-Physician Medical Practitioner	None	1760411037	0	0	BIONDOLILLO, CHRISTINA H NP	10/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3751 KLAMATH LANE	None	PALO ALTO	CA	94303	4262	00	06000	37.43027147	-122.106231	Santa Clara County
312582	Non-Physician Medical Practitioner	None	1023420916	0	0	BAGHAEI, SARA	7/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7828 DAY CREEK BLVD	APT 1221	RANCHO CUCAMONGA	CA	91739	8580	00	06000	34.1112636	-117.5371231	San Bernardino County
312616	Non-Physician Medical Practitioner	None	1669458691	0	0	BONAGUIDI, HEATHER C PA	8/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
312619	Non-Physician Medical Practitioner	None	1912058017	0	0	BLYTHE, JULIANNE	7/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2330 POST ST	4TH FLOOR, #420	SAN FRANCISCO	CA	94115	3465	00	06000	37.78424041	-122.4403628	San Francisco County
312626	Non-Physician Medical Practitioner	None	1952687030	0	0	BADANA, RAMIL T NP	8/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 VIOLA AVENUE	None	GLENDALE	CA	91202	3184	00	06000	34.16391251	-118.2581598	Los Angeles County
312644	Non-Physician Medical Practitioner	None	1629098116	0	0	BORODULIN-SMIK, IRINA	9/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10831 NORTHOAK SQ	None	CUPERTINO	CA	95014	0521	00	06000	37.33533	-122.0272085	Santa Clara County
312650	Non-Physician Medical Practitioner	None	1811751712	0	0	BELTRAN, EMILY NP	7/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
312663	Non-Physician Medical Practitioner	None	1194106914	0	0	BERENJI, TYLER K PA-C	2/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	230 SAN JOSE STREET	None	SALINAS	CA	93901	3901	00	06000	36.65837657	-121.6469645	Monterey County
312683	Non-Physician Medical Practitioner	None	1245349224	0	0	BATISTA, OSVALDO	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4655 48TH ST	None	SAN DIEGO	CA	92115	3206	00	06000	32.761944	-117.090693	San Diego County
312689	Non-Physician Medical Practitioner	None	1184283178	0	0	BARTH, CATHERINE L PA-C	1/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	00	06000	34.0653985	-118.3769177	Los Angeles County
312691	Non-Physician Medical Practitioner	None	1821015553	0	0	BUCHER, PATRICIA ANNE	2/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	155 HWY 50	None	STATELINE	NV	89449	0000	00	06000	38.96860553	-119.9356859	Douglas County
312741	Non-Physician Medical Practitioner	None	1184720062	0	0	BUTLER, AURORA ELIZABETH	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1617 E FIRST ST	STE A	SANTA ANA	CA	92701	0000	00	06000	33.74616534	-117.8462414	Orange County
312755	Non-Physician Medical Practitioner	None	1306994215	0	0	BANSIL, MIRA	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5211 DEL SUR CIR	None	LA PALMA	CA	90623	2211	00	06000	33.84015136	-118.0421765	Orange County
312768	Non-Physician Medical Practitioner	None	1407287469	0	0	BELANGER, TANYA M CNM	11/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29605 SOLONA WAY	APT X6	TEMECULA	CA	92591	5708	00	06000	33.5156448	-117.1510997	Riverside County
312769	Non-Physician Medical Practitioner	None	1275556706	0	0	BELKNAPP, IRENE L	9/21/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
312771	Non-Physician Medical Practitioner	None	1598090326	0	0	BOYER, MONICA A NP	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21561 ARCHER CIRCLE	None	HUNTINGTON BEACH	CA	92646	8017	00	06000	33.64951802	-117.9584047	Orange County
312812	Non-Physician Medical Practitioner	None	1215051974	0	0	BEBAWI, NORA H PA	4/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18021 SKY PARK CIRCLE	STE G	IRVINE	CA	92614	6569	00	06000	33.68904995	-117.8542045	Orange County
312813	Non-Physician Medical Practitioner	None	1245206184	0	0	BATSON, MARGARET ANN	5/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1311 S MILLER ST	SUITE 100	SANTA MARIA	CA	93454	6900	00	06000	34.93818375	-120.4316485	Santa Barbara County
312824	Non-Physician Medical Practitioner	None	1790359917	0	0	BAILEY, KATIE J NP	6/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	00	06000	34.05260995	-118.3015825	Los Angeles County
312830	Non-Physician Medical Practitioner	None	1700864394	0	0	BENDER, NANCY JOAN	4/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	00	06000	38.568402	-121.418019	Sacramento County
312832	Non-Physician Medical Practitioner	None	1639717044	0	0	BALDORADO, BRYANT NP	1/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
312833	Non-Physician Medical Practitioner	None	1528588092	0	0	BENDER, WILLIAM N PA	12/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
312839	Non-Physician Medical Practitioner	None	1760636252	0	0	BERTOLINE, ELISABETH R	2/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	828 BURLINGTON AVENUE	None	VENTURA	CA	93004	3099	00	06000	34.27571614	-119.1708487	Ventura County
312841	Non-Physician Medical Practitioner	None	1770922098	0	0	BUSCHOR, MARY R NP	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 ESCUELA AVE	APT 332	MOUNTAIN VIEW	CA	94040	1814	00	06000	37.39744509	-122.0936334	Santa Clara County
312849	Non-Physician Medical Practitioner	None	1982838736	0	0	BURNETT, LEAH A	5/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4506 ROSADA ST	None	LONG BEACH	CA	90815	2724	00	06000	33.79247112	-118.1404322	Los Angeles County
312856	Non-Physician Medical Practitioner	None	1780881045	0	0	BAGATELOS, KAREN CHRISTINE	8/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 PARNASSUS AVE	SUITE 410	SAN FRANCISCO	CA	94117	3608	00	06000	37.76403932	-122.4561371	San Francisco County
312857	Non-Physician Medical Practitioner	None	1326155052	0	0	BAUMAN, LOREN D	12/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2324 SEA OTTER CT	None	MODESTO	CA	95356	9205	00	06000	37.70099395	-121.0388954	Stanislaus County
312864	Non-Physician Medical Practitioner	None	1740504232	0	0	BRANSBY, PRISCILLA V NP	6/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	855 S LOS ROBLES AVE	None	PASADENA	CA	91106	3716	00	06000	34.13104376	-118.1413213	Los Angeles County
312875	Non-Physician Medical Practitioner	None	1619075629	0	0	BURROUS, SUZETTE JESSIE	1/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3260 KERNER BLVD	None	SAN RAFAEL	CA	94901	4861	00	06000	37.96081282	-122.501833	Marin County
312878	Non-Physician Medical Practitioner	None	1174036214	0	0	BAWDEN, JACQUELINE	2/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	06000	36.1590063	-115.1674415	Clark County
312890	Non-Physician Medical Practitioner	None	1427795301	0	0	BECK, JULIA R PA	2/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	00	06000	38.66751	-121.310028	Sacramento County
312918	Non-Physician Medical Practitioner	None	1659732998	0	0	BERNDSEN, NICOLE C NP	10/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1054 ELKGROVE AVE	APT 3	VENICE	CA	90291	6521	00	06000	34.00205318	-118.4592237	Los Angeles County
312965	Non-Physician Medical Practitioner	None	1164534129	0	0	BINGAMON, THOMAS W PA-C	2/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18133 VENTURA BLVD	300 3RD FLOOR	TARZANA	CA	91356	3612	00	06000	34.1657808	-118.5283188	Los Angeles County
312968	Non-Physician Medical Practitioner	None	1134744287	0	0	BARKER, JILLIAN PA-C	10/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
312982	Non-Physician Medical Practitioner	None	1033760855	0	0	BUGBEE, JESSICA L PA-C	6/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	00	06000	38.570805	-121.4696385	Sacramento County
312997	Non-Physician Medical Practitioner	None	1104341775	0	0	BURRELL, HEATHER R NP	10/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3384 PARIS WAY	None	YUBA CITY	CA	95993	8721	00	06000	39.14642698	-121.6789489	Sutter County
313014	Non-Physician Medical Practitioner	None	1134287543	0	0	BESSON, TAMAR NP	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
313024	Non-Physician Medical Practitioner	None	1942665237	0	0	BAKER, ALYSSA NP	1/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1045 E. PENNSYLVANIA AVE	None	ESCONDIDO	CA	92025	4616	00	06000	33.12864423	-117.0681274	San Diego County
313030	Non-Physician Medical Practitioner	None	1730813403	0	0	BURNETT, KATE E NP	8/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
313040	Non-Physician Medical Practitioner	None	1356739767	0	0	BASA, MARIE S NP	4/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10710 ASHWORTH CIR	None	CERRITOS	CA	90703	2648	00	06000	33.86802157	-118.1080238	Los Angeles County
313043	Non-Physician Medical Practitioner	None	1538700893	0	0	BORMAN, BRITTANY PA	12/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24799 ALICIA PKWY	None	LAGUNA HILLS	CA	92653	4618	00	06000	33.60163541	-117.6914361	Orange County
313044	Non-Physician Medical Practitioner	None	1053078329	0	0	BRINKLEY, CHANTAL NP	6/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
313046	Non-Physician Medical Practitioner	None	1699438515	0	0	BARCA-HALL, ANNALISA NP	11/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 ABBOTT ST	SUITE C	SALINAS	CA	93901	4486	00	06000	36.66658598	-121.6447027	Monterey County
313063	Non-Physician Medical Practitioner	None	1366174922	0	0	BRANDLIN, JASON T PA-C	2/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
313069	Non-Physician Medical Practitioner	None	1619601341	0	0	BAL, SAMEERA K NP	9/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	00	06000	35.39052148	-119.0070765	Kern County
313093	Non-Physician Medical Practitioner	None	1811191687	0	0	BODDEN, FLOYD G	11/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	8816 CORTILE DRIVE	None	LAS VEGAS	NV	89134	6152	00	06000	36.19487469	-115.2883445	Clark County
313098	Non-Physician Medical Practitioner	None	1952176968	0	0	BABBITT RUGGIERO, KELSY PA	1/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1866 N. ORANGE GROVE AVE	104	POMONA	CA	91767	3042	00	06000	34.07771682	-117.7485431	Los Angeles County
313161	Non-Physician Medical Practitioner	None	1306234372	0	0	BRUUN, AIDA T K NP	12/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	363 N RENGSTORFF	SUITE 10	MOUNTAIN VIEW	CA	94043	5136	00	06000	37.40845472	-122.0942721	Santa Clara County
313165	Non-Physician Medical Practitioner	None	1285109892	0	0	BURNS, KENNETH R PA-C	1/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4019	00	06000	33.714	-117.9333585	Orange County
313170	Non-Physician Medical Practitioner	None	1790947315	0	0	BOWEN, EMILY KYO	8/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	00	06000	33.12542915	-117.0764725	San Diego County
313173	Non-Physician Medical Practitioner	None	1548513138	0	0	BLAAUW, ERICA P NP	10/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
313193	Non-Physician Medical Practitioner	None	1023487766	0	0	BASUTKAR, VINEETA NP	1/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7045 BIANCA AVE	None	VAN NUYS	CA	91406	3513	00	06000	34.19888023	-118.513154	Los Angeles County
313198	Non-Physician Medical Practitioner	None	1356498588	0	0	BUCHANAN, DANIEL G	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4510 NORTHRIDGE RD	None	CARNELIAN BAY	CA	96140	1166	00	06000	0	0	None
313210	Non-Physician Medical Practitioner	None	1619635984	0	0	BARUCH, DANIELLE S PA-C	3/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18133 VENTURA BLVD	300 3RD FLOOR	TARZANA	CA	91356	3612	00	06000	34.1657808	-118.5283188	Los Angeles County
313212	Non-Physician Medical Practitioner	None	1588440135	0	0	BIAGINI, ANTONINA NP	3/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	00	06000	37.55769729	-121.9808861	Alameda County
313215	Non-Physician Medical Practitioner	None	1396528477	0	0	BELL, VANESSA E NP	4/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	685 N 13TH AVE	STE 7,8,9	UPLAND	CA	91786	4963	00	06000	34.10202219	-117.6339091	San Bernardino County
313216	Non-Physician Medical Practitioner	None	1659144954	0	0	BLACK, DANIEL PA	6/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
313261	Non-Physician Medical Practitioner	None	1699323030	0	0	BANZON, ROBYN NIGELLE S PA	7/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
313285	Non-Physician Medical Practitioner	None	1376936120	0	0	BAISLEY, SHAWN M PA	12/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10605 SCRIPPS POWAY PKWY	SUITE B AND C	SAN DIEGO	CA	92131	3925	00	06000	32.93714729	-117.0990446	San Diego County
313305	Non-Physician Medical Practitioner	None	1265847057	0	0	BHATT, BHAVNI D NP	7/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8585 BURTON WAY	APT 307	LOS ANGELES	CA	90048	3378	00	06000	34.07238051	-118.3792397	Los Angeles County
313306	Non-Physician Medical Practitioner	None	1144928524	0	0	BAGRI, AMRIT	8/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6515 PANAMA LANE	SUITE 106-107	BAKERSFIELD	CA	93311	9729	00	06000	35.29604449	-119.0756205	Kern County
313335	Non-Physician Medical Practitioner	None	1073720553	0	0	BROWN, DANETTE M	11/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2957 LORENCITA DR	None	ORCUTT	CA	93455	1911	00	06000	34.906212	-120.4402665	Santa Barbara County
313343	Non-Physician Medical Practitioner	None	1629092861	0	0	BOLTON, TANNIS J	12/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	63352 SIERRA ROAD	None	COOS BAY	OR	97420	8256	00	06000	43.34293761	-124.2391695	Coos County
313361	Non-Physician Medical Practitioner	None	1306131545	0	0	BORREGO COMMUNITY HEALTH FOUNDATION	1/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8856 ARLINGTON AVENUE	None	RIVERSIDE	CA	92503	1365	00	06000	33.94647572	-117.4674078	Riverside County
313372	Non-Physician Medical Practitioner	None	1558511147	0	0	BUSKO, SANDRA L NP	7/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1270 CLEVELAND AVE	UNIT E143	SAN DIEGO	CA	92103	3360	00	06000	32.74939027	-117.1519148	San Diego County
313373	Non-Physician Medical Practitioner	None	1336570894	0	0	BERALDO, JACQUELINE F NP	1/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	521 ALEGRIA RD	None	SANTA BARBARA	CA	93105	0000	00	06000	34.43333864	-119.7325979	Santa Barbara County
313403	Non-Physician Medical Practitioner	None	1033760863	0	0	BRAR, JESKEITH NP	12/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	00	06000	33.77224313	-117.8672259	Orange County
313416	Non-Physician Medical Practitioner	None	1013016096	0	0	BALDWIN, MICHAEL S PA	10/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 E WASHINGTON ST	STE 200	COLTON	CA	92324	4192	00	06000	34.04820662	-117.3128102	San Bernardino County
313430	Non-Physician Medical Practitioner	None	1154590024	0	0	BYWALEC, RACHEL E NP	8/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 W 7TH ST	APT 1002	LOS ANGELES	CA	90014	3945	00	06000	34.0441161	-118.2516257	Los Angeles County
313431	Non-Physician Medical Practitioner	None	1275883621	0	0	BABENKO, MYKHAYLO	10/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	110 TURBERRY CT	None	ROSEVILLE	CA	95747	7545	00	06000	38.75986618	-121.3279596	Placer County
313453	Non-Physician Medical Practitioner	None	1801030267	0	0	BILENKAYA, IRINA	8/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3855 HEALTH SCIENCES DR	3RD FLOOR, MAIL CODE 081	LA JOLLA	CA	92093	0819	00	06000	32.87861499	-117.2222042	San Diego County
313457	Non-Physician Medical Practitioner	None	1013630995	0	0	BIRRING, MANJEET K NP	1/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15810 S HARLAN ROAD	STE A	LATHROP	CA	95330	8719	00	06000	37.81877638	-121.292417	San Joaquin County
313478	Non-Physician Medical Practitioner	None	1194931980	0	0	BACOT CARTER, SHARON	1/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
313484	Non-Physician Medical Practitioner	None	1659833291	0	0	BLANCHARD, JULIE PA	3/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	00	06000	37.7634502	-122.4579779	San Francisco County
313486	Non-Physician Medical Practitioner	None	1598952244	0	0	BUCHANAN, CYNTHIA S PA	2/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1220 LAS TABLAS RD	SUITE 1418	TEMPLETON	CA	93465	9756	00	06000	35.55442452	-120.7211175	San Luis Obispo County
313515	Non-Physician Medical Practitioner	None	1124254842	0	0	BACKERT, CHRISTEL N NP	11/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8585 E ACAMPO RD	None	ACAMPO	CA	95220	9476	00	06000	38.17498187	-121.2115149	San Joaquin County
313540	Non-Physician Medical Practitioner	None	1184008641	0	0	BEDWANI, DINA N	6/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	304 SCARBOROUGH	None	THOUSAND OAKS	CA	91361	1346	00	06000	34.16948112	-118.8701507	Ventura County
313544	Non-Physician Medical Practitioner	None	1295200038	0	0	BUDIMAN, KARTIKA R	2/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3119 PARK VISTA DR	None	RIALTO	CA	92376	7100	00	06000	34.09011055	-117.357903	San Bernardino County
313548	Non-Physician Medical Practitioner	None	1598232845	0	0	BARTIE, MATTHEW D PA-C	4/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
313567	Non-Physician Medical Practitioner	None	1558670588	0	0	BLOOM, CAMILLE L	7/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	526 24TH AVE	None	SAN FRANCISCO	CA	94121	2915	00	06000	37.77952637	-122.4835947	San Francisco County
313574	Non-Physician Medical Practitioner	None	1801982061	0	0	BAKER, DEBORAH	10/24/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	236 W 6TH ST	STE 200	RENO	NV	89503	4517	00	06000	39.53151304	-119.8186228	Washoe County
313601	Non-Physician Medical Practitioner	None	1023046364	0	0	BERMAN, LISA S	3/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43644 SAVONA ST	None	TEMECULA	CA	92592	9256	00	06000	33.49366451	-117.0830231	Riverside County
313602	Non-Physician Medical Practitioner	None	1003431305	0	0	BREKKE, CHELSEA M PA-C	8/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4300 GOLDEN CENTER DRIVE	SUITE C	PLACERVILLE	CA	95667	6278	00	06000	38.70657265	-120.82856	El Dorado County
313613	Non-Physician Medical Practitioner	None	1962458745	0	0	BAILEY, JANET M	11/27/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
313615	Non-Physician Medical Practitioner	None	1932255221	0	0	BALL, DONNA	4/17/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 W 19TH ST	None	COSTA MESA	CA	92627	3517	00	06000	33.64342564	-117.9280911	Orange County
313617	Non-Physician Medical Practitioner	None	1871177568	0	0	BOWCUT, BROOKLYN	8/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
313625	Non-Physician Medical Practitioner	None	1427106764	0	0	BRADLEY, LISA L PA	3/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2220 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2514	00	06000	33.9598587	-118.318258	Los Angeles County
313647	Non-Physician Medical Practitioner	None	1073529822	0	0	BUITRAGO, JENNIFER NP	9/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3407 PAULA STREET	None	WEST COVINA	CA	91792	2611	00	06000	34.01893527	-117.8907874	Los Angeles County
313649	Non-Physician Medical Practitioner	None	1710397930	0	0	BECKWITH, KATHERINE	9/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4002 MARION WAY	None	LONG BEACH	CA	90807	3114	00	06000	33.82955156	-118.2017069	Los Angeles County
313650	Non-Physician Medical Practitioner	None	1194355446	0	0	BIRNBAUM, EMILY H NP	6/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5800 HOLLIS ST	None	EMERYVILLE	CA	94608	2016	00	06000	37.84043576	-122.2894291	Alameda County
313667	Non-Physician Medical Practitioner	None	1154836153	0	0	BASIRATMAND, MARK E	12/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26357 MCBEAN PKWY	120,150,205,220,300,310,	SANTA CLARITA	CA	91355	4488	00	06000	34.41257644	-118.5597683	Los Angeles County
313671	Non-Physician Medical Practitioner	None	1578974010	0	0	BLUMREICH, JUSTIN NP	11/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2107 AIRPARK DR	None	REDDING	CA	96001	2433	00	06000	40.57493327	-122.4048185	Shasta County
313689	Non-Physician Medical Practitioner	None	1639690845	0	0	BEHRMANN, LORENA NP	3/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8806 WATERWELL WAY	None	TRACY	CA	95304	8127	00	06000	37.69727964	-121.4140264	San Joaquin County
313737	Non-Physician Medical Practitioner	None	1710039680	0	0	BECKER-SCHWARM, CANDICE CNM	12/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	781 CASIANO DRIVE	UNIT A	SANTA BARBARA	CA	93105	6447	00	06000	34.42814534	-119.7494321	Santa Barbara County
313741	Non-Physician Medical Practitioner	None	1467072132	0	0	BRASKET, ADAM E NP	2/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 W. REDLANDS BLVD	# 234	REDLANDS	CA	92373	8054	00	06000	34.06288379	-117.2156673	San Bernardino County
313761	Non-Physician Medical Practitioner	None	1679093405	0	0	BALDERAS, ANNA C NP	11/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
313762	Non-Physician Medical Practitioner	None	1114428059	0	0	BREWER, ASHLEY N	5/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21 SANTA CATRINA	None	RANCHO SANTA MARG	CA	92688	2400	00	06000	33.63971585	-117.5874685	Orange County
313789	Non-Physician Medical Practitioner	None	1255710901	0	0	BURK, DANIEL E PA	9/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
313795	Non-Physician Medical Practitioner	None	1689872590	0	0	BUTLER, RORY L.	1/31/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
313798	Non-Physician Medical Practitioner	None	1265903868	0	0	BLASER, BROOKE C	4/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	00	06000	33.67783408	-117.8720921	Orange County
313804	Non-Physician Medical Practitioner	None	1629177647	0	0	BENTLEY, DANIEL A	9/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2718 LA CRESTA DR	None	BAKERSFIELD	CA	93305	1718	00	06000	35.39840089	-118.9973625	Kern County
313813	Non-Physician Medical Practitioner	None	1023655560	0	0	BASSI, ROHAN NP	1/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	00	06000	34.07771682	-117.7485431	Los Angeles County
313818	Non-Physician Medical Practitioner	None	1114638459	0	0	BINNING, GURJEET K CNM	7/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	00	06000	37.2882498	-120.4963024	Merced County
313836	Non-Physician Medical Practitioner	None	1699088922	0	0	BELL, JAMES R NP	1/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15022 GILMORE STREET	None	VAN NUYS	CA	91411	1424	00	06000	34.18753608	-118.4603898	Los Angeles County
313842	Non-Physician Medical Practitioner	None	1215603147	0	0	BONILLA, LINDSAY NP	1/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
313867	Non-Physician Medical Practitioner	None	1568804326	0	0	BYRNE, JENNIFER M	5/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2754 MOBLEY STREET	None	SAN DIEGO	CA	92123	3033	00	06000	32.79359271	-117.134658	San Diego County
313870	Non-Physician Medical Practitioner	None	1992495113	0	0	BAYER, SEAN G NP	7/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16279 WALNUT ST	None	HESPERIA	CA	92345	3622	00	06000	34.4213317	-117.3075694	San Bernardino County
313892	Non-Physician Medical Practitioner	None	1700926185	0	0	BACON, LORIN J	2/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2345 FAIR OAKS BLVD # 28	None	SACRAMENTO	CA	95825	4708	00	06000	38.57535	-121.407633	Sacramento County
313895	Non-Physician Medical Practitioner	None	1861556391	0	0	BAUTISTA, MARGARITA C	11/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
313914	Non-Physician Medical Practitioner	None	1083978928	0	0	BROWN, JEFFREY M JR	12/3/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1690 E FIR AVE	#237	FRESNO	CA	93720	2788	00	06000	36.84159	-119.7511605	Fresno County
313917	Non-Physician Medical Practitioner	None	1508471301	0	0	BECKELMAN, MATTHEW R NP	4/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
313928	Non-Physician Medical Practitioner	None	1033144712	0	0	BOB, KURTS PA	6/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5974 PENTZ RD	EMERGENCY DEPARTMENT	PARADISE	CA	95969	5509	00	06000	39.75705992	-121.572292	Butte County
313931	Non-Physician Medical Practitioner	None	1417110347	0	0	BARBOZA, MORIAH PSALM	9/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36867 COOK ST STE 101	None	PALM DESERT	CA	92211	6064	00	06000	33.781338	-116.358507	Riverside County
313938	Non-Physician Medical Practitioner	None	1942634753	0	0	BURKEL, ANNE M PA	6/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
313943	Non-Physician Medical Practitioner	None	1265419170	0	0	BARRERA, RUTH ANNE	3/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2944 FRESNO ST	None	FRESNO	CA	93721	1405	00	06000	36.74288962	-119.7823299	Fresno County
313945	Non-Physician Medical Practitioner	None	1568946705	0	0	BERRY, ADAM PA-C	11/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
313952	Non-Physician Medical Practitioner	None	1225527948	0	0	BRUBAKER, MCQUADE PA	8/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	00	06000	32.95809	-115.5537045	Imperial County
313959	Non-Physician Medical Practitioner	None	1760710065	0	0	BROOKS, ALLISON D NP	11/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9914 PASATIEMPO PLACE	None	MORENO VALLEY	CA	92557	3520	00	06000	33.97719317	-117.2580452	Riverside County
313975	Non-Physician Medical Practitioner	None	1174269310	0	0	BLEDSOE, BYRON C NP	8/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	00	06000	33.749316	-117.868123	Orange County
314000	Non-Physician Medical Practitioner	None	1093743510	0	0	BOWERS, RACHEL C	10/4/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7500 SMOKE RANCH RD	SUITE 200	LAS VEGAS	NV	89128	0324	00	06000	36.20350239	-115.2579709	Clark County
314019	Non-Physician Medical Practitioner	None	1891983664	0	0	BLEIER, WESTON L	3/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1335 BALFOUR CT	None	REDLANDS	CA	92374	5403	00	06000	34.05196961	-117.1568665	San Bernardino County
314035	Non-Physician Medical Practitioner	None	1275215048	0	0	BUSH, ASHLEY E NP	2/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
314036	Non-Physician Medical Practitioner	None	1023368453	0	0	BETH, SMITH A	8/19/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3915 DAVIS CT	None	EUREKA	CA	95503	6085	00	06000	40.7704127	-124.1677227	Humboldt County
314037	Non-Physician Medical Practitioner	None	1407972649	0	0	BREGMAN, GARY H	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20216 DELITA DR	None	WOODLAND HILLS	CA	91364	3522	00	06000	34.16362953	-118.5742298	Los Angeles County
314048	Non-Physician Medical Practitioner	None	1942815998	0	0	BUTLER, ASHLI A NP	5/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2433 CENTRAL AVENUE	SUITE A	ALAMEDA	CA	94501	4564	00	06000	37.76358675	-122.2413153	Alameda County
314053	Non-Physician Medical Practitioner	None	1790062982	0	0	BAEZ, IVAN PA-C	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
314066	Non-Physician Medical Practitioner	None	1275026502	0	0	BURDEN, CHARITY PA	6/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
314067	Non-Physician Medical Practitioner	None	1164881108	0	0	BORKOWSKI, ANA L NP	5/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
314133	Non-Physician Medical Practitioner	None	1396853065	0	0	BRAVO, RICARDO	1/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1072 GRANADA WAY	None	CHULA VISTA	CA	91910	8707	00	06000	32.63098021	-117.0134291	San Diego County
314150	Non-Physician Medical Practitioner	None	1659301000	0	0	BEDEROV, IGOR M	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	262 BONITA LN	None	FOSTER CITY	CA	94404	1982	00	06000	37.55857389	-122.2500525	San Mateo County
314190	Non-Physician Medical Practitioner	None	1619182656	0	0	BALDWIN, LISA A NP	12/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3661 SENASAC AVE	None	LONG BEACH	CA	90808	3752	00	06000	33.82396116	-118.1138466	Los Angeles County
314196	Non-Physician Medical Practitioner	None	1790729655	0	0	BUAN, PATRICK DAVID	11/13/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0000	00	06000	34.5406159	-117.2658221	San Bernardino County
314198	Non-Physician Medical Practitioner	None	1720518855	0	0	BERGERSEN, ERIC J	1/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	899 MORRISON PARK AVE	UNIT 302	SAN JOSE	CA	95126	5319	00	06000	37.33423231	-121.908037	Santa Clara County
314203	Non-Physician Medical Practitioner	None	1013060128	0	0	BRUNET, GREGORY T PA-C	6/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444782	-119.7794675	Santa Barbara County
314232	Non-Physician Medical Practitioner	None	1659003465	0	0	BELYK, KEAGAN PA-C	11/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1805 N CALIFORNIA ST	201	STOCKTON	CA	95204	6032	00	06000	37.9711691	-121.2894221	San Joaquin County
314238	Non-Physician Medical Practitioner	None	1285063347	0	0	BEHRENS, COURTNEY	11/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7306 N PUDDLE DUCK ST	None	LAS VEGAS	NV	89166	6508	00	06000	36.29396423	-115.3233384	Clark County
314239	Non-Physician Medical Practitioner	None	1790118644	0	0	BROTHWELL, AMANDA R NP	6/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2416 SERENA DR	None	RENO	NV	89503	2177	00	06000	39.54531071	-119.8486862	Washoe County
314259	Non-Physician Medical Practitioner	None	1326248592	0	0	BRUNO, NICHOLE LYNN	2/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1300 N. VIRGINIA STREET	None	PORT LAVACA	TX	77979	0000	00	06000	28.62450424	-96.63463786	Calhoun County
314261	Non-Physician Medical Practitioner	None	1700377199	0	0	BEGIER, JENNIFER A NP	9/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1815 5TH STREET	None	OROVILLE	CA	95965	4017	00	06000	39.51579533	-121.5762211	Butte County
314269	Non-Physician Medical Practitioner	None	1013594258	0	0	BARNOLA, DEBORA NP	6/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
314279	Non-Physician Medical Practitioner	None	1821595133	0	0	BATTIATO, VINCENT PA-C	6/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	06000	36.03815706	-114.9842287	Clark County
314281	Non-Physician Medical Practitioner	None	1518117753	0	0	BARR, NICOLE ELAINE	5/5/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	875 BLAKE WILBUR DR	None	PALO ALTO	CA	94304	2205	00	06000	37.43562782	-122.1766097	Santa Clara County
314315	Non-Physician Medical Practitioner	None	1154581247	0	0	BENAVIDEZ-KNIGHT, TUESDAY MARIE	10/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
314326	Non-Physician Medical Practitioner	None	1093054843	0	0	BETTENCOURT, HEATHER A CNP	8/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
314333	Non-Physician Medical Practitioner	None	1477628881	0	0	BAKER, JILL GISVOLD	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	FOUR SOUTHWEST	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
314357	Non-Physician Medical Practitioner	None	1194314104	0	0	BALBAS, SALMA PA-C	5/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	00	06000	33.4799323	-117.1033702	Riverside County
314359	Non-Physician Medical Practitioner	None	1083248868	0	0	BOYCE, TIMMIE PA	4/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
314374	Non-Physician Medical Practitioner	None	1336426840	0	0	BRANDEIS, KAREN P.	2/7/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1629 W 17TH ST STE A	None	SANTA ANA	CA	92706	3335	00	06000	33.7601103	-117.890505	Orange County
314385	Non-Physician Medical Practitioner	None	1346600525	0	0	BLUMSTEIN, BREE J NP	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1266 S CITRUS AVE	APT 19	LOS ANGLES	CA	90019	1612	00	06000	34.0512364	-118.3432593	Los Angeles County
314391	Non-Physician Medical Practitioner	None	1235135740	0	0	BOWLES, LA VETTE NP	12/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
314415	Non-Physician Medical Practitioner	None	1407341605	0	0	BIANCO, BROOKE N NP	11/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	838 5TH ST	APT 3	SANTA MONICA	CA	90403	1349	00	06000	34.02444732	-118.5027873	Los Angeles County
314445	Non-Physician Medical Practitioner	None	1134275456	0	0	BENSON, MINDY S	9/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5220 CLAREMONT AVE	None	OAKLAND	CA	94618	1033	00	06000	37.83868281	-122.2612035	Alameda County
314454	Non-Physician Medical Practitioner	None	1659485886	0	0	BAILER, LISA J	9/6/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	351 HOSPITAL RD	SUITE 401	NEWPORT BEACH	CA	92663	3509	00	06000	33.62579141	-117.9299554	Orange County
314456	Non-Physician Medical Practitioner	None	1891285995	0	0	BOGDANOVICH, HALEY M PA-C	7/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
314470	Non-Physician Medical Practitioner	None	1144541145	0	0	BAYLIS, ANNE M PA-C	8/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1029 MARENGO AVE	None	PASADENA	CA	91103	2602	00	06000	34.16356068	-118.1461605	Los Angeles County
314471	Non-Physician Medical Practitioner	None	1396001640	0	0	BREWSTER, JENNIFER D	1/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5007 MONTOYA AVE	APT 28	SAN PABLO	CA	94805	1050	00	06000	37.95028818	-122.3310205	Contra Costa County
314473	Non-Physician Medical Practitioner	None	1598261612	0	0	BATZ, KELLY L PA-C	12/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	00	06000	37.90582392	-122.0613697	Contra Costa County
314491	Non-Physician Medical Practitioner	None	1629199286	0	0	BROOKS, MADELENE C PA-C	7/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7063 BERYL ST	None	RANCHO CUCAMONGA	CA	91701	5619	00	06000	34.12595591	-117.6071671	San Bernardino County
314498	Non-Physician Medical Practitioner	None	1780088328	0	0	BRIDGES, ASHLEY S	11/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1634 MORRO STREET	None	SAN LUIS OBISPO	CA	93401	4016	00	06000	35.27626112	-120.6577878	San Luis Obispo County
314500	Non-Physician Medical Practitioner	None	1922306042	0	0	BURQUEZ, EDGAR PA	6/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	00	06000	34.02383346	-118.137193	Los Angeles County
314503	Non-Physician Medical Practitioner	None	1730478017	0	0	BROWN, ERICA L	2/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 JEWELL ST	None	SANTA CRUZ	CA	95060	2302	00	06000	36.98803001	-122.0259879	Santa Cruz County
314515	Non-Physician Medical Practitioner	None	1689881310	0	0	BRAVO, SUSAN A NP	6/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	676 YUCCA ST	None	IMPERIAL	CA	92251	8924	00	06000	32.81895202	-115.5933753	Imperial County
314568	Non-Physician Medical Practitioner	None	1851993760	0	0	BREMSER-JILES, EVA M NP	12/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 WASHINGTON STREET	None	SAN DIEGO	CA	92103	2289	00	06000	32.74986289	-117.1599343	San Diego County
314569	Non-Physician Medical Practitioner	None	1487854691	0	0	BERGUM, SHELLY K NP	12/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1581 CHRISTIFER LANE	None	YUBA CITY	CA	95993	1749	00	06000	39.15458782	-121.6390756	Sutter County
314571	Non-Physician Medical Practitioner	None	1952503112	0	0	BECHTOLD, DAVID M NP	2/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1531 ESPLANADE	None	CHICO	CA	95926	3310	00	06000	39.74248474	-121.8493369	Butte County
314574	Non-Physician Medical Practitioner	None	1437575974	0	0	BIRIESCU, CLAUDIA G NP	2/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4622 ROSE DR	None	YORBA LINDA	CA	92886	2032	00	06000	33.893685	-117.8418445	Orange County
314576	Non-Physician Medical Practitioner	None	1952999187	0	0	BUNAG, CHARLES NP	11/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
314584	Non-Physician Medical Practitioner	None	1467731042	0	0	BAQUIR, ABE RUBEN BERNARDO	5/25/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	994 S LA BREA AVE	None	INGLEWOOD	CA	90301	3816	00	06000	33.950556	-118.3525415	Los Angeles County
314586	Non-Physician Medical Practitioner	None	1639508526	0	0	BATHURST, MEAGAN K	1/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 ORANGE AVE	607	REDLANDS	CA	92373	1496	00	06000	34.05201151	-117.207558	San Bernardino County
314593	Non-Physician Medical Practitioner	None	1780776716	0	0	BENNETT, GLORIA D NP	7/19/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1349 MAIN ST	None	NEWMAN	CA	95360	1326	00	06000	37.31496518	-121.0225535	Stanislaus County
314610	Non-Physician Medical Practitioner	None	1760542252	0	0	BABCOCK GILL, LAUREL JEAN	9/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1250 BELLFLOWER BLVD	SHS	LONG BEACH	CA	90840	0201	00	06000	33.783174	-118.119528	Los Angeles County
314636	Non-Physician Medical Practitioner	None	1942687074	0	0	BURGA-HOGAN, GUILLERMO E NP	9/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	385 RIVER OAKS PKWY	APT 3011	SAN JOSE	CA	95134	3477	00	06000	37.40351193	-121.925278	Santa Clara County
314641	Non-Physician Medical Practitioner	None	1447586144	0	0	BIRD, JEREMY J	10/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4134 4TH AVE	UNIT 316	SAN DIEGO	CA	92103	1493	00	06000	32.752575	-117.1613895	San Diego County
314645	Non-Physician Medical Practitioner	None	1225449622	0	0	BOAMPONG, COLLINS RN	5/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6882 HOPCLOVER ROAD	None	EASTVALE	CA	92880	9144	00	06000	33.962886	-117.603821	Riverside County
314658	Non-Physician Medical Practitioner	None	1457758286	0	0	BHADEL, SHRITI PA	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
314688	Non-Physician Medical Practitioner	None	1669730545	0	0	BOICE, LEIZL	9/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPT. 148	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
314709	Non-Physician Medical Practitioner	None	1114491487	0	0	BOYLE, DANIEL J PA-C	2/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
314715	Non-Physician Medical Practitioner	None	1114754736	0	0	BASSI, PREETINDER	4/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
314731	Non-Physician Medical Practitioner	None	1710438825	0	0	BOCCIO, HEATHER D M NP	11/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2531 CHINOOK DR	None	WALNUT CREEK	CA	94598	4318	00	06000	37.90881638	-122.0192065	Contra Costa County
314732	Non-Physician Medical Practitioner	None	1952419202	0	0	BARRY, COURTNEY J	10/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 MAIN ST	None	SOLEDAD	CA	93960	2533	00	06000	36.43281182	-121.3243597	Monterey County
314734	Non-Physician Medical Practitioner	None	1831747492	0	0	BISHOP, EMILY N	9/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
314753	Non-Physician Medical Practitioner	None	1730736752	0	0	BOUCHER, IAN A PA-C	8/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
314767	Non-Physician Medical Practitioner	None	1104479005	0	0	BLANKS, MARCI M NP	9/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 SAN DIMAS ST	101	BAKERSFIELD	CA	93301	5711	00	06000	35.39552345	-119.0082184	Kern County
314777	Non-Physician Medical Practitioner	None	1407237118	0	0	BASSI, SUNNY	8/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	00	06000	33.02310224	-117.2826142	San Diego County
314793	Non-Physician Medical Practitioner	None	1649031345	0	0	BIRD, AELEEN NP	4/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12740 HESPERIA	SUITE A	VICTORVILLE	CA	92395	8306	00	06000	34.48256788	-117.2905361	San Bernardino County
314801	Non-Physician Medical Practitioner	None	1447598867	0	0	BJELAJAC, NATALIE NP	5/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
314811	Non-Physician Medical Practitioner	None	1699479212	0	0	BENYAMMI, LYDIA K PA-C	9/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	00	06000	37.24572659	-121.957997	Santa Clara County
314854	Non-Physician Medical Practitioner	None	1548723422	0	0	BUSH, SUNNY NP	4/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	00	06000	38.44950583	-122.7351601	Sonoma County
314858	Non-Physician Medical Practitioner	None	1154745321	0	0	BATES, CHELSEA D	5/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5947 ARMAGA SPRING ROAD	UNIT G	PALOS VERDES ESTA	CA	90275	4848	00	06000	33.77215815	-118.3824692	Los Angeles County
314874	Non-Physician Medical Practitioner	None	1962767111	0	0	BARNES, KAREN STOVER	2/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2576	00	06000	37.99585174	-122.3021549	Contra Costa County
314880	Non-Physician Medical Practitioner	None	1598518482	0	0	BARAKAT, ABDULFATAH A NP	5/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14901 RINALDI STREET	SUITE 200-201	MISSION HILLS	CA	91345	1254	00	06000	34.27903452	-118.457433	Los Angeles County
314898	Non-Physician Medical Practitioner	None	1730764721	0	0	BARTON, CHERYL NP	6/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
314900	Non-Physician Medical Practitioner	None	1043491764	0	0	BROWN, JANEE NP	12/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 EUCLID ST	203	ANAHEIM	CA	92801	4122	00	06000	33.8420837	-117.9415765	Orange County
314955	Non-Physician Medical Practitioner	None	1588854707	0	0	BOONE, CHRISTOPHER	4/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 COHASSET RD	SUITE 130	CHICO	CA	95926	2241	00	06000	39.75090044	-121.8522609	Butte County
314963	Non-Physician Medical Practitioner	None	1659558948	0	0	BLAUFARB, PAMELA LEMMON	11/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 SAN PABLO AVE	SUITE 400	ALBANY	CA	94706	1127	00	06000	37.89781848	-122.3014067	Alameda County
314970	Non-Physician Medical Practitioner	None	1669646824	0	0	BAKER-BALLANTYNE, JESSICA CNM	7/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 CASA ST	STE 220	SAN LUIS OBISPO	CA	93405	1890	00	06000	35.29359615	-120.6654304	San Luis Obispo County
314971	Non-Physician Medical Practitioner	None	1205379153	0	0	BAE, EILEEN NP	11/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
314979	Non-Physician Medical Practitioner	None	1952012601	0	0	BOURKE, JENNIFER NP	1/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
314987	Non-Physician Medical Practitioner	None	1841956984	0	0	BYRNES, KALEIGH E PA-C	4/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
314988	Non-Physician Medical Practitioner	None	1952896128	0	0	BROWN, KAELIN A NP	10/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21171 BRIARWOOD LANE	None	TRABUCO CANYON	CA	92679	3320	00	06000	33.65500541	-117.5674937	Orange County
314996	Non-Physician Medical Practitioner	None	1902317423	0	0	BLOURTCHI, ROD PA	11/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	00	06000	34.27680789	-119.2480851	Ventura County
315015	Non-Physician Medical Practitioner	None	1093016248	0	0	BENAVIDES-BARON, CAROLINA	8/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4348 COLDWATER CANYON	UNIT A	STUDIO CITY	CA	91604	5016	00	06000	34.149654	-118.4137635	Los Angeles County
315030	Non-Physician Medical Practitioner	None	1093344004	0	0	BUI, TOM A PA	12/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
315046	Non-Physician Medical Practitioner	None	1336504182	0	0	BRAND, KAREN S NP	10/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8906 GENOA AVE	None	ORANGEVALE	CA	95662	4616	00	06000	38.672055	-121.22388	Sacramento County
315075	Non-Physician Medical Practitioner	None	1073253068	0	0	BAKER-LUBIN, LILY PA-C	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315087	Non-Physician Medical Practitioner	None	1336337799	0	0	BJORNSTAD, NAOMI K	12/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	126 WEST 5TH ST	None	SAN DIMAS	CA	91773	2126	00	06000	34.11163377	-117.8084036	Los Angeles County
315099	Non-Physician Medical Practitioner	None	1851761894	0	0	BANKSTON, HAKIMAH A NP	2/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
315110	Non-Physician Medical Practitioner	None	1881099141	0	0	BABER, ROBERT R	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10132 N BAIRD AVE	None	FRESNO	CA	93730	5101	00	06000	36.883152	-119.743584	Fresno County
315114	Non-Physician Medical Practitioner	None	1932542099	0	0	BENUDIZ, NATALIE RACHEL	6/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2324 W PICO BLVD	None	LOS ANGELES	CA	90006	4002	00	06000	34.0472397	-118.28722	Los Angeles County
315116	Non-Physician Medical Practitioner	None	1508318064	0	0	BLANDINO, JANET NP	3/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20922 VAN DEENE AVE	None	TORRANCE	CA	90502	1738	00	06000	33.84008368	-118.2894382	Los Angeles County
315124	Non-Physician Medical Practitioner	None	1447602461	0	0	BRENNER, BENJAMIN J	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1220 SANDRINGHAM RD	None	BALA CYNWYD	PA	19004	2025	00	06000	40.02515322	-75.24331879	Montgomery County
315127	Non-Physician Medical Practitioner	None	1801493424	0	0	BREKKE, CARLEIGH NP	1/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
315131	Non-Physician Medical Practitioner	None	1992108823	0	0	BASHAM, CHRISTINA N PA-C	5/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
315140	Non-Physician Medical Practitioner	None	1548822349	0	0	BERNAL SUAREZ, MARA NP	1/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 CALIFORNIA ST	STE 801	SAN FRANCISCO	CA	94118	1522	00	06000	37.78591809	-122.4575439	San Francisco County
315154	Non-Physician Medical Practitioner	None	1003183146	0	0	BAUTISTA-DURAND, MARIA I NP	3/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13230 RED BIRD CT	None	MOORPARK	CA	93021	1179	00	06000	34.29900601	-118.8795127	Ventura County
315182	Non-Physician Medical Practitioner	None	1083675821	0	0	BAHRAMI, FARIDEH FARID	4/5/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11 TECHNOLOGY DR	None	IRVINE	CA	92618	2302	00	06000	33.64943597	-117.7367785	Orange County
315193	Non-Physician Medical Practitioner	None	1750474177	0	0	BLAKESPEAR, JEREMY DANIEL	1/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3220 MISSION AVE STE 1	None	OCEANSIDE	CA	92058	1354	00	06000	33.2141644	-117.3472638	San Diego County
315220	Non-Physician Medical Practitioner	None	1740339647	0	0	BAAD, DEBORAH A	6/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7811 LAGUNA BLVD	SUITE 170	ELK GROVE	CA	95758	7941	00	06000	38.423259	-121.4118945	Sacramento County
315229	Non-Physician Medical Practitioner	None	1568469922	0	0	BROWN, DARREL JAMES	5/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	00	06000	38.95005226	-122.6264492	Lake County
315235	Non-Physician Medical Practitioner	None	1508064593	0	0	BERMAN, KATHERINE J	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5406 LOCUST AVE	None	CARMICHAEL	CA	95608	6642	00	06000	38.642436	-121.3388145	Sacramento County
315252	Non-Physician Medical Practitioner	None	1538945530	0	0	BUSCH, ALLISON PA	10/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
315301	Non-Physician Medical Practitioner	None	1215105580	0	0	BENAVIDES, MARTHA E NP	1/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2424 TRIDENT DR	None	MODESTO	CA	95355	7917	00	06000	37.68340144	-120.9518734	Stanislaus County
315339	Non-Physician Medical Practitioner	None	1831315068	0	0	BANTIGUE, ANNA MARIE J	10/11/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16300 SAND CANYON AVE	4TH FLOOR	IRVINE	CA	92618	3711	00	06000	33.66115075	-117.7742405	Orange County
315344	Non-Physician Medical Practitioner	None	1215053459	0	0	BEATTIE, HILARIE J	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9041 OCEANWOOD DR	None	HUNTINGTON BEACH	CA	92646	6310	00	06000	33.6594418	-117.9702297	Orange County
315346	Non-Physician Medical Practitioner	None	1104079367	0	0	BODELL, ASHLEIGH E PA-C	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1340 MITCHELL RD	None	MODESTO	CA	95351	4920	00	06000	37.61159722	-120.9387211	Stanislaus County
315360	Non-Physician Medical Practitioner	None	1447077870	0	0	BOCCARDO, SEDONA E PA-C	12/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3331	00	06000	33.85291987	-117.5664344	Riverside County
315372	Non-Physician Medical Practitioner	None	1457745192	0	0	BERRY, DEVON NP	2/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3762 SANTA ROSALIA DR	C30	LOS ANGELES	CA	90008	3612	00	06000	34.0093581	-118.3391847	Los Angeles County
315398	Non-Physician Medical Practitioner	None	1790803666	0	0	BOYER, KATHERINE MARIE	1/22/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9725 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90212	2002	00	06000	34.06710448	-118.4074695	Los Angeles County
315425	Non-Physician Medical Practitioner	None	1437387198	0	0	BOAZ, SAMMANTHA L	12/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	103 NIETO AVE	APT B	LONG BEACH	CA	90803	6926	00	06000	33.75757046	-118.1370588	Los Angeles County
315517	Non-Physician Medical Practitioner	None	1760188890	0	0	BULLARD, REBECCA A NP	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
315529	Non-Physician Medical Practitioner	None	1538398870	0	0	BATTLES, MANDI PA-C	10/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2107 AIRPARK DR	None	REDDING	CA	96001	2433	00	06000	40.57493327	-122.4048185	Shasta County
315530	Non-Physician Medical Practitioner	None	1568430536	0	0	BELINDA, MEDRANO NP	4/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 FLORIDA AVE	SUITE B	MODESTO	CA	95350	4437	00	06000	37.666053	-120.996222	Stanislaus County
315531	Non-Physician Medical Practitioner	None	1194136754	0	0	BURGOS, REGINA R NP	2/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1608 BONAIRE CIR	None	STOCKTON	CA	95210	5671	00	06000	37.99805558	-121.2862633	San Joaquin County
315536	Non-Physician Medical Practitioner	None	1730640624	0	0	BYKOWSKI, MARIA GUADALUPE NP	11/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5823 YORK BLVD	STE 1	LOS ANGELES	CA	90042	2634	00	06000	34.11850913	-118.1915335	Los Angeles County
315544	Non-Physician Medical Practitioner	None	1841388386	0	0	BERNAL, YVONNE	5/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12980 FREDERICK ST	SUITE A	MORENO VALLEY	CA	92553	5263	00	06000	33.931872	-117.2613835	Riverside County
315547	Non-Physician Medical Practitioner	None	1093464679	0	0	BROOKS, KAYLA L PA	9/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	00	06000	33.95062799	-118.0051627	Los Angeles County
315558	Non-Physician Medical Practitioner	None	1811474349	0	0	BAZROY, REEVA C NP	1/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	00	06000	33.749316	-117.868123	Orange County
315560	Non-Physician Medical Practitioner	None	1871074849	0	0	BALLINGER, SHARON NP	4/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	00	06000	38.26109552	-122.0470245	Solano County
315561	Non-Physician Medical Practitioner	None	1780179374	0	0	BRIGHAM, ELIZABETH A PA	9/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
315579	Non-Physician Medical Practitioner	None	1982151825	0	0	BROWNING, GEORGEANA S NP	10/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32560 JUNIPER BERRY DR	None	WINCHESTER	CA	92596	8657	00	06000	33.5917357	-117.0913706	Riverside County
315590	Non-Physician Medical Practitioner	None	1750004040	0	0	BEST, APRIL L NP	1/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	00	06000	37.78594176	-122.421322	San Francisco County
315615	Non-Physician Medical Practitioner	None	1942638978	0	0	BRIGHTER BEGINNINGS	5/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
315624	Non-Physician Medical Practitioner	None	1235203274	0	0	BRUNER-WELCH, ANN S	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 BICENTENNIAL WAY # 1	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
315653	Non-Physician Medical Practitioner	None	1083966931	0	0	BARNELL, GREGORY MILLER	1/29/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
315656	Non-Physician Medical Practitioner	None	1497902639	0	0	BERNARDO, HORACIO J NP	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	730 STEP BEACH ST	None	LAS VEGAS	NV	89138	6100	00	06000	36.16495118	-115.3641271	Clark County
315667	Non-Physician Medical Practitioner	None	1437501350	0	0	BAER, ERICKA W	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5501 HALISON ST	APT 303	TORRANCE	CA	90503	1214	00	06000	33.85129453	-118.3707945	Los Angeles County
315672	Non-Physician Medical Practitioner	None	1306363700	0	0	BLASIC, VANESSA A	1/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8796 AVENIDA MIRADOR	None	RANCHO SANTA FE	CA	92067	0000	00	06000	33.05289846	-117.1345407	San Diego County
315697	Non-Physician Medical Practitioner	None	1013016724	0	0	BEIDER, ELENA PA-C	7/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	901 CAMPUS DR.	None	DALY CITY	CA	94015	4900	00	06000	37.66535778	-122.4763793	San Mateo County
315701	Non-Physician Medical Practitioner	None	1366938342	0	0	BERNENS, CHLOE N PA-C	8/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3301 C ST	STE 550	SACRAMENTO	CA	95816	3372	00	06000	38.579877	-121.456143	Sacramento County
315731	Non-Physician Medical Practitioner	None	1720489289	0	0	BU, YI	12/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12512 CAMERERO CT	None	SAN DIEGO	CA	92130	2279	00	06000	32.94538459	-117.2257379	San Diego County
315740	Non-Physician Medical Practitioner	None	1194865535	0	0	BROWN, KRISTIN R NP	4/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9500 STOCKDALE HWY	STE 203	BAKERSFIELD	CA	93311	3620	00	06000	35.35452448	-119.1074625	Kern County
315753	Non-Physician Medical Practitioner	None	1316053036	0	0	BAILEY, CYNTHIA L	12/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13461 ETON PLACE	None	SANTA ANA	CA	92705	2164	00	06000	33.76666437	-117.8094547	Orange County
315758	Non-Physician Medical Practitioner	None	1871667337	0	0	BRABANT, KAREN E NP	5/10/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29832 REDWOOD DR	None	CANYON LAKE	CA	92587	7947	00	06000	33.68700018	-117.2644347	Riverside County
315770	Non-Physician Medical Practitioner	None	1851464630	0	0	BELLITT, CYNTHIA ANN	5/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 LENNON LN	LASSEN BUILDING - SECOND	WALNUT CREEK	CA	94598	2419	00	06000	37.92699561	-122.0292732	Contra Costa County
315779	Non-Physician Medical Practitioner	None	1518018696	0	0	BARNABA, MARIE-CLAIRE LUCIA	1/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2299 BACON ST	None	CONCORD	CA	94520	2050	00	06000	37.98199042	-122.0349518	Contra Costa County
315799	Non-Physician Medical Practitioner	None	1194011973	0	0	BROWN, KATHRYN A	6/22/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	430 MISSION ST	None	SOUTH PASADENA	CA	91030	3056	00	06000	34.1157065	-118.165455	Los Angeles County
315805	Non-Physician Medical Practitioner	None	1962039503	0	0	BOGAR, DEBRA M NP	5/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 W REDLANDS BLVD	None	REDLANDS	CA	92373	8054	00	06000	34.06288379	-117.2156673	San Bernardino County
315808	Non-Physician Medical Practitioner	None	1093226045	0	0	BAKALIAN, ANNA NP	1/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
315834	Non-Physician Medical Practitioner	None	1891376737	0	0	BUENAVENTURA, CARLA ANDREA L NP	1/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
315839	Non-Physician Medical Practitioner	None	1619173010	0	0	BLODGETT, KEVIN J	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21185 VIA TEODOCIO	None	YORBA LINDA	CA	92887	1820	00	06000	33.89223694	-117.7632095	Orange County
315841	Non-Physician Medical Practitioner	None	1447877519	0	0	BREAULT, RACHEL PA-C	12/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2490 HOSPITAL DRIVE	106	MOUNTAIN VIEW	CA	94040	4122	00	06000	37.369827	-122.0818185	Santa Clara County
315876	Non-Physician Medical Practitioner	None	1548242662	0	0	BANGS, KENNETH E NP	2/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1183 MENLO AVE	None	CLOVIS	CA	93612	0424	00	06000	36.83104282	-119.6936967	Fresno County
315898	Non-Physician Medical Practitioner	None	1316475759	0	0	BAUTISTA, MARIEL B NP	11/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	00	06000	34.51312455	-117.325854	San Bernardino County
315921	Non-Physician Medical Practitioner	None	1831520030	0	0	BUCHANAN, ALICIA N	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4446 LAKEVIEW DRIVE	None	VACAVILLE	CA	95688	9646	00	06000	38.44345925	-121.9739058	Solano County
315932	Non-Physician Medical Practitioner	None	1619469335	0	0	BURTON, SARAH E	12/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6003 RENO AVE	None	TEMPLE CITY	CA	91780	1531	00	06000	34.10783368	-118.0748383	Los Angeles County
315955	Non-Physician Medical Practitioner	None	1427544600	0	0	BARKER, KELLY L PA-C	3/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
315959	Non-Physician Medical Practitioner	None	1902337892	0	0	BRONSON, LILLIAN CNM	3/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
315969	Non-Physician Medical Practitioner	None	1134382013	0	0	BROAD, JOSHUA PA-C	12/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12380 HESPERIA RD	STE 2	VICTORVILLE	CA	92395	5814	00	06000	34.47639649	-117.2913437	San Bernardino County
315990	Non-Physician Medical Practitioner	None	1013456169	0	0	BROWN, BRITTANY M NP	4/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	00	06000	33.62579141	-117.9299554	Orange County
316028	Non-Physician Medical Practitioner	None	1790341238	0	0	BOYD, TAYLOR N PA-C	11/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
316029	Non-Physician Medical Practitioner	None	1871646109	0	0	BROWN, SHARON L NP	8/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3349 G STREET	SUITE F	MERCED	CA	95340	0978	00	06000	37.32432497	-120.4693064	Merced County
316055	Ordering, Referring, Prescribing	N/A	1003011057	0	0	BHUTIA, NAMGYAL D MD	1/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C155127	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
316077	Ordering, Referring, Prescribing	N/A	1003053968	0	0	BULLWINKLE, TANYA E S CNM	2/5/2015	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	238	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
316088	Ordering, Referring, Prescribing	N/A	1003102997	0	0	BLANCO, YOJANNE LMFT	8/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120656	N/A	N/A	N/A	N/A	N/A	43520 DIVISION ST	None	LANCASTER	CA	93535	1002	00	06000	34.673445	-118.130143	Los Angeles County
316098	Ordering, Referring, Prescribing	N/A	1003111386	0	0	BERNAL, MARIA D LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93605	N/A	N/A	N/A	N/A	N/A	1855 W. KATELLA AVE	150	ORANGE	CA	92867	3432	00	06000	33.8061655	-117.872442	Orange County
316111	Ordering, Referring, Prescribing	N/A	1003123258	0	0	BARAJAS, VERONICA P LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68088	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	SUITE 200	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
316118	Ordering, Referring, Prescribing	N/A	1003141847	0	0	BALSAMO, DALIA N MD	5/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142906	N/A	N/A	N/A	N/A	N/A	1820 UNIVERSITY AVENUE	None	RIVERSIDE	CA	92507	5355	00	06000	33.97557853	-117.3511845	Riverside County
316131	Ordering, Referring, Prescribing	N/A	1003162165	0	0	BARRETT, DIANA LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102677	N/A	N/A	N/A	N/A	N/A	16055 VENTURA BLVD.	555	ENCINO	CA	91436	2607	00	06000	34.15632563	-118.4832351	Los Angeles County
316136	Ordering, Referring, Prescribing	N/A	1003167230	0	0	BERMAN, CHARLES Z LCSW	4/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80082	N/A	N/A	N/A	N/A	N/A	982 MISSION ST	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
316138	Ordering, Referring, Prescribing	N/A	1003167404	0	0	BAGNOL, VALERIE L LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68694	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
316148	Ordering, Referring, Prescribing	N/A	1003177478	0	0	BEY, ANDREA N LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115208	N/A	N/A	N/A	N/A	N/A	1255 KENDALL RD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
316152	Ordering, Referring, Prescribing	N/A	1003183146	0	0	BAUTISTA-DURAND, MARIA I	3/18/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0513943	N/A	N/A	N/A	N/A	N/A	2400 SOUTH FLOWER ST	None	LOS ANGELES	CA	90007	2629	00	06000	34.02861627	-118.273964	Los Angeles County
316173	Ordering, Referring, Prescribing	N/A	1003213091	0	0	BRYSON, NATASHA B	12/2/2019	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC3919	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
316194	Ordering, Referring, Prescribing	N/A	1003242793	0	0	BOLAND, JONATHAN R LCSW	8/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75787	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
316214	Ordering, Referring, Prescribing	N/A	1003268426	0	0	BALL, JOHN PHARMD	11/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	45550	N/A	N/A	N/A	N/A	N/A	3400 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	00	06000	34.02767826	-118.2008037	Los Angeles County
316219	Ordering, Referring, Prescribing	N/A	1003278797	0	0	BANDY-KELLY, DEBRA A LMFT	7/27/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35691	N/A	N/A	N/A	N/A	N/A	29122 RANCHO VIEJO ROAD	206	SAN JUAN CAPISTRA	CA	92675	1039	00	06000	33.53997919	-117.6733941	Orange County
316270	Ordering, Referring, Prescribing	N/A	1003349333	0	0	BILLINGS, AJA	3/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120114	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
316278	Ordering, Referring, Prescribing	N/A	1003360108	0	0	BROWN, ANISSA NP	9/16/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012827	N/A	N/A	N/A	N/A	N/A	3501 COFFEE ROAD	7	MODESTO	CA	95355	1343	00	06000	37.689237	-120.9761155	Stanislaus County
316281	Ordering, Referring, Prescribing	N/A	1003365743	0	0	BRUFFEY, CAITLIN E LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111505	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD.	None	PITTSBURG	CA	94565	7232	00	06000	38.0354387	-121.8837345	Contra Costa County
316284	Ordering, Referring, Prescribing	N/A	1003362781	0	0	BENITEZ, DIANA E NP	9/9/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	757608	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
316312	Ordering, Referring, Prescribing	N/A	1003406166	0	0	BURGESS, SUSAN PHARMD	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58285	N/A	N/A	N/A	N/A	N/A	1058 MAIN STREET	None	FORTUNA	CA	95540	2009	00	06000	40.59800746	-124.1558685	Humboldt County
316325	Ordering, Referring, Prescribing	N/A	1003430349	0	0	BACON, JASMINE CCC-SLP	4/28/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	31657	N/A	N/A	N/A	N/A	N/A	3722 KATELLA AVE	SUITE C	LOS ALAMITOS	CA	90720	3102	00	06000	33.8029617	-118.0678946	Orange County
316336	Ordering, Referring, Prescribing	N/A	1003443151	0	0	BELL, JEDIDIAH MD	10/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186039	N/A	N/A	N/A	N/A	N/A	150 HARBOUR WAY	None	RICHMOND	CA	94801	3554	00	06000	37.933713	-122.3599835	Contra Costa County
316341	Ordering, Referring, Prescribing	N/A	1003446766	0	0	BOPP LITZ, JENNIFER	8/24/2019	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3731	N/A	N/A	N/A	N/A	N/A	2440 TULARE ST,	None	FRESNO	CA	93721	2269	00	06000	36.73727495	-119.7852493	Fresno County
316347	Ordering, Referring, Prescribing	N/A	1003453291	0	0	BISLA, NAVJOT K PHARMD	12/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81473	N/A	N/A	N/A	N/A	N/A	3100 FOWLER AVE	None	CLOVIS	CA	93611	2100	00	06000	36.794754	-119.6840025	Fresno County
316394	Ordering, Referring, Prescribing	N/A	1003555889	0	0	BUI, BREANNA M NP	2/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020073	N/A	N/A	N/A	N/A	N/A	1820 J ST.	STE 250	SACRAMENTO	CA	95811	3010	00	06000	38.57688	-121.4816625	Sacramento County
316432	Ordering, Referring, Prescribing	N/A	1003841727	0	0	BUTTERFIELD, JEAN R MD	5/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G175120	N/A	N/A	N/A	N/A	N/A	303 S C ST	None	LOMPOC	CA	93436	7305	00	06000	34.63525845	-120.451628	Santa Barbara County
316462	Ordering, Referring, Prescribing	N/A	1003954744	0	0	BLAKES, ANNETTE C MD	4/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84036	N/A	N/A	N/A	N/A	N/A	4401 CRENSHAW BLVD.	SUITE 300	LOS ANGELES	CA	90043	1200	00	06000	34.00339495	-118.3318951	Los Angeles County
316465	Ordering, Referring, Prescribing	N/A	1003961210	0	0	BAUTISTA, JESSICA M LMFT	5/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96311	N/A	N/A	N/A	N/A	N/A	391 TAYLOR BLVD.	SUITE 100	PLEASANT HILL	CA	94523	2257	00	06000	37.96119614	-122.070409	Contra Costa County
316506	Ordering, Referring, Prescribing	N/A	1013041052	0	0	BAUER, LORI M LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38542	N/A	N/A	N/A	N/A	N/A	225 W BROADWAY	None	GLENDALE	CA	91204	1331	00	06000	34.14673469	-118.257145	Los Angeles County
316512	Ordering, Referring, Prescribing	N/A	1013048008	0	0	BRAMLETT, BOBBY J DC	9/18/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	23751	N/A	N/A	N/A	N/A	N/A	161 N MILL ST	None	TEHACHAPI	CA	93561	1347	00	06000	35.13410412	-118.4520157	Kern County
316518	Ordering, Referring, Prescribing	N/A	1013063478	0	0	BOST-BAXTER, EMILY A MD	3/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A105780	N/A	N/A	N/A	N/A	N/A	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	00	06000	34.05373818	-118.3839685	Los Angeles County
316530	Ordering, Referring, Prescribing	N/A	1013091081	0	0	BOYLAN, BARBARA A MD	6/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G62299	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
316558	Ordering, Referring, Prescribing	N/A	1013152842	0	0	BENATAR, MARTINE LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39564	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD.	None	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
316564	Ordering, Referring, Prescribing	N/A	1013163542	0	0	BRADDOCK, ADAM L MD	1/23/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114671	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
316569	Ordering, Referring, Prescribing	N/A	1013163823	0	0	BYRA-COOK, CYNTHIA J NP	3/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	317897	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	FL 29	LOS ANGELES	CA	90017	1644	00	06000	34.05611213	-118.2570905	Los Angeles County
316605	Ordering, Referring, Prescribing	N/A	1013218668	0	0	BRADBURY, SUZANNE E PHARMD	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52415	N/A	N/A	N/A	N/A	N/A	3550 MURPHY CANYON RD	None	SAN DIEGO	CA	92123	2656	00	06000	32.80792564	-117.1150773	San Diego County
316608	Ordering, Referring, Prescribing	N/A	1013217504	0	0	BANAGA, MICHELLE PHARMD	2/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55732	N/A	N/A	N/A	N/A	N/A	11050 BOLLINGER CANYON R	None	SAN RAMON	CA	94582	4959	00	06000	37.77377147	-121.9221005	Contra Costa County
316623	Ordering, Referring, Prescribing	N/A	1013258946	0	0	BALLEW, ELIZABETH A PHARMD	8/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58766	N/A	N/A	N/A	N/A	N/A	2720 41ST AVE	None	SOQUEL	CA	95073	2111	00	06000	36.986112	-121.9649115	Santa Cruz County
316624	Ordering, Referring, Prescribing	N/A	1013249580	0	0	BEKHIT, DALIA R	9/2/2010	Taxonomy not applicable	NA	n/a	099	DENTIST	D57017	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
316644	Ordering, Referring, Prescribing	N/A	1013294446	0	0	BARTON, MIRIAM LMFT	1/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124001	N/A	N/A	N/A	N/A	N/A	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	00	06000	32.7011883	-117.1261025	San Diego County
316672	Ordering, Referring, Prescribing	N/A	1013328251	0	0	BARROWS, TESSA LMFT	4/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105834	N/A	N/A	N/A	N/A	N/A	2800 PLEASANT HILL RD	SUITE 280	PLEASANT HILL	CA	94523	2003	00	06000	37.95774955	-122.0922963	Contra Costa County
316695	Ordering, Referring, Prescribing	N/A	1013363217	0	0	BRENNER, KRISTINA M PHARMD	3/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	66013	N/A	N/A	N/A	N/A	N/A	1445 R ST	None	MERCED	CA	95340	0000	00	06000	37.303164	-120.4974855	Merced County
316720	Ordering, Referring, Prescribing	N/A	1013402098	0	0	BAE, KAREN PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77568	N/A	N/A	N/A	N/A	N/A	17284 SLOVER AVE	204	FONTANA	CA	92337	7584	00	06000	34.065396	-117.4277475	San Bernardino County
316739	Ordering, Referring, Prescribing	N/A	1013433424	0	0	BENNETT, FRANCES L LMFT	3/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124984	N/A	N/A	N/A	N/A	N/A	14535 SHERMAN CIRCLE	None	LOS ANGELES	CA	91405	3087	00	06000	34.20064259	-118.450312	Los Angeles County
316741	Ordering, Referring, Prescribing	N/A	1013436377	0	0	BOWMAN, CONOR W PHARMD	4/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76039	N/A	N/A	N/A	N/A	N/A	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	00	06000	37.48948529	-122.2232468	San Mateo County
316742	Ordering, Referring, Prescribing	N/A	1013434950	0	0	BOULOS, SHALIMAR F LCSW	4/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115300	N/A	N/A	N/A	N/A	N/A	390 40TH ST	None	OAKLAND	CA	94609	2633	00	06000	37.82836982	-122.2593946	Alameda County
316760	Ordering, Referring, Prescribing	N/A	1013464262	0	0	BETTLEY, AMBER M LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118769	N/A	N/A	N/A	N/A	N/A	8568 DOVE CREEK TRL	None	HESPERIA	CA	92344	8236	00	06000	34.40617577	-117.3470517	San Bernardino County
316761	Ordering, Referring, Prescribing	N/A	1013464205	0	0	BAKER, PHILIP M LMFT	1/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123907	N/A	N/A	N/A	N/A	N/A	2118 WILLOW PASS ROAD	#500	CONCORD	CA	94520	2408	00	06000	37.97666461	-122.033785	Contra Costa County
316794	Ordering, Referring, Prescribing	N/A	1013530039	0	0	BREWSTER, APRIL J NP	10/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013833	N/A	N/A	N/A	N/A	N/A	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
316813	Ordering, Referring, Prescribing	N/A	1013573112	0	0	BENNETT, THERESA U LMFT	6/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139849	N/A	N/A	N/A	N/A	N/A	10200 SEPULVEDA BLVD	#107	MISSION HILLS	CA	91345	3322	00	06000	34.25572562	-118.4673156	Los Angeles County
316819	Ordering, Referring, Prescribing	N/A	1013584127	0	0	BARLOW, ZACHARY MD	8/14/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A198378	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LN	None	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
316827	Ordering, Referring, Prescribing	N/A	1013630995	0	0	BIRRING, MANJEET K NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022612	N/A	N/A	N/A	N/A	N/A	1349 MAIN STREET	None	NEWMAN	CA	95360	1326	00	06000	37.31496518	-121.0225535	Stanislaus County
316831	Ordering, Referring, Prescribing	N/A	1013644798	0	0	BACHALA, COURTNEY CNP	8/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022029	N/A	N/A	N/A	N/A	N/A	505 E. ROMIE LANE	SUITE K	SALINAS	CA	93901	4072	00	06000	36.65998191	-121.6461895	Monterey County
316846	Ordering, Referring, Prescribing	N/A	1013776244	0	0	BEARDSWORTH, KATHLEEN MD	8/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL16081	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
316862	Ordering, Referring, Prescribing	N/A	1013980481	0	0	BORGE, DAVID MD	8/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68939	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3314	00	06000	38.62757555	-122.8638141	Sonoma County
316906	Ordering, Referring, Prescribing	N/A	1023135084	0	0	BARRERA, CHRISTY LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75204	N/A	N/A	N/A	N/A	N/A	1270 NATIVIDAD RD	None	SALINAS	CA	93906	3144	00	06000	36.69733474	-121.6370383	Monterey County
316910	Ordering, Referring, Prescribing	N/A	1023137106	0	0	BERMUDEZ, ROBERT S LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53457	N/A	N/A	N/A	N/A	N/A	930 N. STATE ST.	None	HEMET	CA	92543	1473	00	06000	33.7625523	-116.9717521	Riverside County
316911	Ordering, Referring, Prescribing	N/A	1023144326	0	0	BURROWES, SIMON A LCSW	3/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW62416	N/A	N/A	N/A	N/A	N/A	3715 COLUMBUS ST	None	BAKERSFIELD	CA	93306	2719	00	06000	35.39925709	-118.9522496	Kern County
316957	Ordering, Referring, Prescribing	N/A	1023175619	0	0	BAHNER, KRISTIN E LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38251	N/A	N/A	N/A	N/A	N/A	354 S. HALCYON RD	None	ARROYO GRANDE	CA	93420	0000	00	06000	35.1136354	-120.5916435	San Luis Obispo County
316963	Ordering, Referring, Prescribing	N/A	1023254992	0	0	BUI, THAO P LMFT	4/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105105	N/A	N/A	N/A	N/A	N/A	2295 CALIFORNIA ST.	None	SAN FRANCISCO	CA	94115	0000	00	06000	37.78910735	-122.431927	San Francisco County
316966	Ordering, Referring, Prescribing	N/A	1023272051	0	0	BROWN, KRISTIAN MD	10/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124291	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
316973	Ordering, Referring, Prescribing	N/A	1023281045	0	0	BUCHANAN, RAYMOND W LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44610	N/A	N/A	N/A	N/A	N/A	1830 S. CENTRAL STREET	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
317001	Ordering, Referring, Prescribing	N/A	1023341989	0	0	BAKER, SHEILA D LMFT	8/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42168	N/A	N/A	N/A	N/A	N/A	5362 LEMEE LN	None	MARIPOSA	CA	95338	9556	00	06000	37.499481	-119.984238	Mariposa County
317003	Ordering, Referring, Prescribing	N/A	1023343050	0	0	BENALCAZAR, ALDO A LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68914	N/A	N/A	N/A	N/A	N/A	10355 SLUSHER DR	None	SANTA FE SPRINGS	CA	90670	7353	00	06000	33.94228286	-118.0779517	Los Angeles County
317020	Ordering, Referring, Prescribing	N/A	1023343084	0	0	BRAMMER, CHRISTOPHER J NP	5/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	661871	N/A	N/A	N/A	N/A	N/A	41696 ROAD 128	None	OROSI	CA	93647	2059	00	06000	36.54685753	-119.2869082	Tulare County
317031	Ordering, Referring, Prescribing	N/A	1023403847	0	0	BAMFO, NANA LMFT	2/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131294	N/A	N/A	N/A	N/A	N/A	229 SOUTH RIVERSIDE AVE	110	RIALTO	CA	92376	3285	00	06000	34.0977093	-117.3701818	San Bernardino County
317040	Ordering, Referring, Prescribing	N/A	1023413085	0	0	BARRY, DANIEL C PA-C	5/13/2020	Taxonomy not applicable	NA	n/a	000	Unknown	54430	N/A	N/A	N/A	N/A	N/A	209 NEVADA STREET	None	DOWNEVILLE	CA	95936	0151	00	06000	39.55907195	-120.8295366	Sierra County
317059	Ordering, Referring, Prescribing	N/A	1023440955	0	0	BUSTOS, JOSE L	3/16/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	D27246	N/A	N/A	N/A	N/A	N/A	36977 PARK AVE	None	BURNEY	CA	96013	4067	00	06000	40.87640189	-121.6730441	Shasta County
317074	Ordering, Referring, Prescribing	N/A	1023464864	0	0	BROWN, MATTHEW LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113303	N/A	N/A	N/A	N/A	N/A	550 W VISTA WAY	407	VISTA	CA	92083	5732	00	06000	33.19564771	-117.2534095	San Diego County
317075	Ordering, Referring, Prescribing	N/A	1023463874	0	0	BARDAKJIAN, SHANT G LMFT	2/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108744	N/A	N/A	N/A	N/A	N/A	237 N CENTRAL AVE	C	GLENDALE	CA	91203	3526	00	06000	34.14943423	-118.2579487	Los Angeles County
317076	Ordering, Referring, Prescribing	N/A	1023471174	0	0	BOLIN, JEREMY MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151508	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
317086	Ordering, Referring, Prescribing	N/A	1023481975	0	0	BARRICK, EMILY L PA	6/3/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53005	N/A	N/A	N/A	N/A	N/A	1700 W HILLSDALE BLVD	BLDG 1, ROOM 226	SAN MATEO	CA	94402	3757	00	06000	37.53183837	-122.3352514	San Mateo County
317112	Ordering, Referring, Prescribing	N/A	1023516390	0	0	BRISENO, DAYDA M LMFT	11/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151217	N/A	N/A	N/A	N/A	N/A	131 W MIDWAY DR	None	ANAHEIM	CA	92805	6507	00	06000	33.81259746	-117.910782	Orange County
317124	Ordering, Referring, Prescribing	N/A	1023530219	0	0	BORCHGREVINK, KELBY PA-C	10/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63438	N/A	N/A	N/A	N/A	N/A	3425 N FIRST STREET	None	FRESNO	CA	93726	6821	00	06000	36.78186519	-119.7726482	Fresno County
317151	Ordering, Referring, Prescribing	N/A	1023586930	0	0	BEERS, JENNIFER M LMFT	5/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125861	N/A	N/A	N/A	N/A	N/A	1940 E DEERE AVE	100	SANTA ANA	CA	92705	5718	00	06000	33.70430421	-117.8482556	Orange County
317176	Ordering, Referring, Prescribing	N/A	1023627627	0	0	BOYER, PAUL J LCSW	8/29/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117813	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
317178	Ordering, Referring, Prescribing	N/A	1023628435	0	0	BETANCOURT, SONIA I NP	7/15/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014929	N/A	N/A	N/A	N/A	N/A	621 N. STATE ST. #3	None	SAN JACINTO	CA	92583	6567	00	06000	33.79501272	-116.9715035	Riverside County
317198	Ordering, Referring, Prescribing	N/A	1023679115	0	0	BEJAR, CHRISTOPHER	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80535	N/A	N/A	N/A	N/A	N/A	3800 ROSEDALE HWY	None	BAKERSFIELD	CA	93308	6235	00	06000	35.38336645	-119.0492391	Kern County
317222	Ordering, Referring, Prescribing	N/A	1023753423	0	0	BROWN, CHERYL C RN	5/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	384494	N/A	N/A	N/A	N/A	N/A	1401 BROADWAY AVE	None	ATWATER	CA	95301	3546	00	06000	37.34777935	-120.6114041	Merced County
317234	Ordering, Referring, Prescribing	N/A	1023841491	0	0	BEGGS, AMANDA NP	8/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031810	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVENUE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
317250	Ordering, Referring, Prescribing	N/A	1033133020	0	0	BRISKIN BERENSON, ROBIN JOY LMFT	9/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	19328	N/A	N/A	N/A	N/A	N/A	1330 LINCOLN AVE	201	SAN RAFAEL	CA	94901	2142	00	06000	37.97629089	-122.5226851	Marin County
317288	Ordering, Referring, Prescribing	N/A	1033240890	0	0	BRONSTEIN, LLOYD C LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41742	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
317293	Ordering, Referring, Prescribing	N/A	1033240361	0	0	BAGORIO, ELAINE M LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48534	N/A	N/A	N/A	N/A	N/A	849 E. 6TH ST	None	LOS ANGELES	CA	90021	1026	00	06000	34.03994957	-118.2414778	Los Angeles County
317302	Ordering, Referring, Prescribing	N/A	1033265285	0	0	BARMORE, TIMOTHY D PA	5/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA15444	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
317326	Ordering, Referring, Prescribing	N/A	1033305610	0	0	BAKILANA, MARTINA B LMFT	8/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120899	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVENUE	STE. 125 C	OAKLAND	CA	04605	2424	00	06000	37.768221	-122.17608	Alameda County
317331	Ordering, Referring, Prescribing	N/A	1033309539	0	0	BASKERVILLE, SHEATON M LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87029	N/A	N/A	N/A	N/A	N/A	3870 CRENSHAW BLVD.	None	LOS ANGELES	CA	90008	1819	00	06000	34.0152336	-118.3348463	Los Angeles County
317369	Ordering, Referring, Prescribing	N/A	1033379805	0	0	BERDEJA, CESAR R	6/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124989	N/A	N/A	N/A	N/A	N/A	2130 N VENTURA RD	None	OXNARD	CA	93036	2246	00	06000	34.22414993	-119.1944701	Ventura County
317378	Ordering, Referring, Prescribing	N/A	1033394952	0	0	BURK, ERIC LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53199	N/A	N/A	N/A	N/A	N/A	2531 W WOODLAND DR	None	ANAHEIM	CA	92801	2637	00	06000	33.8492705	-117.973044	Orange County
317382	Ordering, Referring, Prescribing	N/A	1033410238	0	0	BARADI, MARNEL C C	4/20/2017	Taxonomy not applicable	NA	n/a	000	Unknown	21314	N/A	N/A	N/A	N/A	N/A	337 E KINGS ST	None	AVENAL	CA	93204	1630	00	06000	36.00253508	-120.1335979	Kings County
317394	Ordering, Referring, Prescribing	N/A	1033435300	0	0	BARRAGAN, HUMBERTO DO	5/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10994	N/A	N/A	N/A	N/A	N/A	2201 COOPER AVE	None	MERCED	CA	95348	4307	00	06000	37.31636094	-120.5098993	Merced County
317459	Ordering, Referring, Prescribing	N/A	1033509823	0	0	BENYAMIN, GRETEL LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115888	N/A	N/A	N/A	N/A	N/A	2933 EL NIDO DR	None	ALTADENA	CA	91001	4529	00	06000	34.19549106	-118.1655134	Los Angeles County
317463	Ordering, Referring, Prescribing	N/A	1033512249	0	0	BROOKING-LANG, CASSIDY S LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75939	N/A	N/A	N/A	N/A	N/A	310 HARBOR BLVD	None	BELMONT	CA	94002	4018	00	06000	37.52045283	-122.2680405	San Mateo County
317467	Ordering, Referring, Prescribing	N/A	1033514898	0	0	BRODIE, SHAUNA NP	12/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001607	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
317488	Ordering, Referring, Prescribing	N/A	1033554324	0	0	BRAZIER, SETH J	5/29/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5251	N/A	N/A	N/A	N/A	N/A	41696 ROAD 128	None	OROSI	CA	93647	2059	00	06000	36.54685753	-119.2869082	Tulare County
317498	Ordering, Referring, Prescribing	N/A	1033565395	0	0	BOURNE, CHRISTINA	8/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150575	N/A	N/A	N/A	N/A	N/A	201 29TH STREET	B	SACRAMENTO	CA	95816	3288	00	06000	38.581875	-121.463802	Sacramento County
317509	Ordering, Referring, Prescribing	N/A	1033574454	0	0	BRITO, JESSICA LCSW	12/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93426	N/A	N/A	N/A	N/A	N/A	1014 N. BROADWAY ST.	None	SANTA ANA	CA	92701	3408	00	06000	33.75354748	-117.8697553	Orange County
317515	Ordering, Referring, Prescribing	N/A	1033564109	0	0	BALDIVIA, PAMELA SUE C	5/19/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	735381	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	7207	00	06000	34.06633051	-118.4452686	Los Angeles County
317516	Ordering, Referring, Prescribing	N/A	1033592571	0	0	BUSSE, JOSHUA D T MD	3/6/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146055	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	None	LONG BEACH	CA	90813	3295	00	06000	33.779655	-118.1880065	Los Angeles County
317541	Ordering, Referring, Prescribing	N/A	1033640164	0	0	BURNETT, ANNIKA MD	12/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158427	N/A	N/A	N/A	N/A	N/A	1749 14TH ST	None	SANTA MONICA	CA	90404	4342	00	06000	34.01877575	-118.4794554	Los Angeles County
317564	Ordering, Referring, Prescribing	N/A	1033672282	0	0	BRAUN, ARLO R PSYD	10/27/2019	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3888	N/A	N/A	N/A	N/A	N/A	714 N WHITE ST	None	HANFORD	CA	93230	4029	00	06000	36.332613	-119.6395665	Kings County
317568	Ordering, Referring, Prescribing	N/A	1033675541	0	0	BELL, DANEANE W LMFT	7/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123504	N/A	N/A	N/A	N/A	N/A	905 N LA BREA AVE	None	INGLEWOOD	CA	90302	2207	00	06000	33.9749861	-118.3577191	Los Angeles County
317581	Ordering, Referring, Prescribing	N/A	1033691936	0	0	BEED, KYLA R LMFT	9/7/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39747	N/A	N/A	N/A	N/A	N/A	5801 SUNDALE AVE	None	BAKERSFIELD	CA	93309	2924	00	06000	35.34387226	-119.0654328	Kern County
317597	Ordering, Referring, Prescribing	N/A	1033718077	0	0	BIXBY, JORDAN NP	10/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015695	N/A	N/A	N/A	N/A	N/A	351 FELICE DRIVE	None	HOLLISTER	CA	95023	3361	00	06000	36.85325269	-121.4170104	San Benito County
317616	Ordering, Referring, Prescribing	N/A	1033760863	0	0	BRAR, JESKEITH NP	2/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012784	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	None	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
317654	Ordering, Referring, Prescribing	N/A	1033962600	0	0	BAUTISTA, NATHAN DO	9/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	3936	N/A	N/A	N/A	N/A	N/A	2035 CAMFIELD AVE	None	LOS ANGELES	CA	90040	1501	00	06000	34.00869305	-118.1558956	Los Angeles County
317658	Ordering, Referring, Prescribing	N/A	1033979323	0	0	BANSAL, RENU MD	8/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	15226	N/A	N/A	N/A	N/A	N/A	501 J ST	None	SACRAMENTO	CA	95814	2325	00	06000	38.582118	-121.499325	Sacramento County
317663	Ordering, Referring, Prescribing	N/A	1033997242	0	0	BROADNAX, TASHEENA PA	3/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64223	N/A	N/A	N/A	N/A	N/A	1014 1/2 N VERMONT AVE	None	LOS ANGELES	CA	90029	2620	00	06000	34.0900257	-118.2916693	Los Angeles County
317665	Ordering, Referring, Prescribing	N/A	1043043409	0	0	BAILEY, CLEO M DDS	8/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110549	N/A	N/A	N/A	N/A	N/A	3701 J ST	201	SACRAMENTO	CA	95816	5518	00	06000	38.571237	-121.4566245	Sacramento County
317678	Ordering, Referring, Prescribing	N/A	1043269491	0	0	BRACKETT, BESS E MD	5/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88618	N/A	N/A	N/A	N/A	N/A	1345 (PAUL) BUNYAN ROAD	A	SUSANVILLE	CA	96130	3159	00	06000	40.43531297	-120.6557201	Lassen County
317682	Ordering, Referring, Prescribing	N/A	1043282957	0	0	BLAIR, SLOANE R MD	1/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G87085	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE B	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
317702	Ordering, Referring, Prescribing	N/A	1043346927	0	0	BELISLE, DARLENE I	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44192	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	0000	00	06000	34.54007429	-117.2744761	San Bernardino County
317704	Ordering, Referring, Prescribing	N/A	1043349228	0	0	BAKER, MELISSA LMFT	11/2/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135640	N/A	N/A	N/A	N/A	N/A	1445 VETERANS MEMORIAL C	SUITE C	YUBA CITY	CA	95993	3011	00	06000	39.14469836	-121.6380819	Sutter County
317709	Ordering, Referring, Prescribing	N/A	1043354533	0	0	BALCHEN, ROBIN D LCSW	6/5/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26782	N/A	N/A	N/A	N/A	N/A	290 I.O.O.F. AVENUE	None	GILROY	CA	95020	5204	00	06000	37.0137857	-121.5686472	Santa Clara County
317721	Ordering, Referring, Prescribing	N/A	1043377294	0	0	BLACK, SIERRA A LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46100	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE.	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
317729	Ordering, Referring, Prescribing	N/A	1043383078	0	0	BETANCOURT, ALEXANDER	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT37830	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
317744	Ordering, Referring, Prescribing	N/A	1043419195	0	0	BARSOTTI, MELISSA I LCSW	1/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64017	N/A	N/A	N/A	N/A	N/A	1080 N WESTERN AVE	None	LOS ANGELES	CA	90029	2310	00	06000	34.090281	-118.3091425	Los Angeles County
317750	Ordering, Referring, Prescribing	N/A	1043423916	0	0	BOOR, TERRY A	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	NDF1141	N/A	N/A	N/A	N/A	N/A	26700 TOWNE CENTRE DRIVE	115	FOOTHILL RANCH	CA	92610	2839	00	06000	33.67455886	-117.6639195	Orange County
317760	Ordering, Referring, Prescribing	N/A	1043453988	0	0	BRAVO CUSHING, GHISELA E	7/11/1994	Taxonomy not applicable	NA	n/a	099	DENTIST	D42525	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
317801	Ordering, Referring, Prescribing	N/A	1043543945	0	0	BRIONES, VASNI Y LCSW	3/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65810	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MAIL STOP #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
317807	Ordering, Referring, Prescribing	N/A	1043560840	0	0	BELERIQUE, JESUINA LMFT	12/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129581	N/A	N/A	N/A	N/A	N/A	3360 N HWY 59	SUITE K	MERCED	CA	95348	8556	00	06000	37.32547941	-120.5047136	Merced County
317818	Ordering, Referring, Prescribing	N/A	1043581234	0	0	BIVIN, KATRINA J LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49863	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	SUITE 207	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
317825	Ordering, Referring, Prescribing	N/A	1043592595	0	0	BOCTOR, DAHLIA	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH53006	N/A	N/A	N/A	N/A	N/A	3000 S BRISTOL ST	None	SANTA ANA	CA	92704	6707	00	06000	33.70717088	-117.8855039	Orange County
317844	Ordering, Referring, Prescribing	N/A	1043613458	0	0	BEVERLY, ARNETA R	7/25/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	549292	N/A	N/A	N/A	N/A	N/A	9705 S. HOLMES AVE	None	LOS ANGELES	CA	90002	3031	00	06000	33.94797442	-118.2408345	Los Angeles County
317854	Ordering, Referring, Prescribing	N/A	1043628597	0	0	BAL, REBECCA	8/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100731	N/A	N/A	N/A	N/A	N/A	395 TAYLOR BLVD	200	PLEASANT HILL	CA	94523	2286	00	06000	37.96119614	-122.070409	Contra Costa County
317885	Ordering, Referring, Prescribing	N/A	1043685886	0	0	BLANCO VILLEGAS, ARTURO	6/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126519	N/A	N/A	N/A	N/A	N/A	2415 UNIVERSITY AVE	3	EAST PALO ALTO	CA	94303	1164	00	06000	37.47232529	-122.139568	San Mateo County
317897	Ordering, Referring, Prescribing	N/A	1043692841	0	0	BAGLEY, SHOICHI P LCSW	9/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103825	N/A	N/A	N/A	N/A	N/A	11303 W WASHINGTON BLVD	200	LOS ANGELES	CA	90066	6003	00	06000	34.00408212	-118.4147433	Los Angeles County
317906	Ordering, Referring, Prescribing	N/A	1043707805	0	0	BHANDARI, NIPUN MD MPH	8/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174291	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
317925	Ordering, Referring, Prescribing	N/A	1043733868	0	0	BITTNER, RANDI M LCSW	10/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104860	N/A	N/A	N/A	N/A	N/A	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	00	06000	36.99191102	-122.0176744	Santa Cruz County
317944	Ordering, Referring, Prescribing	N/A	1043758949	0	0	BENITEZ, AIMARA A LMFT	7/1/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147790	N/A	N/A	N/A	N/A	N/A	1910 MAGNOLIA AVE	None	LOS ANGELES	CA	90007	1220	00	06000	34.039638	-118.2864045	Los Angeles County
317949	Ordering, Referring, Prescribing	N/A	1043763733	0	0	BARAJAS, MARIANA L LMFT	2/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124611	N/A	N/A	N/A	N/A	N/A	1002 E GRAND AVE	None	ESCONDIDO	CA	92025	4605	00	06000	33.12639838	-117.0682191	San Diego County
317958	Ordering, Referring, Prescribing	N/A	1043782147	0	0	BASULTO FUENTES, NERCY L LMFT	12/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123495	N/A	N/A	N/A	N/A	N/A	2829 WATT AVE	SUITE 200	SACRAMENTO	CA	95821	6200	00	06000	38.615247	-121.383558	Sacramento County
317987	Ordering, Referring, Prescribing	N/A	1043836679	0	0	BRIDENSTINE, MARIAN A NP	6/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021508	N/A	N/A	N/A	N/A	N/A	105 E SYDNOR AVE	None	RIDGECREST	CA	93555	5546	00	06000	35.64096373	-117.6688699	Kern County
318017	Ordering, Referring, Prescribing	N/A	1043882426	0	0	BARRIOZ, VALLI L CNM	6/8/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW236192	N/A	N/A	N/A	N/A	N/A	204 E.BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
318032	Ordering, Referring, Prescribing	N/A	1043960222	0	0	BURDEKIN, EMMA D MD	3/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190148	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
318035	Ordering, Referring, Prescribing	N/A	1043966278	0	0	BRADY, SHAUNE M LMFT	12/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130248	N/A	N/A	N/A	N/A	N/A	366 MAIN STREET	None	MURPHYS	CA	95247	9625	00	06000	38.13759513	-120.4633758	Calaveras County
318072	Ordering, Referring, Prescribing	N/A	1053123216	0	0	BAHENA, YOLANDA	9/3/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032010	N/A	N/A	N/A	N/A	N/A	4770 N CEDAR AVE	None	FRESNO	CA	93726	1065	00	06000	36.804717	-119.754103	Fresno County
318075	Ordering, Referring, Prescribing	N/A	1053137703	0	0	BOLLINGER, RACHAEL E NP	6/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95030494	N/A	N/A	N/A	N/A	N/A	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	00	06000	34.02749142	-118.486063	Los Angeles County
318126	Ordering, Referring, Prescribing	N/A	1053443812	0	0	BRISTOW, ALICE L LCSW	8/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23079	N/A	N/A	N/A	N/A	N/A	435 COLLEGE AVE	MORRIS BLDG 108	MODESTO	CA	95350	5808	00	06000	37.651068	-121.0098195	Stanislaus County
318130	Ordering, Referring, Prescribing	N/A	1053447854	0	0	BALTEZORE, ERICA L LMFT	7/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96971	N/A	N/A	N/A	N/A	N/A	350 MAIN ST	None	QUINCY	CA	95971	9375	00	06000	39.9367	-120.9457587	Plumas County
318135	Ordering, Referring, Prescribing	N/A	1053464420	0	0	BROWN, STEPHEN J NP	5/2/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16540	N/A	N/A	N/A	N/A	N/A	301 VICTORIA STREET	None	COSTA MESA	CA	92627	7131	00	06000	33.65258952	-117.9121545	Orange County
318146	Ordering, Referring, Prescribing	N/A	1053471714	0	0	BETTMAN, ZELDA M LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	14485	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	207	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
318163	Ordering, Referring, Prescribing	N/A	1053499780	0	0	BORDEN, SHERRI A NP	2/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14368	N/A	N/A	N/A	N/A	N/A	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
318190	Ordering, Referring, Prescribing	N/A	1053534438	0	0	BECKER-DENNEY, TERRI A LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT79271	N/A	N/A	N/A	N/A	N/A	215 S 4TH ST	None	CHOWCHILLA	CA	93610	2818	00	06000	37.12051777	-120.2606405	Madera County
318212	Ordering, Referring, Prescribing	N/A	1053581991	0	0	BELAN, KATHLEEN M LPCC	12/3/2019	Taxonomy not applicable	NA	n/a	000	Unknown	267	N/A	N/A	N/A	N/A	N/A	480 E 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
318244	Ordering, Referring, Prescribing	N/A	1053647396	0	0	BARRON, TOBY A	6/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89672	N/A	N/A	N/A	N/A	N/A	1625 N. SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
318254	Ordering, Referring, Prescribing	N/A	1053667881	0	0	BRISSEY, TONYA R	5/11/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71407	N/A	N/A	N/A	N/A	N/A	29632 E HIGHWAY 299	None	ROUND MOUNTAIN	CA	96084	8000	00	06000	40.80385331	-121.9397745	Shasta County
318288	Ordering, Referring, Prescribing	N/A	1053708875	0	0	BELK,CHRISTOPHER C	9/10/2017	Taxonomy not applicable	NA	n/a	000	Unknown	2766	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
318321	Ordering, Referring, Prescribing	N/A	1053747279	0	0	BAUTISTA, PALOMA D LCSW	3/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88602	N/A	N/A	N/A	N/A	N/A	1120 W LA VETA AVE	660	ORANGE	CA	92868	4231	00	06000	33.78029455	-117.864369	Orange County
318335	Ordering, Referring, Prescribing	N/A	1053770008	0	0	BREWAH, LLOYDETTE H NP	1/14/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003681	N/A	N/A	N/A	N/A	N/A	18651 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07044952	-117.3974715	San Bernardino County
318382	Ordering, Referring, Prescribing	N/A	1053826248	0	0	BESSER, MADISON LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116174	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	STE. 100	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
318415	Ordering, Referring, Prescribing	N/A	1053876250	0	0	BURGER, KRISTEN E LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81110	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	200	SAN MATEO	CA	94403	1269	00	06000	37.54524373	-122.3205511	San Mateo County
318417	Ordering, Referring, Prescribing	N/A	1053876011	0	0	BUI, LAURIE V PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79143	N/A	N/A	N/A	N/A	N/A	19501 BEACH BLVD	None	HUNTINGTON BEACH	CA	92646	2648	00	06000	33.6789	-117.988766	Orange County
318437	Ordering, Referring, Prescribing	N/A	1053926626	0	0	BOLANO, CARL ANN REI P LCSW	3/18/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	129353	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	STE 300	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
318438	Ordering, Referring, Prescribing	N/A	1053952770	0	0	BEMIS, HEATHER PHD	2/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31076	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
318442	Ordering, Referring, Prescribing	N/A	1053954636	0	0	BRADKIN, TANIA LCSW	3/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100410	N/A	N/A	N/A	N/A	N/A	3701 STOCKER STREET	SUITE 205	LOS ANGELES	CA	90008	5108	00	06000	34.00687315	-118.3375934	Los Angeles County
318466	Ordering, Referring, Prescribing	N/A	1063020600	0	0	BARCELOS, MARISSA R LMFT	5/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118706	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
318500	Ordering, Referring, Prescribing	N/A	1063130250	0	0	BORGMAN, KATIE G LMSW	12/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	9038	N/A	N/A	N/A	N/A	N/A	1559 WATASHEAMU RD	None	GARDNERVILLE	NV	89460	7455	00	06000	38.90016089	-119.7157447	Douglas County
318501	Ordering, Referring, Prescribing	N/A	1063100527	0	0	BRUNS, CAITLIN A	6/30/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	33623	N/A	N/A	N/A	N/A	N/A	324 S LINCOLN ST	None	FORT BRAGG	CA	95437	4416	00	06000	39.43754003	-123.7955415	Mendocino County
318512	Ordering, Referring, Prescribing	N/A	1063161297	0	0	BIRADAR, SHRADHA MD	2/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22118	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
318525	Ordering, Referring, Prescribing	N/A	1063292522	0	0	BARRAGAN-LOMELI, JACQUELINE	10/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021359	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
318539	Ordering, Referring, Prescribing	N/A	1063447704	0	0	BILODEAU, GARY E PA-C	9/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60088	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
318555	Ordering, Referring, Prescribing	N/A	1063507457	0	0	BELTRAN, ERIKA M LCSW	2/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69900	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
318598	Ordering, Referring, Prescribing	N/A	1063556009	0	0	BISHOP, EVANGELINE PSYD	3/4/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25157	N/A	N/A	N/A	N/A	N/A	1339 20TH ST	None	SANTA MONICA	CA	90404	1001	00	06000	34.02917949	-118.4805651	Los Angeles County
318600	Ordering, Referring, Prescribing	N/A	1063563955	0	0	BATES, BRADY C PHD	3/5/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19984	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
318622	Ordering, Referring, Prescribing	N/A	1063597102	0	0	BYRNE, MICHAEL L OD	8/15/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT4891	N/A	N/A	N/A	N/A	N/A	12819 VALLEY VIEW AVE.	None	LA MIRADA	CA	90638	1945	00	06000	33.91521727	-118.0293935	Los Angeles County
318645	Ordering, Referring, Prescribing	N/A	1063655652	0	0	BARTELS, ANDREA J PHARMD	9/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61357	N/A	N/A	N/A	N/A	N/A	2020 COFFEE RD	STE C2	MODESTO	CA	95355	2427	00	06000	37.672569	-120.9757125	Stanislaus County
318651	Ordering, Referring, Prescribing	N/A	1063660546	0	0	BUTZ, DEBORAH G NP	9/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001465	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
318662	Ordering, Referring, Prescribing	N/A	1063690931	0	0	BOURNE, KENRICK C	5/8/2017	Taxonomy not applicable	NA	n/a	000	Unknown	12018	N/A	N/A	N/A	N/A	N/A	1695 S SAN JACINTO AVE	None	SAN JACINTO	CA	92583	5103	00	06000	33.770961	-116.954649	Riverside County
318663	Ordering, Referring, Prescribing	N/A	1063697001	0	0	BERG, JANYCE R NP	6/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013550	N/A	N/A	N/A	N/A	N/A	200 CASENTINI ST	None	SALINAS	CA	93907	2299	00	06000	36.68672253	-121.6582304	Monterey County
318717	Ordering, Referring, Prescribing	N/A	1063768778	0	0	BLENGGIO MARTINEZ, TERESA L LMFT	11/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101015	N/A	N/A	N/A	N/A	N/A	1130 N 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
318722	Ordering, Referring, Prescribing	N/A	1063782746	0	0	BERAL, KOUROSH M	12/2/1999	Taxonomy not applicable	NA	n/a	099	DENTIST	D46749	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
318745	Ordering, Referring, Prescribing	N/A	1063807105	0	0	BATRA, KANCHI K MD	11/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144165	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
318763	Ordering, Referring, Prescribing	N/A	1063822138	0	0	BRETTLER, TALYA J MD	2/26/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141576	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
318773	Ordering, Referring, Prescribing	N/A	1063839462	0	0	BLECHINGER, DEREK R C MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137927	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
318790	Ordering, Referring, Prescribing	N/A	1063868511	0	0	BARNETT, CHRISTIE N LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120025	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
318795	Ordering, Referring, Prescribing	N/A	1063870947	0	0	BACH, CHRISTINE PHARMD	11/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56781	N/A	N/A	N/A	N/A	N/A	7895 HIGHLAND VILLAGE PL	None	SAN DIEGO	CA	92129	5180	00	06000	32.96198925	-117.15318	San Diego County
318802	Ordering, Referring, Prescribing	N/A	1063883551	0	0	BRADLEY, LAUREN L NP	2/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003232	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	MOB 20	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
318823	Ordering, Referring, Prescribing	N/A	1063900520	0	0	BARNES, NANA A MD	7/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173974	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
318829	Ordering, Referring, Prescribing	N/A	1063918506	0	0	BROPHY, CHRISTOPHER MD	3/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159364	N/A	N/A	N/A	N/A	N/A	4860 Y ST	SUITE 2700	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
318856	Ordering, Referring, Prescribing	N/A	1063949865	0	0	BURKE, VICTORIA E LMFT	1/16/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT144373	N/A	N/A	N/A	N/A	N/A	680 CHADBOURNE RD	None	FAIRFIELD	CA	94605	4124	00	06000	38.23322678	-122.0837235	Solano County
318864	Ordering, Referring, Prescribing	N/A	1063979268	0	0	BERGER FELD, ALEXANDRA M CA	11/19/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC18028	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVENUE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
318867	Ordering, Referring, Prescribing	N/A	1063983088	0	0	BROWN, JENNY L NP	1/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017896	N/A	N/A	N/A	N/A	N/A	5959 GREENBACK LANE	210	CITRUS HEIGHTS	CA	95621	4700	00	06000	38.681397	-121.322682	Sacramento County
318871	Ordering, Referring, Prescribing	N/A	1063989226	0	0	BUI, JULIA PHARMD	3/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	79063	N/A	N/A	N/A	N/A	N/A	8054 GARVEY AVE STE 101	STE 101	ROSEMEAD	CA	91770	2449	00	06000	34.06262455	-118.092753	Los Angeles County
318875	Ordering, Referring, Prescribing	N/A	1063991370	0	0	BALLI, SWETHA MD	9/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174790	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
318897	Ordering, Referring, Prescribing	N/A	1073030649	0	0	BADRA, SUSAN LCSW	9/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111642	N/A	N/A	N/A	N/A	N/A	539 G ST	107	EUREKA	CA	95501	1030	00	06000	40.80141234	-124.1647338	Humboldt County
318898	Ordering, Referring, Prescribing	N/A	1073031472	0	0	BELOSHAPKO, ANASTASIA LCSW	9/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96642	N/A	N/A	N/A	N/A	N/A	99 S HUMBOLDT ST	None	WILLITS	CA	95490	3509	00	06000	39.41147147	-123.3533082	Mendocino County
318903	Ordering, Referring, Prescribing	N/A	1073039392	0	0	BIASE, GABRIELLA LAC	8/23/2019	Taxonomy not applicable	NA	n/a	000	Unknown	13344	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
318942	Ordering, Referring, Prescribing	N/A	1073097630	0	0	BAUMKER, ERICA L NP	10/3/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010207	N/A	N/A	N/A	N/A	N/A	260 HOSPITAL DRIVE	SUITE 204	UKIAH	CA	95482	4568	00	06000	39.15349918	-123.2039443	Mendocino County
318977	Ordering, Referring, Prescribing	N/A	1073178828	0	0	BLANCO, MARY LMFT	11/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143180	N/A	N/A	N/A	N/A	N/A	739 10TH STREET	None	ARCATA	CA	95521	6209	00	06000	40.86971807	-124.0860103	Humboldt County
318995	Ordering, Referring, Prescribing	N/A	1073270906	0	0	BAE, SHARON	9/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85179	N/A	N/A	N/A	N/A	N/A	20901 DEVONSHIRE ST.	None	CHATSWORTH	CA	91311	2313	00	06000	34.25728053	-118.589265	Los Angeles County
318997	Ordering, Referring, Prescribing	N/A	1073286985	0	0	BISCHOFF, BLAKE C MD	3/14/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194692	N/A	N/A	N/A	N/A	N/A	2 UPPER RAGSDALE DR	B210	MONTEREY	CA	93940	5736	00	06000	36.57940327	-121.8142876	Monterey County
319000	Ordering, Referring, Prescribing	N/A	1073287207	0	0	BERTAO, JOSEPH R LMFT	4/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146284	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
319026	Ordering, Referring, Prescribing	N/A	1073546404	0	0	BONDS, CURLEY L MD	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G78525	N/A	N/A	N/A	N/A	N/A	3751 STOCKER ST	None	VIEW PARK	CA	90008	5101	00	06000	34.00616017	-118.3385751	Los Angeles County
319030	Ordering, Referring, Prescribing	N/A	1073585725	0	0	BARRETO, WILLIAM PA-C	2/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA11387	N/A	N/A	N/A	N/A	N/A	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	00	06000	36.332757	-119.288682	Tulare County
319051	Ordering, Referring, Prescribing	N/A	1073648382	0	0	BERGMAN, JESSICA R	3/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020239	N/A	N/A	N/A	N/A	N/A	5700 WATT AVE	None	NORTH HIGHLANDS	CA	95660	0000	00	06000	38.670723	-121.3823745	Sacramento County
319065	Ordering, Referring, Prescribing	N/A	1073684346	0	0	BENARDIS, PETER D PHARMD	3/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49691	N/A	N/A	N/A	N/A	N/A	12254 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2804	00	06000	33.921405	-118.125323	Los Angeles County
319070	Ordering, Referring, Prescribing	N/A	1073688255	0	0	BIRHAN, ZUBEIDA PA	12/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA18176	N/A	N/A	N/A	N/A	N/A	3314 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	2938	00	06000	33.95457876	-118.2106077	Los Angeles County
319072	Ordering, Referring, Prescribing	N/A	1073694600	0	0	BUNTAIN, LAURIE	11/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43300	N/A	N/A	N/A	N/A	N/A	1330 LINCOLN AVE	SUITE 201	SAN RAFAEL	CA	94901	2120	00	06000	37.97629089	-122.5226851	Marin County
319087	Ordering, Referring, Prescribing	N/A	1073742268	0	0	BAHENA-COLLEY, SANDRA PHD	1/9/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29792	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
319103	Ordering, Referring, Prescribing	N/A	1073793972	0	0	BRENDLEN, CINDY M LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109516	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
319123	Ordering, Referring, Prescribing	N/A	1073825113	0	0	BUFFINGTON, JENNIFER A LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74477	N/A	N/A	N/A	N/A	N/A	101 WIKIUP DR	None	SANTA ROSA	CA	95403	1375	00	06000	38.50788547	-122.7587646	Sonoma County
319127	Ordering, Referring, Prescribing	N/A	1073828166	0	0	BOONYARIT, EVELYN C MSW LCSW	3/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81506	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
319138	Ordering, Referring, Prescribing	N/A	1073850350	0	0	BREWER, JENNIFER M MD	7/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123445	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN ST	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
319149	Ordering, Referring, Prescribing	N/A	1073881645	0	0	BORAK, ASHLEY M LMFT	11/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85746	N/A	N/A	N/A	N/A	N/A	45111 FERN AVE	None	LANCASTER	CA	93534	2301	00	06000	34.70150394	-118.1452081	Los Angeles County
319173	Ordering, Referring, Prescribing	N/A	1073913745	0	0	BEVINGTON, TRACY K LMFT	4/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53455	N/A	N/A	N/A	N/A	N/A	2716 OCEAN PARK BLVD STE	None	SANTA MONICA	CA	90405	5232	00	06000	34.01841154	-118.4564228	Los Angeles County
319179	Ordering, Referring, Prescribing	N/A	1073924957	0	0	BEAVERS-SILVA, PRISCILLA E NP	7/18/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031212	N/A	N/A	N/A	N/A	N/A	2023 VALE RD	None	SAN PABLO	CA	94806	3834	00	06000	37.95369824	-122.3378493	Contra Costa County
319243	Ordering, Referring, Prescribing	N/A	1083024012	0	0	BONAVITACOLA, PATRICK J A MD	7/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143925	N/A	N/A	N/A	N/A	N/A	1311 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
319286	Ordering, Referring, Prescribing	N/A	1083071484	0	0	BRALOCK, ANITA CNM	11/4/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	1115	N/A	N/A	N/A	N/A	N/A	2972 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	1101	00	06000	34.06178055	-118.2862935	Los Angeles County
319330	Ordering, Referring, Prescribing	N/A	1083142236	0	0	BOWMAN, SHELBY DDS	7/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	103506	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	CLINIC 1N	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
319331	Ordering, Referring, Prescribing	N/A	1083140610	0	0	BOYLE-DAY, CORAL LMFT	8/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141006	N/A	N/A	N/A	N/A	N/A	302 CHERRY LANE	None	MANTECA	CA	95336	5337	00	06000	37.8013889	-121.2310042	San Joaquin County
319335	Ordering, Referring, Prescribing	N/A	1083153647	0	0	BLISS, JENNIFER L LCSW	12/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22954	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
319357	Ordering, Referring, Prescribing	N/A	1083177372	0	0	BESSETTE, JESSICA NP	2/28/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011301	N/A	N/A	N/A	N/A	N/A	1704 W MANCHESTER AVE	SUITE 109	LOS ANGELES	CA	90047	3063	00	06000	33.9599425	-118.307079	Los Angeles County
319363	Ordering, Referring, Prescribing	N/A	1083193486	0	0	BARROS, RACHEL PA-C	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55798	N/A	N/A	N/A	N/A	N/A	1555 S GAREY AVE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
319368	Ordering, Referring, Prescribing	N/A	1083196885	0	0	BASSILY, NERMINE	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62154	N/A	N/A	N/A	N/A	N/A	21463 FOOTHILL BLVD	None	HAYWARD	CA	94541	2108	00	06000	37.68387865	-122.0906554	Alameda County
319375	Ordering, Referring, Prescribing	N/A	1083222624	0	0	BRISKY, REBECCA R LMFT	8/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121013	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
319378	Ordering, Referring, Prescribing	N/A	1083225106	0	0	BITAR, DANIA PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82782	N/A	N/A	N/A	N/A	N/A	429 BIRMINGHAM RD	None	BURBANK	CA	91504	3908	00	06000	34.1954952	-118.3211957	Los Angeles County
319385	Ordering, Referring, Prescribing	N/A	1083238638	0	0	BAUER, MADELINE M OT	3/17/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	19800	N/A	N/A	N/A	N/A	N/A	2686 SPRING ST	None	REDWOOD CITY	CA	94063	3522	00	06000	37.48231745	-122.2081659	San Mateo County
319411	Ordering, Referring, Prescribing	N/A	1083286249	0	0	BYRD, ALYSSA K NP	8/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016302	N/A	N/A	N/A	N/A	N/A	2740 S ELM AVENUE	None	FRESNO	CA	93706	5435	00	06000	36.70101129	-119.7908643	Fresno County
319434	Ordering, Referring, Prescribing	N/A	1083377006	0	0	BOPARAI, HANNA K PA-C	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60759	N/A	N/A	N/A	N/A	N/A	622 H ST	None	EUREKA	CA	95501	1026	00	06000	40.80080061	-124.1634879	Humboldt County
319447	Ordering, Referring, Prescribing	N/A	1083463996	0	0	BOOCHIE, MARTHA N NP	4/18/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029865	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
319450	Ordering, Referring, Prescribing	N/A	1083436133	0	0	BAKESHLOU AFSHAR, LILY	10/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032780	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	110	MISSION VIEJO	CA	92691	6410	00	06000	33.55952733	-117.6645199	Orange County
319468	Ordering, Referring, Prescribing	N/A	1083683619	0	0	BHOJWANI, DEEPA MD	12/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C135644	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS#54	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
319484	Ordering, Referring, Prescribing	N/A	1083733398	0	0	BOELK, MARISA DC	2/27/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	29340	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
319496	Ordering, Referring, Prescribing	N/A	1083744155	0	0	BOTERO, JAIME LCSW	8/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26451	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
319507	Ordering, Referring, Prescribing	N/A	1083783906	0	0	BENOIT, STANLEY LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48923	N/A	N/A	N/A	N/A	N/A	11850 SEBASTIAN WAY	None	RANCHO CUCAMONGA	CA	91730	0703	00	06000	34.10422153	-117.546741	San Bernardino County
319515	Ordering, Referring, Prescribing	N/A	1083793780	0	0	BOLLAR, CAROL J LMFT	10/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53493	N/A	N/A	N/A	N/A	N/A	1529 E PALMDALE BLVD	210	PALMDALE	CA	93550	2034	00	06000	34.57966052	-118.102275	Los Angeles County
319522	Ordering, Referring, Prescribing	N/A	1083806426	0	0	BYRNE, ATHENA LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93538	N/A	N/A	N/A	N/A	N/A	6711 ARLINGTON AVENUE	SUITE B	RIVERSIDE	CA	92504	1923	00	06000	33.9459035	-117.442989	Riverside County
319523	Ordering, Referring, Prescribing	N/A	1083800460	0	0	BRAN, MARLENE E LCSW	12/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29477	N/A	N/A	N/A	N/A	N/A	1529 E PALMDALE BLVD	150	PALMDALE	CA	93550	2034	00	06000	34.57966052	-118.102275	Los Angeles County
319524	Ordering, Referring, Prescribing	N/A	1083807200	0	0	BENTO, DANIELLE L LMFT	8/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45796	N/A	N/A	N/A	N/A	N/A	6711 ARLINGTON AVE	A	RIVERSIDE	CA	92504	1955	00	06000	33.9459035	-117.442989	Riverside County
319537	Ordering, Referring, Prescribing	N/A	1083847123	0	0	BAER, JEFFREY B LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64650	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	6TH FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
319551	Ordering, Referring, Prescribing	N/A	1083870349	0	0	BAILEY, ELIZABETH R LCSW	8/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28042	N/A	N/A	N/A	N/A	N/A	5121 COLLEGE AVE	None	BAKERSFIELD	CA	93301	0000	00	06000	35.38311783	-118.9467403	Kern County
319660	Ordering, Referring, Prescribing	N/A	1093049918	0	0	BURGOS, YVONNE PSYD	12/30/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26917	N/A	N/A	N/A	N/A	N/A	6631 N. STEPHENS RANCH R	None	LA VERNE	CA	91750	1146	00	06000	34.154775	-117.740052	Los Angeles County
319684	Ordering, Referring, Prescribing	N/A	1093107625	0	0	BARBA, KARLA F LMFT	4/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125275	N/A	N/A	N/A	N/A	N/A	16360 ROSCOE BLVD	2ND FLOOR	VAN NUYS	CA	91406	0000	00	06000	34.22126852	-118.490805	Los Angeles County
319694	Ordering, Referring, Prescribing	N/A	1093127268	0	0	BOWMAN, JESSICA	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140796	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
319697	Ordering, Referring, Prescribing	N/A	1093125759	0	0	BASSI, BRUCE D MD	1/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160634	N/A	N/A	N/A	N/A	N/A	630 S BRAWLEY AVE	STE 4	BRAWLEY	CA	92227	3107	00	06000	32.97215183	-115.5425908	Imperial County
319700	Ordering, Referring, Prescribing	N/A	1093140048	0	0	BAKER, SUSAN M LMFT	9/25/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109571	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
319703	Ordering, Referring, Prescribing	N/A	1093142028	0	0	BRAY, ASHLEY LPCC	11/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	4194	N/A	N/A	N/A	N/A	N/A	2060 CAMPUS DR	None	YREKA	CA	96097	9538	00	06000	41.7050458	-122.6481121	Siskiyou County
319712	Ordering, Referring, Prescribing	N/A	1093149536	0	0	BUFALINI, ERIN PHARMD	7/10/2019	Taxonomy not applicable	NA	n/a	000	Unknown	68818	N/A	N/A	N/A	N/A	N/A	774 ADMIRAL CALLAGHAN LN	None	VALLEJO	CA	94591	3650	00	06000	38.12591271	-122.2280142	Solano County
319731	Ordering, Referring, Prescribing	N/A	1093179319	0	0	BUCHFUHRER, JULIA E DO	10/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15806	N/A	N/A	N/A	N/A	N/A	11480 BROOKSHIRE AVE	SUITE 108	DOWNEY	CA	90241	5020	00	06000	33.93622932	-118.1311752	Los Angeles County
319735	Ordering, Referring, Prescribing	N/A	1093181695	0	0	BOW, KEITH L PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57578	N/A	N/A	N/A	N/A	N/A	1700 S BRADLEY RD	None	SANTA MARIA	CA	93454	8001	00	06000	34.92801184	-120.4200671	Santa Barbara County
319804	Ordering, Referring, Prescribing	N/A	1093281156	0	0	BALOY, CZARINA A	6/4/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	103471	N/A	N/A	N/A	N/A	N/A	1039 W FLORENCE AVE	None	LOS ANGELES	CA	90044	2441	00	06000	33.97463885	-118.2933327	Los Angeles County
319807	Ordering, Referring, Prescribing	N/A	1093284796	0	0	BROWN, CARVEL PHARMD	10/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	66692	N/A	N/A	N/A	N/A	N/A	2350 NORIEGA ST	None	SAN FRANCISCO	CA	94122	4240	00	06000	37.75371991	-122.4888992	San Francisco County
319809	Ordering, Referring, Prescribing	N/A	1093282576	0	0	BROWN, COURTNEY PA-C	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56019	N/A	N/A	N/A	N/A	N/A	2299 POST ST	207	SAN FRANCISCO	CA	94115	3441	00	06000	37.78434298	-122.4392033	San Francisco County
319818	Ordering, Referring, Prescribing	N/A	1093313413	0	0	BANKSON, DANIELLE LMFT	3/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145963	N/A	N/A	N/A	N/A	N/A	1720 MARCO POLO WAY	STE E	BURLINGAME	CA	94010	4512	00	06000	37.58986055	-122.3842811	San Mateo County
319824	Ordering, Referring, Prescribing	N/A	1093319915	0	0	BOWDEN, DESTINEE PA-C	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58935	N/A	N/A	N/A	N/A	N/A	344 E 6TH ST	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
319830	Ordering, Referring, Prescribing	N/A	1093343014	0	0	BUCHANAN, JACK H MD	11/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	4833	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
319834	Ordering, Referring, Prescribing	N/A	1093353856	0	0	BUI, CATHERINE PHARMD	1/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	81209	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	0001	00	06000	38.36981229	-120.8002806	Amador County
319836	Ordering, Referring, Prescribing	N/A	1093353112	0	0	BLUM, JENS V LMFT	2/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144930	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4172	00	06000	35.3830369	-118.9680991	Kern County
319838	Ordering, Referring, Prescribing	N/A	1093354573	0	0	BENTLEY, KEITH D PA	4/7/2024	Taxonomy not applicable	NA	n/a	000	Unknown	60272	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
319852	Ordering, Referring, Prescribing	N/A	1093391310	0	0	BARNES, JENNA LMFT	7/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140347	N/A	N/A	N/A	N/A	N/A	505 N EUCLID ST	300	ANAHEIM	CA	92801	5506	00	06000	33.8379454	-117.9416147	Orange County
319870	Ordering, Referring, Prescribing	N/A	1093478182	0	0	BELTRAN, CLAUDIA LCSW	3/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96237	N/A	N/A	N/A	N/A	N/A	1000 SUNSET BLVD	SUITE 140	ROCKLIN	CA	95765	3791	00	06000	38.81665958	-121.2884287	Placer County
319889	Ordering, Referring, Prescribing	N/A	1093592693	0	0	BANUELOS, STEPHANIE DDS	8/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109192	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	SUITE 200	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
319895	Ordering, Referring, Prescribing	N/A	1093718454	0	0	BUTLER, ROBERT LCSW	9/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW7338	N/A	N/A	N/A	N/A	N/A	2455 BENNETT VALLEY RD	C210	SANTA ROSA	CA	95404	5671	00	06000	38.434284	-122.6918565	Sonoma County
319900	Ordering, Referring, Prescribing	N/A	1093747511	0	0	BUBY, MYRA S LCSW	1/29/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23172	N/A	N/A	N/A	N/A	N/A	352 L ST	None	CHULA VISTA	CA	91911	1208	00	06000	32.61997526	-117.0739163	San Diego County
319910	Ordering, Referring, Prescribing	N/A	1093786683	0	0	BLUE, CHRISTINE M	4/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10733	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
319926	Ordering, Referring, Prescribing	N/A	1093840373	0	0	BARREIRO, ANTHONY L LCSW	4/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19308	N/A	N/A	N/A	N/A	N/A	375 89TH ST	None	DALY CITY	CA	94015	1802	00	06000	37.69175212	-122.474006	San Mateo County
319934	Ordering, Referring, Prescribing	N/A	1093848566	0	0	BELSHAW, KRISTIN L LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40053	N/A	N/A	N/A	N/A	N/A	1545 CHURCH STREET	None	SAN FRANCISCO	CA	94131	2017	00	06000	37.74621757	-122.4268882	San Francisco County
319937	Ordering, Referring, Prescribing	N/A	1093865222	0	0	BECWAR, ALLISON S LCSW	6/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24309	N/A	N/A	N/A	N/A	N/A	1266 14TH STREET	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
319961	Ordering, Referring, Prescribing	N/A	1093894008	0	0	BALDIVINO, MARISSA M PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52026	N/A	N/A	N/A	N/A	N/A	9400 EAST ROSECRANS AVE	None	BELLFLOWER	CA	90706	8805	00	06000	33.9040752	-118.1328995	Los Angeles County
319993	Ordering, Referring, Prescribing	N/A	1093942609	0	0	BACA, DONNA LCSW	9/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65322	N/A	N/A	N/A	N/A	N/A	11121 SKY COUNTRY DR	None	JURUPA VALLEY	CA	91752	2140	00	06000	33.97627437	-117.5256638	Riverside County
320000	Ordering, Referring, Prescribing	N/A	1093956658	0	0	BRIDGES, CHRIS E LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	67603	N/A	N/A	N/A	N/A	N/A	1224 N VINE ST	None	LOS ANGELES	CA	90036	1612	00	06000	34.093332	-118.326603	Los Angeles County
320020	Ordering, Referring, Prescribing	N/A	1104005024	0	0	BAKOWSKY, JENNIFER M LMFT	9/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53757	N/A	N/A	N/A	N/A	N/A	1101 ALBERTA WAY	None	CONCORD	CA	94521	3747	00	06000	37.94894647	-121.9677577	Contra Costa County
320052	Ordering, Referring, Prescribing	N/A	1104079573	0	0	BETTY, NICHOLAS S PHD	7/16/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC42812	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
320069	Ordering, Referring, Prescribing	N/A	1104108992	0	0	BERNSTEIN, GALEN E PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55501	N/A	N/A	N/A	N/A	N/A	4351 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2318	00	06000	33.93079627	-118.1842645	Los Angeles County
320098	Ordering, Referring, Prescribing	N/A	1104176999	0	0	BUHLER, ELIZABETH NP	1/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22048	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
320128	Ordering, Referring, Prescribing	N/A	1104208131	0	0	BIACAN, ARDITH E LMFT	3/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109711	N/A	N/A	N/A	N/A	N/A	8929 S SEPULVEDA BLVD	201	LOS ANGELES	CA	90045	3616	00	06000	33.955164	-118.396248	Los Angeles County
320158	Ordering, Referring, Prescribing	N/A	1104257500	0	0	BAUTISTA, MONICA LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109949	N/A	N/A	N/A	N/A	N/A	1221 E DYER RD	220	SANTA ANA	CA	92705	5600	00	06000	33.70872153	-117.857052	Orange County
320160	Ordering, Referring, Prescribing	N/A	1104234541	0	0	BUHL, MARIESA Y L NP	5/16/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	712446	N/A	N/A	N/A	N/A	N/A	747 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	7207	00	06000	34.06589027	-118.4454109	Los Angeles County
320165	Ordering, Referring, Prescribing	N/A	1104271683	0	0	BEARDMORE, MEGAN PHD	9/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32037	N/A	N/A	N/A	N/A	N/A	13130 BURBANK BLVD	None	SHERMAN OAKS	CA	91401	1401	00	06000	34.17210778	-118.4192552	Los Angeles County
320174	Ordering, Referring, Prescribing	N/A	1104261296	0	0	BUI, CYNTHIA H MD	7/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134222	N/A	N/A	N/A	N/A	N/A	24422 AVENIDA DE LA CARL	SUITE 130	LAGUNA HILLS	CA	92653	3636	00	06000	33.56726005	-117.705397	Orange County
320198	Ordering, Referring, Prescribing	N/A	1104334416	0	0	BARAJAS, ANGELICA O LCSW	5/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101446	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
320205	Ordering, Referring, Prescribing	N/A	1104342070	0	0	BRUBAKER, ANDREA B NP	2/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007296	N/A	N/A	N/A	N/A	N/A	2426 BUHNE STREET	None	EUREKA	CA	95501	3207	00	06000	40.78592355	-124.1405936	Humboldt County
320211	Ordering, Referring, Prescribing	N/A	1104341338	0	0	BAILEY, TAILOR M LMFT	11/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135972	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
320213	Ordering, Referring, Prescribing	N/A	1104349091	0	0	BRANDON, ADRIANNA	9/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141647	N/A	N/A	N/A	N/A	N/A	11800 CENTRAL AVE	225	CHINO	CA	91710	7200	00	06000	34.0388092	-117.689654	San Bernardino County
320236	Ordering, Referring, Prescribing	N/A	1104375393	0	0	BLAKE, KATIE LCSW	5/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93792	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5441	00	06000	38.425482	-122.75262	Sonoma County
320252	Ordering, Referring, Prescribing	N/A	1104403591	0	0	BONAGIRI, PRANAY R DO	7/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21252	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
320276	Ordering, Referring, Prescribing	N/A	1104468057	0	0	BABAIAN, ARMEN Y	3/18/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104479	N/A	N/A	N/A	N/A	N/A	7451 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	00	06000	34.20616081	-118.3878161	Los Angeles County
320284	Ordering, Referring, Prescribing	N/A	1104485994	0	0	BELL, MICHELE	4/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49803	N/A	N/A	N/A	N/A	N/A	1515 SLOAT BLVD.	None	SAN FRANCISCO	CA	94132	1222	00	06000	37.73398956	-122.4893153	San Francisco County
320292	Ordering, Referring, Prescribing	N/A	1104494509	0	0	BARBO, CYNTHIA R NP	3/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018029	N/A	N/A	N/A	N/A	N/A	706 PEACH ST	None	CORNING	CA	96021	3355	00	06000	39.928689	-122.174397	Tehama County
320333	Ordering, Referring, Prescribing	N/A	1104861384	0	0	BARON, SCOTT C PA	2/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	12400	N/A	N/A	N/A	N/A	N/A	23962 ALICIA PKWY	None	MISSION VIEJO	CA	92691	3940	00	06000	33.61418475	-117.6795692	Orange County
320343	Ordering, Referring, Prescribing	N/A	1104906916	0	0	BUDIS, JOHN M PHARMD	8/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44049	N/A	N/A	N/A	N/A	N/A	303 2ND ST	None	LOS ALTOS	CA	94022	2739	00	06000	37.377242	-122.1157995	Santa Clara County
320361	Ordering, Referring, Prescribing	N/A	1104958156	0	0	BOSSHARDT, THOMAS MD	9/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G78405	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
320383	Ordering, Referring, Prescribing	N/A	1104981125	0	0	BOURCIER, JEANINE M LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51833	N/A	N/A	N/A	N/A	N/A	6160 MISSION GORGE RD ST	#108	SAN DIEGO	CA	92120	3425	00	06000	32.7868143	-117.0977635	San Diego County
320402	Ordering, Referring, Prescribing	N/A	1114025269	0	0	BIAL, VIRGINIA D LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22026	N/A	N/A	N/A	N/A	N/A	3665 KEARNY VILLA RD	500	SAN DIEGO	CA	92123	1953	00	06000	32.80816826	-117.1510112	San Diego County
320408	Ordering, Referring, Prescribing	N/A	1114041142	0	0	BOLOGNA, JOSEPH LMFT	7/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT25342	N/A	N/A	N/A	N/A	N/A	10755 APPLE VALLEY RD	None	APPLE VALLEY	CA	92308	3684	00	06000	34.444179	-117.2316915	San Bernardino County
320438	Ordering, Referring, Prescribing	N/A	1114096369	0	0	BAUTISTA-LECHNER, SANDRA E LCSW	4/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22942	N/A	N/A	N/A	N/A	N/A	1499 HUNTINGTON DRIVE	SUITE 101	SOUTH PASADENA	CA	91030	1600	00	06000	34.10404853	-118.150551	Los Angeles County
320445	Ordering, Referring, Prescribing	N/A	1114120474	0	0	BECK, JASON D MD	7/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C135430	N/A	N/A	N/A	N/A	N/A	2740 S ELM AVENUE	None	FRESNO	CA	93706	5435	00	06000	36.70101129	-119.7908643	Fresno County
320446	Ordering, Referring, Prescribing	N/A	1114117041	0	0	BANZUELA, MARITA Y MD	6/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71047	N/A	N/A	N/A	N/A	N/A	1303 W 6TH ST	SUITE 105	CORONA	CA	92882	3196	00	06000	33.87785815	-117.5891694	Riverside County
320484	Ordering, Referring, Prescribing	N/A	1114154002	0	0	BENCUYA, NATALIE L PHD	10/5/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28405	N/A	N/A	N/A	N/A	N/A	1000 VETERAN AVENUE	2ND FLOOR	LOS ANGELES	CA	90064	2201	00	06000	34.0605595	-118.4499527	Los Angeles County
320488	Ordering, Referring, Prescribing	N/A	1114202512	0	0	BRIFFA, CHRISTOPHER	5/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH60624	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
320526	Ordering, Referring, Prescribing	N/A	1114267598	0	0	BAKEER-PULLUM, AKILAH LCSW	6/12/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS82376	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
320553	Ordering, Referring, Prescribing	N/A	1114320421	0	0	BERNAL SALAS, ROSALIA LCSW	6/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101963	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
320570	Ordering, Referring, Prescribing	N/A	1114329935	0	0	BUTLER, KAYLA A LCSW	5/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101596	N/A	N/A	N/A	N/A	N/A	2275 ARLINGTON DRIVE	None	SAN LEANDRO	CA	94578	1132	00	06000	37.70851907	-122.1117036	Alameda County
320598	Ordering, Referring, Prescribing	N/A	1114379203	0	0	BUZBEE, PASCALE LCSW	12/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69871	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	SUITE 300	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
320734	Ordering, Referring, Prescribing	N/A	1114693231	0	0	BEATTY, SARAH AU	3/29/2022	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	AU3659	N/A	N/A	N/A	N/A	N/A	5333 HOLLISTER AVE	SUITE 165	SANTA BARBARA	CA	93111	2341	00	06000	34.43491982	-119.8105484	Santa Barbara County
320759	Ordering, Referring, Prescribing	N/A	1114940020	0	0	BERMAN, MARVIN DMD	10/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS106997	N/A	N/A	N/A	N/A	N/A	311 W NOBLE AVE	None	VISALIA	CA	93277	2669	00	06000	36.326304	-119.295477	Tulare County
320765	Ordering, Referring, Prescribing	N/A	1114945128	0	0	BAUTISTA, MARYROSE MD	3/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70192	N/A	N/A	N/A	N/A	N/A	1111 N EL DORADO ST	None	STOCKTON	CA	95202	1305	00	06000	37.96379262	-121.2929073	San Joaquin County
320766	Ordering, Referring, Prescribing	N/A	1114968310	0	0	BYRD, LORRAINE R DO	9/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15621	N/A	N/A	N/A	N/A	N/A	2200 TYDD STREET	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
320775	Ordering, Referring, Prescribing	N/A	1124021035	0	0	BIREN, CATHERINE A MD	3/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G48190	N/A	N/A	N/A	N/A	N/A	9781 BLUE LARKSPUR LANE	STE 100	MONTEREY	CA	93940	6509	00	06000	36.57152408	-121.8037459	Monterey County
320779	Ordering, Referring, Prescribing	N/A	1124037155	0	0	BURSTEIN, SAMUEL MD	7/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53328	N/A	N/A	N/A	N/A	N/A	6325 TOPANGA CANYON BLVD	SUITE # 224	WOODLAND HILLS	CA	91367	2006	00	06000	34.184934	-118.6059175	Los Angeles County
320780	Ordering, Referring, Prescribing	N/A	1124042460	0	0	BOONE, THOMAS M	3/31/1985	Taxonomy not applicable	NA	n/a	099	DENTIST	D34661	N/A	N/A	N/A	N/A	N/A	11702 BEACH BLVD	None	SUNSET BEACH	CA	90742	1543	00	06000	33.792777	-117.9928615	Orange County
320783	Ordering, Referring, Prescribing	N/A	1124042817	0	0	BARTON, JENNIFER N PHARMD	4/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58630	N/A	N/A	N/A	N/A	N/A	1700 S BRADLEY RD	None	SANTA MARIA	CA	93454	8001	00	06000	34.92801184	-120.4200671	Santa Barbara County
320809	Ordering, Referring, Prescribing	N/A	1124115969	0	0	BURNEY, LENORA I PSYD	3/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20653	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
320832	Ordering, Referring, Prescribing	N/A	1124156591	0	0	BENITEZ, CHRISTOPHER T MD	11/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88540	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
320847	Ordering, Referring, Prescribing	N/A	1124190699	0	0	BRENZA, TINA M DDS	7/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	103392	N/A	N/A	N/A	N/A	N/A	164 KINMAN AVE	None	GOLETA	CA	93117	3481	00	06000	34.436277	-119.8222815	Santa Barbara County
320856	Ordering, Referring, Prescribing	N/A	1124198163	0	0	BERNARD, GEOFFREY S LMFT	2/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48796	N/A	N/A	N/A	N/A	N/A	500 W FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
320881	Ordering, Referring, Prescribing	N/A	1124250337	0	0	BELLO, SONIA LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86056	N/A	N/A	N/A	N/A	N/A	3150 18TH STREET	SUITE 354, 408	SAN FRANCISCO	CA	94110	2077	00	06000	37.76218347	-122.4141845	San Francisco County
320905	Ordering, Referring, Prescribing	N/A	1124313168	0	0	BUI, VIEN X PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65172	N/A	N/A	N/A	N/A	N/A	1634 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	4616	00	06000	34.13588549	-117.2518245	San Bernardino County
320923	Ordering, Referring, Prescribing	N/A	1124338116	0	0	BURKHOLDER, LISANNE R MD	2/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G84136	N/A	N/A	N/A	N/A	N/A	1111 N NAGLE ST	None	ALTURAS	CA	96101	3840	00	06000	41.48746641	-120.5528507	Modoc County
320925	Ordering, Referring, Prescribing	N/A	1124339957	0	0	BAILEY, KENDRA PHD	1/3/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28536	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
320975	Ordering, Referring, Prescribing	N/A	1124425558	0	0	BAKER, MARY LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107830	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	None	LOS ANGELES	CA	90008	0000	00	06000	34.00888336	-118.3389334	Los Angeles County
320978	Ordering, Referring, Prescribing	N/A	1124425822	0	0	BUCHLER, MARYBEL M LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116648	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	None	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
320980	Ordering, Referring, Prescribing	N/A	1124430129	0	0	BURRELL, KATHLEEN LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83066	N/A	N/A	N/A	N/A	N/A	4955 ALTA ST.	None	SIMI VALLEY	CA	93063	0000	00	06000	34.28440504	-118.6967314	Ventura County
320982	Ordering, Referring, Prescribing	N/A	1124428503	0	0	BUI, PRISCILLIA LCSW	6/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83463	N/A	N/A	N/A	N/A	N/A	124 RIVER ROAD	None	SALINAS	CA	93908	9601	00	06000	36.61705976	-121.6608103	Monterey County
321039	Ordering, Referring, Prescribing	N/A	1124521901	0	0	BENITEZ, MARTHA G DO	2/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19248	N/A	N/A	N/A	N/A	N/A	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
321051	Ordering, Referring, Prescribing	N/A	1124545397	0	0	BENJAMIN, DANIEL LCSW	4/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101087	N/A	N/A	N/A	N/A	N/A	1617 CRAVENS AVENUE	None	TORRANCE	CA	90501	3203	00	06000	33.83269486	-118.3158222	Los Angeles County
321102	Ordering, Referring, Prescribing	N/A	1124623236	0	0	BASSETT, RENEE E LCSW	5/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115450	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LN	100	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
321114	Ordering, Referring, Prescribing	N/A	1124646906	0	0	BERNSTEIN, JEFFREY D MD	5/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	A186073	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
321139	Ordering, Referring, Prescribing	N/A	1124732623	0	0	BRZEZINSKI, TARA PA	2/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62351	N/A	N/A	N/A	N/A	N/A	49-111 CALIFORNIA 111	6A	COACHELLA	CA	92236	0000	00	06000	33.67241866	-116.1673887	Riverside County
321144	Ordering, Referring, Prescribing	N/A	1124751300	0	0	BROWN, ANN MARIE NP	9/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022079	N/A	N/A	N/A	N/A	N/A	129 SOPHIA CT	None	NAPA	CA	94558	5947	00	06000	38.28929965	-122.3087475	Napa County
321156	Ordering, Referring, Prescribing	N/A	1124789474	0	0	BOULES, SAMEH H PHARMD	4/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85759	N/A	N/A	N/A	N/A	N/A	4801 CENTRAL AVE	None	RICHMOND	CA	94804	5801	00	06000	37.89726914	-122.3212101	Contra Costa County
321167	Ordering, Referring, Prescribing	N/A	1134119308	0	0	BAUTISTA, JOSE L MD	1/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43293	N/A	N/A	N/A	N/A	N/A	2570 JENSEN AVE	106	SANGER	CA	93657	2269	00	06000	36.70680647	-119.5736715	Fresno County
321172	Ordering, Referring, Prescribing	N/A	1134132483	0	0	BELTZ, STEPHANIE L NP	7/25/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	832489	N/A	N/A	N/A	N/A	N/A	760 RENZ LN	None	GILROY	CA	95020	9584	00	06000	37.00466254	-121.5555242	Santa Clara County
321173	Ordering, Referring, Prescribing	N/A	1134123672	0	0	BOGGS, HELAINE M NP	5/1/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN535651	N/A	N/A	N/A	N/A	N/A	1133 N CHELSEA STREET	None	RIDGECREST	CA	93555	1133	00	06000	35.64262361	-117.6671491	Kern County
321187	Ordering, Referring, Prescribing	N/A	1134204027	0	0	BUCHERT, STEPHANIE L MD	4/6/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A82087	N/A	N/A	N/A	N/A	N/A	525 N. CABRILLO PARK DR.	300	SANTA ANA	CA	92701	5014	00	06000	33.75047365	-117.8404984	Orange County
321201	Ordering, Referring, Prescribing	N/A	1134212160	0	0	BAHA, PUNEH OD	9/18/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	11596	N/A	N/A	N/A	N/A	N/A	11717 BERNARDO PLAZA COU	STE 105	SAN DIEGO	CA	92128	2419	00	06000	33.01929872	-117.0777714	San Diego County
321203	Ordering, Referring, Prescribing	N/A	1134232259	0	0	BROWNELL, KRISTIN J MD	12/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80154	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
321207	Ordering, Referring, Prescribing	N/A	1134244155	0	0	BOAZ ALVAREZ, MEGHAN K LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46142	N/A	N/A	N/A	N/A	N/A	784 HIGH STREET	None	SAN LUIS OBISPO	CA	93401	5243	00	06000	35.27225362	-120.6564501	San Luis Obispo County
321211	Ordering, Referring, Prescribing	N/A	1134246739	0	0	BLANCHARD, LISA PSYD	10/22/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17396	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
321239	Ordering, Referring, Prescribing	N/A	1134289655	0	0	BLEUEL, OLGA L	6/16/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D52713	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
321241	Ordering, Referring, Prescribing	N/A	1134289960	0	0	BARR, JULIE A LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39369	N/A	N/A	N/A	N/A	N/A	3200 ADELINE ST	None	BERKELEY	CA	94703	2407	00	06000	37.8503811	-122.2710539	Alameda County
321244	Ordering, Referring, Prescribing	N/A	1134299308	0	0	BENNET, JUSTIN D MD	11/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88202	N/A	N/A	N/A	N/A	N/A	1505 SOQUEL DR	12	SANTA CRUZ	CA	95065	1716	00	06000	36.98803429	-121.9848045	Santa Cruz County
321256	Ordering, Referring, Prescribing	N/A	1134332562	0	0	BOOTH, TAMME	1/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45043	N/A	N/A	N/A	N/A	N/A	1850 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9518	00	06000	38.649942	-121.165524	Sacramento County
321265	Ordering, Referring, Prescribing	N/A	1134352099	0	0	BENITEZ, CLAUDIA L LCSW	5/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74310	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	UNIT 6B	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
321279	Ordering, Referring, Prescribing	N/A	1134381619	0	0	BAHAMONDE, LOURDES G DO	8/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13517	N/A	N/A	N/A	N/A	N/A	1720 E. CESAR CHAVEZ AVE	None	LA	CA	90033	2414	00	06000	34.04925	-118.2177405	Los Angeles County
321295	Ordering, Referring, Prescribing	N/A	1134418007	0	0	BOLLENBACHER, SHELBY H LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81137	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
321326	Ordering, Referring, Prescribing	N/A	1134488042	0	0	BRICCHETTI, ANTHONY R	2/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61397	N/A	N/A	N/A	N/A	N/A	7000 AUBURN BLVD	None	CITRUS HEIGHTS	CA	95621	4342	00	06000	38.689875	-121.2975585	Sacramento County
321331	Ordering, Referring, Prescribing	N/A	1134488877	0	0	BANANI, NAUSHAD P DPM	11/23/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5356	N/A	N/A	N/A	N/A	N/A	611 GATEWAY BOULEVARD	SUITE 120 PMB 1017	SOUTH SAN FRANCIS	CA	94080	7066	00	06000	37.65774486	-122.3994553	San Mateo County
321332	Ordering, Referring, Prescribing	N/A	1134494321	0	0	BOLOS, DAVID MD	7/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127574	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
321337	Ordering, Referring, Prescribing	N/A	1134498884	0	0	BURCH, JAN NP	12/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023725	N/A	N/A	N/A	N/A	N/A	25 ALLEN STREET	None	MARTINEZ	CA	94553	0000	00	06000	38.00739608	-122.1331318	Contra Costa County
321356	Ordering, Referring, Prescribing	N/A	1134520489	0	0	BANSIL, RAJAT D	3/30/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	69199	N/A	N/A	N/A	N/A	N/A	70 W HEDDING ST	None	SAN JOSE	CA	95110	1705	00	06000	37.35249294	-121.9050815	Santa Clara County
321382	Ordering, Referring, Prescribing	N/A	1134572423	0	0	BARBICAS, JOSEPH M NP	8/27/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95186261	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
321435	Ordering, Referring, Prescribing	N/A	1134652217	0	0	BLACK, MICHAEL W MD	7/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157088	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
321442	Ordering, Referring, Prescribing	N/A	1134657067	0	0	BABAJIDE, LUKMAN-AFIS O MD	4/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178195	N/A	N/A	N/A	N/A	N/A	2001 WILSHIRE BLVD	STE 320	SANTA BARBARA	CA	90403	5683	00	06000	34.03162362	-118.4829513	Los Angeles County
321449	Ordering, Referring, Prescribing	N/A	1134668510	0	0	BREAKEY, SHANNON N OT	3/9/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT24764	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	None	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
321454	Ordering, Referring, Prescribing	N/A	1134669997	0	0	BOBOWSKI, CHRISTINA E PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76176	N/A	N/A	N/A	N/A	N/A	1567 CITY CENTER ROAD	None	MCKINLEYVILLE	CA	95519	3600	00	06000	40.94311258	-124.1035874	Humboldt County
321463	Ordering, Referring, Prescribing	N/A	1134688047	0	0	BHATTACHARJEE, ARLIN	9/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176614	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0002	00	06000	34.1268333	-117.2687417	San Bernardino County
321472	Ordering, Referring, Prescribing	N/A	1134707722	0	0	BAZZY, JIMMY MD	11/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180697	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR.	None	SYLMAR	CA	91342	0000	00	06000	34.32450186	-118.4456317	Los Angeles County
321487	Ordering, Referring, Prescribing	N/A	1134752694	0	0	BARAJAS, CRYSTAL NP	9/24/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012893	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT	100	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
321495	Ordering, Referring, Prescribing	N/A	1134763170	0	0	BROWN, JAMES G LPCC	11/15/2020	Taxonomy not applicable	NA	n/a	000	Unknown	6435	N/A	N/A	N/A	N/A	N/A	9199 GOODSPEED ST	9	DURHAM	CA	95938	9444	00	06000	39.63886521	-121.7996934	Butte County
321568	Ordering, Referring, Prescribing	N/A	1144309790	0	0	BERNARDEZ, RHODA A DO MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68899	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
321582	Ordering, Referring, Prescribing	N/A	1144351123	0	0	BLAIR-RANDOLPH, JOANNE NP	12/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019487	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2300	00	06000	33.806097	-118.151378	Los Angeles County
321586	Ordering, Referring, Prescribing	N/A	1144354309	0	0	BOVENKERK, MATTHEW T LMFT	9/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41226	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVE	None	CERES	CA	95307	4562	00	06000	37.60031128	-120.9658226	Stanislaus County
321589	Ordering, Referring, Prescribing	N/A	1144357138	0	0	BIEN, MONICA PA	9/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	17274	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
321613	Ordering, Referring, Prescribing	N/A	1144396870	0	0	BUGNACKI, PAUL S	5/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23039	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
321624	Ordering, Referring, Prescribing	N/A	1144426859	0	0	BOMBEN, CHANDRA K LMFT	9/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112196	N/A	N/A	N/A	N/A	N/A	11768 ATWOOD ROAD	SUITE 106	AUBURN	CA	95603	9005	00	06000	38.93488248	-121.0969061	Placer County
321633	Ordering, Referring, Prescribing	N/A	1144412297	0	0	BIRKINSHA, REBECKAH A LMFT	5/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48887	N/A	N/A	N/A	N/A	N/A	1370 S STATE ST STE B	STE B	SAN JACINTO	CA	92583	4922	00	06000	33.773796	-116.9719185	Riverside County
321636	Ordering, Referring, Prescribing	N/A	1144454158	0	0	BRAMLETT, DESIREE M LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79108	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
321642	Ordering, Referring, Prescribing	N/A	1144475013	0	0	BOURNE, KANITA D LCSW	1/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28312	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
321672	Ordering, Referring, Prescribing	N/A	1144529926	0	0	BENESCH, ERIN MD DO	5/15/2017	Taxonomy not applicable	NA	n/a	000	Unknown	20A12465	N/A	N/A	N/A	N/A	N/A	1100 B N TUSTIN AVE	F	SANTA ANA	CA	92705	3509	00	06000	33.754707	-117.8342455	Orange County
321699	Ordering, Referring, Prescribing	N/A	1144587726	0	0	BERGMAN, LINDA M CNP	10/5/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7610	N/A	N/A	N/A	N/A	N/A	1530 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
321701	Ordering, Referring, Prescribing	N/A	1144596586	0	0	BUTLER, JENNIFER A PSYD	1/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108093	N/A	N/A	N/A	N/A	N/A	1433 S. ROBERTSON BLVD.	None	LOS ANGELES	CA	90035	3414	00	06000	34.05373818	-118.3839685	Los Angeles County
321722	Ordering, Referring, Prescribing	N/A	1144621426	0	0	BAJOREK, SARAH A	7/7/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	65800	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	ROOM 0762	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
321747	Ordering, Referring, Prescribing	N/A	1144666462	0	0	BERCUN, JANELLE LCSW	2/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97253	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	6M	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
321789	Ordering, Referring, Prescribing	N/A	1144716044	0	0	BARULIC, ELAINA LMFT	10/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115884	N/A	N/A	N/A	N/A	N/A	2931 SHATTUCK AVENUE	None	BERKELEY	CA	94705	1986	00	06000	37.85574785	-122.2665517	Alameda County
321822	Ordering, Referring, Prescribing	N/A	1144755679	0	0	BATES, VICTORIA LMFT	2/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131171	N/A	N/A	N/A	N/A	N/A	100 W WALNUT STREET	375	PASADENA	CA	91124	0001	00	06000	34.14963648	-118.1522925	Los Angeles County
321945	Ordering, Referring, Prescribing	N/A	1144998378	0	0	BERMUDEZ, KRYSTAL T CNP	6/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95021232	N/A	N/A	N/A	N/A	N/A	1611 1ST ST	None	BAKERSFIELD	CA	93304	2901	00	06000	35.35506651	-119.020518	Kern County
321947	Ordering, Referring, Prescribing	N/A	1154033538	0	0	BUI, NANCY T NP	9/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022477	N/A	N/A	N/A	N/A	N/A	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
321964	Ordering, Referring, Prescribing	N/A	1154092559	0	0	BOASE, TRACY L	9/12/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT149709	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
322033	Ordering, Referring, Prescribing	N/A	1154457950	0	0	BRASHER, NATALIE LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49396	N/A	N/A	N/A	N/A	N/A	35912 AVENUE H	None	YUCAIPA	CA	92399	5206	00	06000	34.01032324	-117.0223299	San Bernardino County
322035	Ordering, Referring, Prescribing	N/A	1154456481	0	0	BULL, INGALL W LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS18864	N/A	N/A	N/A	N/A	N/A	4485 24TH STREET	None	SAN FRANCISCO	CA	94114	3558	00	06000	37.75076545	-122.4424067	San Francisco County
322043	Ordering, Referring, Prescribing	N/A	1154479996	0	0	BLEMAN, DANIEL B MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G34560	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5400	00	06000	38.425482	-122.75262	Sonoma County
322056	Ordering, Referring, Prescribing	N/A	1154506962	0	0	BICKFORD, LINCOLN C MD	2/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C152747	N/A	N/A	N/A	N/A	N/A	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	00	06000	33.8102385	-118.3441185	Los Angeles County
322078	Ordering, Referring, Prescribing	N/A	1154543114	0	0	BOOKER, YOLANDA A LMFT	4/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50776	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
322115	Ordering, Referring, Prescribing	N/A	1154618551	0	0	BERREA, CARLOS R MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124448	N/A	N/A	N/A	N/A	N/A	3567 W MT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	00	06000	36.43078218	-119.8620732	Fresno County
322125	Ordering, Referring, Prescribing	N/A	1154634541	0	0	BRISENO, VANESSA LMFT	10/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135282	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD	None	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
322128	Ordering, Referring, Prescribing	N/A	1154639250	0	0	BLANCO, ERICA L LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102281	N/A	N/A	N/A	N/A	N/A	2200 W ORANGEWOOD AVE	#212	ORANGE	CA	92868	1945	00	06000	33.79576054	-117.875655	Orange County
322179	Ordering, Referring, Prescribing	N/A	1154731289	0	0	BREWART, NADIA LMFT	12/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92605	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
322216	Ordering, Referring, Prescribing	N/A	1154792398	0	0	BROKER, SARAH D LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91325	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BUILDING 400	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
322235	Ordering, Referring, Prescribing	N/A	1154831311	0	0	BANAFTI, SHIVA F LCSW	2/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121115	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	350	INGLEWOOD	CA	90301	4501	00	06000	33.966333	-118.3439975	Los Angeles County
322238	Ordering, Referring, Prescribing	N/A	1154832780	0	0	BANUELOS, KASSANDRA A LMFT	9/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150145	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
322280	Ordering, Referring, Prescribing	N/A	1154893683	0	0	BARAJAS, LAUREN N LCSW	5/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101688	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	2ND FLOOR	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
322302	Ordering, Referring, Prescribing	N/A	1154948909	0	0	BARRAZA, MELISSA A LCSW	8/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117593	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	STE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
322307	Ordering, Referring, Prescribing	N/A	1154954600	0	0	BAYARD, NICOLE M NP	5/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018781	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
322308	Ordering, Referring, Prescribing	N/A	1154952109	0	0	BARCENAS-PORTUGAL, YAMILET J LMFT	6/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147292	N/A	N/A	N/A	N/A	N/A	124 RIVER RD	None	SALINAS	CA	93908	9601	00	06000	36.61705976	-121.6608103	Monterey County
322330	Ordering, Referring, Prescribing	N/A	1154988319	0	0	BURGA, LORRAINE M LMFT	3/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131958	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	None	COVINA	CA	91723	3186	00	06000	34.079904	-117.8863235	Los Angeles County
322345	Ordering, Referring, Prescribing	N/A	1164034419	0	0	BAILEY, MEGAN E PA-C	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA58620	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	GE07	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
322379	Ordering, Referring, Prescribing	N/A	1164083028	0	0	BLACKHILL, JESSE LCSW	1/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106727	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
322407	Ordering, Referring, Prescribing	N/A	1164188330	0	0	BAJRACHARYA, MONALISHA NP	9/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017883	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
322411	Ordering, Referring, Prescribing	N/A	1164166732	0	0	BARNES, KELSEY Z NP	5/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020745	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
322446	Ordering, Referring, Prescribing	N/A	1164515540	0	0	BARAHONA, VICTOR MD	8/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A30717	N/A	N/A	N/A	N/A	N/A	11499 BARTLETT AVE	None	ADELANTO	CA	92301	1902	00	06000	34.57915154	-117.414216	San Bernardino County
322448	Ordering, Referring, Prescribing	N/A	1164509584	0	0	BENITEZ, JOANNA M LCSW	11/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28061	N/A	N/A	N/A	N/A	N/A	601 S. GLENOAKS BLVD	None	BURBANK	CA	91502	1000	00	06000	34.17930759	-118.3011138	Los Angeles County
322450	Ordering, Referring, Prescribing	N/A	1164509790	0	0	BOWMAN, ROBERT J LMFT	1/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39132	N/A	N/A	N/A	N/A	N/A	1510 S CENTRAL AVE	STE 600	GLENDALE	CA	91204	2548	00	06000	34.12709764	-118.2577911	Los Angeles County
322456	Ordering, Referring, Prescribing	N/A	1164530622	0	0	BIK, LYMAR G MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A56516	N/A	N/A	N/A	N/A	N/A	155 S FIFTH ST	None	COALINGA	CA	93210	1903	00	06000	36.13845412	-120.3582671	Fresno County
322479	Ordering, Referring, Prescribing	N/A	1164550752	0	0	BONNER, MICHELLE N LMFT	11/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87977	N/A	N/A	N/A	N/A	N/A	24077 STATE HIGHWAY 49	None	NEVADA CITY	CA	95959	8519	00	06000	39.321882	-121.0992075	Nevada County
322480	Ordering, Referring, Prescribing	N/A	1164570560	0	0	BASS, JESSICA LCSW	12/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69524	N/A	N/A	N/A	N/A	N/A	22245 MAIN ST	SUIT 200	HAYWARD	CA	94541	4053	00	06000	37.67674766	-122.0863181	Alameda County
322491	Ordering, Referring, Prescribing	N/A	1164579702	0	0	BECERRA, MARINA LMFT	5/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80241	N/A	N/A	N/A	N/A	N/A	2311 LOVERIDGE RD	2ND FLOOR	PITTSBURG	CA	94565	5117	00	06000	38.00694767	-121.8712439	Contra Costa County
322493	Ordering, Referring, Prescribing	N/A	1164596300	0	0	BERTELLE, LISA LMFT	9/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40984	N/A	N/A	N/A	N/A	N/A	1031 25TH ST	None	SAN DIEGO	CA	92102	2102	00	06000	32.716404	-117.1402635	San Diego County
322552	Ordering, Referring, Prescribing	N/A	1164713194	0	0	BAUTISTA, JUAN G MD	10/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122998	N/A	N/A	N/A	N/A	N/A	1805 E FIR AVE	101	FRESNO	CA	93720	3859	00	06000	36.83911347	-119.749869	Fresno County
322566	Ordering, Referring, Prescribing	N/A	1164739884	0	0	BRADY, MELISSA DMD	9/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	D9486	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
322575	Ordering, Referring, Prescribing	N/A	1164741120	0	0	BERRY, KIERA E	8/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61314	N/A	N/A	N/A	N/A	N/A	101 S B ST	None	LOMPOC	CA	93436	6933	00	06000	34.63860089	-120.4503641	Santa Barbara County
322577	Ordering, Referring, Prescribing	N/A	1164757563	0	0	BARRON, JESSICA LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29506	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 404	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
322582	Ordering, Referring, Prescribing	N/A	1164763769	0	0	BALDERAS PEREZ, SANDRA	3/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115548	N/A	N/A	N/A	N/A	N/A	800 SCENIC DR	BUILDING 4	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
322594	Ordering, Referring, Prescribing	N/A	1164782587	0	0	BUCK, CAITLIN LCSW	1/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85623	N/A	N/A	N/A	N/A	N/A	6601 STEPHENS RANCH RD	None	LA VERNE	CA	91750	1146	00	06000	34.154775	-117.740052	Los Angeles County
322597	Ordering, Referring, Prescribing	N/A	1164799730	0	0	BURNETT, ASPEN LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18696	N/A	N/A	N/A	N/A	N/A	5650 JILLSON ST.	None	COMMERCE	CA	90040	1482	00	06000	34.00007121	-118.1563132	Los Angeles County
322602	Ordering, Referring, Prescribing	N/A	1164804431	0	0	BEJKO, ETLEVA MD	6/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169155	N/A	N/A	N/A	N/A	N/A	2023 W VISTA WAY	STE H	VISTA	CA	92083	6030	00	06000	33.18569169	-117.2846332	San Diego County
322605	Ordering, Referring, Prescribing	N/A	1164802377	0	0	BROASTER, HILARRY D PHARMD	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47322	N/A	N/A	N/A	N/A	N/A	1735 W. ARTESIA BLVD.	None	GARDENA	CA	90247	0000	00	06000	33.87298146	-118.308258	Los Angeles County
322618	Ordering, Referring, Prescribing	N/A	1164809463	0	0	BASRAVI, SUNNIYA K DO	8/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14608	N/A	N/A	N/A	N/A	N/A	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	00	06000	34.05855992	-118.209755	Los Angeles County
322651	Ordering, Referring, Prescribing	N/A	1164891289	0	0	BENITEZ, TANYA A NP	4/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000274	N/A	N/A	N/A	N/A	N/A	11888 BARTLETT AVE	None	ADELANTO	CA	92301	1709	00	06000	34.57927736	-117.4068692	San Bernardino County
322655	Ordering, Referring, Prescribing	N/A	1164895892	0	0	BORJON, GUADALUPE MSW LCSW	5/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94534	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	6TH FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
322690	Ordering, Referring, Prescribing	N/A	1164948204	0	0	BAGHASARIAN, MARIA LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116898	N/A	N/A	N/A	N/A	N/A	2345 N ATLANTIC BLVD	1028	ALHAMBRA	CA	91801	0000	00	06000	34.10043294	-118.1346885	Los Angeles County
322718	Ordering, Referring, Prescribing	N/A	1164998480	0	0	BI, CHRISTINA L	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79668	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
322773	Ordering, Referring, Prescribing	N/A	1174083984	0	0	BROMLEY, WINDY L NP	3/19/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011447	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	190	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
322823	Ordering, Referring, Prescribing	N/A	1174159024	0	0	BREAUD, SCOTT J NP	3/19/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014255	N/A	N/A	N/A	N/A	N/A	2311 LOVERIDGE RD	None	PITTSBURG	CA	94565	5117	00	06000	38.00694767	-121.8712439	Contra Costa County
322828	Ordering, Referring, Prescribing	N/A	1174179725	0	0	BORUNDA, KARLY J NP	7/1/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012066	N/A	N/A	N/A	N/A	N/A	1140 W LA VETA AVE	#730	ORANGE	CA	92868	4225	00	06000	33.7802984	-117.8651669	Orange County
322836	Ordering, Referring, Prescribing	N/A	1174212567	0	0	BRISCOE, KRISHANN LCSW	9/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107070	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
322848	Ordering, Referring, Prescribing	N/A	1174244586	0	0	BUI, JOSEPH Q OD	9/2/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35254	N/A	N/A	N/A	N/A	N/A	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	00	06000	34.04297786	-118.2220181	Los Angeles County
322857	Ordering, Referring, Prescribing	N/A	1174265102	0	0	BAIS, HAZEL MAY A NP	5/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020846	N/A	N/A	N/A	N/A	N/A	857 W CHILDS AVENUE	None	MERCED	CA	95341	6862	00	06000	37.2882813	-120.497688	Merced County
322860	Ordering, Referring, Prescribing	N/A	1174299911	0	0	BUENO, VERONICA	8/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133464	N/A	N/A	N/A	N/A	N/A	3100 BRISTOL ST	150	COSTA MESA	CA	92626	3099	00	06000	33.6865398	-117.885491	Orange County
322893	Ordering, Referring, Prescribing	N/A	1174638373	0	0	BATRES, ERIC R MD	12/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G44726	N/A	N/A	N/A	N/A	N/A	5101 FLORENCE AVE	SUITE 4	BELL	CA	90201	3801	00	06000	33.96904913	-118.1757922	Los Angeles County
322914	Ordering, Referring, Prescribing	N/A	1174659056	0	0	BRISCOE, LESLIE F LMFT	9/18/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48505	N/A	N/A	N/A	N/A	N/A	5801 SUNDALE AVE	None	BAKERSFIELD	CA	93309	2924	00	06000	35.34387226	-119.0654328	Kern County
322921	Ordering, Referring, Prescribing	N/A	1174643647	0	0	BARRIOS, CARLOS MD	11/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55096	N/A	N/A	N/A	N/A	N/A	4211 SOUTH AVALON BLVD.	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
322927	Ordering, Referring, Prescribing	N/A	1174684260	0	0	BEAUMONT, DENISE M CRNA	12/16/2021	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95001642	N/A	N/A	N/A	N/A	N/A	250 N FIRST STREET	None	BLYTHE	CA	92225	1702	00	06000	33.61293	-114.5955035	Riverside County
322928	Ordering, Referring, Prescribing	N/A	1174685960	0	0	BOCKS III, CHARLES R	12/21/1985	Taxonomy not applicable	NA	n/a	099	DENTIST	D22783	N/A	N/A	N/A	N/A	N/A	1660 WILLOW ST	SUITE 7	SAN JOSE	CA	95125	5101	00	06000	37.30376805	-121.9154518	Santa Clara County
322931	Ordering, Referring, Prescribing	N/A	1174698195	0	0	BUYS, KATHRYN E LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34173	N/A	N/A	N/A	N/A	N/A	3720 SUNSET LANE	SUITE D	ANTIOCH	CA	94509	1624	00	06000	37.98416157	-121.804246	Contra Costa County
322944	Ordering, Referring, Prescribing	N/A	1174723597	0	0	BALDWIN, TABITHA E LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46032	N/A	N/A	N/A	N/A	N/A	2440 TULARE STREET	SUITE 200	FRESNO	CA	93721	2208	00	06000	36.73727495	-119.7852493	Fresno County
322951	Ordering, Referring, Prescribing	N/A	1174729271	0	0	BEECKMAN, JENNIFER L CNP	8/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13545	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
322957	Ordering, Referring, Prescribing	N/A	1174749634	0	0	BARGHOUTH, GEORGE B	11/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D38489	N/A	N/A	N/A	N/A	N/A	55 EAST JULIAN STREET	None	SAN JOSE	CA	95112	0000	00	06000	37.34118198	-121.8925795	Santa Clara County
322972	Ordering, Referring, Prescribing	N/A	1174784581	0	0	BURGER, JAMIE LMFT	11/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35250	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
322974	Ordering, Referring, Prescribing	N/A	1174786388	0	0	BARNETT, BROOKE PSYD	6/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25820	N/A	N/A	N/A	N/A	N/A	1266 14TH STREET	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
323018	Ordering, Referring, Prescribing	N/A	1174868137	0	0	BRANSON, LEAH A LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68070	N/A	N/A	N/A	N/A	N/A	2484 SHATTUCK AVENUE	SUITE 210	BERKELEY	CA	94704	1209	00	06000	37.8641716	-122.2676092	Alameda County
323026	Ordering, Referring, Prescribing	N/A	1174878151	0	0	BUSH, CLARISSA M	9/9/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP23399	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
323064	Ordering, Referring, Prescribing	N/A	1174913925	0	0	BHATIA, GEETA	5/13/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003752	N/A	N/A	N/A	N/A	N/A	500 W FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
323119	Ordering, Referring, Prescribing	N/A	1174988190	0	0	BUCKLEY, COLEEN LCSW	6/30/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103210	N/A	N/A	N/A	N/A	N/A	1989 VICENTE DRIVE	None	SAN LUIS OBISPO	CA	93405	6863	00	06000	35.25396985	-120.6858341	San Luis Obispo County
323123	Ordering, Referring, Prescribing	N/A	1174994172	0	0	BENNETT, TRAVIS PHARMD	4/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52323	N/A	N/A	N/A	N/A	N/A	3450 MARRON RD	None	OCEANSIDE	CA	92056	0000	00	06000	33.17824695	-117.2957151	San Diego County
323126	Ordering, Referring, Prescribing	N/A	1174997381	0	0	BADILLO-VASQUEZ, MIREYA LMFT	10/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT128617	N/A	N/A	N/A	N/A	N/A	5628 E SLAUSON AVE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
323166	Ordering, Referring, Prescribing	N/A	1184046153	0	0	BERKOVITZ, CATHY S	6/21/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	235735	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
323173	Ordering, Referring, Prescribing	N/A	1184048308	0	0	BRITO RUIZ-RAMOS, ELIVET LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104569	N/A	N/A	N/A	N/A	N/A	18350 MT. LANGLEY	SUITE 200	FOUNTAIN VALLEY	CA	92708	6900	00	06000	33.69633523	-117.9420534	Orange County
323230	Ordering, Referring, Prescribing	N/A	1184133431	0	0	BRITTAIN, DESIREE M LMFT	11/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86289	N/A	N/A	N/A	N/A	N/A	286 EUCLID AVE	STE 104	SAN DIEGO	CA	92114	3610	00	06000	32.70706919	-117.0850896	San Diego County
323232	Ordering, Referring, Prescribing	N/A	1184124026	0	0	BERGERON, SHEENA M LMFT	5/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126084	N/A	N/A	N/A	N/A	N/A	325 BUENA CREEK RD	None	SAN MARCOS	CA	92069	9679	00	06000	33.18307285	-117.160072	San Diego County
323251	Ordering, Referring, Prescribing	N/A	1184166316	0	0	BLANTON-HUBBARD, ELISE OT	12/24/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT16845	N/A	N/A	N/A	N/A	N/A	391 TAYLOR BLVD.	SUITE 100	PLEASANT HILL	CA	94523	2289	00	06000	37.96119614	-122.070409	Contra Costa County
323277	Ordering, Referring, Prescribing	N/A	1184214694	0	0	BELTRAN-PADILLA, STEPHANIE PA	12/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59313	N/A	N/A	N/A	N/A	N/A	1035 PLACER ST	None	REDDING	CA	96001	4245	00	06000	40.58349378	-122.3853903	Shasta County
323311	Ordering, Referring, Prescribing	N/A	1184279101	0	0	BURNES, CYNTHIA L LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT30676	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
323357	Ordering, Referring, Prescribing	N/A	1184399966	0	0	BAU, BRYAN D PHARMD	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84736	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
323427	Ordering, Referring, Prescribing	N/A	1184766784	0	0	BIANCHI, TERI J	7/9/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D42722	N/A	N/A	N/A	N/A	N/A	310 UPPER LAKE RD	None	LAKE SHERWOOD	CA	91361	0000	00	06000	34.13515033	-118.8699012	Ventura County
323444	Ordering, Referring, Prescribing	N/A	1184823965	0	0	BERNDT, LISA R LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14637	N/A	N/A	N/A	N/A	N/A	747 52TH STREET	None	OAKLAND	CA	94609	1653	00	06000	37.83734639	-122.2672128	Alameda County
323455	Ordering, Referring, Prescribing	N/A	1184842171	0	0	BIEL, DUSTIN K LMFT	3/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45692	N/A	N/A	N/A	N/A	N/A	1222 W LACEY BLVD	2ND FL	HANFORD	CA	93230	5901	00	06000	36.32815828	-119.6645297	Kings County
323466	Ordering, Referring, Prescribing	N/A	1184864639	0	0	BLISS, JESSIE A LMFT	1/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86645	N/A	N/A	N/A	N/A	N/A	15400 CHOLAME RD	None	VICTORVILLE	CA	92392	2480	00	06000	34.5021895	-117.327879	San Bernardino County
323473	Ordering, Referring, Prescribing	N/A	1184880510	0	0	BUCKLEY, MICHELLE M LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64164	N/A	N/A	N/A	N/A	N/A	1885 LUNDY AVE	223	SAN JOSE	CA	95131	0000	00	06000	37.39329538	-121.8907367	Santa Clara County
323479	Ordering, Referring, Prescribing	N/A	1184886756	0	0	BURDEN, RANDALL LMFT	11/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34409	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
323489	Ordering, Referring, Prescribing	N/A	1184891236	0	0	BURKHARDT, BRANDON LCSW	5/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84750	N/A	N/A	N/A	N/A	N/A	5603 S CENTRAL AVENUE	None	LOS ANGELES	CA	90011	5967	00	06000	33.99138	-118.256479	Los Angeles County
323545	Ordering, Referring, Prescribing	N/A	1184986275	0	0	BUI, BAO-CHAU C PHARMD	10/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	48965	N/A	N/A	N/A	N/A	N/A	500 TULLY RD	None	SAN JOSE	CA	95111	1917	00	06000	37.30579894	-121.8506333	Santa Clara County
323607	Ordering, Referring, Prescribing	N/A	1194113241	0	0	BERADZE, TEA LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99232	N/A	N/A	N/A	N/A	N/A	1356 RIDDER PARK DR	None	SAN JOSE	CA	95131	2313	00	06000	37.38742031	-121.9009533	Santa Clara County
323609	Ordering, Referring, Prescribing	N/A	1194111393	0	0	BAUER, INGRID MD	11/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146416	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
323617	Ordering, Referring, Prescribing	N/A	1194125278	0	0	BOLEA, SUSAN M LMFT	8/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99858	N/A	N/A	N/A	N/A	N/A	2901 SHATTUCK AVENUE	SUITE B	BERKELEY	CA	94705	1808	00	06000	37.85662208	-122.266663	Alameda County
323638	Ordering, Referring, Prescribing	N/A	1194154096	0	0	BERG, JASON A PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58358	N/A	N/A	N/A	N/A	N/A	33961 DOHENY PARK RD	None	SAN JUAN CAPISTRA	CA	92675	4835	00	06000	33.469758	-117.6781095	Orange County
323646	Ordering, Referring, Prescribing	N/A	1194177410	0	0	BOYDEN-DESHAZER, CHRISTOPHER	7/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105913	N/A	N/A	N/A	N/A	N/A	5901 W OLYMPIC BLVD	SUITE 310	LOS ANGELES	CA	90036	4664	00	06000	34.05764121	-118.3603115	Los Angeles County
323647	Ordering, Referring, Prescribing	N/A	1194180828	0	0	BAGUIA, MARIA IMELDA M NP	3/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008174	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
323669	Ordering, Referring, Prescribing	N/A	1194208405	0	0	BALAKRISHNAN, VIDYA PA-C	11/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA56856	N/A	N/A	N/A	N/A	N/A	5959 GREENBACK LN	500	CITRUS HEIGHTS	CA	95621	4700	00	06000	38.681397	-121.322682	Sacramento County
323700	Ordering, Referring, Prescribing	N/A	1194250316	0	0	BANSAL, SARAJINDER K MD	8/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164640	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
323702	Ordering, Referring, Prescribing	N/A	1194256339	0	0	BOPARAI, ESHANDEEP S MD	7/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157324	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
323706	Ordering, Referring, Prescribing	N/A	1194263129	0	0	BATES, ROSE T NP	4/14/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	614874	N/A	N/A	N/A	N/A	N/A	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	00	06000	34.02749142	-118.486063	Los Angeles County
323715	Ordering, Referring, Prescribing	N/A	1194275966	0	0	BROWN, CHERRELLE LMFT	11/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132768	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
323722	Ordering, Referring, Prescribing	N/A	1194292458	0	0	BESA, PAULA PA-C	5/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA56482	N/A	N/A	N/A	N/A	N/A	9041 MAGNOLIA AVE	107	RIVERSIDE	CA	92503	3900	00	06000	33.92541585	-117.4378266	Riverside County
323732	Ordering, Referring, Prescribing	N/A	1194325431	0	0	BYEON, KEUMHEE NP	7/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021523	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
323735	Ordering, Referring, Prescribing	N/A	1194339457	0	0	BOHANNON, MAYA A LCSW	8/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW125561	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
323739	Ordering, Referring, Prescribing	N/A	1194348771	0	0	BORAH, MELISSA LCSW	7/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116394	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	200	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
323741	Ordering, Referring, Prescribing	N/A	1194351189	0	0	BAYSINGER, AMBER N MD	6/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179833	N/A	N/A	N/A	N/A	N/A	1749 14TH STREET	None	SANTA MONICA	CA	90404	4342	00	06000	34.01877575	-118.4794554	Los Angeles County
323752	Ordering, Referring, Prescribing	N/A	1194382077	0	0	BENNETT, KIRK PA-C	9/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62204	N/A	N/A	N/A	N/A	N/A	1550 BROADWAY	None	SAN DIEGO	CA	92101	5713	00	06000	32.71579987	-117.1499238	San Diego County
323762	Ordering, Referring, Prescribing	N/A	1194419978	0	0	BEGINO, CLAUDIA E LCSW	9/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24410	N/A	N/A	N/A	N/A	N/A	1601 E CHESTNUT AVE	None	SANTA ANA	CA	92701	6322	00	06000	33.74262565	-117.8470706	Orange County
323788	Ordering, Referring, Prescribing	N/A	1194499921	0	0	BERMAN, MIA LCSW	9/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99906	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	475	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
323794	Ordering, Referring, Prescribing	N/A	1194713164	0	0	BEATTE, HOPE C MD	1/4/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C168553	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
323799	Ordering, Referring, Prescribing	N/A	1194740217	0	0	BRADFORD, LETITIA L MD	9/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70194	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE B	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
323814	Ordering, Referring, Prescribing	N/A	1194810374	0	0	BAMBERGER, MEGAN L PHARMD	3/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56016	N/A	N/A	N/A	N/A	N/A	15 LOS CERROS DR	None	GREENBRAE	CA	94904	1118	00	06000	37.94984718	-122.5269215	Marin County
323840	Ordering, Referring, Prescribing	N/A	1194863027	0	0	BENDECK, SAMUEL	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115534	N/A	N/A	N/A	N/A	N/A	359 GABILAN DRIVE	None	SOLEDAD	CA	93960	3550	00	06000	36.43614633	-121.3277604	Monterey County
323847	Ordering, Referring, Prescribing	N/A	1194863464	0	0	BRANHAM, ASHLEY	8/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82398	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
323849	Ordering, Referring, Prescribing	N/A	1194868190	0	0	BLACH, SUE ANN A LMFT	8/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40423	N/A	N/A	N/A	N/A	N/A	47950 DUNE PALMS RD	None	LA QUINTA	CA	92253	4000	00	06000	33.70220565	-116.2774057	Riverside County
323865	Ordering, Referring, Prescribing	N/A	1194891705	0	0	BRAVERMAN, ELENA	3/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89862	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
323866	Ordering, Referring, Prescribing	N/A	1194886481	0	0	BORCHERT, SHERRY D PHARMD	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55093	N/A	N/A	N/A	N/A	N/A	2940 EAST ST.	None	ANDERSON	CA	96007	3411	00	06000	40.45107638	-122.2980834	Shasta County
323873	Ordering, Referring, Prescribing	N/A	1194909507	0	0	BUI, HIEN T PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60212	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
323881	Ordering, Referring, Prescribing	N/A	1194922187	0	0	BERRY, KATHLEEN D LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78608	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
323896	Ordering, Referring, Prescribing	N/A	1194966200	0	0	BAIKOV, SIMA MSW LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64388	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
323899	Ordering, Referring, Prescribing	N/A	1194970061	0	0	BAGNER III, ERNEST A MD	12/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A69614	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	None	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
323901	Ordering, Referring, Prescribing	N/A	1194967083	0	0	BRICENO, KAREN A LCSW	12/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28988	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	1009	00	06000	34.06300636	-118.2054784	Los Angeles County
323909	Ordering, Referring, Prescribing	N/A	1194984948	0	0	BERRY, DANA E	4/12/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D47596	N/A	N/A	N/A	N/A	N/A	7970 LANDER AVE	STE A	HILMAR	CA	95324	8350	00	06000	37.403703	-120.850121	Merced County
323911	Ordering, Referring, Prescribing	N/A	1194983825	0	0	BRENT, DINA MD	8/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G46412	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
323913	Ordering, Referring, Prescribing	N/A	1194976795	0	0	BREAUD, CAROLYN LMFT	7/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77137	N/A	N/A	N/A	N/A	N/A	191 SAND CREEK RD.	202-K	BRENTWOOD	CA	94513	2220	00	06000	37.94665949	-121.7001303	Contra Costa County
323924	Ordering, Referring, Prescribing	N/A	1205023736	0	0	BHATTI, MOEEN MD	7/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100193	N/A	N/A	N/A	N/A	N/A	290 I O O F AVE	None	GILROY	CA	95020	5204	00	06000	37.0137857	-121.5686472	Santa Clara County
323930	Ordering, Referring, Prescribing	N/A	1205043320	0	0	BASS, JOHN M LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT89909	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	SUITE 125C	OAKLAND	CA	94605	2454	00	06000	37.768221	-122.17608	Alameda County
323967	Ordering, Referring, Prescribing	N/A	1205114295	0	0	BRENNAN, MEGHAN E NP	1/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	SP024625	N/A	N/A	N/A	N/A	N/A	409 SE 95TH AVE	None	VANCOUVER	WA	98664	3420	00	06000	45.617949	-122.575671	Clark County
323992	Ordering, Referring, Prescribing	N/A	1205149887	0	0	BADON, SHIRLEY M	2/4/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0763378	N/A	N/A	N/A	N/A	N/A	21001 SHERMAN WAY	#9	CANOGA PARK	CA	91303	3683	00	06000	34.20113553	-118.5912126	Los Angeles County
323996	Ordering, Referring, Prescribing	N/A	1205151024	0	0	BOTT, KRISTIE L LCSW	11/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23791	N/A	N/A	N/A	N/A	N/A	2045 S SAN JACINTO AVE	None	SAN JACINTO	CA	92583	5626	00	06000	33.76536396	-116.9587092	Riverside County
324019	Ordering, Referring, Prescribing	N/A	1205225471	0	0	BAILEY, AMY LMFT	4/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125272	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
324050	Ordering, Referring, Prescribing	N/A	1205271798	0	0	BEHRENS, BEATRIZ LCSW	2/29/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121322	N/A	N/A	N/A	N/A	N/A	1360 NORTH DUTTON AVE	C	SANTA ROSA	CA	95401	4596	00	06000	38.450583	-122.7337065	Sonoma County
324084	Ordering, Referring, Prescribing	N/A	1205313319	0	0	BECERRA, GABRIEL C LCSW	4/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114743	N/A	N/A	N/A	N/A	N/A	425 N. DATE ST.	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
324089	Ordering, Referring, Prescribing	N/A	1205326436	0	0	BELEC, MELISSA DO	11/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19835	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
324093	Ordering, Referring, Prescribing	N/A	1205332665	0	0	BRYAN, ERIN M LMFT	8/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120683	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
324096	Ordering, Referring, Prescribing	N/A	1205331469	0	0	BARAKZAI, MARIA PA	4/15/2020	Taxonomy not applicable	NA	n/a	000	Unknown	55564	N/A	N/A	N/A	N/A	N/A	11306 MOUNTAIN VIEW AVE	SUITE B	LOMA LINDA	CA	92354	0001	00	06000	34.047513	-117.243647	San Bernardino County
324124	Ordering, Referring, Prescribing	N/A	1205370079	0	0	BLAND, NATALIE CNP	7/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005600	N/A	N/A	N/A	N/A	N/A	661 W 1ST STREET	G	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
324136	Ordering, Referring, Prescribing	N/A	1205392925	0	0	BRAKEMAN, TRAVIS PT	7/30/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	40950	N/A	N/A	N/A	N/A	N/A	24065 BIGGAR LN	None	COVELO	CA	95428	0000	00	06000	39.80972354	-123.2469688	Mendocino County
324148	Ordering, Referring, Prescribing	N/A	1205418969	0	0	BRING, KATHLEEN E	9/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7446	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
324185	Ordering, Referring, Prescribing	N/A	1205502960	0	0	BUZI, LOUISIE OT	5/4/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	22140	N/A	N/A	N/A	N/A	N/A	1000 S. FREMONT AVENUE,	10220	ALHAMBRA	CA	91803	8849	00	06000	34.081452	-118.1518515	Los Angeles County
324187	Ordering, Referring, Prescribing	N/A	1205533957	0	0	BISSELL, ELIZABETH R LCSW	6/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94933	N/A	N/A	N/A	N/A	N/A	1350 CHERRY ST	None	SAN CARLOS	CA	94070	3008	00	06000	37.50406985	-122.2612475	San Mateo County
324201	Ordering, Referring, Prescribing	N/A	1205589314	0	0	BOMER, SAVANNA LMFT	9/5/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149446	N/A	N/A	N/A	N/A	N/A	2034 DE LA VINA	None	SANTA BARBARA	CA	93105	3814	00	06000	34.4295686	-119.7179965	Santa Barbara County
324219	Ordering, Referring, Prescribing	N/A	1205800984	0	0	BURGAMY-STEVENS, CINDY NP	1/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	22260	N/A	N/A	N/A	N/A	N/A	760 E ALMOND AVE	None	MADERA	CA	93637	5617	00	06000	36.94546284	-120.04872	Madera County
324246	Ordering, Referring, Prescribing	N/A	1205929346	0	0	BECHEFSKY, CARA LCSW	9/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18685	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92110	3841	00	06000	32.77025942	-117.2017196	San Diego County
324252	Ordering, Referring, Prescribing	N/A	1205950623	0	0	BERGE, FRED J MD	2/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83911	N/A	N/A	N/A	N/A	N/A	4500 HOLLISTER AVE	None	SANTA BARBARA	CA	93110	1710	00	06000	34.43911625	-119.7758606	Santa Barbara County
324258	Ordering, Referring, Prescribing	N/A	1205955671	0	0	BERKOWITZ, STEVEN LMFT	2/3/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77643	N/A	N/A	N/A	N/A	N/A	1030 CALIFORNIA AVE.	None	MODESTO	CA	95351	2102	00	06000	37.63138833	-121.0221179	Stanislaus County
324290	Ordering, Referring, Prescribing	N/A	1215014469	0	0	BOCC, EDWARD PA	2/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	18351	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
324320	Ordering, Referring, Prescribing	N/A	1215070016	0	0	BURROUGHS, MELISSA M LCSW	8/20/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25259	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
324395	Ordering, Referring, Prescribing	N/A	1215219712	0	0	BOLANOS, FRANKLIN LCSW	11/19/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73741	N/A	N/A	N/A	N/A	N/A	1000 W. CARSON ST.	D5	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
324399	Ordering, Referring, Prescribing	N/A	1215221510	0	0	BARAJAS, JANET HERNANDEZ	1/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75532	N/A	N/A	N/A	N/A	N/A	1611 BUNKER HILL WAY	120	SALINAS	CA	93906	6004	00	06000	36.69971964	-121.6172769	Monterey County
324426	Ordering, Referring, Prescribing	N/A	1215279724	0	0	BELYEU, BRITTANEY M MD	11/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144003	N/A	N/A	N/A	N/A	N/A	351 E TEMPLE ST	None	LOS ANGELES	CA	90012	3328	00	06000	34.05210395	-118.2392143	Los Angeles County
324437	Ordering, Referring, Prescribing	N/A	1215290440	0	0	BUENCAMINO, RAPHAEL H MD	8/30/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145204	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
324486	Ordering, Referring, Prescribing	N/A	1215357819	0	0	BAJNATH, JOLENE LMFT	12/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99386	N/A	N/A	N/A	N/A	N/A	1910 MAGNOLI AVE LOS ANG	None	LANCASTER	CA	90007	1234	00	06000	34.039638	-118.2864045	Los Angeles County
324514	Ordering, Referring, Prescribing	N/A	1215375712	0	0	BEECHER-FLAD, JULIA C LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109152	N/A	N/A	N/A	N/A	N/A	7003 N. FIGUEROA	None	LOS ANGELES	CA	90042	1247	00	06000	34.12951669	-118.1880773	Los Angeles County
324526	Ordering, Referring, Prescribing	N/A	1215433016	0	0	BLACK, LAURA L LMFT	8/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120628	N/A	N/A	N/A	N/A	N/A	505 N EUCLID ST	300	ANAHEIM	CA	92801	5506	00	06000	33.8379454	-117.9416147	Orange County
324543	Ordering, Referring, Prescribing	N/A	1215468459	0	0	BOLLER, MARIE J MD	10/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158900	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
324548	Ordering, Referring, Prescribing	N/A	1215477765	0	0	BALDONADO, ANALICIA G PA-C	11/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61683	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
324562	Ordering, Referring, Prescribing	N/A	1215486287	0	0	BABAYAN, VARDAN PHARMD	4/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74807	N/A	N/A	N/A	N/A	N/A	43112 15TH ST W	None	LANCASTER	CA	93534	6219	00	06000	34.66467	-118.1567445	Los Angeles County
324572	Ordering, Referring, Prescribing	N/A	1215497276	0	0	BUNHOR, DARVIN MD MPH	11/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191307	N/A	N/A	N/A	N/A	N/A	1818 N ORANGE GROVE AVE	STE 200	POMONA	CA	91767	3028	00	06000	34.07694934	-117.7489598	Los Angeles County
324590	Ordering, Referring, Prescribing	N/A	1215542394	0	0	BUGG, MARY SCOTT NP	1/11/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016361	N/A	N/A	N/A	N/A	N/A	965 E YOSEMITE AVE	#2	MANTECA	CA	95336	0000	00	06000	37.79749432	-121.2033865	San Joaquin County
324613	Ordering, Referring, Prescribing	N/A	1215592787	0	0	BRACKER, BRITTNEY N LMFT	1/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144430	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
324644	Ordering, Referring, Prescribing	N/A	1215691332	0	0	BACKER, SHEENA NP	6/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025449	N/A	N/A	N/A	N/A	N/A	3939 ATLANTIC AVE	STE 102	LONG BEACH	CA	90807	3536	00	06000	33.830073	-118.1851065	Los Angeles County
324655	Ordering, Referring, Prescribing	N/A	1215909205	0	0	BUCKNER, JOSEPH PA	10/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	18363	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS ROAD	None	SAN DIEGO	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego
324657	Ordering, Referring, Prescribing	N/A	1215792700	0	0	BAKER, MICHELLE	6/4/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	3867	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
324678	Ordering, Referring, Prescribing	N/A	1225052236	0	0	BENNETT, DEBORAH L LCSW	6/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23029	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
324698	Ordering, Referring, Prescribing	N/A	1225128002	0	0	BECKER, STACY L PSYD	10/30/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY14119	N/A	N/A	N/A	N/A	N/A	19231 VICTORY BLVD.	110	RESEDA	CA	91335	6300	00	06000	34.18659852	-118.552221	Los Angeles County
324749	Ordering, Referring, Prescribing	N/A	1225206279	0	0	BAIG, SHAHIDA MD	7/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101749	N/A	N/A	N/A	N/A	N/A	711 W. FLORENCE AVENUE	None	LOS ANGELES	CA	90044	6105	00	06000	33.9746755	-118.286415	Los Angeles County
324754	Ordering, Referring, Prescribing	N/A	1225212269	0	0	BRIMMER, WILLIAM P LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28633	N/A	N/A	N/A	N/A	N/A	170 S SPRUCE AVE	200	SOUTH SAN FRANCIS	CA	94080	4557	00	06000	37.64883531	-122.4187311	San Mateo County
324774	Ordering, Referring, Prescribing	N/A	1225252372	0	0	BRITO, MATILDE LCSW	5/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20265	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
324780	Ordering, Referring, Prescribing	N/A	1225281884	0	0	BALQUIEDRA, NYRA L PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61863	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
324806	Ordering, Referring, Prescribing	N/A	1225323165	0	0	BRIGGS, JANET J DO	8/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13507	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
324864	Ordering, Referring, Prescribing	N/A	1225427941	0	0	BIBAY, ELEIA F NP	1/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	752490	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4048	00	06000	35.407179	-119.0208925	Kern County
324869	Ordering, Referring, Prescribing	N/A	1225434277	0	0	BROWN, ASHLEY A LMFT	6/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147596	N/A	N/A	N/A	N/A	N/A	2101 GEER RD	120	TURLOCK	CA	95382	2454	00	06000	37.512324	-120.8489985	Stanislaus County
324870	Ordering, Referring, Prescribing	N/A	1225442643	0	0	BACHARACH, REBECCA E DO	2/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15459	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
324889	Ordering, Referring, Prescribing	N/A	1225463292	0	0	BHAKTA, PRIYA S PHARMD	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70060	N/A	N/A	N/A	N/A	N/A	1237 CRANBROOK PL	None	FULLERTON	CA	92833	1406	00	06000	33.88377254	-117.9752064	Orange County
324890	Ordering, Referring, Prescribing	N/A	1225466063	0	0	BUSTAMANTE, JESUS	7/7/2014	Taxonomy not applicable	NA	n/a	000	Unknown	23307	N/A	N/A	N/A	N/A	N/A	2101 7TH ST	None	WASCO	CA	93280	1502	00	06000	35.59426049	-119.3498955	Kern County
324917	Ordering, Referring, Prescribing	N/A	1225509649	0	0	BENIPAL, PRABHJOT PHARMD	3/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78887	N/A	N/A	N/A	N/A	N/A	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	7243	00	06000	38.38851772	-121.9382798	Solano County
324924	Ordering, Referring, Prescribing	N/A	1225514292	0	0	BRODGINSKI, EMMA J LMFT	3/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124816	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
324925	Ordering, Referring, Prescribing	N/A	1225511744	0	0	BLUMER, LAUREN	7/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126849	N/A	N/A	N/A	N/A	N/A	3801 3RD ST	620	SAN FRANCISCO	CA	94124	1409	00	06000	37.74208019	-122.3880422	San Francisco County
324961	Ordering, Referring, Prescribing	N/A	1225562028	0	0	BLAINE, ASHLEE DO	9/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18743	N/A	N/A	N/A	N/A	N/A	2 UPPER RAGSDALE DR	BLDG A	MONTEREY	CA	93940	5736	00	06000	36.57940327	-121.8142876	Monterey County
324969	Ordering, Referring, Prescribing	N/A	1225566714	0	0	BLESSING, JOSHUA MD	4/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173612	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
325003	Ordering, Referring, Prescribing	N/A	1225646813	0	0	BABARINDE, OLOLADE CNP	9/11/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016079	N/A	N/A	N/A	N/A	N/A	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	00	06000	35.37461686	-119.020062	Kern County
325047	Ordering, Referring, Prescribing	N/A	1225817935	0	0	BEMIS, AMANDA CNP	9/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027282	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE,	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
325049	Ordering, Referring, Prescribing	N/A	1225857253	0	0	BLOOMENSTEIN, CIARA DDS	9/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110812	N/A	N/A	N/A	N/A	N/A	1009 N AVALON BLVD	None	WILMINGTON	CA	90744	4505	00	06000	33.78320457	-118.2627263	Los Angeles County
325052	Ordering, Referring, Prescribing	N/A	1235135427	0	0	BASSO, TRACY L DPM	10/30/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	000E36260	N/A	N/A	N/A	N/A	N/A	635 ANDERSON ROAD	SUITE 19	DAVIS	CA	95616	3505	00	06000	38.5487623	-121.7587554	Yolo County
325063	Ordering, Referring, Prescribing	N/A	1235180944	0	0	BERTSCH, THOMAS W MD	10/16/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G86836	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	STE 1300	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
325069	Ordering, Referring, Prescribing	N/A	1235206210	0	0	BALSHAW,ANDREW G	7/11/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101421	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
325070	Ordering, Referring, Prescribing	N/A	1235205931	0	0	BYRNE, LINDSAY M	8/15/2017	Taxonomy not applicable	NA	n/a	000	Unknown	16614	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
325071	Ordering, Referring, Prescribing	N/A	1235196429	0	0	BRADBURN, BARBARA J NP	2/4/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	10777	N/A	N/A	N/A	N/A	N/A	850 STATE HWY 96	None	WILLOW CREEK	CA	95573	9703	00	06000	40.94970076	-123.6384991	Humboldt County
325114	Ordering, Referring, Prescribing	N/A	1235293127	0	0	BALDONADO, JESUS P	11/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68306	N/A	N/A	N/A	N/A	N/A	1500 6TH STREET	None	DELANO	CA	93215	3011	00	06000	35.76504054	-119.236779	Kern County
325130	Ordering, Referring, Prescribing	N/A	1235332966	0	0	BURNETT, MITZE A LMFT	3/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50064	N/A	N/A	N/A	N/A	N/A	3419 VALLE VERDE DR.	None	NAPA	CA	94558	2114	00	06000	38.32542048	-122.292335	Napa County
325161	Ordering, Referring, Prescribing	N/A	1235385188	0	0	BRODIE, TERRY LMFT	9/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46116	N/A	N/A	N/A	N/A	N/A	14567 IDAHO MARYLAND RD	None	NEVADA CITY	CA	95959	8954	00	06000	39.23737172	-120.9749402	Nevada County
325175	Ordering, Referring, Prescribing	N/A	1235412172	0	0	BAUMAN, FATHIAH M LMFT	4/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107664	N/A	N/A	N/A	N/A	N/A	310 PINE AVE	SUITE B	GOLETA	CA	93117	3737	00	06000	34.43451781	-119.8266063	Santa Barbara County
325178	Ordering, Referring, Prescribing	N/A	1235413816	0	0	BENJAMIN, JEFFERY PHARMD	12/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56809	N/A	N/A	N/A	N/A	N/A	1445 R. STREET	None	MERCED	CA	95340	5850	00	06000	37.303164	-120.4974855	Merced County
325203	Ordering, Referring, Prescribing	N/A	1235461153	0	0	BROOKS, JINA	10/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40033	N/A	N/A	N/A	N/A	N/A	800 COLLEGE AVE	None	SANTA ROSA	CA	95404	4109	00	06000	38.445336	-122.7133485	Sonoma County
325211	Ordering, Referring, Prescribing	N/A	1235470360	0	0	BERNARDO, RIA KRISTINE B	3/19/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0630378	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
325234	Ordering, Referring, Prescribing	N/A	1235509068	0	0	BARRIOS, SABRINA M NP	12/28/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	834607	N/A	N/A	N/A	N/A	N/A	570 S MT VERNON AVENUE	STE G	SAN BERNARDINO	CA	92410	2760	00	06000	34.090776	-117.3138565	San Bernardino County
325241	Ordering, Referring, Prescribing	N/A	1235520552	0	0	BRIGGS, ELIZABETH LMFT	1/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105069	N/A	N/A	N/A	N/A	N/A	2560 SKYWAY DR	None	SANTA MARIA	CA	93455	1507	00	06000	34.91283225	-120.454027	Santa Barbara County
325250	Ordering, Referring, Prescribing	N/A	1235530387	0	0	BENEDICT, AMANDA W PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71243	N/A	N/A	N/A	N/A	N/A	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
325258	Ordering, Referring, Prescribing	N/A	1235547522	0	0	BROWN, ERICA O	8/15/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006246	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
325276	Ordering, Referring, Prescribing	N/A	1235570730	0	0	BUI, TAM Q PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72676	N/A	N/A	N/A	N/A	N/A	1826 WEST ORANGETHORPE	None	FULLERTON	CA	92833	4406	00	06000	33.85917352	-117.96057	Orange County
325327	Ordering, Referring, Prescribing	N/A	1235653668	0	0	BRIDGEMAN, BRANDON C LMFT	1/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124014	N/A	N/A	N/A	N/A	N/A	3132 JEFFERSON ST	None	SAN DIEGO	CA	92110	4421	00	06000	32.75567499	-117.203517	San Diego County
325343	Ordering, Referring, Prescribing	N/A	1235669854	0	0	BALESTRINI PEREZ, KIRA C	7/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169475	N/A	N/A	N/A	N/A	N/A	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	00	06000	36.4172997	-119.0975768	Tulare County
325355	Ordering, Referring, Prescribing	N/A	1235691734	0	0	BROWN, JENNIFER M LCSW	1/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78874	N/A	N/A	N/A	N/A	N/A	26137 LA PAZ RD	230	MISSION VIEJO	CA	92691	5319	00	06000	33.60038172	-117.6735855	Orange County
325398	Ordering, Referring, Prescribing	N/A	1235811571	0	0	BRAR, AMRITPAL NP	8/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026475	N/A	N/A	N/A	N/A	N/A	6608 MERCY CT	None	FAIR OAKS	CA	95628	3170	00	06000	38.665917	-121.3106895	Sacramento County
325448	Ordering, Referring, Prescribing	N/A	1245277714	0	0	BHATTACHARYA, JOYDIP DO	9/24/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8773	N/A	N/A	N/A	N/A	N/A	1575 SOQUEL DR,	SUITE B	SANTA CRUZ	CA	95065	1700	00	06000	36.98861921	-121.9831127	Santa Cruz County
325449	Ordering, Referring, Prescribing	N/A	1245255207	0	0	BERNHEIMER, JONATHAN M MD	6/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88386	N/A	N/A	N/A	N/A	N/A	711 STONY POINT RD	SUITE 17	SANTA ROSA	CA	95407	6802	00	06000	38.428848	-122.7420045	Sonoma County
325480	Ordering, Referring, Prescribing	N/A	1245357110	0	0	BARR, DENICE M	4/11/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0305516	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
325481	Ordering, Referring, Prescribing	N/A	1245354448	0	0	BETLACHIN, NATALIE PSYD	7/19/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27138	N/A	N/A	N/A	N/A	N/A	1816 S FIGUEROA ST	None	LOS ANGELES	CA	90015	3422	00	06000	34.03542929	-118.2713663	Los Angeles County
325489	Ordering, Referring, Prescribing	N/A	1245360999	0	0	BUTLER, KELLEY LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19697	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
325490	Ordering, Referring, Prescribing	N/A	1245366798	0	0	BANFIELD, KENYON DMD	11/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109720	N/A	N/A	N/A	N/A	N/A	116 W MINNESOTA AVE	None	MCCLOUD	CA	96057	0001	00	06000	41.25214176	-122.1368284	Siskiyou County
325503	Ordering, Referring, Prescribing	N/A	1245385376	0	0	BARRETO, RACHAEL E LCSW	5/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65820	N/A	N/A	N/A	N/A	N/A	438 N. WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
325508	Ordering, Referring, Prescribing	N/A	1245406800	0	0	BUDD, ROSANA M	12/30/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0480996	N/A	N/A	N/A	N/A	N/A	907 W LANCASTER BLVD	None	LANCASTER	CA	93534	2305	00	06000	34.69735779	-118.1471724	Los Angeles County
325562	Ordering, Referring, Prescribing	N/A	1245494996	0	0	BOUNLOM, ELISA	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59861	N/A	N/A	N/A	N/A	N/A	333 S HOPE ST	C145	LOS ANGELES	CA	90071	1406	00	06000	34.05335946	-118.2526978	Los Angeles County
325566	Ordering, Referring, Prescribing	N/A	1245505411	0	0	BHARGAVA, SAMHITA MD	7/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C174043	N/A	N/A	N/A	N/A	N/A	1531 N STREET	509	SACRAMENTO	CA	95814	5524	00	06000	38.573883	-121.4872875	Sacramento County
325586	Ordering, Referring, Prescribing	N/A	1245536895	0	0	BURKE, ANGELINA R MD	11/10/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131633	N/A	N/A	N/A	N/A	N/A	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	00	06000	37.82397231	-122.2578822	Alameda County
325587	Ordering, Referring, Prescribing	N/A	1245530401	0	0	BRINN, CHRISTINE LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91184	N/A	N/A	N/A	N/A	N/A	672 S LAFAYETTE PARK PL	SUITE 6	LOS ANGELES	CA	90057	3251	00	06000	34.06045149	-118.2837744	Los Angeles County
325603	Ordering, Referring, Prescribing	N/A	1245573039	0	0	BUONO, KRISTEN K R MD	8/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131712	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
325635	Ordering, Referring, Prescribing	N/A	1245613819	0	0	BRODY, BROOKE LCSW	10/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99030	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
325646	Ordering, Referring, Prescribing	N/A	1245630615	0	0	BLOXHAM, WILLIAM PSYD	4/21/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34173	N/A	N/A	N/A	N/A	N/A	3095 RICHMOND PKWY	201	RICHMOND	CA	94806	5773	00	06000	37.99005821	-122.3290377	Contra Costa County
325653	Ordering, Referring, Prescribing	N/A	1245646017	0	0	BECK, CYNTHIA G LMFT	12/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119627	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	None	OXNARD	CA	93036	0617	00	06000	34.219566	-119.1539365	Ventura County
325676	Ordering, Referring, Prescribing	N/A	1245672500	0	0	BOUGARD JORDAN, KELLIE LPCC	4/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC7815	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	None	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
325692	Ordering, Referring, Prescribing	N/A	1245705201	0	0	BATRA, AMANDEEP PHARMD	8/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	79514	N/A	N/A	N/A	N/A	N/A	19555 S. MOUNTAIN HOUSE	None	TRACY	CA	95350	8500	00	06000	37.77480331	-121.5317761	San Joaquin County
325706	Ordering, Referring, Prescribing	N/A	1245737170	0	0	BABY, BINTU NP	10/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008289	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	0001	00	06000	37.30176	-121.9136465	Santa Clara County
325728	Ordering, Referring, Prescribing	N/A	1245762319	0	0	BOTTOM, CAITLYN LMFT	5/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126057	N/A	N/A	N/A	N/A	N/A	325 BUENA CREEK RD	None	SAN MARCOS	CA	92069	9679	00	06000	33.18307285	-117.160072	San Diego County
325732	Ordering, Referring, Prescribing	N/A	1245764695	0	0	BROWN, KEVIN C MD	1/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162628	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	300	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
325737	Ordering, Referring, Prescribing	N/A	1245768787	0	0	BOUTROS, MATTHEW A DO	1/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16673	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
325742	Ordering, Referring, Prescribing	N/A	1245773217	0	0	BOSS, RHONDA L	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107847	N/A	N/A	N/A	N/A	N/A	340 HWY 138	None	CRESTLINE	CA	92325	6300	00	06000	34.247106	-117.300798	San Bernardino County
325754	Ordering, Referring, Prescribing	N/A	1245781020	0	0	BARTHEL, KARA S LCSW	1/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99519	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
325787	Ordering, Referring, Prescribing	N/A	1245839893	0	0	BURDGICK, AMANDA LCSW	8/8/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117189	N/A	N/A	N/A	N/A	N/A	12141 BROOKHURST ST	201	GARDEN GROVE	CA	92840	2865	00	06000	33.78614503	-117.9587915	Orange County
325807	Ordering, Referring, Prescribing	N/A	1245879071	0	0	BOYADZHYAN, ANGELIKA LMFT	1/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87047	N/A	N/A	N/A	N/A	N/A	2990 INLAND EMPIRE BLVD	101	ONTARIO	CA	91764	4899	00	06000	34.069824	-117.5873175	San Bernardino County
325808	Ordering, Referring, Prescribing	N/A	1245879337	0	0	BURGA, JOANNA I	3/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87916	N/A	N/A	N/A	N/A	N/A	604 ROSE AVE	None	VENICE	CA	90291	2767	00	06000	33.99891527	-118.4714129	Los Angeles County
325819	Ordering, Referring, Prescribing	N/A	1245908912	0	0	BITTNER, LAUREN LMFT	4/19/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132821	N/A	N/A	N/A	N/A	N/A	950 W JULIAN ST	None	SAN JOSE	CA	95126	2719	00	06000	37.33352455	-121.9089111	Santa Clara County
325842	Ordering, Referring, Prescribing	N/A	1245992635	0	0	BEDFORD, LERONICA D	8/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017715	N/A	N/A	N/A	N/A	N/A	27260 LOS ALTOS	1214	MISSION VIEJO	CA	92691	7312	00	06000	33.56692945	-117.6674609	Orange County
325843	Ordering, Referring, Prescribing	N/A	1255000493	0	0	BHATT, RISHMA V NP	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95019189	N/A	N/A	N/A	N/A	N/A	16465 SIERRA LAKES PKWY	300	FONTANA	CA	92336	1242	00	06000	34.13805177	-117.4457839	San Bernardino County
325850	Ordering, Referring, Prescribing	N/A	1255014114	0	0	BARRIENTOS, LINDSAY NP	8/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026568	N/A	N/A	N/A	N/A	N/A	6 CENTERPOINTE DR STE 70	STE 700	LA PALMA	CA	90623	2545	00	06000	33.86052378	-118.0296232	Orange County
325854	Ordering, Referring, Prescribing	N/A	1255023123	0	0	BARTOLAY, OLIVER JOSEPH PT	6/28/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	33642	N/A	N/A	N/A	N/A	N/A	1601 PRECISION PARK LN	None	SAN DIEGO	CA	92173	1345	00	06000	32.56692	-117.0594273	San Diego County
325855	Ordering, Referring, Prescribing	N/A	1255028999	0	0	BRAVO LOERA, SELEINA CNP	5/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024011	N/A	N/A	N/A	N/A	N/A	751 LOMBARDI COURT	None	SANTA ROSA	CA	95407	6798	00	06000	38.427804	-122.7493035	Sonoma County
325870	Ordering, Referring, Prescribing	N/A	1255066593	0	0	BALDERAS, SAIRA S CNP	7/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021789	N/A	N/A	N/A	N/A	N/A	1093 11TH STREET	None	REEDLEY	CA	93654	2950	00	06000	36.60074456	-119.4445203	Fresno County
325898	Ordering, Referring, Prescribing	N/A	1255383352	0	0	BORLAND, KOREN A DDS	7/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	45229	N/A	N/A	N/A	N/A	N/A	1133 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05124618	-119.0425626	Tulare County
325903	Ordering, Referring, Prescribing	N/A	1255407839	0	0	BARTON, MARIE L L	7/18/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	A58477	N/A	N/A	N/A	N/A	N/A	4860 Y STREET	SUITE 0400, ROOM 0247	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
325953	Ordering, Referring, Prescribing	N/A	1255495297	0	0	BIENKOWSKI, EDMUND S PHD	5/6/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY12572	N/A	N/A	N/A	N/A	N/A	1080 MARINA VILLAGE PKWY	100	ALAMEDA	CA	94501	6427	00	06000	37.78544731	-122.270323	Alameda County
325964	Ordering, Referring, Prescribing	N/A	1255528709	0	0	BROWN, AUDREY R LCSW	1/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25042	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST.	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
325971	Ordering, Referring, Prescribing	N/A	1255534400	0	0	BABBITT, TONIA T LMFT	11/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53524	N/A	N/A	N/A	N/A	N/A	43520 DIVISION ST	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
325996	Ordering, Referring, Prescribing	N/A	1255611828	0	0	BAKHTARI, MICHELLE D PHARMD	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60930	N/A	N/A	N/A	N/A	N/A	3521 DEL PASO ROAD	None	SACRAMENTO	CA	95835	2800	00	06000	38.65608	-121.541625	Sacramento County
326003	Ordering, Referring, Prescribing	N/A	1255613402	0	0	BEDFORD, RONALD M	10/25/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21299	N/A	N/A	N/A	N/A	N/A	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
326012	Ordering, Referring, Prescribing	N/A	1255631693	0	0	BARBESINO, PAOLA M PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	45100	N/A	N/A	N/A	N/A	N/A	1366 EAST AVE	None	CHICO	CA	95926	7336	00	06000	39.76111951	-121.8226455	Butte County
326056	Ordering, Referring, Prescribing	N/A	1255709424	0	0	BATTUNG, GENEVIEVE C NP	10/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	NP95009843	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
326057	Ordering, Referring, Prescribing	N/A	1255709036	0	0	BORSE, JYOTI D RCP	2/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61956	N/A	N/A	N/A	N/A	N/A	660 BAILEY ROAD	None	PITTSBURG	CA	94565	6206	00	06000	38.01615505	-121.9419732	Contra Costa County
326068	Ordering, Referring, Prescribing	N/A	1255717997	0	0	BURTON, RACHEL E LCSW	1/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83193	N/A	N/A	N/A	N/A	N/A	900 E MAIN ST STE 201	STE 201	GRASS VALLEY	CA	95945	5853	00	06000	39.22827201	-121.0517684	Nevada County
326140	Ordering, Referring, Prescribing	N/A	1255831731	0	0	BARAKE, KATHERINE LMFT	9/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT128434	N/A	N/A	N/A	N/A	N/A	300 E LELAND RD	100	PITTSBURG	CA	94565	4960	00	06000	38.01129897	-121.8878132	Contra Costa County
326144	Ordering, Referring, Prescribing	N/A	1255847414	0	0	BEHROUZIAN, KIMYA PSYD	10/25/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33393	N/A	N/A	N/A	N/A	N/A	36101 BOB HOPE DRIVE	A	RANCHO MIRAGE	CA	92270	2002	00	06000	33.786126	-116.406086	Riverside County
326206	Ordering, Referring, Prescribing	N/A	1255921557	0	0	BUSCH, CHRISTINA M LCSW	8/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103553	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
326221	Ordering, Referring, Prescribing	N/A	1255964417	0	0	BRIGNOLE, ANGELA LCSW	9/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83715	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	STE 475	LOS ANGELES	CA	90017	4262	00	06000	34.04532806	-118.258462	Los Angeles County
326252	Ordering, Referring, Prescribing	N/A	1265020895	0	0	BAKER, STEPHANI M PA-C	12/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA58979	N/A	N/A	N/A	N/A	N/A	1100 N PALM CANYON DR ST	STE 206	PALM SPRINGS	CA	92262	4426	00	06000	33.838182	-116.546744	Riverside County
326255	Ordering, Referring, Prescribing	N/A	1265034912	0	0	BURNS, CHEYANNE K NP	10/7/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015638	N/A	N/A	N/A	N/A	N/A	461 TENESSEE ST SUITE C	None	REDLANDS	CA	92359	9522	00	06000	34.058745	-117.2000975	San Bernardino County
326282	Ordering, Referring, Prescribing	N/A	1265104293	0	0	BROWN, HANNAH	9/8/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018343	N/A	N/A	N/A	N/A	N/A	201 29TH STREET	B	SACRAMENTO	CA	95816	0000	00	06000	38.581875	-121.463802	Sacramento County
326319	Ordering, Referring, Prescribing	N/A	1265277503	0	0	BOUWHUIS, BRAYDON PA	10/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65247	N/A	N/A	N/A	N/A	N/A	207 N BUTTE ST	None	WILLOWS	CA	95988	2803	00	06000	39.52212468	-122.195408	Glenn County
326328	Ordering, Referring, Prescribing	N/A	1265403117	0	0	BRAATZ, STEVEN E MD	3/10/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G87968	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
326360	Ordering, Referring, Prescribing	N/A	1265552236	0	0	BOGEN, PAMELA J LCSW	8/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25419	N/A	N/A	N/A	N/A	N/A	102 GUTIERREZ	None	SANTA BARBARA	CA	93101	3424	00	06000	34.41699259	-119.6929055	Santa Barbara County
326364	Ordering, Referring, Prescribing	N/A	1265554851	0	0	BENAVENTE, ANA E LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116853	N/A	N/A	N/A	N/A	N/A	3208 ROSEMEAD BLVD	100	EL MONTE	CA	91731	2830	00	06000	34.06580258	-118.0676162	Los Angeles County
326377	Ordering, Referring, Prescribing	N/A	1265568364	0	0	BLIFELD, CINDY MD FAAP	3/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43842	N/A	N/A	N/A	N/A	N/A	1111 E OCEAN AVENUE	SUITE 6	LOMPOC	CA	93436	7076	00	06000	34.63889719	-120.4447732	Santa Barbara County
326379	Ordering, Referring, Prescribing	N/A	1265572002	0	0	BUTLER, CARLEY I LCSW	5/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61483	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
326380	Ordering, Referring, Prescribing	N/A	1265573422	0	0	BONNER, TANIYA K LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28849	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
326381	Ordering, Referring, Prescribing	N/A	1265576755	0	0	BACKER, JENNIFER J NP	7/17/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	480709	N/A	N/A	N/A	N/A	N/A	2525 GRAND AVENUE	ROOM 106	LONG BEACH	CA	90815	1765	00	06000	33.8026265	-118.1480993	Los Angeles County
326396	Ordering, Referring, Prescribing	N/A	1265607998	0	0	BAUM, RACHEL LMFT	8/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36159	N/A	N/A	N/A	N/A	N/A	820 S. SIERRA BONITA AVE	None	LOS ANGELES	CA	90036	4704	00	06000	34.05998149	-118.3548198	Los Angeles County
326406	Ordering, Referring, Prescribing	N/A	1265651574	0	0	BAHOH, CAROLYN S PSYD	6/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24650	N/A	N/A	N/A	N/A	N/A	1624 SANTA CLARA DRIVE	SUITE 145	ROSEVILLE	CA	95661	3500	00	06000	38.74308965	-121.2620987	Placer County
326412	Ordering, Referring, Prescribing	N/A	1265662977	0	0	BENSONHAVER, KIMBERLY DDS	9/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109419	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6450	00	06000	39.12772164	-123.2111168	Mendocino County
326414	Ordering, Referring, Prescribing	N/A	1265659981	0	0	BOEHLER, BARBARA	5/23/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0358407	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
326415	Ordering, Referring, Prescribing	N/A	1265664783	0	0	BAUCHAM, JANETTE LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	54027	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	SUITE 100	PACOIMA	CA	91331	1392	00	06000	34.27894489	-118.4044363	Los Angeles County
326452	Ordering, Referring, Prescribing	N/A	1265716542	0	0	BHANGOO, SANDEEP K NP	8/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	711054	N/A	N/A	N/A	N/A	N/A	6327 N FRESNO ST	STE 101	FRESNO	CA	93710	5236	00	06000	36.82875536	-119.781417	Fresno County
326456	Ordering, Referring, Prescribing	N/A	1265714869	0	0	BRADBARD, JACQUELYN J LCSW	1/29/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23174	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
326475	Ordering, Referring, Prescribing	N/A	1265748479	0	0	BAKER, NICHOLAS D PHARMD	2/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64406	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
326481	Ordering, Referring, Prescribing	N/A	1265753404	0	0	BOSTIC, MARQUES J OD	11/5/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34454TLG	N/A	N/A	N/A	N/A	N/A	65 N HOCKETT ST	None	PORTERVILLE	CA	93257	0000	00	06000	36.0663928	-119.01714	Tulare County
326489	Ordering, Referring, Prescribing	N/A	1265775092	0	0	BAHAR, RUNALIA MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133805	N/A	N/A	N/A	N/A	N/A	4150 V ST	None	SACRAMENTO	CA	95817	1460	00	06000	38.556081	-121.4570475	Sacramento County
326517	Ordering, Referring, Prescribing	N/A	1265819023	0	0	BRADFORD, RUSTI L LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110309	N/A	N/A	N/A	N/A	N/A	1445 VETERANS MEMORIAL C	None	YUBA CITY	CA	95993	3011	00	06000	39.14469836	-121.6380819	Sutter County
326519	Ordering, Referring, Prescribing	N/A	1265830616	0	0	BANJO, OLUBUNMI F NP	5/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000540	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
326527	Ordering, Referring, Prescribing	N/A	1265836365	0	0	BANUELOS, RINA LCSW	3/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91530	N/A	N/A	N/A	N/A	N/A	345 5TH ST	None	COLUSA	CA	95932	2445	00	06000	39.21248116	-122.0085455	Colusa County
326529	Ordering, Referring, Prescribing	N/A	1265844351	0	0	BURGDORFER, AUDREY M NP	3/6/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	568509	N/A	N/A	N/A	N/A	N/A	26455 ROCKWELL CANYON RD	None	SANTA CLARITA	CA	91355	1803	00	06000	34.404021	-118.569906	Los Angeles County
326535	Ordering, Referring, Prescribing	N/A	1265857049	0	0	BOLKHOVITINOV, MOHINI S MSW LCSW	6/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73179	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
326557	Ordering, Referring, Prescribing	N/A	1265876833	0	0	BHUTANI, MANINDER S MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143230	N/A	N/A	N/A	N/A	N/A	24077 STATE HIGHWAY 49	None	NEVADA CITY	CA	95959	8519	00	06000	39.321882	-121.0992075	Nevada County
326583	Ordering, Referring, Prescribing	N/A	1265921118	0	0	BYLER, REBECCA A LPCC	11/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC12718	N/A	N/A	N/A	N/A	N/A	1328 W MANCHESTER AVENUE	None	LOS ANGELES	CA	90044	2240	00	06000	33.95998503	-118.2992802	Los Angeles County
326614	Ordering, Referring, Prescribing	N/A	1265980437	0	0	BHAKTA, NITIN PHARMD	12/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	42971	N/A	N/A	N/A	N/A	N/A	520 N PROSPECT AVENUE	SUITE 110	REDONDO BEACH	CA	90277	3033	00	06000	33.8529819	-118.3802954	Los Angeles County
326621	Ordering, Referring, Prescribing	N/A	1265995757	0	0	BENAVIDES MARTINEZ, CARIDAD MD	7/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180705	N/A	N/A	N/A	N/A	N/A	401 QUARRY ROAD	None	PALO ALTO	CA	94304	9999	00	06000	37.43886471	-122.1713882	Santa Clara County
326639	Ordering, Referring, Prescribing	N/A	1275039950	0	0	BAHATYREVICH, NATALIYA MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164345	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
326645	Ordering, Referring, Prescribing	N/A	1275041568	0	0	BUI, PASCAL P PHARMD	6/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75547	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
326661	Ordering, Referring, Prescribing	N/A	1275079170	0	0	BARBA, PAOLA T LMFT	6/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126266	N/A	N/A	N/A	N/A	N/A	10776 FREMONT ST	None	YUCAIPA	CA	92399	9260	00	06000	34.058052	-117.0280305	San Bernardino County
326686	Ordering, Referring, Prescribing	N/A	1275117079	0	0	BROWN, CALAI	10/23/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109334	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT.	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
326691	Ordering, Referring, Prescribing	N/A	1275132151	0	0	BISHOP, RACHEL M OT	5/26/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	19734	N/A	N/A	N/A	N/A	N/A	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	00	06000	37.86379498	-122.2689084	Alameda County
326709	Ordering, Referring, Prescribing	N/A	1275179012	0	0	BOUDREAUX, JENNIFER H NP	10/10/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013036	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY STREET	None	REDDING	CA	96001	0811	00	06000	40.5857177	-122.3870781	Shasta County
326710	Ordering, Referring, Prescribing	N/A	1275177149	0	0	BUAN, PAUL JOHN M NP	10/2/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012159	N/A	N/A	N/A	N/A	N/A	1039 W FLORENCE AVE	None	LOS ANGELES	CA	90044	2441	00	06000	33.97463885	-118.2933327	Los Angeles County
326741	Ordering, Referring, Prescribing	N/A	1275273088	0	0	BERNSTEIN, DANIEL MD	9/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190641	N/A	N/A	N/A	N/A	N/A	1503 GRANT RD	110	MOUNTAIN VIEW	CA	94040	3270	00	06000	37.37672165	-122.0757295	Santa Clara County
326743	Ordering, Referring, Prescribing	N/A	1275296360	0	0	BERMUDEZ, EMMA NP	10/4/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018683	N/A	N/A	N/A	N/A	N/A	69175 RAMON RD	A	CATHEDRAL CITY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
326745	Ordering, Referring, Prescribing	N/A	1275287963	0	0	BARRAGAN, LIZANDRO PA-C	2/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60785	N/A	N/A	N/A	N/A	N/A	1700 KEYSTONE PACIFIC PK	UNIT B	PATTERSON	CA	95363	8874	00	06000	37.47600952	-121.160718	Stanislaus County
326761	Ordering, Referring, Prescribing	N/A	1275519175	0	0	BUI, HANH M MD	11/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79185	N/A	N/A	N/A	N/A	N/A	2067 W VISTA WAY	SUITE 225	VISTA	CA	92083	6031	00	06000	33.18505594	-117.285958	San Diego County
326786	Ordering, Referring, Prescribing	N/A	1275612392	0	0	BOWMAN, JANICE L	5/14/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT11638	N/A	N/A	N/A	N/A	N/A	1901 N.RICE AVE	SUITE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
326833	Ordering, Referring, Prescribing	N/A	1275698623	0	0	BURMEISTER, GAIL E NP	6/12/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	534174	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	210	SACRAMENTO	CA	95815	3318	00	06000	38.60568	-121.4345385	Sacramento County
326858	Ordering, Referring, Prescribing	N/A	1275765372	0	0	BREWER, KATHERINE M LCSW	6/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84756	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
326869	Ordering, Referring, Prescribing	N/A	1275738346	0	0	BAHL, RAJAN MD	2/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116259	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR. S	628	LOS ANGELES	CA	90008	3600	00	06000	34.00888336	-118.3389334	Los Angeles County
326871	Ordering, Referring, Prescribing	N/A	1275801805	0	0	BISCHOF, BAILEY PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61604	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	4TH FLOOR	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
326886	Ordering, Referring, Prescribing	N/A	1275817140	0	0	BALAGA, BHAVANI	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55275	N/A	N/A	N/A	N/A	N/A	2595 E BIDWELL ST	None	FOLSOM	CA	95630	6439	00	06000	38.65824	-121.129425	Sacramento County
326890	Ordering, Referring, Prescribing	N/A	1275818890	0	0	BAIRAMIAN, NAZELI A PHARMD	11/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	65909	N/A	N/A	N/A	N/A	N/A	1000 S FREMONT AVE	SUITE 10150	ALHAMBRA	CA	91803	8800	00	06000	34.081452	-118.1518515	Los Angeles County
326904	Ordering, Referring, Prescribing	N/A	1275847436	0	0	BITE, DIANE E NP	7/13/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	607268	N/A	N/A	N/A	N/A	N/A	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	00	06000	34.58013142	-118.0898273	Los Angeles County
326909	Ordering, Referring, Prescribing	N/A	1275866329	0	0	BURGESS, WHITNEY E LMFT	7/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	78355	N/A	N/A	N/A	N/A	N/A	1270 NATIVIDAD RD	None	SALINAS	CA	93906	3144	00	06000	36.69733474	-121.6370383	Monterey County
326925	Ordering, Referring, Prescribing	N/A	1275885113	0	0	BETTIS, MICHAEL W LMFT	5/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117278	N/A	N/A	N/A	N/A	N/A	17053 E. FOOTHILL BLVD.,	None	FONTANA	CA	92335	0920	00	06000	34.10655148	-117.432828	San Bernardino County
326927	Ordering, Referring, Prescribing	N/A	1275889800	0	0	BEHAN, JENNIFER E	6/20/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	67329	N/A	N/A	N/A	N/A	N/A	1380 HOWARD	SUITE 130	SAN FRANCISCO	CA	94103	2614	00	06000	37.77424669	-122.4141502	San Francisco County
326930	Ordering, Referring, Prescribing	N/A	1275890287	0	0	BENARD, SHAWNA W	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141367	N/A	N/A	N/A	N/A	N/A	1200 NORTH STATE STREET	None	LOS ANGELES	CA	90033	1011	00	06000	34.05855992	-118.209755	Los Angeles County
326938	Ordering, Referring, Prescribing	N/A	1275901845	0	0	BOOTH, CHRISTY LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111261	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	101	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
326942	Ordering, Referring, Prescribing	N/A	1275908386	0	0	BHATT, ELIZABETH LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112418	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD	SUITE E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
326950	Ordering, Referring, Prescribing	N/A	1275916348	0	0	BALAJELINI, FATEMEH A	4/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100488	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
326960	Ordering, Referring, Prescribing	N/A	1275927923	0	0	BAYES, KERRY L NP	7/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95006609	N/A	N/A	N/A	N/A	N/A	400 WEST PUEBLO	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
326971	Ordering, Referring, Prescribing	N/A	1275939092	0	0	BROWN, NICHOLAS P DO	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18162	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
327023	Ordering, Referring, Prescribing	N/A	1285013177	0	0	BOB, JENNIFER PSYD	11/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31444	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	SUITE 140	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
327031	Ordering, Referring, Prescribing	N/A	1285024166	0	0	BLANCKE, ANN PHARMD	7/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	43852	N/A	N/A	N/A	N/A	N/A	16251 MAIN ST	None	GUERNEVILLE	CA	95446	8300	00	06000	38.50196181	-122.9981182	Sonoma County
327041	Ordering, Referring, Prescribing	N/A	1285040709	0	0	BALTRUS, JUSTINE LMFT	3/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132018	N/A	N/A	N/A	N/A	N/A	1666 PRECISION PARK LN	None	SAN YSIDRO	CA	92173	1322	00	06000	32.5659146	-117.059667	San Diego County
327046	Ordering, Referring, Prescribing	N/A	1285047811	0	0	BAKKE, GARRETT T LCSW	11/30/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW119469	N/A	N/A	N/A	N/A	N/A	1145 E CLARK AVE	STE F	SANTA MARIA	CA	93455	5105	00	06000	34.8650893	-120.4170345	Santa Barbara County
327075	Ordering, Referring, Prescribing	N/A	1285082958	0	0	BELTRAN, ANDREW M LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115457	N/A	N/A	N/A	N/A	N/A	850 E. FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
327079	Ordering, Referring, Prescribing	N/A	1285090167	0	0	BROWN, RAVEN M LMFT	5/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126129	N/A	N/A	N/A	N/A	N/A	1221 E DYER RD	None	SANTA ANA	CA	92705	5600	00	06000	33.70872153	-117.857052	Orange County
327081	Ordering, Referring, Prescribing	N/A	1285096057	0	0	BORHANIAN, SARRA MD	3/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150934	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE. 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
327092	Ordering, Referring, Prescribing	N/A	1285112698	0	0	BAHADARAKHANN, SALMA PHARMD	4/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77519	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
327100	Ordering, Referring, Prescribing	N/A	1285120006	0	0	BAROUTIHA, ELNAZ PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79657	N/A	N/A	N/A	N/A	N/A	1040 COAST VILLAGE RD	B	MONTECITO	CA	93108	2715	00	06000	34.42199438	-119.6515242	Santa Barbara County
327112	Ordering, Referring, Prescribing	N/A	1285145243	0	0	BASS, CHLOE E	6/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160066	N/A	N/A	N/A	N/A	N/A	825 N SAN VICENTE BLVD	None	WEST HOLLYWOOD	CA	90069	4505	00	06000	34.0855723	-118.3845783	Los Angeles County
327122	Ordering, Referring, Prescribing	N/A	1285165100	0	0	BERNSTEIN, RUTH LCSW	11/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93036	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
327135	Ordering, Referring, Prescribing	N/A	1285191742	0	0	BAJWA, BALRAJ S NP	2/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95020092	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
327148	Ordering, Referring, Prescribing	N/A	1285212613	0	0	BAHNS, MAXINE LMFT	5/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139623	N/A	N/A	N/A	N/A	N/A	4955 ALTA ST.	None	SIMI VALLEY	CA	93063	0000	00	06000	34.28440504	-118.6967314	Ventura County
327149	Ordering, Referring, Prescribing	N/A	1285215640	0	0	BRATHWAITE, SARA MD	5/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191320	N/A	N/A	N/A	N/A	N/A	1000 W CARSON STREET	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
327176	Ordering, Referring, Prescribing	N/A	1285250365	0	0	BATANGHARI, KIMBERLY MD	6/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187251	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
327194	Ordering, Referring, Prescribing	N/A	1285281782	0	0	BABALOLA, ESTHER O	8/4/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012218	N/A	N/A	N/A	N/A	N/A	301 S LA CADENA DR	None	COLTON	CA	92324	3419	00	06000	34.06170401	-117.3254683	San Bernardino County
327215	Ordering, Referring, Prescribing	N/A	1285352443	0	0	BLANCO, RUDY LMFT	4/12/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146354	N/A	N/A	N/A	N/A	N/A	405 W 5TH ST	211	SANTA ANA	CA	92701	4599	00	06000	33.74893088	-117.8713859	Orange County
327230	Ordering, Referring, Prescribing	N/A	1285417170	0	0	BARONIA, MARIELLE ANGELINE CCC-SLP	3/20/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	34902	N/A	N/A	N/A	N/A	N/A	3720 RIO HONDO AVE	None	ROSEMEAD	CA	91770	2043	00	06000	34.07602692	-118.0643182	Los Angeles County
327271	Ordering, Referring, Prescribing	N/A	1285722827	0	0	BALLARDO, NICHOL M LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80101	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	SUITE 2	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
327286	Ordering, Referring, Prescribing	N/A	1285760488	0	0	BANH, AMY M LMFT	3/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53496	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	700	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
327290	Ordering, Referring, Prescribing	N/A	1285763896	0	0	BELL, ALLYSON K PHD	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49024	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8530	00	06000	34.18921316	-119.0340743	Ventura County
327292	Ordering, Referring, Prescribing	N/A	1285768770	0	0	BIBLER, ANDRIA A LMFT	5/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49956	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LA	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
327329	Ordering, Referring, Prescribing	N/A	1285843086	0	0	BANDYOPADHYAY, SUNANDA K	1/11/2002	Taxonomy not applicable	NA	n/a	099	DENTIST	D48086	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	STE 500	MARYSVILLE	CA	95901	7119	00	06000	39.12014523	-121.5659991	Yuba County
327342	Ordering, Referring, Prescribing	N/A	1285881151	0	0	BROWN-WADE, JACINTA L LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103253	N/A	N/A	N/A	N/A	N/A	809 PLUMAS STREET	None	YUBA CITY	CA	95991	4437	00	06000	39.13989097	-121.6173645	Sutter County
327359	Ordering, Referring, Prescribing	N/A	1285906883	0	0	BERGER, JANE R NP	1/6/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21311	N/A	N/A	N/A	N/A	N/A	7275 E SOUTHGATE DR	204	SACRAMENTO	CA	95823	2629	00	06000	38.493576	-121.436559	Sacramento County
327376	Ordering, Referring, Prescribing	N/A	1285929075	0	0	BERRY, ANGELA T PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62861	N/A	N/A	N/A	N/A	N/A	3430 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	00	06000	33.852105	-117.8444835	Orange County
327380	Ordering, Referring, Prescribing	N/A	1285931147	0	0	BORRUSO, ADAM R	5/31/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0663424	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
327413	Ordering, Referring, Prescribing	N/A	1295000172	0	0	BROWN, KIMBERLY K LMFT	11/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123141	N/A	N/A	N/A	N/A	N/A	15116 S. GIBSON AVE.	None	COMPTON	CA	90221	3106	00	06000	33.89561249	-118.1889466	Los Angeles County
327426	Ordering, Referring, Prescribing	N/A	1295018513	0	0	BALLESTEROS, LALA	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63991	N/A	N/A	N/A	N/A	N/A	9200 ELK GROVE FLORIN RD	None	ELK GROVE	CA	95624	1609	00	06000	38.423097	-121.372128	Sacramento County
327430	Ordering, Referring, Prescribing	N/A	1295033504	0	0	BAUMAN, MAGDALENA M LMFT	9/5/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95512	N/A	N/A	N/A	N/A	N/A	175 FAIRVIEW LN	None	SONORA	CA	95370	4809	00	06000	37.97889249	-120.3913563	Tuolumne County
327439	Ordering, Referring, Prescribing	N/A	1295049567	0	0	BANARES, LINDA W PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63962	N/A	N/A	N/A	N/A	N/A	1011 SNEATH LN	None	SAN BRUNO	CA	94066	2311	00	06000	37.63437084	-122.4264474	San Mateo County
327448	Ordering, Referring, Prescribing	N/A	1295077154	0	0	BROWN, NATHANIEL A MD	11/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134688	N/A	N/A	N/A	N/A	N/A	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	00	06000	33.12123297	-117.1199417	San Diego County
327458	Ordering, Referring, Prescribing	N/A	1295094845	0	0	BRAM-MOSTYN, AVRAM A DO	4/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16910	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
327474	Ordering, Referring, Prescribing	N/A	1295117331	0	0	BEARD, BEE NP	3/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002042	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
327504	Ordering, Referring, Prescribing	N/A	1295179901	0	0	BOPARAI, RUHEL MD	10/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159340	N/A	N/A	N/A	N/A	N/A	300 E 15TH ST	None	MERCED	CA	95341	6217	00	06000	37.29443362	-120.4719616	Merced County
327529	Ordering, Referring, Prescribing	N/A	1295220614	0	0	BANDY, MICHELLE A LCSW	4/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121909	N/A	N/A	N/A	N/A	N/A	3727 SUNSET LN	110	ANTIOCH	CA	94509	6134	00	06000	37.98376866	-121.8041894	Contra Costa County
327546	Ordering, Referring, Prescribing	N/A	1295243848	0	0	BODAKUNTA, PRAVEEN NP	11/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95023203	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	401	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
327561	Ordering, Referring, Prescribing	N/A	1295265833	0	0	BOZMAN, MICHELLE A LMFT	12/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123716	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
327568	Ordering, Referring, Prescribing	N/A	1295272318	0	0	BURCH, AMY NP	10/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023149	N/A	N/A	N/A	N/A	N/A	1660 HOTEL CIRCLE NORTH	STE 101	SAN DIEGO	CA	92108	2801	00	06000	32.75964178	-117.1791442	San Diego County
327569	Ordering, Referring, Prescribing	N/A	1295282242	0	0	BATAZ, FABIOLA LMSW	2/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100230	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3RD FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
327570	Ordering, Referring, Prescribing	N/A	1295281244	0	0	BAROT, NEELAM PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78134	N/A	N/A	N/A	N/A	N/A	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
327585	Ordering, Referring, Prescribing	N/A	1295308336	0	0	BESHIR, SOUFIA PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84053	N/A	N/A	N/A	N/A	N/A	9031 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2046	00	06000	33.9038495	-118.1420904	Los Angeles County
327627	Ordering, Referring, Prescribing	N/A	1295403921	0	0	BAJAJ, SUPARNA OD	8/9/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34898	N/A	N/A	N/A	N/A	N/A	27420 TOURNEY RD	100	VALENCIA	CA	91355	5601	00	06000	34.42122797	-118.5787489	Los Angeles County
327630	Ordering, Referring, Prescribing	N/A	1295443927	0	0	BARAJAS, GISELA J NP	11/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023404	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
327653	Ordering, Referring, Prescribing	N/A	1295577229	0	0	BOBADILLA, MELINA NP	5/3/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030013	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
327660	Ordering, Referring, Prescribing	N/A	1295712206	0	0	BAUTISTA, LUIS G MD	9/15/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97270	N/A	N/A	N/A	N/A	N/A	4844 N FIRST ST	STE 104	FRESNO	CA	93726	0529	00	06000	36.80569286	-119.7720261	Fresno County
327673	Ordering, Referring, Prescribing	N/A	1295754737	0	0	BROWN, MICHELE L LMFT	11/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT37475	N/A	N/A	N/A	N/A	N/A	921 W. AVE. J	SUITE C	LANCASTER	CA	93534	0131	00	06000	34.6895043	-118.1463998	Los Angeles County
327676	Ordering, Referring, Prescribing	N/A	1295767622	0	0	BOBROW, DAVID MD	8/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G77638	N/A	N/A	N/A	N/A	N/A	8765 AERO DR	STE 310A	SAN DIEGO	CA	92123	1781	00	06000	32.80965252	-117.139383	San Diego County
327683	Ordering, Referring, Prescribing	N/A	1295775211	0	0	BROWN, FREDERICK M MD	1/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63804	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
327687	Ordering, Referring, Prescribing	N/A	1295802650	0	0	BUSQUE, MARIE-CHRISTINE LCSW	7/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25007	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
327699	Ordering, Referring, Prescribing	N/A	1295841245	0	0	BIDDLE, KATHRYN K	4/11/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0340849	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
327703	Ordering, Referring, Prescribing	N/A	1295853570	0	0	BACH, JONATHAN H LMFT	12/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50320	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	300	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
327727	Ordering, Referring, Prescribing	N/A	1295882439	0	0	BARRERA, DIANA E MSW LCSW	8/9/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17483	N/A	N/A	N/A	N/A	N/A	517 S MADERA AVE	None	KERMAN	CA	93630	1523	00	06000	36.72710606	-120.060325	Fresno County
327769	Ordering, Referring, Prescribing	N/A	1295988848	0	0	BROBERG, NED S LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52605	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
327790	Ordering, Referring, Prescribing	N/A	1306037312	0	0	BARNETT, CHRISTOPHER S MD	7/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99750	N/A	N/A	N/A	N/A	N/A	1535 PLUMAS COURT	None	YUBA CITY	CA	95991	2960	00	06000	39.15296602	-121.6185859	Sutter County
327794	Ordering, Referring, Prescribing	N/A	1306046123	0	0	BHAGAT, BIPINCHANDRA V MD	11/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55207	N/A	N/A	N/A	N/A	N/A	17290 JASMINE ST	STE 101	VICTORVILLE	CA	92395	7735	00	06000	34.47495546	-117.285822	San Bernardino County
327821	Ordering, Referring, Prescribing	N/A	1306117619	0	0	BEAS, EMILIA P NP	2/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	504585	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
327837	Ordering, Referring, Prescribing	N/A	1306129143	0	0	BUI, THANG PHARMD	8/25/2020	Taxonomy not applicable	NA	n/a	000	Unknown	46269	N/A	N/A	N/A	N/A	N/A	8640 SIERRA COLLEGE BLVD	None	ROSEVILLE	CA	95661	5936	00	06000	38.741904	-121.2285285	Placer County
327907	Ordering, Referring, Prescribing	N/A	1306230214	0	0	BENHAM-SUK, KATE MD	6/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143898	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
327938	Ordering, Referring, Prescribing	N/A	1306282728	0	0	BARR, RICHARD A LCSW	3/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76119	N/A	N/A	N/A	N/A	N/A	11424 CHAMBERLAINE WAY	#11-12	ADELANTO	CA	92301	2869	00	06000	34.58644549	-117.4160385	San Bernardino County
327946	Ordering, Referring, Prescribing	N/A	1306298849	0	0	BATES, CARRIE LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89569	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
327953	Ordering, Referring, Prescribing	N/A	1306308564	0	0	BITO, XUE R	2/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176548	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD.	MS#54	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
327967	Ordering, Referring, Prescribing	N/A	1306331699	0	0	BARN, JASWINDER NP	7/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009304	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
327980	Ordering, Referring, Prescribing	N/A	1306362348	0	0	BEVERIDGE, ERIN T	10/25/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101905	N/A	N/A	N/A	N/A	N/A	3535 ROSS AVE	STE 300	SAN JOSE	CA	95124	3054	00	06000	37.2629239	-121.9163171	Santa Clara County
327983	Ordering, Referring, Prescribing	N/A	1306364112	0	0	BECK, NATHAN L	10/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D64618	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
327992	Ordering, Referring, Prescribing	N/A	1306390893	0	0	BAPTISTE, VICTORIA M PSYD	5/11/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32587	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
328004	Ordering, Referring, Prescribing	N/A	1306409586	0	0	BOWMAN, ANDREW D MD	7/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180444	N/A	N/A	N/A	N/A	N/A	3234 MARYSVILLE BLVD	None	SACRAMENTO	CA	95815	1411	00	06000	38.626371	-121.4322615	Sacramento County
328015	Ordering, Referring, Prescribing	N/A	1306441308	0	0	BIRKEL, MARLENA PHARMD	7/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84953	N/A	N/A	N/A	N/A	N/A	2401 WATERMAN BLVD	None	FAIRFIELD	CA	94534	1800	00	06000	38.27247986	-122.0542083	Solano County
328030	Ordering, Referring, Prescribing	N/A	1306487061	0	0	BEDOLLA, SILVIA N NP	1/5/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012868	N/A	N/A	N/A	N/A	N/A	9520 ROAD 238	None	TERRA BELLA	CA	93270	0000	00	06000	35.962758	-119.039961	Tulare County
328039	Ordering, Referring, Prescribing	N/A	1306493101	0	0	BOMBANE, ERIN NP	7/16/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009124	N/A	N/A	N/A	N/A	N/A	2040 CAMFIELD AVE	None	LOS ANGELES	CA	90040	1501	00	06000	34.00861575	-118.1559052	Los Angeles County
328045	Ordering, Referring, Prescribing	N/A	1306499132	0	0	BAQIR, HUMA MD	10/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188608	N/A	N/A	N/A	N/A	N/A	2130 NATIONAL AVENUE	None	SAN DIEGO	CA	92113	2209	00	06000	32.69800063	-117.1411927	San Diego County
328051	Ordering, Referring, Prescribing	N/A	1306506860	0	0	BROMLEY, JESSICA R LMFT	11/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108736	N/A	N/A	N/A	N/A	N/A	16387 1ST STREET	None	GUERNEVILLE	CA	95446	0226	00	06000	38.50111158	-122.9999868	Sonoma County
328057	Ordering, Referring, Prescribing	N/A	1306532742	0	0	BOKHARI, SAHAR	3/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62512	N/A	N/A	N/A	N/A	N/A	1550 N GAREY AVENUE	None	POMONA	CA	91767	3826	00	06000	34.07356342	-117.7522392	Los Angeles County
328094	Ordering, Referring, Prescribing	N/A	1306836507	0	0	BLEHM, ROBERT L PA-C	4/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	16784	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
328115	Ordering, Referring, Prescribing	N/A	1306911219	0	0	BRICENO, JOAN E NP	12/1/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	486847	N/A	N/A	N/A	N/A	N/A	3409 CALLOWAY DR	SUITE 300	BAKERSFIELD	CA	93312	3409	00	06000	35.39132551	-119.11007	Kern County
328116	Ordering, Referring, Prescribing	N/A	1306913793	0	0	BULLARD, MONICA CNM	11/8/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	1506	N/A	N/A	N/A	N/A	N/A	2935 BECHELLI LANE	None	REDDING	CA	96002	1905	00	06000	40.56452304	-122.3626362	Shasta County
328121	Ordering, Referring, Prescribing	N/A	1306917265	0	0	BRUEMMER, BRITA A	8/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63772	N/A	N/A	N/A	N/A	N/A	46896 HIGHWAY 1	None	BIG SUR	CA	93920	9693	00	06000	36.26867238	-121.8064797	Monterey County
328145	Ordering, Referring, Prescribing	N/A	1306977384	0	0	BURKETT, TARA L LMFT	1/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99442	N/A	N/A	N/A	N/A	N/A	6950 65TH ST	None	SACRAMENTO	CA	95823	2316	00	06000	38.50065	-121.4357265	Sacramento County
328195	Ordering, Referring, Prescribing	N/A	1316075724	0	0	BARNEY, HELENE S	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37141	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	None	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
328199	Ordering, Referring, Prescribing	N/A	1316077522	0	0	BARAJAS-CALKINS, ROSALINDA L PSYD	1/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21732	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	None	COVINA	CA	91723	3186	00	06000	34.079904	-117.8863235	Los Angeles County
328209	Ordering, Referring, Prescribing	N/A	1316105109	0	0	BRESSEL, CARLA V PSYD	6/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	21305	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
328231	Ordering, Referring, Prescribing	N/A	1316171614	0	0	BAE, SOYOUNG OT	2/1/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	11604	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
328241	Ordering, Referring, Prescribing	N/A	1316197510	0	0	BECKWITH, ELIKA C LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51705	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
328260	Ordering, Referring, Prescribing	N/A	1316221260	0	0	BALLARD, LISA PSYD	6/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25854	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD, UNIT B	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
328289	Ordering, Referring, Prescribing	N/A	1316269525	0	0	BREDEHOFT, JACQUELINE D CNP	1/7/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14352	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH RD	300	PICO RIVERA	CA	90660	4909	00	06000	33.96454327	-118.1134473	Los Angeles County
328312	Ordering, Referring, Prescribing	N/A	1316318942	0	0	BERGER, KERIN	5/13/2019	Taxonomy not applicable	NA	n/a	000	Unknown	53344	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
328348	Ordering, Referring, Prescribing	N/A	1316371370	0	0	BIBAY, ETHEL L NP	3/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	645942	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4048	00	06000	35.407179	-119.0208925	Kern County
328358	Ordering, Referring, Prescribing	N/A	1316387673	0	0	BUABENG, KWAME MD	4/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150969	N/A	N/A	N/A	N/A	N/A	14320 PALM DRIVE	None	DESERT HOT SPRING	CA	92240	6874	00	06000	33.94460044	-116.5012511	Riverside County
328404	Ordering, Referring, Prescribing	N/A	1316442296	0	0	BAKER, DAVID A DO	1/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20607	N/A	N/A	N/A	N/A	N/A	6010 HIDDEN VALLEY ROAD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
328426	Ordering, Referring, Prescribing	N/A	1316475759	0	0	BAUTISTA, MARIEL B CNP	9/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006528	N/A	N/A	N/A	N/A	N/A	4000 METROPOLITAN DRIVE	SUITE 120	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
328427	Ordering, Referring, Prescribing	N/A	1316476328	0	0	BARR, CHRISTOPHER J PSYD	5/23/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28977	N/A	N/A	N/A	N/A	N/A	652 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4256	00	06000	38.39662494	-122.8201368	Sonoma County
328430	Ordering, Referring, Prescribing	N/A	1316475643	0	0	BASSIRI, TROY MD	6/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	21337	N/A	N/A	N/A	N/A	N/A	535 AIRPORT RD	None	HOOPA	CA	95546	9615	00	06000	41.04169689	-123.6656063	Humboldt County
328439	Ordering, Referring, Prescribing	N/A	1316487119	0	0	BREEDLOVE, AMANDA LMFT	4/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139230	N/A	N/A	N/A	N/A	N/A	1666 PRECISION PARK LN	None	SAN DIEGO	CA	97123	1345	00	06000	32.5659146	-117.059667	San Diego County
328459	Ordering, Referring, Prescribing	N/A	1316504673	0	0	BARRON, BRIANA M LCSW	9/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126188	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
328506	Ordering, Referring, Prescribing	N/A	1316617418	0	0	BUI, TRAN BAO PHARMD	6/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85160	N/A	N/A	N/A	N/A	N/A	2030 N IMPERIAL AVE	None	EL CENTRO	CA	92243	1323	00	06000	32.81202	-115.5733515	Imperial County
328516	Ordering, Referring, Prescribing	N/A	1316644172	0	0	BROWN, CLOVER E	8/26/2023	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	703	N/A	N/A	N/A	N/A	N/A	5405 RED HILL RD	None	PETALUMA	CA	94952	9480	00	06000	38.18260352	-122.6686816	Marin County
328530	Ordering, Referring, Prescribing	N/A	1316712086	0	0	BENCH, JONATHAN LAC	1/15/2024	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC19777	N/A	N/A	N/A	N/A	N/A	100 E NORTH ST	None	TAFT	CA	93268	3606	00	06000	35.13962803	-119.4517471	Kern County
328541	Ordering, Referring, Prescribing	N/A	1316931439	0	0	BECERRA, OSCAR D	10/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C159108	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
328563	Ordering, Referring, Prescribing	N/A	1326020884	0	0	BRINKOP, MICHELLE MD	10/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A75141	N/A	N/A	N/A	N/A	N/A	5200 N LAKE RD	None	MERCED	CA	95343	5001	00	06000	37.363914	-120.4256025	Merced County
328569	Ordering, Referring, Prescribing	N/A	1326073297	0	0	BARTENSTEIN, DEBRA A LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW14628	N/A	N/A	N/A	N/A	N/A	264 WEST BROADMOOR BLVD	None	SAN LEANDRO	CA	94566	1645	00	06000	37.73366748	-122.1659129	Alameda County
328591	Ordering, Referring, Prescribing	N/A	1326118399	0	0	BARZELL-WEBER, LEORA Y LCSW	8/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20656	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
328611	Ordering, Referring, Prescribing	N/A	1326162306	0	0	BRANDERHORST, JOHN	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42823	N/A	N/A	N/A	N/A	N/A	3300 DOUGLAS BLVD	240	ROSEVILLE	CA	95661	3844	00	06000	38.74393533	-121.2327358	Placer County
328664	Ordering, Referring, Prescribing	N/A	1326247628	0	0	BHATTACHARYA, BHASWATI MD MPH	1/15/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C200757	N/A	N/A	N/A	N/A	N/A	5133 W 137TH PL	None	HAWTHORNE	CA	90250	6538	00	06000	33.9069042	-118.3682773	Los Angeles County
328702	Ordering, Referring, Prescribing	N/A	1326310319	0	0	BULLON, JEAN PIERRE PHARMD	4/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66210	N/A	N/A	N/A	N/A	N/A	4410 LEONARD WAY	None	CORONA	CA	92883	0672	00	06000	33.81089137	-117.5365887	Riverside County
328771	Ordering, Referring, Prescribing	N/A	1326393141	0	0	BARMAN, RAJDIP MD	6/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187246	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
328774	Ordering, Referring, Prescribing	N/A	1326399312	0	0	BUI, ANN T PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67269	N/A	N/A	N/A	N/A	N/A	2621 TENTH ST.	None	BERKELEY	CA	94710	2674	00	06000	37.85811852	-122.2898175	Alameda County
328795	Ordering, Referring, Prescribing	N/A	1326434739	0	0	BREWER, CHELSEA PHD	3/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29153	N/A	N/A	N/A	N/A	N/A	3301 E 12TH STREET	STE 269	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
328838	Ordering, Referring, Prescribing	N/A	1326495078	0	0	BAINS, NIRPAUL S MD	8/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158268	N/A	N/A	N/A	N/A	N/A	2705 HIGHLAND AVE	None	SELMA	CA	93662	3389	00	06000	36.57294963	-119.6288289	Fresno County
328840	Ordering, Referring, Prescribing	N/A	1326500356	0	0	BOWERS, PHILIP MD	3/5/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A201515	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR	None	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
328858	Ordering, Referring, Prescribing	N/A	1326538588	0	0	BARNES-FOX, DIANA K LMFT	9/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115415	N/A	N/A	N/A	N/A	N/A	161 W WILLIAMS ST	None	BANNING	CA	92220	4746	00	06000	33.9272313	-116.878477	Riverside County
328880	Ordering, Referring, Prescribing	N/A	1326577552	0	0	BOOMGARDEN, KATI J NP	6/22/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	845076	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
328893	Ordering, Referring, Prescribing	N/A	1326601568	0	0	BERTULFO, MONIQUE NP	1/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013742	N/A	N/A	N/A	N/A	N/A	1510 FLORIDA AVE	None	MODESTO	CA	95350	4437	00	06000	37.666053	-120.996222	Stanislaus County
328942	Ordering, Referring, Prescribing	N/A	1326697699	0	0	BOTTONI, JEANINE A	12/27/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104116	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DSRT HOT SPGS	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
328956	Ordering, Referring, Prescribing	N/A	1326721390	0	0	BARNES, SAMANTHA OD	8/1/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35578	N/A	N/A	N/A	N/A	N/A	576 N. SUNRISE AVE	STE 110	ROSEVILLE	CA	95661	4107	00	06000	38.75781026	-121.253352	Placer County
328961	Ordering, Referring, Prescribing	N/A	1326746702	0	0	BALDWIN, SANAM NP	1/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024041	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
328998	Ordering, Referring, Prescribing	N/A	1336205756	0	0	BAKER, MICHELANNE PSYD	8/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18433	N/A	N/A	N/A	N/A	N/A	1930 MARKET STREET	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
329006	Ordering, Referring, Prescribing	N/A	1336213792	0	0	BRACKEN, JOHN D LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35536	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
329022	Ordering, Referring, Prescribing	N/A	1336261544	0	0	BELL, NELLIE G LMFT	9/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	13730	N/A	N/A	N/A	N/A	N/A	5220 CLARK AVENUE	SUITE 355	LAKEWOOD	CA	90712	2611	00	06000	33.8527092	-118.1337623	Los Angeles County
329030	Ordering, Referring, Prescribing	N/A	1336270339	0	0	BUENAVENTURA, SOCORRO C LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39133	N/A	N/A	N/A	N/A	N/A	790 E BONITA AVE	None	POMONA	CA	91767	1906	00	06000	34.09621447	-117.737406	Los Angeles County
329047	Ordering, Referring, Prescribing	N/A	1336285568	0	0	BRUGNANO, JACLIN G LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	30537	N/A	N/A	N/A	N/A	N/A	260 COHASSET RD	120	CHICO	CA	95926	2282	00	06000	39.754035	-121.851117	Butte County
329061	Ordering, Referring, Prescribing	N/A	1336337732	0	0	BLACK, MELISSA K LCSW	1/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79673	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION	None	SALINAS	CA	93902	0390	00	06000	36.696987	-121.633164	Monterey County
329090	Ordering, Referring, Prescribing	N/A	1336383702	0	0	BASURTO-VARELA, ROSE LCSW	11/25/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26275	N/A	N/A	N/A	N/A	N/A	13742 AMAR RD	None	LA PUENTE	CA	91746	1683	00	06000	34.05381532	-117.9766355	Los Angeles County
329111	Ordering, Referring, Prescribing	N/A	1336423417	0	0	BRAVO, ROCIO PSYD	11/5/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28648	N/A	N/A	N/A	N/A	N/A	1339 20TH ST	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
329144	Ordering, Referring, Prescribing	N/A	1336481712	0	0	BURTON, MONICA M LMFT	8/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127643	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
329146	Ordering, Referring, Prescribing	N/A	1336498518	0	0	BRILLANTES, SUZETTE Y LCSW	9/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102044	N/A	N/A	N/A	N/A	N/A	3165 OLIN AVE	None	SAN JOSE	CA	95117	1635	00	06000	37.3204645	-121.9521375	Santa Clara County
329152	Ordering, Referring, Prescribing	N/A	1336505312	0	0	BENDER, ROCIO M PHARMD	10/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72420	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
329156	Ordering, Referring, Prescribing	N/A	1336508506	0	0	BEBAL, BRENDA L NP	10/15/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95003948	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
329166	Ordering, Referring, Prescribing	N/A	1336517838	0	0	BARSEGIAN, JESSICA L PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73444	N/A	N/A	N/A	N/A	N/A	615 W AVENUE L	None	LANCASTER	CA	93534	7211	00	06000	34.6603515	-118.1419695	Los Angeles County
329171	Ordering, Referring, Prescribing	N/A	1336522861	0	0	BARNETT, CARL R	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	27829	N/A	N/A	N/A	N/A	N/A	880 SUTON WAY	None	GRASS VALLEY	CA	95945	5167	00	06000	39.23520763	-121.0340543	Nevada County
329239	Ordering, Referring, Prescribing	N/A	1336621655	0	0	BADAWY, AHMED	10/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	78579	N/A	N/A	N/A	N/A	N/A	6340 COMMERCE BLVD	None	ROHNERT PARK	CA	94928	2404	00	06000	38.34744961	-122.7095577	Sonoma County
329242	Ordering, Referring, Prescribing	N/A	1336624436	0	0	BYRD, DONALD K LCSW	1/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101101	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DRIV	SUITE 401	ORANGE	CA	92868	3506	00	06000	33.78016046	-117.8956101	Orange County
329258	Ordering, Referring, Prescribing	N/A	1336651587	0	0	BHULLAR, YADVINDER S	6/1/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102018	N/A	N/A	N/A	N/A	N/A	1208 FITZGERALD DR	None	PINOLE	CA	94564	2252	00	06000	37.98677702	-122.3128766	Contra Costa County
329266	Ordering, Referring, Prescribing	N/A	1336657204	0	0	BAILON, LLURIANA NP	5/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007882	N/A	N/A	N/A	N/A	N/A	2801 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	2023	00	06000	34.01966657	-118.2625434	Los Angeles County
329267	Ordering, Referring, Prescribing	N/A	1336652429	0	0	BALIBAY, GAVRIELLE C PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77159	N/A	N/A	N/A	N/A	N/A	27951 BASELINE ST	None	HIGHLAND	CA	92346	3346	00	06000	34.12120447	-117.194688	San Bernardino County
329293	Ordering, Referring, Prescribing	N/A	1336694512	0	0	BERDUGO, ANN NP	7/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004605	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	5000	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
329307	Ordering, Referring, Prescribing	N/A	1336709914	0	0	BROWN, ERIN-ASHLEY LMFT	5/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139401	N/A	N/A	N/A	N/A	N/A	405 E 5TH ST	None	SANTA ANA	CA	92701	4711	00	06000	33.74894221	-117.8641991	Orange County
329313	Ordering, Referring, Prescribing	N/A	1336723477	0	0	BONAFEDE, KAELA	10/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT133863	N/A	N/A	N/A	N/A	N/A	3939 13TH ST.	None	RIVERSIDE	CA	92501	4000	00	06000	33.97849414	-117.3806754	Riverside County
329331	Ordering, Referring, Prescribing	N/A	1336779297	0	0	BROWN, SAMANTHA LMFT	12/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135696	N/A	N/A	N/A	N/A	N/A	2313 I ST	None	EUREKA	CA	95501	4244	00	06000	40.78679534	-124.1601037	Humboldt County
329334	Ordering, Referring, Prescribing	N/A	1336781988	0	0	BATTLE, KASHAY N LCSW	3/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121740	N/A	N/A	N/A	N/A	N/A	1212 NORTH CALIFORNIA ST	None	STOCKTON	CA	95202	5202	00	06000	37.96681769	-121.2881382	San Joaquin County
329340	Ordering, Referring, Prescribing	N/A	1336801182	0	0	BONTA, MISTY D PSYD	10/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	3664	N/A	N/A	N/A	N/A	N/A	2861 WOMBLE ROAD	None	SAN DIEGO	CA	92106	6025	00	06000	32.73540151	-117.2169778	San Diego County
329341	Ordering, Referring, Prescribing	N/A	1336797661	0	0	BRACHO, MARIA L LMFT	8/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134398	N/A	N/A	N/A	N/A	N/A	628 E MICHELTORENA ST	None	SANTA BARBARA	CA	93103	2217	00	06000	34.43343217	-119.7004872	Santa Barbara County
329344	Ordering, Referring, Prescribing	N/A	1336812692	0	0	BOWENS, LATONYA NP	7/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017953	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
329359	Ordering, Referring, Prescribing	N/A	1336862283	0	0	BATTH, MANJOT OD	11/18/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35364	N/A	N/A	N/A	N/A	N/A	344 E 6TH ST	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
329378	Ordering, Referring, Prescribing	N/A	1346008414	0	0	BANUELOS RAMIREZ, CARLOS PA	2/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64123	N/A	N/A	N/A	N/A	N/A	4305 S SANTA FE AVE	None	VERNON	CA	90058	1714	00	06000	34.004754	-118.2302665	Los Angeles County
329379	Ordering, Referring, Prescribing	N/A	1346002664	0	0	BRIZUELA ROMERO, JULIO C NP	5/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95027766	N/A	N/A	N/A	N/A	N/A	7301 STATE ST	None	HUNTINGTON PARK	CA	90255	5823	00	06000	33.97149395	-118.2097278	Los Angeles County
329397	Ordering, Referring, Prescribing	N/A	1346248077	0	0	BRYSON, DAVID R MD	6/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71842	N/A	N/A	N/A	N/A	N/A	5645 W HILLSDALE AVE	None	VISALIA	CA	93297	5143	00	06000	36.32931	-119.354148	Tulare County
329409	Ordering, Referring, Prescribing	N/A	1346302064	0	0	BLOCK, DAVID R MD	12/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A103648	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
329416	Ordering, Referring, Prescribing	N/A	1346307642	0	0	BIESEMEYER, AMY E LMFT	7/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46767	N/A	N/A	N/A	N/A	N/A	120 N REDWOOD DR	None	SAN RAFAEL	CA	94903	1941	00	06000	38.02041177	-122.5361402	Marin County
329424	Ordering, Referring, Prescribing	N/A	1346337904	0	0	BRODSKY, MARK E MD	11/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53623	N/A	N/A	N/A	N/A	N/A	3705 MISSION BLVD	None	SAN DIEGO	CA	92109	7104	00	06000	32.78273202	-117.2524549	San Diego County
329431	Ordering, Referring, Prescribing	N/A	1346354990	0	0	BRENNAN, CATHERINE S MD	11/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G73257	N/A	N/A	N/A	N/A	N/A	1712 PICASSO AVE	D	DAVIS	CA	95618	0546	00	06000	38.56413437	-121.7303634	Yolo County
329443	Ordering, Referring, Prescribing	N/A	1346374469	0	0	BARAJAS, PRISCILLA C PHD	11/12/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22289	N/A	N/A	N/A	N/A	N/A	13130 BURBANK BLVD	None	SHERMAN OAKS	CA	91401	1401	00	06000	34.17210778	-118.4192552	Los Angeles County
329447	Ordering, Referring, Prescribing	N/A	1346378247	0	0	BADGETT, REBECCA M LCSW	4/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101265	N/A	N/A	N/A	N/A	N/A	1600 E BELLE TER	None	BAKERSFIELD	CA	93307	3871	00	06000	35.34672702	-118.9837495	Kern County
329448	Ordering, Referring, Prescribing	N/A	1346375946	0	0	BINGEL-MCKILLIPS, MARK A LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81627	N/A	N/A	N/A	N/A	N/A	6925 CHABOT RD	None	OAKLAND	CA	94618	1921	00	06000	37.85128091	-122.2394664	Alameda County
329473	Ordering, Referring, Prescribing	N/A	1346426921	0	0	BRUCE, PATRICIA R LCSW	4/23/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62698	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
329476	Ordering, Referring, Prescribing	N/A	1346430949	0	0	BYRNE, AMY M	10/27/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66320	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
329491	Ordering, Referring, Prescribing	N/A	1346462314	0	0	BRINER, BARBARA L	9/29/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	10896	N/A	N/A	N/A	N/A	N/A	18144 SECO ST	18144	JAMESTOWN	CA	95327	9498	00	06000	37.95208073	-120.4216785	Tuolumne County
329509	Ordering, Referring, Prescribing	N/A	1346498649	0	0	BURNHAM, MICHELLE LPCC	12/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	7400	N/A	N/A	N/A	N/A	N/A	25 N 14TH ST	None	SAN JOSE	CA	95112	6204	00	06000	37.34293357	-121.8775187	Santa Clara County
329576	Ordering, Referring, Prescribing	N/A	1346600525	0	0	BLUMSTEIN, BREE J NP	4/19/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	830479	N/A	N/A	N/A	N/A	N/A	1250 16TH	None	SANTA MONICA	CA	90404	1249	00	06000	34.02749142	-118.486063	Los Angeles County
329580	Ordering, Referring, Prescribing	N/A	1346617289	0	0	BURGERT, NICHOLAS PT	10/19/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	42742	N/A	N/A	N/A	N/A	N/A	880 3RD AVE	None	CHULA VISTA	CA	91911	1305	00	06000	32.62153846	-117.0722021	San Diego County
329589	Ordering, Referring, Prescribing	N/A	1346628880	0	0	BUI, ANTHONY T MD	6/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146965	N/A	N/A	N/A	N/A	N/A	333 H ST	SUITE 2010	CHULA VISTA	CA	91910	5555	00	06000	32.63411233	-117.0783636	San Diego County
329594	Ordering, Referring, Prescribing	N/A	1346639614	0	0	BOOKER, BRITTNEE R NP	9/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010050	N/A	N/A	N/A	N/A	N/A	1104 BUCHANAN ROAD	#C10	ANTIOCH	CA	94509	4226	00	06000	37.99867244	-121.823243	Contra Costa County
329595	Ordering, Referring, Prescribing	N/A	1346602604	0	0	BALDONADO, MEG CAMILLE T NP	3/14/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	782993	N/A	N/A	N/A	N/A	N/A	200 MEDICAL PLZ	365, 420, 120	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
329607	Ordering, Referring, Prescribing	N/A	1346652989	0	0	BUSHRA, MOSTAFA I LMFT	4/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114477	N/A	N/A	N/A	N/A	N/A	3125 MYERS ST	None	RIVERSIDE	CA	92503	5527	00	06000	33.90932558	-117.4428095	Riverside County
329610	Ordering, Referring, Prescribing	N/A	1346652468	0	0	BROWN, WENDY LMFT	8/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104837	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
329630	Ordering, Referring, Prescribing	N/A	1346695004	0	0	BAIDWAN, SUKHMANDEEP MD	10/30/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166420	N/A	N/A	N/A	N/A	N/A	2951 FULTON AVE	None	SACRAMENTO	CA	95821	4909	00	06000	38.618991	-121.402692	Sacramento County
329663	Ordering, Referring, Prescribing	N/A	1346737392	0	0	BIEDLINGMAIER, ANDREW MD	12/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164337	N/A	N/A	N/A	N/A	N/A	505 M ST	None	RIO LINDA	CA	95673	2218	00	06000	38.691414	-121.4542395	Sacramento County
329668	Ordering, Referring, Prescribing	N/A	1346750445	0	0	BROWN, EMALINE K	10/19/2017	Taxonomy not applicable	NA	n/a	000	Unknown	929	N/A	N/A	N/A	N/A	N/A	4110 SORRENTO VALLEY BLV	None	SAN DIEGO	CA	92121	1429	00	06000	32.90375674	-117.2170258	San Diego County
329689	Ordering, Referring, Prescribing	N/A	1346779378	0	0	BARBE, ROXANNE S NP	11/8/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023250	N/A	N/A	N/A	N/A	N/A	11499 BARTLETT AVE	None	ADELANTO	CA	92301	1902	00	06000	34.57915154	-117.414216	San Bernardino County
329707	Ordering, Referring, Prescribing	N/A	1346809035	0	0	BUI, KHOA PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78198	N/A	N/A	N/A	N/A	N/A	11930 STUDEBAKER RD	None	NORWALK	CA	90650	7548	00	06000	33.92251077	-118.0991696	Los Angeles County
329715	Ordering, Referring, Prescribing	N/A	1346830767	0	0	BOYADJIAN, ZAREH G PHARMD	11/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	83825	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
329771	Ordering, Referring, Prescribing	N/A	1346993466	0	0	BASHEER, MAY A DDS	12/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107179	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
329792	Ordering, Referring, Prescribing	N/A	1356064000	0	0	BILLING, DIANA M CCC-SLP	12/20/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	32846	N/A	N/A	N/A	N/A	N/A	215 W MISSION ST	None	SANTA BARBARA	CA	93101	2820	00	06000	34.42816282	-119.7173341	Santa Barbara County
329805	Ordering, Referring, Prescribing	N/A	1356125314	0	0	BYRN, ERIN NP	7/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026362	N/A	N/A	N/A	N/A	N/A	751 LOMBARDI CT	None	SANTA ROSA	CA	95407	6798	00	06000	38.427804	-122.7493035	Sonoma County
329833	Ordering, Referring, Prescribing	N/A	1356403117	0	0	BETHEL, LESLEY LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34051	N/A	N/A	N/A	N/A	N/A	1510 FASHION ISLAND BLVD	None	SAN MATEO	CA	94404	1596	00	06000	37.5583415	-122.2861555	San Mateo County
329834	Ordering, Referring, Prescribing	N/A	1356411334	0	0	BROWN, COURTNEY N LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27745	N/A	N/A	N/A	N/A	N/A	16350 FILBERT STREET	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
329855	Ordering, Referring, Prescribing	N/A	1356443196	0	0	BRYAN, MICHAEL G MD	6/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G169095	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
329856	Ordering, Referring, Prescribing	N/A	1356463947	0	0	BACHICHA, CHRISTINA J LCSW	4/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74446	N/A	N/A	N/A	N/A	N/A	4205 W FIGARDEN DR	None	FRESNO	CA	93722	6051	00	06000	36.82930754	-119.8669532	Fresno County
329863	Ordering, Referring, Prescribing	N/A	1356479117	0	0	BUGARIN, ADRIANA M LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24087	N/A	N/A	N/A	N/A	N/A	2750 E. WASHINGTON BLVD.	230	PASADENA	CA	91107	1449	00	06000	34.1680038	-118.0943955	Los Angeles County
329914	Ordering, Referring, Prescribing	N/A	1356606081	0	0	BARAHONA, MONICA M LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110118	N/A	N/A	N/A	N/A	N/A	572 N. ARROWHEAD AVE.	None	SAN BERNARDINO	CA	92401	9999	00	06000	34.109667	-117.289669	San Bernardino County
329931	Ordering, Referring, Prescribing	N/A	1356625446	0	0	BOSTON, MARISA N PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65543	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
329937	Ordering, Referring, Prescribing	N/A	1356632376	0	0	BUDHDEV, RASHIDA S PHARMD	3/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	40665	N/A	N/A	N/A	N/A	N/A	5101 BUSINESS CENTER DR	None	FAIRFIELD	CA	94534	1624	00	06000	38.21577011	-122.1459125	Solano County
329967	Ordering, Referring, Prescribing	N/A	1356684757	0	0	BELMONTE, CHARI D L MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133291	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
330002	Ordering, Referring, Prescribing	N/A	1356724694	0	0	BECH, LISA M LCSW	9/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110470	N/A	N/A	N/A	N/A	N/A	1030 NEVADA ST	200	REDLANDS	CA	92374	2957	00	06000	34.064172	-117.217431	San Bernardino County
330007	Ordering, Referring, Prescribing	N/A	1356739163	0	0	BECK, HEATHER P	2/27/2015	Taxonomy not applicable	NA	n/a	000	Unknown	9999	N/A	N/A	N/A	N/A	N/A	18457 MADISON AVE	None	CASTRO VALLEY	CA	94546	1637	00	06000	37.71329669	-122.0637383	Alameda County
330013	Ordering, Referring, Prescribing	N/A	1356755581	0	0	BUTLER, RYAN LCSW	11/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	5868004	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
330023	Ordering, Referring, Prescribing	N/A	1356758031	0	0	BULLOCK, YENYFER P LMFT	6/3/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT86390	N/A	N/A	N/A	N/A	N/A	300 S C ST	None	TUSTIN	CA	92780	3695	00	06000	33.74318295	-117.8249377	Orange County
330027	Ordering, Referring, Prescribing	N/A	1356766802	0	0	BYRNE, KATHLEEN LMFT	6/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103839	N/A	N/A	N/A	N/A	N/A	50100 GOLSH RD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
330034	Ordering, Referring, Prescribing	N/A	1356776587	0	0	BAINS, KIRANJEET K LCSW	3/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94301	N/A	N/A	N/A	N/A	N/A	515 S CEDAR AVE	None	FRESNO	CA	93702	2908	00	06000	36.73744912	-119.7543742	Fresno County
330043	Ordering, Referring, Prescribing	N/A	1356782213	0	0	BEARD, BETHANY LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87934	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	STE 100	LONG BEACH	CA	90804	3394	00	06000	33.7831762	-118.1333125	Los Angeles County
330056	Ordering, Referring, Prescribing	N/A	1356801666	0	0	BARRON, KIRA G	7/19/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	104879	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
330062	Ordering, Referring, Prescribing	N/A	1356816458	0	0	BYER, BRANDON L RN	10/30/2017	Taxonomy not applicable	NA	n/a	000	Unknown	799103	N/A	N/A	N/A	N/A	N/A	5000 W CYPRESS AVE	None	VISALIA	CA	93277	8300	00	06000	36.324207	-119.3463225	Tulare County
330064	Ordering, Referring, Prescribing	N/A	1356824189	0	0	BOSQUE, ERICA J LCSW	4/29/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81547	N/A	N/A	N/A	N/A	N/A	1691 BURBANK AVE	None	SANTA ROSA	CA	95407	7433	00	06000	38.420703	-122.735142	Sonoma County
330074	Ordering, Referring, Prescribing	N/A	1356837173	0	0	BASQUEZ, MONICA V LMFT	10/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128892	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS STE 22	STE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
330094	Ordering, Referring, Prescribing	N/A	1356878615	0	0	BEACH, SARAH D NP	9/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	683643	N/A	N/A	N/A	N/A	N/A	733 CEDAR ST	None	GARBERVILLE	CA	95542	3204	00	06000	40.10148699	-123.7927018	Humboldt County
330122	Ordering, Referring, Prescribing	N/A	1356939136	0	0	BAHADURJI, SHIRIN Y	7/26/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106141	N/A	N/A	N/A	N/A	N/A	3861 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4605	00	06000	34.01133074	-118.4159833	Los Angeles County
330124	Ordering, Referring, Prescribing	N/A	1356942221	0	0	BRAINARD, JOSEPH C PT	5/24/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT299811	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
330168	Ordering, Referring, Prescribing	N/A	1366023707	0	0	BHATTI, PARAMBIR DO	3/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22633	N/A	N/A	N/A	N/A	N/A	1975 VERDUGO BLVD	B	LA CANADA FLINTRI	CA	91011	3022	00	06000	34.20501855	-118.219857	Los Angeles County
330234	Ordering, Referring, Prescribing	N/A	1366207615	0	0	BINGHAM, ELIJAH MD	8/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	15868	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
330239	Ordering, Referring, Prescribing	N/A	1366200693	0	0	BASULTO, TATYANA PA-C	2/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64098	N/A	N/A	N/A	N/A	N/A	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	00	06000	34.04297786	-118.2220181	Los Angeles County
330250	Ordering, Referring, Prescribing	N/A	1366425357	0	0	BERNSTEIN, KENNETH MD	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A30137	N/A	N/A	N/A	N/A	N/A	344 E 6TH ST	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
330290	Ordering, Referring, Prescribing	N/A	1366576977	0	0	BEAUDRY, ELIZABETH A LMFT	7/18/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44098	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
330325	Ordering, Referring, Prescribing	N/A	1366641821	0	0	BROOKS, MARILYN NP	6/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13224	N/A	N/A	N/A	N/A	N/A	1328 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
330333	Ordering, Referring, Prescribing	N/A	1366687204	0	0	BAKER, KATHERINE C CNP	2/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP17694	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
330348	Ordering, Referring, Prescribing	N/A	1366719569	0	0	BUDA, ZOE A NP	2/14/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0712499	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BLVD	STE 300	LAWNDALE	CA	90260	1590	00	06000	33.898572	-118.3527775	Los Angeles County
330355	Ordering, Referring, Prescribing	N/A	1366706996	0	0	BHOJANI, SHABNAMZEHRA MD	5/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162461	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
330374	Ordering, Referring, Prescribing	N/A	1366767402	0	0	BRAVO, MANUEL PHARMD	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61282	N/A	N/A	N/A	N/A	N/A	1363 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3912	00	06000	37.78227214	-122.4392935	San Francisco County
330384	Ordering, Referring, Prescribing	N/A	1366785214	0	0	BEG, MUNA A MD	7/18/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139125	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPWY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
330385	Ordering, Referring, Prescribing	N/A	1366784365	0	0	BORROMEO, JOSEPHINE M NP	11/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22569	N/A	N/A	N/A	N/A	N/A	593 W. 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
330392	Ordering, Referring, Prescribing	N/A	1366794646	0	0	BRUCE, ADRIENNE M LMFT	7/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99440	N/A	N/A	N/A	N/A	N/A	1000 CORPORATE CENTER DR	SUITE #650	MONTEREY PARK	CA	97154	7639	00	06000	34.0512793	-118.1623484	Los Angeles County
330411	Ordering, Referring, Prescribing	N/A	1366818890	0	0	BEVILLE, SILVANA LMFT	5/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108266	N/A	N/A	N/A	N/A	N/A	137 N. COTTONWOOD	None	WOODLAND	CA	95695	2200	00	06000	38.68538399	-121.7933582	Yolo County
330413	Ordering, Referring, Prescribing	N/A	1366819344	0	0	BARSOUMIAN, VAHE D	3/1/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65024	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 EAST	None	ROUND MOUNTAIN	CA	96084	0000	00	06000	40.80385331	-121.9397745	Shasta County
330427	Ordering, Referring, Prescribing	N/A	1366847931	0	0	BERNER, AMY LMFT	3/28/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46465	N/A	N/A	N/A	N/A	N/A	1741 BEVERLY PL	None	BERKELEY	CA	94707	2704	00	06000	37.8845736	-122.2769504	Alameda County
330436	Ordering, Referring, Prescribing	N/A	1366860868	0	0	BRAVO, ELIZABETH LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106156	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
330457	Ordering, Referring, Prescribing	N/A	1366890113	0	0	BATTEN, ANNELISE M LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118724	N/A	N/A	N/A	N/A	N/A	3800 WATT AVE	110	SACRAMENTO	CA	95821	2670	00	06000	38.634417	-121.3818435	Sacramento County
330461	Ordering, Referring, Prescribing	N/A	1366898199	0	0	BONNER, BARBARA CSW	12/17/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127778	N/A	N/A	N/A	N/A	N/A	5078 BULLION ST	2	MARIPOSA	CA	95338	2416	00	06000	37.48819922	-119.967001	Mariposa County
330482	Ordering, Referring, Prescribing	N/A	1366927378	0	0	BAINS, AMRIT S PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79214	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	BUILDING C	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
330498	Ordering, Referring, Prescribing	N/A	1366960155	0	0	BOBO, MYESHIA LCSW	2/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92725	N/A	N/A	N/A	N/A	N/A	4001 LONG BEACH BLVD	None	LONG BEACH	CA	90807	2616	00	06000	33.83091	-118.189377	Los Angeles County
330517	Ordering, Referring, Prescribing	N/A	1366989493	0	0	BAYAA, HUDA M LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118301	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
330547	Ordering, Referring, Prescribing	N/A	1376037879	0	0	BEER, ADAM	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43142	N/A	N/A	N/A	N/A	N/A	4660 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1638	00	06000	32.82425423	-117.121121	San Diego County
330548	Ordering, Referring, Prescribing	N/A	1376041400	0	0	BRAGGINS, ELISA M LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100790	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD.	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
330568	Ordering, Referring, Prescribing	N/A	1376067025	0	0	BHAT, NISHANT MD	6/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187020	N/A	N/A	N/A	N/A	N/A	7828 BROADWAY	None	LEMON GROVE	CA	91945	1801	00	06000	32.7428403	-117.0298029	San Diego County
330616	Ordering, Referring, Prescribing	N/A	1376171520	0	0	BURTON, LUCAS J DO	3/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20786	N/A	N/A	N/A	N/A	N/A	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
330618	Ordering, Referring, Prescribing	N/A	1376173476	0	0	BRYDEN, SHARON S CNP	7/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012882	N/A	N/A	N/A	N/A	N/A	240 LA CASA VIA	200	WALNUT CREEK	CA	94598	4891	00	06000	37.90970689	-122.0374534	Contra Costa County
330651	Ordering, Referring, Prescribing	N/A	1376323436	0	0	BEYENE, HELEN CNP	9/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024618	N/A	N/A	N/A	N/A	N/A	809 S MAIN ST	A	SANTA ANA	CA	92701	6605	00	06000	33.73791434	-117.8676848	Orange County
330652	Ordering, Referring, Prescribing	N/A	1376366096	0	0	BEASLA, MANRAJ NP	9/24/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032330	N/A	N/A	N/A	N/A	N/A	5959 GREENBACK LN	STE 500	CITRUS HEIGHTS	CA	95621	4700	00	06000	38.681397	-121.322682	Sacramento County
330662	Ordering, Referring, Prescribing	N/A	1376532846	0	0	BULLARD, RONALD D MD	8/19/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G152199	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
330675	Ordering, Referring, Prescribing	N/A	1376609149	0	0	BEGEL, DANIEL	1/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G85110	N/A	N/A	N/A	N/A	N/A	1247 7TH ST	None	SANTA MONICA	CA	90401	1643	00	06000	34.02039477	-118.4942357	Los Angeles County
330683	Ordering, Referring, Prescribing	N/A	1376622803	0	0	BOULANGE, MARYSE PHARMD	3/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH37545	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
330700	Ordering, Referring, Prescribing	N/A	1376661942	0	0	BANUELOS, ANTONIO LCSW	11/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26798	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
330707	Ordering, Referring, Prescribing	N/A	1376670471	0	0	BISAGA, JEFFREY S PHD	6/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY5229	N/A	N/A	N/A	N/A	N/A	10 INDEPENDENCE CIRCLE	None	CHICO	CA	95973	0381	00	06000	39.77093631	-121.8750587	Butte County
330734	Ordering, Referring, Prescribing	N/A	1376648956	0	0	BERNARD, DAWN D	8/16/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA13757	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
330746	Ordering, Referring, Prescribing	N/A	1376744789	0	0	BIRAMIAN, HERMINEH PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67059	N/A	N/A	N/A	N/A	N/A	105 E GLENOAKS BLVD	None	GLENDALE	CA	91207	2007	00	06000	34.15926623	-118.2549129	Los Angeles County
330757	Ordering, Referring, Prescribing	N/A	1376775825	0	0	BOHNSACK, MONIE LCSW	8/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW59612	N/A	N/A	N/A	N/A	N/A	2351 OLIVERA RD	None	CONCORD	CA	94520	1698	00	06000	37.99636083	-122.0356799	Contra Costa County
330791	Ordering, Referring, Prescribing	N/A	1376839175	0	0	BYNUM, KRISSY LMFT	4/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101249	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
330795	Ordering, Referring, Prescribing	N/A	1376846386	0	0	BURLISON, JANEEN R NP	7/28/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN775181	N/A	N/A	N/A	N/A	N/A	1463 SOUTH 4TH STREET	None	EL CENTRO	CA	92243	4749	00	06000	32.78037178	-115.5523224	Imperial County
330798	Ordering, Referring, Prescribing	N/A	1376862102	0	0	BASSI, MARIANNE	4/26/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RN319725	N/A	N/A	N/A	N/A	N/A	1301 NORTH A STREET	None	LOMPOC	CA	93436	1118	00	06000	34.65870843	-120.4489031	Santa Barbara County
330801	Ordering, Referring, Prescribing	N/A	1376857847	0	0	BLANCHARD, CLARISE LMFT	12/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT32977	N/A	N/A	N/A	N/A	N/A	610 ELM STREET	212	SAN CARLOS	CA	94070	2118	00	06000	37.50498314	-122.2629552	San Mateo County
330804	Ordering, Referring, Prescribing	N/A	1376864801	0	0	BARRON, JOCELYN N LMFT	2/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84492	N/A	N/A	N/A	N/A	N/A	1620 MARKET ST	None	REDDING	CA	96001	1021	00	06000	40.58309514	-122.390293	Shasta County
330807	Ordering, Referring, Prescribing	N/A	1376879908	0	0	BALCOM, HEATHER A LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53268	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	SUITE 155	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
330810	Ordering, Referring, Prescribing	N/A	1376882209	0	0	BANKS, DEVELLA LMFT	8/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131389	N/A	N/A	N/A	N/A	N/A	1741 E 120TH ST	None	LOS ANGELES	CA	90059	3051	00	06000	33.92464326	-118.2427028	Los Angeles County
330825	Ordering, Referring, Prescribing	N/A	1376908145	0	0	BAILY, EVAN PA	12/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58861	N/A	N/A	N/A	N/A	N/A	760 E ALMOND AVE	None	MADERA	CA	93637	5617	00	06000	36.94546284	-120.04872	Madera County
330826	Ordering, Referring, Prescribing	N/A	1376911016	0	0	BINDRA, JASKIRAT K PHARMD	2/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73445	N/A	N/A	N/A	N/A	N/A	37323 FREMONT BLVD	None	FREMONT	CA	94536	3702	00	06000	37.55820562	-122.0070406	Alameda County
330845	Ordering, Referring, Prescribing	N/A	1376934141	0	0	BARBERA, LATISHA LMFT	2/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106115	N/A	N/A	N/A	N/A	N/A	13634 CORDARY AVE	None	HAWTHORNE	CA	90250	7409	00	06000	33.907257	-118.3416915	Los Angeles County
330852	Ordering, Referring, Prescribing	N/A	1376936120	0	0	BAISLEY, SHAWN M PA	2/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA52347	N/A	N/A	N/A	N/A	N/A	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
330870	Ordering, Referring, Prescribing	N/A	1376970558	0	0	BENKO, JONATHAN	10/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81650	N/A	N/A	N/A	N/A	N/A	555 SOQUEL AVE	330A	SANTA CRUZ	CA	95062	2336	00	06000	36.97623386	-122.0170137	Santa Cruz County
330871	Ordering, Referring, Prescribing	N/A	1376972513	0	0	BREITLING, ERIK M AU	5/11/2019	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	AU2832	N/A	N/A	N/A	N/A	N/A	3744 MT DIABLO BLVD	100	LAFAYETTE	CA	94549	3694	00	06000	37.88913271	-122.1324037	Contra Costa County
330894	Ordering, Referring, Prescribing	N/A	1386001220	0	0	BERMAN, JORI R DC	2/10/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36024	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY STREET	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
330919	Ordering, Referring, Prescribing	N/A	1386014975	0	0	BARRIOS, ERIKA M LCSW	11/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98631	N/A	N/A	N/A	N/A	N/A	6001 CLARA ST	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
330921	Ordering, Referring, Prescribing	N/A	1386043370	0	0	BACA LEANOS, KATHLEEN J LMSW	12/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98974	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	None	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
330929	Ordering, Referring, Prescribing	N/A	1386035541	0	0	BAROLDY, SHELLY N LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107981	N/A	N/A	N/A	N/A	N/A	12970 3RD ST	None	CHINO	CA	91710	3464	00	06000	34.01815857	-117.695635	San Bernardino County
330971	Ordering, Referring, Prescribing	N/A	1386120723	0	0	BELEN, NEZER B NP	12/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009292	N/A	N/A	N/A	N/A	N/A	525 E MAIN STREET	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
330975	Ordering, Referring, Prescribing	N/A	1386121119	0	0	BARBOUR, JOHN LMFT	4/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115543	N/A	N/A	N/A	N/A	N/A	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
330991	Ordering, Referring, Prescribing	N/A	1386150795	0	0	BURGOS, NICOLE MSW LCSW	9/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW118331	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	K	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
331003	Ordering, Referring, Prescribing	N/A	1386158624	0	0	BERNHARDSON MASSOLO, CLIO LCSW	3/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100721	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
331014	Ordering, Referring, Prescribing	N/A	1386171585	0	0	BRIDEWELL, PATRICIA A NP	12/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005599	N/A	N/A	N/A	N/A	N/A	200 PINE AVE	SUITE #400	LONG BEACH	CA	90802	0405	00	06000	33.76962	-118.1923435	Los Angeles County
331046	Ordering, Referring, Prescribing	N/A	1386218436	0	0	BILLS, SOPHIA PA	10/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63519	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
331052	Ordering, Referring, Prescribing	N/A	1386235372	0	0	BATTA, KETAN PHARMD	9/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84059	N/A	N/A	N/A	N/A	N/A	2001 MCHENRY AVE	None	MODESTO	CA	95350	3245	00	06000	37.67338576	-120.9942007	Stanislaus County
331070	Ordering, Referring, Prescribing	N/A	1386275428	0	0	BORILLO, ROSE MARIE OT	2/11/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	20900	N/A	N/A	N/A	N/A	N/A	425 DIVISADERO ST.	SUITE 300	SAN FRANICSCO	CA	94117	2242	00	06000	37.77336026	-122.4375022	San Francisco
331071	Ordering, Referring, Prescribing	N/A	1386282176	0	0	BAKER, ASHLEY M CNM	7/1/2024	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW236466	N/A	N/A	N/A	N/A	N/A	3690 MISSION BOULEVARD	None	SAN DIEGO	CA	92109	7368	00	06000	32.78237635	-117.2525812	San Diego County
331089	Ordering, Referring, Prescribing	N/A	1386293801	0	0	BUTCHER, ALINNE J M LMFT	3/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138864	N/A	N/A	N/A	N/A	N/A	21545 CENTER POINT PARKW	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
331102	Ordering, Referring, Prescribing	N/A	1386376408	0	0	BAUER, DANIEL DMD	8/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108195	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	0000	00	06000	38.62757555	-122.8638141	Sonoma County
331106	Ordering, Referring, Prescribing	N/A	1386381325	0	0	BANTUG, LORENA T NP	7/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020522	N/A	N/A	N/A	N/A	N/A	808 W 58 ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
331189	Ordering, Referring, Prescribing	N/A	1386773786	0	0	BATTAGLIA, SUZANNE F PSYD	6/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23499	N/A	N/A	N/A	N/A	N/A	951 BLANCO CIR STE B	STE B	SALINAS	CA	93901	4451	00	06000	36.65589725	-121.6366313	Monterey County
331192	Ordering, Referring, Prescribing	N/A	1386776003	0	0	BRATTON, ELENE Y LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34662	N/A	N/A	N/A	N/A	N/A	1600 PACIFIC HWY	None	SAN DIEGO	CA	92101	2429	00	06000	32.7217581	-117.1711788	San Diego County
331199	Ordering, Referring, Prescribing	N/A	1386778504	0	0	BILOTTA-SMITH, MICHELLE S PSYD	11/3/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24756	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
331202	Ordering, Referring, Prescribing	N/A	1386779833	0	0	BANUELOS RODRIGUEZ, EMERITA LCSW	6/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21417	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
331230	Ordering, Referring, Prescribing	N/A	1386831063	0	0	BAIG, SHAN A LMFT	8/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53898	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
331242	Ordering, Referring, Prescribing	N/A	1386850998	0	0	BEDOLLA, JUAN A NP	9/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95005969	N/A	N/A	N/A	N/A	N/A	4411 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.73594649	-119.7521955	Fresno County
331246	Ordering, Referring, Prescribing	N/A	1386875771	0	0	BODIE, KIM L LCSW	9/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29020	N/A	N/A	N/A	N/A	N/A	302 N. MIDWAY DRIVE	None	ESCONDIDO	CA	92027	2741	00	06000	33.13619959	-117.0509061	San Diego County
331251	Ordering, Referring, Prescribing	N/A	1386879807	0	0	BRUM PAVAN, DANIELLE D MD	3/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106277	N/A	N/A	N/A	N/A	N/A	5420 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4118	00	06000	34.10779213	-118.196385	Los Angeles County
331315	Ordering, Referring, Prescribing	N/A	1396012969	0	0	BANSAL, NILAM OD	12/27/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33339	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVENUE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
331329	Ordering, Referring, Prescribing	N/A	1396026894	0	0	BURROW, KAYLA PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49519	N/A	N/A	N/A	N/A	N/A	4949 GOSFORD RD	None	BAKERSFIELD	CA	93311	4992	00	06000	35.309754	-119.0922855	Kern County
331333	Ordering, Referring, Prescribing	N/A	1396038931	0	0	BHANVADIA, SUMEET K MD	6/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116945	N/A	N/A	N/A	N/A	N/A	105 E SYDNOR AVE	100	RIDGECREST	CA	93555	5546	00	06000	35.64096373	-117.6688699	Kern County
331385	Ordering, Referring, Prescribing	N/A	1396117800	0	0	BRENNAN, STEFANIE L NP	6/27/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	730614	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	7207	00	06000	34.06633051	-118.4452686	Los Angeles County
331397	Ordering, Referring, Prescribing	N/A	1396157061	0	0	BOKLUND, MARIA C LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48496	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
331462	Ordering, Referring, Prescribing	N/A	1396241915	0	0	BENIN, SAMANTHA MD MPH	7/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173499	N/A	N/A	N/A	N/A	N/A	1780 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	4618	00	06000	34.13588446	-117.248634	San Bernardino County
331509	Ordering, Referring, Prescribing	N/A	1396327656	0	0	BODDEN, JESSICA L MD	7/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192200	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	SUITE 100	LOS ANGELES	CA	90018	1353	00	06000	34.037415	-118.3176815	Los Angeles County
331514	Ordering, Referring, Prescribing	N/A	1396333456	0	0	BUCKNER, CHRISTINA PSYD	7/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31935	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4841	00	06000	35.407179	-119.0208925	Kern County
331522	Ordering, Referring, Prescribing	N/A	1396353066	0	0	BRINER, JENNIFER NP	7/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95014951	N/A	N/A	N/A	N/A	N/A	1355 EAST STREET	STE. 200	REDDING	CA	96001	0801	00	06000	40.58628506	-122.3887911	Shasta County
331530	Ordering, Referring, Prescribing	N/A	1396362984	0	0	BARRIOS LOPEZ, ANA Y LCSW	6/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123534	N/A	N/A	N/A	N/A	N/A	300 HARTLE CT	None	NAPA	CA	94559	4078	00	06000	38.28326249	-122.2801759	Napa County
331550	Ordering, Referring, Prescribing	N/A	1396388062	0	0	BECKWITH, MORGAN T PA	8/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7730	N/A	N/A	N/A	N/A	N/A	1402 BAILEY AVE	None	NEEDLES	CA	92363	3104	00	06000	34.832781	-114.618349	San Bernardino County
331554	Ordering, Referring, Prescribing	N/A	1396390878	0	0	BECK, VIENNA L LMFT	10/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150502	N/A	N/A	N/A	N/A	N/A	540 N CALIFORNIA ST	None	STOCKTON	CA	95202	2117	00	06000	37.95929627	-121.2861102	San Joaquin County
331568	Ordering, Referring, Prescribing	N/A	1396444246	0	0	BALDWYN, RACHEL NP	9/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022798	N/A	N/A	N/A	N/A	N/A	271 N L STREET	None	DINUBA	CA	93618	2107	00	06000	36.54248431	-119.3921496	Tulare County
331573	Ordering, Referring, Prescribing	N/A	1396455648	0	0	BENAVIDES, GILLIAN C PHARMD	11/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH87334	N/A	N/A	N/A	N/A	N/A	37160 47TH ST E	None	PALMDALE	CA	93552	4450	00	06000	34.557426	-118.0452945	Los Angeles County
331586	Ordering, Referring, Prescribing	N/A	1396494001	0	0	BURNETT, LAUREN A DO	8/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21783	N/A	N/A	N/A	N/A	N/A	800 N MAIN ST	None	SANTA ANA	CA	92701	3576	00	06000	33.751332	-117.867639	Orange County
331593	Ordering, Referring, Prescribing	N/A	1396576187	0	0	BOSIO, MICHAEL PA	12/13/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65577	N/A	N/A	N/A	N/A	N/A	1057 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2504	00	06000	35.1190684	-120.5953068	San Luis Obispo County
331615	Ordering, Referring, Prescribing	N/A	1396802963	0	0	BANCROFT, ROBERT P LMFT	7/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	19909	N/A	N/A	N/A	N/A	N/A	17000 ARNOLD DRIVE	None	SONOMA	CA	95476	3242	00	06000	38.320938	-122.5059975	Sonoma County
331640	Ordering, Referring, Prescribing	N/A	1396846036	0	0	BERRY, GLADYS L DDS	7/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS39969	N/A	N/A	N/A	N/A	N/A	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	00	06000	32.71482507	-117.0098243	San Diego County
331644	Ordering, Referring, Prescribing	N/A	1396856837	0	0	BATES, STEVEN R MD	7/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C42243	N/A	N/A	N/A	N/A	N/A	333 S. TWIN OAKS VALLEY	STE. 100	SAN MARCOS	CA	92096	0001	00	06000	33.12741952	-117.1651625	San Diego County
331649	Ordering, Referring, Prescribing	N/A	1396862710	0	0	BECKMAN, CHAD W LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42396	N/A	N/A	N/A	N/A	N/A	511 N BROOKHURST ST	200	ANAHEIM	CA	92801	5231	00	06000	33.839253	-117.959068	Orange County
331655	Ordering, Referring, Prescribing	N/A	1396864989	0	0	BERMAN, RUSSELL B LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87108	N/A	N/A	N/A	N/A	N/A	760 HARRISON ST.	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
331673	Ordering, Referring, Prescribing	N/A	1396886008	0	0	BALASH, CAROL L	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38878	N/A	N/A	N/A	N/A	N/A	1330 E COOLEY DRIVE	None	COLTON	CA	92324	0006	00	06000	34.0544745	-117.305721	San Bernardino County
331706	Ordering, Referring, Prescribing	N/A	1396961868	0	0	BURRE, ANN M AU	3/30/2022	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	AU1181	N/A	N/A	N/A	N/A	N/A	5333 HOLLISTER AVE	SUITE 165	SANTA BARBARA	CA	93111	2461	00	06000	34.43491982	-119.8105484	Santa Barbara County
331719	Ordering, Referring, Prescribing	N/A	1396987319	0	0	BULNES-GERARDO, BRENDA LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52875	N/A	N/A	N/A	N/A	N/A	450 E SAN JACINTO AVE	None	PERRIS	CA	92571	2833	00	06000	33.78662816	-117.2164923	Riverside County
331728	Ordering, Referring, Prescribing	N/A	1407005655	0	0	BUERGLER, BECKY LMFT	1/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92787	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
331733	Ordering, Referring, Prescribing	N/A	1407012594	0	0	BLANZA, JENNIFER A LCSW	6/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28866	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD.	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
331802	Ordering, Referring, Prescribing	N/A	1407188915	0	0	BONILLA, MARIA C LMFT	1/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114679	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD STE 250	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
331805	Ordering, Referring, Prescribing	N/A	1407191901	0	0	BENITEZ-HERGET, JOSELLE G LMFT	5/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139679	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	SUITE 259	OAKLAND	CA	94601	3424	00	06000	37.77617499	-122.2247899	Alameda County
331816	Ordering, Referring, Prescribing	N/A	1407210248	0	0	BOUDZINSKAIA, MAIA A MD	11/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150319	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3RD FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
331826	Ordering, Referring, Prescribing	N/A	1407221526	0	0	BOKEN, ANNETTE LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103982	N/A	N/A	N/A	N/A	N/A	540 NORTH FIRST STREET	None	SAN JOSE	CA	95112	5319	00	06000	37.34571835	-121.8975601	Santa Clara County
331828	Ordering, Referring, Prescribing	N/A	1407237118	0	0	BASSI, SUNNY NP	2/26/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	760774	N/A	N/A	N/A	N/A	N/A	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
331846	Ordering, Referring, Prescribing	N/A	1407279219	0	0	BENITEZ, JANI LCSW	7/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116337	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
331877	Ordering, Referring, Prescribing	N/A	1407307580	0	0	BAGHDASARIAN, SHAKEH LMSW	3/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68093	N/A	N/A	N/A	N/A	N/A	813 E 4TH PL	None	LOS ANGELES	CA	90013	1805	00	06000	34.04412628	-118.2359868	Los Angeles County
331887	Ordering, Referring, Prescribing	N/A	1407330681	0	0	BOGDANOVA, MARIA A PA	10/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60241	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DR	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
331963	Ordering, Referring, Prescribing	N/A	1407464522	0	0	BRADIGAN, LAURA A NP	1/31/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014597	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
331967	Ordering, Referring, Prescribing	N/A	1407492598	0	0	BAILOR, LORAINE A LCSW	2/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26919	N/A	N/A	N/A	N/A	N/A	4892 SAN PABLO DAM RD	None	EL SOBRANTE	CA	94803	3222	00	06000	37.96337568	-122.2929195	Contra Costa County
332002	Ordering, Referring, Prescribing	N/A	1407591522	0	0	BAINIWAL, AJAY S MD	8/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A198192	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	MED STAFF OFFICE A2250	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
332009	Ordering, Referring, Prescribing	N/A	1407679848	0	0	BAHN, ALEXANDER DDS	9/10/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110755	N/A	N/A	N/A	N/A	N/A	11919 HESPERIA ROAD	None	HESPERIA	CA	92345	2158	00	06000	34.46759507	-117.2925837	San Bernardino County
332033	Ordering, Referring, Prescribing	N/A	1407908841	0	0	BORCHERS, TRICIA A PA-C	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA15992	N/A	N/A	N/A	N/A	N/A	7777 MILLIKEN AVE	240	RANCHO CUCAMONGA	CA	91730	6780	00	06000	34.10843256	-117.5570865	San Bernardino County
332037	Ordering, Referring, Prescribing	N/A	1407903982	0	0	BEAVERS, MICHAEL LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT33698	N/A	N/A	N/A	N/A	N/A	340 N. HIGHWAY 138	None	CRESTLINE	CA	92325	6300	00	06000	34.247106	-117.300798	San Bernardino County
332038	Ordering, Referring, Prescribing	N/A	1407924400	0	0	BROWN, TENEE LPCC	1/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	3751	N/A	N/A	N/A	N/A	N/A	1290 RIDDER PARK DRIVE	None	SAN JOSE	CA	95131	2304	00	06000	37.38284451	-121.9009893	Santa Clara County
332057	Ordering, Referring, Prescribing	N/A	1407965478	0	0	BARTEL, PATRICIA PA-C	2/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA13905	N/A	N/A	N/A	N/A	N/A	2315 E ILLINOIS AVE	None	FRESNO	CA	93701	2219	00	06000	36.74505638	-119.783366	Fresno County
332058	Ordering, Referring, Prescribing	N/A	1407953227	0	0	BARTZ, PAUL E DC	8/12/2019	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	30097	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
332064	Ordering, Referring, Prescribing	N/A	1407976103	0	0	BARB, NOELLA M LMFT	10/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112273	N/A	N/A	N/A	N/A	N/A	71175 AURORA RD	None	DESERT HOT SPRING	CA	92241	7631	00	06000	33.92130141	-116.4203976	Riverside County
332080	Ordering, Referring, Prescribing	N/A	1407991821	0	0	BOWEN, ROBERT OT	3/28/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	6738	N/A	N/A	N/A	N/A	N/A	1115 WEST AVE M-14	None	PALMDALE	CA	93551	1407	00	06000	34.63305646	-118.1505735	Los Angeles County
332100	Ordering, Referring, Prescribing	N/A	1417043340	0	0	BARRAZA, HENRY R PA-C	6/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	16753	N/A	N/A	N/A	N/A	N/A	1704 COLORADO BLVD	None	LOS ANGELES	CA	90041	1338	00	06000	34.13930153	-118.203894	Los Angeles County
332112	Ordering, Referring, Prescribing	N/A	1417072836	0	0	BURROUGHS, WHITNEY D NP	2/26/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0742307	N/A	N/A	N/A	N/A	N/A	1833 FILLMORE ST	FL 3	SAN FRANCISCO	CA	94115	3181	00	06000	37.78652252	-122.4333821	San Francisco County
332126	Ordering, Referring, Prescribing	N/A	1417086489	0	0	BOYLE, AELRED MD	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88639	N/A	N/A	N/A	N/A	N/A	1224 VINE ST	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
332137	Ordering, Referring, Prescribing	N/A	1417103169	0	0	BOLEN, JENNIFER D LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53385	N/A	N/A	N/A	N/A	N/A	4910 E ASHLAN AVE	None	FRESNO	CA	93726	3020	00	06000	36.79411387	-119.7309194	Fresno County
332144	Ordering, Referring, Prescribing	N/A	1417113689	0	0	BARTCZAK, MARIE L LMFT	12/10/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38100	N/A	N/A	N/A	N/A	N/A	11521 BLOCKER DR	SUITE 102	AUBURN	CA	95603	4654	00	06000	38.9034802	-121.0828595	Placer County
332151	Ordering, Referring, Prescribing	N/A	1417125238	0	0	BRAZIER, JAMES C	6/23/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D26592	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
332159	Ordering, Referring, Prescribing	N/A	1417145103	0	0	BOYLE, CAROL A NP	8/26/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	279595	N/A	N/A	N/A	N/A	N/A	5500 CAMPANILE DRIVE	None	SAN DIEGO	CA	92182	4701	00	06000	32.77590585	-117.0722922	San Diego County
332268	Ordering, Referring, Prescribing	N/A	1417337379	0	0	BORZI, SCOTT PHARMD	10/8/2018	Taxonomy not applicable	NA	n/a	000	Unknown	36985	N/A	N/A	N/A	N/A	N/A	18579 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	6746	00	06000	33.69313539	-117.9542897	Orange County
332281	Ordering, Referring, Prescribing	N/A	1417343625	0	0	BOWLIN, SASCHA LCSW	10/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99557	N/A	N/A	N/A	N/A	N/A	1300 NEW AIRPORT RD.	None	AUBURN	CA	95603	9596	00	06000	38.93843913	-121.0863866	Placer County
332303	Ordering, Referring, Prescribing	N/A	1417393828	0	0	BHATT, DEEMPAL C PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64882	N/A	N/A	N/A	N/A	N/A	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	00	06000	37.69960369	-121.7628917	Alameda County
332329	Ordering, Referring, Prescribing	N/A	1417436635	0	0	BAUTISTA, BRIGITTE LCSW	8/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109700	N/A	N/A	N/A	N/A	N/A	335 E AVENUE I	None	LANCASTER	CA	93535	1916	00	06000	34.7041113	-118.1247548	Los Angeles County
332375	Ordering, Referring, Prescribing	N/A	1417515883	0	0	BOWERS, KEEGAN MD	4/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195750	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
332387	Ordering, Referring, Prescribing	N/A	1417537150	0	0	BROOKS, WENDY LMFT	11/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151620	N/A	N/A	N/A	N/A	N/A	1280 E GIBSON RD	None	WOODLAND	CA	95776	6315	00	06000	38.660391	-121.761837	Yolo County
332421	Ordering, Referring, Prescribing	N/A	1417614199	0	0	BOYLE, CHRISTINA M NP	7/23/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017888	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
332439	Ordering, Referring, Prescribing	N/A	1417656653	0	0	BOOTERBAUGH, COLETTE A LMFT	2/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101810	N/A	N/A	N/A	N/A	N/A	1750 CIRBY WAY	None	ROSEVILLE	CA	95661	5520	00	06000	38.72953047	-121.258368	Placer County
332461	Ordering, Referring, Prescribing	N/A	1417778754	0	0	BECK, BARBETTE LMFT	8/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148919	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
332474	Ordering, Referring, Prescribing	N/A	1417960352	0	0	BROWN, DEAN B	2/14/2018	Taxonomy not applicable	NA	n/a	000	Unknown	13922	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
332528	Ordering, Referring, Prescribing	N/A	1427165513	0	0	BRIGHT, EDWARDS D	10/24/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	564354	N/A	N/A	N/A	N/A	N/A	355 DOVER PKWY	None	DELANO	CA	93215	3440	00	06000	35.7610493	-119.2523273	Kern County
332533	Ordering, Referring, Prescribing	N/A	1427180116	0	0	BROOKS, LESLIE C PA-C	11/27/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA57556	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE A	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
332544	Ordering, Referring, Prescribing	N/A	1427190636	0	0	BELTRAN, ELADIA G LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90538	N/A	N/A	N/A	N/A	N/A	1424 30TH ST	A	SAN DIEGO	CA	92154	3421	00	06000	32.57104918	-117.0672037	San Diego County
332555	Ordering, Referring, Prescribing	N/A	1427210954	0	0	BEGOYAN, GAYANE MD	12/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113904	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE	None	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
332580	Ordering, Referring, Prescribing	N/A	1427275080	0	0	BENADIBA, PAMELA A LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40907	N/A	N/A	N/A	N/A	N/A	277 SOUTH STREET SUITE T	None	SAN LUIS OBISPO	CA	93401	5039	00	06000	35.26950549	-120.666573	San Luis Obispo County
332591	Ordering, Referring, Prescribing	N/A	1427300821	0	0	BRANDO, REBECCA LPT	8/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120725	N/A	N/A	N/A	N/A	N/A	370 S. CRENSHAW BLVD	S 100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
332599	Ordering, Referring, Prescribing	N/A	1427325166	0	0	BINETTE, DONYA L NP	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95001653	N/A	N/A	N/A	N/A	N/A	2210 MESA DR	SUITE 300	OCEANSIDE	CA	92054	3756	00	06000	33.20786753	-117.3579677	San Diego County
332631	Ordering, Referring, Prescribing	N/A	1427372606	0	0	BRIEDEN, CRYSTAL PA	5/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	20716	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
332634	Ordering, Referring, Prescribing	N/A	1427390764	0	0	BYERLEY, JAMES R LMFT	3/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44828	N/A	N/A	N/A	N/A	N/A	65772 MEADOW AVE	None	BRADLEY	CA	93426	9694	00	06000	35.86393644	-120.8022433	Monterey County
332647	Ordering, Referring, Prescribing	N/A	1427414606	0	0	BHAGAT, TAPASYA LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98963	N/A	N/A	N/A	N/A	N/A	4545 N WEST AVE	None	FRESNO	CA	93705	0946	00	06000	36.799623	-119.8264355	Fresno County
332660	Ordering, Referring, Prescribing	N/A	1427433457	0	0	BINUS, MELISSA L NP	6/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003373	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0518	00	06000	39.03521526	-120.9755343	Placer County
332670	Ordering, Referring, Prescribing	N/A	1427451673	0	0	BENITEZ, DANIEL V LCSW	2/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100120	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
332711	Ordering, Referring, Prescribing	N/A	1427502533	0	0	BRIGNONI, KELLY S LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93373	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	208	CERRITOS	CA	90706	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
332725	Ordering, Referring, Prescribing	N/A	1427526359	0	0	BOLOUHARI, ENSI PHARMD	7/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	74301	N/A	N/A	N/A	N/A	N/A	12555 GARDEN GROVE BLVD	102	GARDEN GROVE	CA	92843	1902	00	06000	33.77450946	-117.913041	Orange County
332728	Ordering, Referring, Prescribing	N/A	1427530831	0	0	BALL, JORDAN L PA-C	5/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57846	N/A	N/A	N/A	N/A	N/A	1430 22ND ST	None	SACRAMENTO	CA	95816	5708	00	06000	38.570715	-121.4797995	Sacramento County
332772	Ordering, Referring, Prescribing	N/A	1427595792	0	0	BRADSHAW, CHARLES E PHARMD	8/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51248	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS AVE	STE 101	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
332814	Ordering, Referring, Prescribing	N/A	1427689686	0	0	BURNS, KHALIMA PA-C	5/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61143	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
332829	Ordering, Referring, Prescribing	N/A	1427751262	0	0	BUI, THERESA MD MPH	10/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A199644	N/A	N/A	N/A	N/A	N/A	276 INTERNATIONAL CIRCLE	BUILDING 1	SAN JOSE	CA	95119	1103	00	06000	37.2402111	-121.8021684	Santa Clara County
332836	Ordering, Referring, Prescribing	N/A	1427782432	0	0	BRADY, MELANIE L NP	6/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021314	N/A	N/A	N/A	N/A	N/A	3203 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	3008	00	06000	33.97264641	-118.2101997	Los Angeles County
332848	Ordering, Referring, Prescribing	N/A	1427818368	0	0	BONGATO, CHARLENE MEG DO	9/26/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL4002	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
332857	Ordering, Referring, Prescribing	N/A	1437123312	0	0	BALLINGER, KATHARINE A MD	8/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88464	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
332863	Ordering, Referring, Prescribing	N/A	1437131067	0	0	BARAKAT, GEORGE MD	8/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G42411	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
332869	Ordering, Referring, Prescribing	N/A	1437184975	0	0	BRUNS, BRYAN E	7/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G29642	N/A	N/A	N/A	N/A	N/A	23461 S POINTE DR	SUITE 220	LAGUNA HILLS	CA	92653	1547	00	06000	33.62535142	-117.7206568	Orange County
332892	Ordering, Referring, Prescribing	N/A	1437242856	0	0	BOUTROS, LETICIA R RN CPNP	1/31/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	10287	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
332895	Ordering, Referring, Prescribing	N/A	1437258035	0	0	BAEZ, SAYONARA J MD	8/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C145486	N/A	N/A	N/A	N/A	N/A	625 34TH STREET	SUITE 100 AND 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
332906	Ordering, Referring, Prescribing	N/A	1437280328	0	0	BLOCK, KATHRYN R LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53170	N/A	N/A	N/A	N/A	N/A	1012 MAIN ST	101	RAMONA	CA	92065	2170	00	06000	33.04181722	-116.8689096	San Diego County
332915	Ordering, Referring, Prescribing	N/A	1437285061	0	0	BASMADJIAN, MARTHA C LMFT	11/25/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43010	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	LOS ANGELES	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
332926	Ordering, Referring, Prescribing	N/A	1437299765	0	0	BARTELS, SHARON L NP	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	14521	N/A	N/A	N/A	N/A	N/A	4200 FARM HILL BLVD	BLDG 5, ROOM 303	REDWOOD CITY	CA	94061	1030	00	06000	37.447452	-122.263164	San Mateo County
332934	Ordering, Referring, Prescribing	N/A	1437318813	0	0	BARR, SHIMUL K MD	5/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102432	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
332973	Ordering, Referring, Prescribing	N/A	1437384096	0	0	BARTH, KIMBERLY A PSYD	11/2/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25850	N/A	N/A	N/A	N/A	N/A	3910 OAKWOOD AVE.	None	LOS ANGELES	CA	90004	3413	00	06000	34.07769531	-118.2924147	Los Angeles County
332976	Ordering, Referring, Prescribing	N/A	1437394012	0	0	BLUM, CHRISTOPHER LMFT	11/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85017	N/A	N/A	N/A	N/A	N/A	1080 MARINA VILLAGE PKWY	100	ALAMEDA	CA	94501	6427	00	06000	37.78544731	-122.270323	Alameda County
332981	Ordering, Referring, Prescribing	N/A	1437404118	0	0	BONGATO, MATILDE C LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101503	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
332984	Ordering, Referring, Prescribing	N/A	1437409455	0	0	BENNETT, KARLA LCSW	1/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69208	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
333051	Ordering, Referring, Prescribing	N/A	1437506581	0	0	BAUTISTA, MARY S G NP	8/24/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	676857	N/A	N/A	N/A	N/A	N/A	2499 E LAKESHORE DR	None	LAKE ELSINORE	CA	92530	4411	00	06000	33.66050702	-117.3018956	Riverside County
333056	Ordering, Referring, Prescribing	N/A	1437519865	0	0	BUGG, JULIA NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022566	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
333081	Ordering, Referring, Prescribing	N/A	1437557444	0	0	BULGER, BECKY A LMFT	3/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102211	N/A	N/A	N/A	N/A	N/A	2130 N VENTURA RD	None	OXNARD	CA	93036	0000	00	06000	34.22414993	-119.1944701	Ventura County
333092	Ordering, Referring, Prescribing	N/A	1437576972	0	0	BAUTISTA, ERIC B MD	7/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138728	N/A	N/A	N/A	N/A	N/A	2525 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78246242	-122.4448129	San Francisco County
333160	Ordering, Referring, Prescribing	N/A	1437658408	0	0	BLEWETT, JENNA LMFT	5/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136866	N/A	N/A	N/A	N/A	N/A	1212 N. CALIFORNIA ST.	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
333168	Ordering, Referring, Prescribing	N/A	1437672714	0	0	BRENNAN, SIOBHAN NP	8/5/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011624	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
333193	Ordering, Referring, Prescribing	N/A	1437707221	0	0	BUTCHER, CATHERINE J LMFT	8/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT134123	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	7938	00	06000	33.61712389	-117.6780482	Orange County
333208	Ordering, Referring, Prescribing	N/A	1437721297	0	0	BAUER, VIRGINIA LMFT	6/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133100	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
333271	Ordering, Referring, Prescribing	N/A	1437877248	0	0	BOWERS, CHASTACEY M NP	8/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022186	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3243	00	06000	33.89475493	-118.2080292	Los Angeles County
333277	Ordering, Referring, Prescribing	N/A	1437922333	0	0	BABAYAN, SOSEH NP	11/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027948	N/A	N/A	N/A	N/A	N/A	2048 MONTROSE AVE	None	MONTROSE	CA	91020	1605	00	06000	34.2059936	-118.2248206	Los Angeles County
333321	Ordering, Referring, Prescribing	N/A	1447315452	0	0	BERK, PERRY A LMFT	10/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT21196	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
333324	Ordering, Referring, Prescribing	N/A	1447324405	0	0	BERTINO, TERESA R NP	8/26/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	492146	N/A	N/A	N/A	N/A	N/A	5500 CAMPANILE DRIVE	None	SAN DIEGO	CA	92182	4701	00	06000	32.77590585	-117.0722922	San Diego County
333330	Ordering, Referring, Prescribing	N/A	1447335377	0	0	BARG, INNA	2/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64081	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
333359	Ordering, Referring, Prescribing	N/A	1447393061	0	0	BEASLEY, SHARON G	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50377	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1000	00	06000	34.44240122	-119.7765542	Santa Barbara County
333418	Ordering, Referring, Prescribing	N/A	1447520796	0	0	BIGA, BRIAN E PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66627	N/A	N/A	N/A	N/A	N/A	3398 MISSION ST	None	SAN FRANCISCO	CA	94110	5009	00	06000	37.7424724	-122.4219457	San Francisco County
333437	Ordering, Referring, Prescribing	N/A	1447542659	0	0	BAIOU, MOHAMED MD	4/15/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149492	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
333445	Ordering, Referring, Prescribing	N/A	1447584974	0	0	BARRETTE, KRISTY A LMFT	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85749	N/A	N/A	N/A	N/A	N/A	354 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3876	00	06000	35.1136354	-120.5916435	San Luis Obispo County
333467	Ordering, Referring, Prescribing	N/A	1447631668	0	0	BAUER, MARISA	3/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70713	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
333470	Ordering, Referring, Prescribing	N/A	1447638234	0	0	BERBERIAN, MARIAM NP	1/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95001795	N/A	N/A	N/A	N/A	N/A	451 WEST LINCOLN AVENUE	SUITE 100	ANAHEIM	CA	92805	2912	00	06000	33.83445082	-117.9189372	Orange County
333474	Ordering, Referring, Prescribing	N/A	1447643168	0	0	BRIGGS, HEATHER M LCSW	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82437	N/A	N/A	N/A	N/A	N/A	18217 HALE AVE # 301	None	MORGAN HILL	CA	95037	3550	00	06000	37.13761496	-121.6664813	Santa Clara County
333492	Ordering, Referring, Prescribing	N/A	1447663182	0	0	BENAVIDEZ, DAVID MD	3/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162091	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
333500	Ordering, Referring, Prescribing	N/A	1447680491	0	0	BYRNE, CATHERINE M LMFT	11/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116481	N/A	N/A	N/A	N/A	N/A	3030 BRIDGEWAY	SUITE 241	SAUSALITO	CA	95965	3801	00	06000	37.87041225	-122.5035792	Marin County
333528	Ordering, Referring, Prescribing	N/A	1447700414	0	0	BLACK, JALEESA LMFT	11/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122264	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
333549	Ordering, Referring, Prescribing	N/A	1447733134	0	0	BAKER, JONATHAN LMFT	3/31/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132076	N/A	N/A	N/A	N/A	N/A	1019 GAYLEY AVE FL 2	FL 2	LOS ANGELES	CA	90024	3437	00	06000	34.06153366	-118.4476278	Los Angeles County
333573	Ordering, Referring, Prescribing	N/A	1447788252	0	0	BHATIA, MINAL MD	1/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163850	N/A	N/A	N/A	N/A	N/A	1396 W HERNDON AVE	None	FRESNO	CA	93711	7126	00	06000	36.83736941	-119.8153047	Fresno County
333576	Ordering, Referring, Prescribing	N/A	1447789037	0	0	BOCK, LESLIE LMFT	5/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146820	N/A	N/A	N/A	N/A	N/A	6711 ARLINGTON AVE STE B	STE B	RIVERSIDE	CA	92504	1966	00	06000	33.9459035	-117.442989	Riverside County
333589	Ordering, Referring, Prescribing	N/A	1447818083	0	0	BILLINGSLEY, LISA LMFT	10/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135443	N/A	N/A	N/A	N/A	N/A	1529 GRAND AVE	SUITE A	SAN MARCOS	CA	92078	2464	00	06000	33.14484004	-117.1969923	San Diego County
333600	Ordering, Referring, Prescribing	N/A	1447854716	0	0	BROOKS-TORREGANO, SONIA NP	6/8/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016052	N/A	N/A	N/A	N/A	N/A	818 MAGNOLIA AVE	201	CORONA	CA	92879	3128	00	06000	33.86017816	-117.5520551	Riverside County
333607	Ordering, Referring, Prescribing	N/A	1447875927	0	0	BANG, JOHN M	8/24/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104921	N/A	N/A	N/A	N/A	N/A	250 E HANFORD ARMONA RD	None	LEMOORE	CA	93245	2141	00	06000	36.31347649	-119.7771345	Kings County
333615	Ordering, Referring, Prescribing	N/A	1447888284	0	0	BRUHN, JOSHUA D MD	6/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186694	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
333708	Ordering, Referring, Prescribing	N/A	1457411639	0	0	BRUNO, CHRISTINE B	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57237	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
333711	Ordering, Referring, Prescribing	N/A	1457422966	0	0	BANZON, CHARLES A LMFT	10/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49126	N/A	N/A	N/A	N/A	N/A	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	00	06000	32.75537928	-117.1416551	San Diego County
333730	Ordering, Referring, Prescribing	N/A	1457476038	0	0	BLACKWATER, NORMA L MD	6/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83912	N/A	N/A	N/A	N/A	N/A	1453 W TEMPLE ST	None	LOS ANGELES	CA	90026	5648	00	06000	34.06757953	-118.2579864	Los Angeles County
333734	Ordering, Referring, Prescribing	N/A	1457485484	0	0	BUSSE, SARA B LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51166	N/A	N/A	N/A	N/A	N/A	345 CROWN POINT CIR	None	GRASS VALLEY	CA	95945	9526	00	06000	39.22037959	-121.0291961	Nevada County
333763	Ordering, Referring, Prescribing	N/A	1457542318	0	0	BUSTAMANTE, HEATHER LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52295	N/A	N/A	N/A	N/A	N/A	31946 MISSION TRL	B	LAKE ELSINORE	CA	92530	4539	00	06000	33.65640803	-117.2979656	Riverside County
333782	Ordering, Referring, Prescribing	N/A	1457574501	0	0	BARKER, SIMON J	1/5/2015	Taxonomy not applicable	NA	n/a	000	Unknown	128	N/A	N/A	N/A	N/A	N/A	740 N LAKE AVE	None	PASADENA	CA	91104	4557	00	06000	34.158762	-118.132432	Los Angeles County
333797	Ordering, Referring, Prescribing	N/A	1457616120	0	0	BHALLA, GAURAV MD	8/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	4301100838	N/A	N/A	N/A	N/A	N/A	4190 24TH AVE.	SUITE 201	FORT GRATIOT	MI	48059	0000	00	06000	43.02961683	-82.45605899	St. Clair County
333825	Ordering, Referring, Prescribing	N/A	1457665424	0	0	BEECHER-VAN HORN, JOANNE NP	2/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95013879	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
333837	Ordering, Referring, Prescribing	N/A	1457677361	0	0	BELL, DORIS C LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85641	N/A	N/A	N/A	N/A	N/A	117 E TUNNEL ST	None	SANTA MARIA	CA	93458	4037	00	06000	34.95755912	-120.4350235	Santa Barbara County
333840	Ordering, Referring, Prescribing	N/A	1457689309	0	0	BLOCKER, NIRIT S PT	4/18/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT30272	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
333857	Ordering, Referring, Prescribing	N/A	1457725202	0	0	BESHAY, SARAH PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74037	N/A	N/A	N/A	N/A	N/A	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	00	06000	38.72827776	-121.2904066	Placer County
333878	Ordering, Referring, Prescribing	N/A	1457763088	0	0	BERI, NEIL MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140127	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333886	Ordering, Referring, Prescribing	N/A	1457769531	0	0	BARRON, MARIBEL LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94214	N/A	N/A	N/A	N/A	N/A	6601 STEPHENS RANCH RD	None	LA VERNE	CA	91750	1146	00	06000	34.154775	-117.740052	Los Angeles County
333916	Ordering, Referring, Prescribing	N/A	1457809089	0	0	BRONSTEIN, JAIME LPCC	6/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7457	N/A	N/A	N/A	N/A	N/A	45 FARALLONES ST	None	SAN FRANCISCO	CA	94112	3005	00	06000	37.71408691	-122.4538573	San Francisco County
333924	Ordering, Referring, Prescribing	N/A	1457820680	0	0	BACON, CHLOE T LCSW	12/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105864	N/A	N/A	N/A	N/A	N/A	33 ENCINA AVE	None	PALO ALTO	CA	94301	2300	00	06000	37.43913037	-122.1608344	Santa Clara County
333938	Ordering, Referring, Prescribing	N/A	1457830150	0	0	BOLTER, ALYSSA M	5/13/2019	Taxonomy not applicable	NA	n/a	000	Unknown	55847	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
333948	Ordering, Referring, Prescribing	N/A	1457837353	0	0	BURKMAN, DUSTIN N	7/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55726	N/A	N/A	N/A	N/A	N/A	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	00	06000	36.332757	-119.288682	Tulare County
333965	Ordering, Referring, Prescribing	N/A	1457865677	0	0	BERILLA, MATTHEW B PA	2/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	60198	N/A	N/A	N/A	N/A	N/A	50249 CESAR CHAVEZ ST	K	COACHELLA	CA	92236	1530	00	06000	33.68245553	-116.1816607	Riverside County
333967	Ordering, Referring, Prescribing	N/A	1457865081	0	0	BORGIE, TODD J LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119705	N/A	N/A	N/A	N/A	N/A	233 37TH ST	None	RICHMOND	CA	94805	2105	00	06000	37.93340231	-122.3344089	Contra Costa County
333985	Ordering, Referring, Prescribing	N/A	1457886616	0	0	BEN ABRAHAM, KARUNDRA PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74044	N/A	N/A	N/A	N/A	N/A	2300 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	2854	00	06000	37.47986244	-122.2166029	San Mateo County
333990	Ordering, Referring, Prescribing	N/A	1457899353	0	0	BUBELA, ROMAN LCSW	9/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110457	N/A	N/A	N/A	N/A	N/A	11512 B AVE	None	AUBURN	CA	95603	2605	00	06000	38.93969517	-121.1046397	Placer County
334008	Ordering, Referring, Prescribing	N/A	1457916579	0	0	BROWN, SPENCER M MD	3/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177321	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
334050	Ordering, Referring, Prescribing	N/A	1467010801	0	0	BAUTISTA, REBECCA D LMFT	12/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT152103	N/A	N/A	N/A	N/A	N/A	237 N. CENTRAL AVE	C	GLENDALE	CA	91203	2531	00	06000	34.14943423	-118.2579487	Los Angeles County
334101	Ordering, Referring, Prescribing	N/A	1467127332	0	0	BELLOSO, MARINA E NP	8/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018045	N/A	N/A	N/A	N/A	N/A	7725 LEEDS ST	BUILDING D	DOWNEY	CA	90242	3489	00	06000	33.92794074	-118.1566993	Los Angeles County
334123	Ordering, Referring, Prescribing	N/A	1467276014	0	0	BAINS, SUKHVIR NP	12/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022291	N/A	N/A	N/A	N/A	N/A	6608 MERCY COURT	None	SACRAMENTO	CA	95628	3170	00	06000	38.665917	-121.3106895	Sacramento
334134	Ordering, Referring, Prescribing	N/A	1467292706	0	0	BOGHOSIAN, SARA NP	10/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95227136	N/A	N/A	N/A	N/A	N/A	501 S. IDAHO ST.	100	LA HABRA	CA	90631	6047	00	06000	33.927525	-117.959216	Orange County
334139	Ordering, Referring, Prescribing	N/A	1467462457	0	0	BARTON, ARNOLD L MD	4/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G10818	N/A	N/A	N/A	N/A	N/A	23861 MCBEAN PKWY	SUITE E-12	VALENCIA	CA	91355	2077	00	06000	34.39567343	-118.5542698	Los Angeles County
334152	Ordering, Referring, Prescribing	N/A	1467517458	0	0	BLISS, NISHANGA LAC	10/16/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	7355	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2006	00	06000	37.86680859	-122.2969443	Alameda County
334169	Ordering, Referring, Prescribing	N/A	1467573378	0	0	BERESFORD, JANE C PSYD	10/24/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16618	N/A	N/A	N/A	N/A	N/A	15300 VENTURA BOULEVARD	SUITE 301	SHERMAN OAKS	CA	91403	3101	00	06000	34.15387425	-118.4666626	Los Angeles County
334177	Ordering, Referring, Prescribing	N/A	1467588095	0	0	BOEN-PADILLA, TAMMY LMFT	9/13/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34029	N/A	N/A	N/A	N/A	N/A	5801 SUNDALE AVE	None	BAKERSFIELD	CA	93309	2924	00	06000	35.34387226	-119.0654328	Kern County
334181	Ordering, Referring, Prescribing	N/A	1467593103	0	0	BARACEROS, MARY ELLEN LCSW	7/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24140	N/A	N/A	N/A	N/A	N/A	7986 DAGGET ST	None	SAN DIEGO	CA	92111	2321	00	06000	32.82363345	-117.1512855	San Diego County
334195	Ordering, Referring, Prescribing	N/A	1467633735	0	0	BLACK, MITZEN	10/14/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30574	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
334216	Ordering, Referring, Prescribing	N/A	1467657437	0	0	BALCE, MA AILEEN V	12/19/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D43896	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
334218	Ordering, Referring, Prescribing	N/A	1467670182	0	0	BARRIENTOS, ERIC M	10/23/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D43898	N/A	N/A	N/A	N/A	N/A	2180 N MAIN ST	None	SALINAS	CA	93906	1735	00	06000	36.72675972	-121.6563161	Monterey County
334226	Ordering, Referring, Prescribing	N/A	1467693168	0	0	BURNS, SHANA L LMFT	3/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53207	N/A	N/A	N/A	N/A	N/A	324 E CARRILLO ST	C	SANTA BARBARA	CA	93101	1433	00	06000	34.42529487	-119.6977685	Santa Barbara County
334251	Ordering, Referring, Prescribing	N/A	1467735860	0	0	BARBAT, SAM PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57656	N/A	N/A	N/A	N/A	N/A	640 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3213	00	06000	32.74837353	-117.15894	San Diego County
334254	Ordering, Referring, Prescribing	N/A	1467735605	0	0	BOTONES, LAVENDER L PHARMD	4/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60758	N/A	N/A	N/A	N/A	N/A	2660 PARK CENTER DR	None	SIMI VALLEY	CA	93065	6207	00	06000	34.28442036	-118.7968257	Ventura County
334279	Ordering, Referring, Prescribing	N/A	1467786053	0	0	BROWNING, MELISSA A NP	4/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95004388	N/A	N/A	N/A	N/A	N/A	106 MAPLE AVENUE	None	WATSONVILLE	CA	95076	3127	00	06000	36.90992773	-121.7546894	Santa Cruz County
334286	Ordering, Referring, Prescribing	N/A	1467793398	0	0	BELLENDIR, JULIE M NP	12/27/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22858	N/A	N/A	N/A	N/A	N/A	711 E BALL RD	201	ANAHEIM	CA	92805	5930	00	06000	33.81811751	-117.90108	Orange County
334298	Ordering, Referring, Prescribing	N/A	1467811711	0	0	BLYAKHEROVA, YULIYA PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74033	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	B25	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
334305	Ordering, Referring, Prescribing	N/A	1467818724	0	0	BUCCAT, JANELLE D OT	2/18/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	16222	N/A	N/A	N/A	N/A	N/A	425 DIVISADERO ST.	SUITE 300	SAN FRANCISCO	CA	94117	2242	00	06000	37.77336026	-122.4375022	San Francisco County
334325	Ordering, Referring, Prescribing	N/A	1467838680	0	0	BERNINGER, EVIE Y PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72880	N/A	N/A	N/A	N/A	N/A	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
334361	Ordering, Referring, Prescribing	N/A	1467893693	0	0	BLASKOVICH, DAGNY A LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88191	N/A	N/A	N/A	N/A	N/A	300 HARVEY WEST BLVD	None	SANTA CRUZ	CA	95060	2103	00	06000	36.98485698	-122.0394541	Santa Cruz County
334370	Ordering, Referring, Prescribing	N/A	1467902288	0	0	BALTAZAR, JOVEN PHARMD	3/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75038	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
334375	Ordering, Referring, Prescribing	N/A	1467907048	0	0	BAZILIAN, CHELSEA B LCSW	4/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101313	N/A	N/A	N/A	N/A	N/A	1311 NORTH SAN FERNANDO	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
334457	Ordering, Referring, Prescribing	N/A	1477012516	0	0	BAILEY, AMANDA E MD	6/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179211	N/A	N/A	N/A	N/A	N/A	7821 S AVALON BLVD	None	LOS ANGELES	CA	90003	2358	00	06000	33.969393	-118.265197	Los Angeles County
334473	Ordering, Referring, Prescribing	N/A	1477058550	0	0	BERNSTEIN, ROBERT S MD	10/15/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G46522	N/A	N/A	N/A	N/A	N/A	20111 CEDAR RD N	None	SONORA	CA	95370	5939	00	06000	37.98813587	-120.3664247	Tuolumne County
334501	Ordering, Referring, Prescribing	N/A	1477115368	0	0	BUSCH, LINDSAY K LMFT	4/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132337	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
334527	Ordering, Referring, Prescribing	N/A	1477180032	0	0	BECERRA RAMIREZ, MILAGROS MD	7/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188188	N/A	N/A	N/A	N/A	N/A	625 34TH STREET STE 100	None	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
334559	Ordering, Referring, Prescribing	N/A	1477289783	0	0	BLOUNT, KIM A RDH	11/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	020011641	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
334561	Ordering, Referring, Prescribing	N/A	1477293850	0	0	BULL, STEPHANIE PA-C	9/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65003	N/A	N/A	N/A	N/A	N/A	333 LAWS	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
334563	Ordering, Referring, Prescribing	N/A	1477296424	0	0	BURCOVSCHI, LUDMILA NP	10/5/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020770	N/A	N/A	N/A	N/A	N/A	901 OAK PARK BLVD	STE 101	PISMO BEACH	CA	93449	3409	00	06000	35.13460775	-120.6050814	San Luis Obispo County
334576	Ordering, Referring, Prescribing	N/A	1477518868	0	0	BARUJA-BAQUER, CESAR L MD	3/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C175307	N/A	N/A	N/A	N/A	N/A	706 PEACH ST	None	CORNING	CA	96021	3355	00	06000	39.928689	-122.174397	Tehama County
334592	Ordering, Referring, Prescribing	N/A	1477576130	0	0	BOWMAN, ROBIN L MSW LCSW	2/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20288	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
334612	Ordering, Referring, Prescribing	N/A	1477589331	0	0	BAYARD, MARGARET A MD	11/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C179173	N/A	N/A	N/A	N/A	N/A	333 S TWIN OAKS VALLEY R	BLDG. 21	SAN MARCOS	CA	92096	0001	00	06000	33.12741952	-117.1651625	San Diego County
334675	Ordering, Referring, Prescribing	N/A	1477749505	0	0	BRANNON, ANJANETTE D LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45733	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400 SUITE 202	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
334677	Ordering, Referring, Prescribing	N/A	1477751667	0	0	BENSON, JIMI O MD	7/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116611	N/A	N/A	N/A	N/A	N/A	1351 BROADWAY	None	EL CAJON	CA	92021	5811	00	06000	32.80767948	-116.933868	San Diego County
334689	Ordering, Referring, Prescribing	N/A	1477783900	0	0	BAILEY, DORIANA MD	4/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110163	N/A	N/A	N/A	N/A	N/A	1309 EVANS AVE.	None	SAN FRANCISCO	CA	94124	1705	00	06000	37.74005234	-122.3834106	San Francisco County
334745	Ordering, Referring, Prescribing	N/A	1477860344	0	0	BEVERIDGE, MICHELLE LCSW	1/29/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73511	N/A	N/A	N/A	N/A	N/A	781 N SEQUOIA AVE	STE 3	LINDSAY	CA	93247	1448	00	06000	36.21240571	-119.0961081	Tulare County
334747	Ordering, Referring, Prescribing	N/A	1477854560	0	0	BONNER, LANVI T PHARMD	4/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	57839	N/A	N/A	N/A	N/A	N/A	450 S VENTURA RD	None	OXNARD	CA	93030	6557	00	06000	34.19840042	-119.194659	Ventura County
334748	Ordering, Referring, Prescribing	N/A	1477871945	0	0	BOWEN, ANDREA S MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127319	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
334758	Ordering, Referring, Prescribing	N/A	1477890242	0	0	BRETCHES, LISA R NP	11/21/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	388136	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	SUITE 300	MISSION VIEJO	CA	92691	6409	00	06000	33.55952733	-117.6645199	Orange County
334771	Ordering, Referring, Prescribing	N/A	1477912806	0	0	BURNHAM, TRAVIS A	1/11/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	101887	N/A	N/A	N/A	N/A	N/A	959 MYRTLE AVE	None	EUREKA	CA	95501	1219	00	06000	40.80062789	-124.1497475	Humboldt County
334775	Ordering, Referring, Prescribing	N/A	1477913853	0	0	BELL, TRAVIS J	4/30/2017	Taxonomy not applicable	NA	n/a	000	Unknown	2016006363	N/A	N/A	N/A	N/A	N/A	525 BRANSON LANDING BLVD	None	BRANSON	MO	65616	2052	00	06000	36.65109796	-93.2204608	Taney County
334810	Ordering, Referring, Prescribing	N/A	1477973626	0	0	BARILLAS, YURIDIA E LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101603	N/A	N/A	N/A	N/A	N/A	5740 RALSTON ST	201	VENTURA	CA	93003	6051	00	06000	34.26070802	-119.213699	Ventura County
334820	Ordering, Referring, Prescribing	N/A	1477989598	0	0	BANKER, KELLY J PHARMD	12/15/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74351	N/A	N/A	N/A	N/A	N/A	325 S WILLIS ST	None	VISALIA	CA	93291	6105	00	06000	36.327717	-119.2981005	Tulare County
334874	Ordering, Referring, Prescribing	N/A	1487054888	0	0	BREWER, JOELLA LCSW	2/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89140	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE # A, B & C	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
334896	Ordering, Referring, Prescribing	N/A	1487073839	0	0	BANDARPALLE, SUSHANT MD	1/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15221	N/A	N/A	N/A	N/A	N/A	808 W. 58TH ST.	None	LOS ANGELES	CA	90037	4045	00	06000	33.98965917	-118.287673	Los Angeles County
334921	Ordering, Referring, Prescribing	N/A	1487119681	0	0	BITZER, ANDREA M LMFT	6/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139603	N/A	N/A	N/A	N/A	N/A	711 E BALL RD	201	ANAHEIM	CA	92805	5930	00	06000	33.81811751	-117.90108	Orange County
334974	Ordering, Referring, Prescribing	N/A	1487196283	0	0	BAUTISTA, JENNIFER B PHARMD	4/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74260	N/A	N/A	N/A	N/A	N/A	3701 W AVENUE 42	None	LOS ANGELES	CA	90065	4401	00	06000	34.11936085	-118.2249186	Los Angeles County
334985	Ordering, Referring, Prescribing	N/A	1487210373	0	0	BAER, MICHELLE M MD	3/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176816	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
335030	Ordering, Referring, Prescribing	N/A	1487305504	0	0	BERBERIAN, NATALIE A	4/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84980	N/A	N/A	N/A	N/A	N/A	6100 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	3241	00	06000	34.181325	-118.463634	Los Angeles County
335061	Ordering, Referring, Prescribing	N/A	1487386967	0	0	BARRAGAN, ANALLELI LMFT	2/4/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153018	N/A	N/A	N/A	N/A	N/A	16580 HARBOR BLVD	STE M	FOUNTAIN VALLEY	CA	92708	1385	00	06000	33.72282	-117.9197845	Orange County
335084	Ordering, Referring, Prescribing	N/A	1487666186	0	0	BAGLEY, WYLIE J LMFT	11/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122872	N/A	N/A	N/A	N/A	N/A	3858 HAWVER RD.	None	SAN ANDREAS	CA	95249	0000	00	06000	38.2319743	-120.6496796	Calaveras County
335104	Ordering, Referring, Prescribing	N/A	1487719258	0	0	BENNETT, KIMBERLY PHD	11/24/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16324	N/A	N/A	N/A	N/A	N/A	975 FLYNN ROAD	None	CAMARILLO	CA	93012	8704	00	06000	34.22667906	-119.0196947	Ventura County
335118	Ordering, Referring, Prescribing	N/A	1487764833	0	0	BLACKETER, BETHANY MD	1/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A69805	N/A	N/A	N/A	N/A	N/A	1330 LAS TABLAS RD	None	TEMPLETON	CA	93465	9758	00	06000	35.55442548	-120.723759	San Luis Obispo County
335123	Ordering, Referring, Prescribing	N/A	1487771994	0	0	BATRES, ROSA LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102591	N/A	N/A	N/A	N/A	N/A	50 E FOOTHILL BLVD	3RD FLOOR	ARCADIA	CA	91006	2314	00	06000	34.15096965	-118.0295442	Los Angeles County
335143	Ordering, Referring, Prescribing	N/A	1487789699	0	0	BARTON, JOEL C	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50339	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	8TH FLOOR	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
335144	Ordering, Referring, Prescribing	N/A	1487794020	0	0	BARKER, JOHN C	4/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G84024	N/A	N/A	N/A	N/A	N/A	1990 41ST AVENUE	None	SAN FRANCISCO	CA	94116	1101	00	06000	37.74984135	-122.4997872	San Francisco County
335157	Ordering, Referring, Prescribing	N/A	1487819074	0	0	BHANDARI, SONALI DDS	11/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	102059	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
335166	Ordering, Referring, Prescribing	N/A	1487849592	0	0	BROWN, DAVID M LMFT	12/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77390	N/A	N/A	N/A	N/A	N/A	6833 STOCKTON BLVD	485	SACRAMENTO	CA	95823	2376	00	06000	38.502684	-121.430124	Sacramento County
335182	Ordering, Referring, Prescribing	N/A	1487891354	0	0	BUGAY, JESSICA MARIE V PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62109	N/A	N/A	N/A	N/A	N/A	5403 BROOK HOLLOW CT	None	STOCKTON	CA	95219	2440	00	06000	37.99157459	-121.3591726	San Joaquin County
335198	Ordering, Referring, Prescribing	N/A	1487930798	0	0	BROWN, TONI LMFT	6/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133119	N/A	N/A	N/A	N/A	N/A	1124 N CHINOWTH ST	101	VISALIA	CA	93291	7896	00	06000	36.338427	-119.333925	Tulare County
335208	Ordering, Referring, Prescribing	N/A	1487944575	0	0	BIDLINGMEYER, NICOLETTE J MSW LCSW	2/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69525	N/A	N/A	N/A	N/A	N/A	21707 HAWTHORNE BLVD	300	TORRANCE	CA	90503	7016	00	06000	33.83065871	-118.3526165	Los Angeles County
335224	Ordering, Referring, Prescribing	N/A	1487964755	0	0	BRAMPTON, RICKI-LEIGH L MD	1/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119619	N/A	N/A	N/A	N/A	N/A	18217 HALE AVE	None	MORGAN HILL	CA	95037	3550	00	06000	37.13761496	-121.6664813	Santa Clara County
335320	Ordering, Referring, Prescribing	N/A	1497121461	0	0	BYERS, FRANCINE LMFT	4/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125434	N/A	N/A	N/A	N/A	N/A	1885 LUNDY AVE	None	SAN JOSE	CA	95131	1887	00	06000	37.39329538	-121.8907367	Santa Clara County
335326	Ordering, Referring, Prescribing	N/A	1497120604	0	0	BURNFIN, AMANDA LMFT	9/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103570	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
335330	Ordering, Referring, Prescribing	N/A	1497137855	0	0	BOUNTHON, ASHLEY PHARMD	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72646	N/A	N/A	N/A	N/A	N/A	3232 FOOTHILL BLVD	None	OAKLAND	CA	94601	3113	00	06000	37.78344416	-122.2218117	Alameda County
335332	Ordering, Referring, Prescribing	N/A	1497139661	0	0	BUENROSTRO, MARCENA LCSW	3/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94373	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE	None	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
335337	Ordering, Referring, Prescribing	N/A	1497152680	0	0	BHAKTA, MANJARI J	2/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	683224	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
335338	Ordering, Referring, Prescribing	N/A	1497148464	0	0	BUJANDA, AMY LMFT	8/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121314	N/A	N/A	N/A	N/A	N/A	3787 SOUTH VERMONT AVENU	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
335345	Ordering, Referring, Prescribing	N/A	1497162689	0	0	BRENES, JENNIFER LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86188	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
335347	Ordering, Referring, Prescribing	N/A	1497163711	0	0	BELLISARIO, MARK J	6/14/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D60996	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
335352	Ordering, Referring, Prescribing	N/A	1497172589	0	0	BIERMAN, CAYENNE LCSW	7/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	59634	N/A	N/A	N/A	N/A	N/A	9 COMMERCIAL BLVD	STE 100	NOVATO	CA	94949	6118	00	06000	38.06858293	-122.5329327	Marin County
335354	Ordering, Referring, Prescribing	N/A	1497166029	0	0	BARAJAS, GRISELDA LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105040	N/A	N/A	N/A	N/A	N/A	480 E 13TH ST	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
335355	Ordering, Referring, Prescribing	N/A	1497172332	0	0	BRIDGES, AMBER MD	7/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138097	N/A	N/A	N/A	N/A	N/A	1000 W. CARSON ST.	8W	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
335357	Ordering, Referring, Prescribing	N/A	1497182786	0	0	BOGACS, MOLLY PHARMD	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	69726	N/A	N/A	N/A	N/A	N/A	1187 SOUTH MAIN STREET	None	MANTECA	CA	95337	5747	00	06000	37.78661716	-121.2160875	San Joaquin County
335361	Ordering, Referring, Prescribing	N/A	1497186829	0	0	BURNETT, KIMBERLY S LCSW	2/27/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25878	N/A	N/A	N/A	N/A	N/A	4151 MEXICALI DR	None	BAKERSFIELD	CA	93313	2065	00	06000	35.317233	-119.081649	Kern County
335363	Ordering, Referring, Prescribing	N/A	1497183560	0	0	BROWN, ANGELA R NP	3/2/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	728532	N/A	N/A	N/A	N/A	N/A	2505 MERCED ST	None	FRESNO	CA	93721	1811	00	06000	36.74081939	-119.7879808	Fresno County
335365	Ordering, Referring, Prescribing	N/A	1497190995	0	0	BIDWAL, MONICA	4/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67533	N/A	N/A	N/A	N/A	N/A	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	00	06000	37.23948065	-121.8005798	Santa Clara County
335472	Ordering, Referring, Prescribing	N/A	1497394928	0	0	BARNEY, SYDNEY L PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81302	N/A	N/A	N/A	N/A	N/A	11000 VENTURA BLVD	None	STUDIO CITY	CA	91604	3729	00	06000	34.14047342	-118.3703398	Los Angeles County
335482	Ordering, Referring, Prescribing	N/A	1497402200	0	0	BERLINER, SUSAN NP	10/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032528	N/A	N/A	N/A	N/A	N/A	116 W MINNESOTA AVE	None	MCCLOUD	CA	96057	0001	00	06000	41.25214176	-122.1368284	Siskiyou County
335522	Ordering, Referring, Prescribing	N/A	1497494538	0	0	BROWNING, ADAM J LMFT	2/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137987	N/A	N/A	N/A	N/A	N/A	23461 S POINTE DR	100	LAGUNA HILLS	CA	92653	1523	00	06000	33.62535142	-117.7206568	Orange County
335525	Ordering, Referring, Prescribing	N/A	1497712202	0	0	BALTZER BAUER, INGRID S	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27649	N/A	N/A	N/A	N/A	N/A	439 W. 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
335540	Ordering, Referring, Prescribing	N/A	1497800353	0	0	BLAIR, JENNIFER E LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45339	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
335541	Ordering, Referring, Prescribing	N/A	1497808786	0	0	BYINGTON, BRAD DC	10/28/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	20534	N/A	N/A	N/A	N/A	N/A	12640 HESPERIA RD	None	VICTORVILLE	CA	92395	7753	00	06000	34.48056876	-117.2907887	San Bernardino County
335573	Ordering, Referring, Prescribing	N/A	1497884498	0	0	BECKER, NICOLE PSYD	2/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26010	N/A	N/A	N/A	N/A	N/A	303 C ST.	None	LOMPOC	CA	93436	7305	00	06000	34.64226582	-120.4514394	Santa Barbara County
335591	Ordering, Referring, Prescribing	N/A	1497906192	0	0	BARTON, MICHELE PA	9/26/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA22966	N/A	N/A	N/A	N/A	N/A	14372 BEACH BLVD	None	WESTMINSTER	CA	92683	4578	00	06000	33.75341465	-117.989413	Orange County
335594	Ordering, Referring, Prescribing	N/A	1497917967	0	0	BURTON, CYNTHIA R LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29889	N/A	N/A	N/A	N/A	N/A	4545 N WEST AVE	None	FRESNO	CA	93705	0946	00	06000	36.799623	-119.8264355	Fresno County
335597	Ordering, Referring, Prescribing	N/A	1497931851	0	0	BURGER, FERNANDA LMFT	6/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT140089	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4172	00	06000	35.3830369	-118.9680991	Kern County
335598	Ordering, Referring, Prescribing	N/A	1497930119	0	0	BRYANT, TANYA E MD	1/30/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53527	N/A	N/A	N/A	N/A	N/A	437 N. EUCLID AVE.	None	ONTARIO	CA	91762	3456	00	06000	34.067988	-117.6521805	San Bernardino County
335599	Ordering, Referring, Prescribing	N/A	1497931950	0	0	BISHARA, MARIAM N	7/29/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A00102845	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
335603	Ordering, Referring, Prescribing	N/A	1497938641	0	0	BAL, JASPREET E	9/7/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D46744	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
335611	Ordering, Referring, Prescribing	N/A	1497963771	0	0	BEYAOJU, DIANE DDS	9/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	33953	N/A	N/A	N/A	N/A	N/A	307 PLACENTIA AVE	None	NEWPORT BEACH	CA	92663	3310	00	06000	33.62631386	-117.9310576	Orange County
335631	Ordering, Referring, Prescribing	N/A	1508022914	0	0	BIR, GURPREET K	6/5/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D55050	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
335632	Ordering, Referring, Prescribing	N/A	1508012113	0	0	BOILEAU, SEAN PSYD	7/21/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24035	N/A	N/A	N/A	N/A	N/A	611 S KINGSLEY DR.	None	LOS ANGELES	CA	90005	2319	00	06000	34.06305793	-118.3028813	Los Angeles County
335633	Ordering, Referring, Prescribing	N/A	1508012956	0	0	BAPTISTE, KELLY K PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61186	N/A	N/A	N/A	N/A	N/A	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
335645	Ordering, Referring, Prescribing	N/A	1508051269	0	0	BAYE, SHARON LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29627	N/A	N/A	N/A	N/A	N/A	550 S. VERMONT AVE	10TH FLOOR	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
335655	Ordering, Referring, Prescribing	N/A	1508066671	0	0	BANKS, KALILA D PA-C	4/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA19269	N/A	N/A	N/A	N/A	N/A	1120 E CHURCH AVE	None	FRESNO	CA	93650	5435	00	06000	36.7140837	-119.7975576	Fresno County
335659	Ordering, Referring, Prescribing	N/A	1508093725	0	0	BLANCO, GRACIELA LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119691	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
335666	Ordering, Referring, Prescribing	N/A	1508113887	0	0	BANDES, MARIO S LMFT	10/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116186	N/A	N/A	N/A	N/A	N/A	1350 ARNOLD DR	102	MARTINEZ	CA	94553	4190	00	06000	37.99217145	-122.0982508	Contra Costa County
335671	Ordering, Referring, Prescribing	N/A	1508118993	0	0	BAYCHER, ANNA OD	8/15/2014	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14489	N/A	N/A	N/A	N/A	N/A	7976 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	5109	00	06000	34.0907785	-118.3641255	Los Angeles County
335704	Ordering, Referring, Prescribing	N/A	1508154469	0	0	BATTLE, REGINA D	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107639	N/A	N/A	N/A	N/A	N/A	480 E 13TH ST	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
335705	Ordering, Referring, Prescribing	N/A	1508164682	0	0	BAY, LORINE E LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79301	N/A	N/A	N/A	N/A	N/A	287 RIO LINDO AVE	None	CHICO	CA	95926	1973	00	06000	39.75438707	-121.8542235	Butte County
335713	Ordering, Referring, Prescribing	N/A	1508174608	0	0	BORN, TODD A	12/24/2014	Taxonomy not applicable	NA	n/a	000	Unknown	599	N/A	N/A	N/A	N/A	N/A	512 WESTLINE DR	STE 204	ALAMEDA	CA	94501	7605	00	06000	37.76543497	-122.2715354	Alameda County
335726	Ordering, Referring, Prescribing	N/A	1508174269	0	0	BRUCE, KELL K	2/19/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0644516	N/A	N/A	N/A	N/A	N/A	11722 S WILMINGTON AVE	None	LOS ANGELES	CA	90059	2543	00	06000	33.9267675	-118.2390104	Los Angeles County
335734	Ordering, Referring, Prescribing	N/A	1508208109	0	0	BELL, ZARINA K	10/31/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104473	N/A	N/A	N/A	N/A	N/A	137 N VIRGIL AVE	None	LOS ANGELES	CA	90004	4811	00	06000	34.07457287	-118.2868414	Los Angeles County
335773	Ordering, Referring, Prescribing	N/A	1508272642	0	0	BERBERIAN, HAROUT H LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76716	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	None	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
335776	Ordering, Referring, Prescribing	N/A	1508275272	0	0	BARRERA DOWNS-NAIVALU, KATINA LPCC	8/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	17216	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
335778	Ordering, Referring, Prescribing	N/A	1508277245	0	0	BROWN, JASMIN M MD	6/27/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152364	N/A	N/A	N/A	N/A	N/A	55497 VAN BUREN ST	None	THERMAL	CA	92274	9412	00	06000	33.645622	-116.1988867	Riverside County
335780	Ordering, Referring, Prescribing	N/A	1508284274	0	0	BARBERO, ERIKA M MD	7/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139096	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
335791	Ordering, Referring, Prescribing	N/A	1508299637	0	0	BROOKS, JULIA H	7/26/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D62754	N/A	N/A	N/A	N/A	N/A	3743 S LA BREA AVE	None	LOS ANGELES	CA	90016	5309	00	06000	34.01991	-118.355626	Los Angeles County
335793	Ordering, Referring, Prescribing	N/A	1508307745	0	0	BASMADZHYAN, ANDRE DO	5/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	20A18560	N/A	N/A	N/A	N/A	N/A	732 MOTT ST SUITE 100/11	None	SAN FERNANDO	CA	91340	4378	00	06000	34.27661761	-118.4442372	Los Angeles County
335817	Ordering, Referring, Prescribing	N/A	1508344458	0	0	BOSWORTH, REBECCA A LCSW	12/29/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83417	N/A	N/A	N/A	N/A	N/A	48774 ROAD 426	#D	OAKHURST	CA	93644	8690	00	06000	37.31324694	-119.6153993	Madera County
335837	Ordering, Referring, Prescribing	N/A	1508374653	0	0	BYMUN, JENNIFER LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99287	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	SUITE 359	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
335840	Ordering, Referring, Prescribing	N/A	1508382979	0	0	BENYAMEN, SARAH R	6/24/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102226	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
335842	Ordering, Referring, Prescribing	N/A	1508393141	0	0	BENJAMIN, JACQUELINE PHARMD	11/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	74930	N/A	N/A	N/A	N/A	N/A	13651 WILLARD ST	None	PANORAMA CITY	CA	91402	1111	00	06000	34.2177693	-118.4298601	Los Angeles County
335909	Ordering, Referring, Prescribing	N/A	1508536616	0	0	BEAL, DAVID E NP	12/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023531	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
335926	Ordering, Referring, Prescribing	N/A	1508591454	0	0	BOWEN, JONATHAN NP	11/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022138	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
335928	Ordering, Referring, Prescribing	N/A	1508605502	0	0	BUFFINI, SOPHIA M PA-C	5/13/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64476	N/A	N/A	N/A	N/A	N/A	4725 MARKET STREET	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
335968	Ordering, Referring, Prescribing	N/A	1508901695	0	0	BERGAM, KATHERINE R LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44399	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
335976	Ordering, Referring, Prescribing	N/A	1508921958	0	0	BAUSEK, GERALD MD	10/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G42761	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVENUE	None	SAN JOSE	CA	95125	0001	00	06000	37.30176	-121.9136465	Santa Clara County
335984	Ordering, Referring, Prescribing	N/A	1508926031	0	0	BOOTH, SUMIKO N LCSW	2/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106888	N/A	N/A	N/A	N/A	N/A	2245 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5418	00	06000	38.42559	-122.751243	Sonoma County
335985	Ordering, Referring, Prescribing	N/A	1508933425	0	0	BASICAL, SOFRONIO MD	6/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G79124	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
335991	Ordering, Referring, Prescribing	N/A	1508948068	0	0	BOROUKHIM, SILVANA MD	1/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53627	N/A	N/A	N/A	N/A	N/A	377 E CHAPMAN AVE	110	PLACENTIA	CA	92870	5055	00	06000	33.87122847	-117.8635161	Orange County
335995	Ordering, Referring, Prescribing	N/A	1508975327	0	0	BISCOTTI, BRIAN S DC	2/6/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	25410	N/A	N/A	N/A	N/A	N/A	41820 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1649	00	06000	34.24651473	-116.8897879	San Bernardino County
336000	Ordering, Referring, Prescribing	N/A	1508940107	0	0	BOSEOVSKI, CHRIS DMD	10/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56189	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
336006	Ordering, Referring, Prescribing	N/A	1508991753	0	0	BURTRON, SHERYLE L LMFT	4/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146189	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA RD	None	VICTORVILLE	CA	92395	7720	00	06000	34.48058899	-117.2907353	San Bernardino County
336024	Ordering, Referring, Prescribing	N/A	1518013192	0	0	BLUMBERG, LOUIS M PHD	4/14/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY5338	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
336048	Ordering, Referring, Prescribing	N/A	1518063528	0	0	BURSCH, BRADLEY M MD	9/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A83220	N/A	N/A	N/A	N/A	N/A	1500 E CHEVY CHASE DR	#250	GLENDALE	CA	91206	4152	00	06000	34.15201194	-118.2322051	Los Angeles County
336049	Ordering, Referring, Prescribing	N/A	1518074996	0	0	BAKER, LISA M LCSW	12/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21041	N/A	N/A	N/A	N/A	N/A	12966 EUCLID STREET	STE. 280	GARDEN GROVE	CA	92840	5200	00	06000	33.77455935	-117.9378298	Orange County
336059	Ordering, Referring, Prescribing	N/A	1518080738	0	0	BERINSTEIN KIRKMAN, HEIDI LMFT	10/15/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43301	N/A	N/A	N/A	N/A	N/A	9113 FOOTHILL	SUITE 130	RANCHO CUCAMONGA	CA	91730	6565	00	06000	34.10651347	-117.606528	San Bernardino County
336071	Ordering, Referring, Prescribing	N/A	1518098565	0	0	BENEDICT, AMELIA F LMFT	1/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51589	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
336077	Ordering, Referring, Prescribing	N/A	1518115880	0	0	BOGHOSIAN, MARGRIT A LCSW	5/29/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25188	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
336094	Ordering, Referring, Prescribing	N/A	1518152636	0	0	BURKE, ELIZABETH J LCSW	12/7/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84712	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
336100	Ordering, Referring, Prescribing	N/A	1518155308	0	0	BAEK, GRACE PHARMD	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60112	N/A	N/A	N/A	N/A	N/A	3430 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	00	06000	33.852105	-117.8444835	Orange County
336114	Ordering, Referring, Prescribing	N/A	1518194554	0	0	BRAY, SAMANTHA M LCSW	10/31/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29325	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
336136	Ordering, Referring, Prescribing	N/A	1518238120	0	0	BANH, LE G PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57391	N/A	N/A	N/A	N/A	N/A	2501 W MAGNOLIA BLVD	None	BURBANK	CA	91505	3030	00	06000	34.17187593	-118.3351483	Los Angeles County
336146	Ordering, Referring, Prescribing	N/A	1518249325	0	0	BAUZON, MARY JOY M PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50828	N/A	N/A	N/A	N/A	N/A	1430 EASTLAKE PKWY	None	CHULA VISTA	CA	91915	1926	00	06000	32.62994867	-116.9650465	San Diego County
336166	Ordering, Referring, Prescribing	N/A	1518296706	0	0	BABAYEV, MIKHAIL MSW LCSW	2/10/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106861	N/A	N/A	N/A	N/A	N/A	6100 REDWOOD BLVD	None	NOVATO	CA	94945	4501	00	06000	38.09578333	-122.5627508	Marin County
336170	Ordering, Referring, Prescribing	N/A	1518294602	0	0	BAGNALL, KAITLIN LCSW	8/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72277	N/A	N/A	N/A	N/A	N/A	1300 17TH ST	None	BAKERSFIELD	CA	93301	4504	00	06000	35.37476047	-119.016774	Kern County
336185	Ordering, Referring, Prescribing	N/A	1518333483	0	0	BRUMLEY, KACIE G MD	10/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138923	N/A	N/A	N/A	N/A	N/A	852 E DANENBERG DR	None	EL CENTRO	CA	92243	8511	00	06000	32.773176	-115.5270465	Imperial County
336208	Ordering, Referring, Prescribing	N/A	1518347863	0	0	BHAKTA, HINABEN PHARMD	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	48144	N/A	N/A	N/A	N/A	N/A	810 S STATE COLLEGE BLVD	None	ANAHEIM	CA	92806	4663	00	06000	33.83129548	-117.8891795	Orange County
336222	Ordering, Referring, Prescribing	N/A	1518376821	0	0	BROWN, ERICA LPCC	1/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC11038	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
336235	Ordering, Referring, Prescribing	N/A	1518394170	0	0	BEAUDOIN, SHANNON L LMFT	9/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34176	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	SUITE 207	SANTA ROSA	CA	95470	5478	00	06000	38.425266	-122.749875	Sonoma County
336239	Ordering, Referring, Prescribing	N/A	1518409366	0	0	BERNARDINO, LUISA A LMFT	3/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124659	N/A	N/A	N/A	N/A	N/A	10929 SOUTH STREET	SUITE 208B	CERRITOS	CA	90703	5368	00	06000	33.85836353	-118.101204	Los Angeles County
336266	Ordering, Referring, Prescribing	N/A	1518445923	0	0	BREDL, ELAINE O LMFT	8/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131954	N/A	N/A	N/A	N/A	N/A	4212 MISSOURI FLAT ROAD	None	PLACERVILLE	CA	95667	6269	00	06000	38.706228	-120.834891	El Dorado County
336270	Ordering, Referring, Prescribing	N/A	1518444348	0	0	BRAGA, KIMBERLY V LMFT	4/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146320	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
336277	Ordering, Referring, Prescribing	N/A	1518481001	0	0	BUENO-GARCIA, CECILIA	6/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123552	N/A	N/A	N/A	N/A	N/A	1126 N GRAND AVE	None	COVINA	CA	91724	1551	00	06000	34.100082	-117.8724825	Los Angeles County
336284	Ordering, Referring, Prescribing	N/A	1518489004	0	0	BROWN, KATELYN M LMFT	12/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123362	N/A	N/A	N/A	N/A	N/A	3164 CONDO CT	None	SANTA ROSA	CA	95403	2557	00	06000	38.468709	-122.7425085	Sonoma County
336295	Ordering, Referring, Prescribing	N/A	1518489855	0	0	BEL TRAN, ANGELICA P	2/25/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74489	N/A	N/A	N/A	N/A	N/A	74-710 HIGHWAY 111	102	PALM DESERT	CA	92260	3820	00	06000	33.721101	-116.3648803	Riverside County
336303	Ordering, Referring, Prescribing	N/A	1518523109	0	0	BURG-SCHNIRMAN, DEBORAH LCSW	10/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86627	N/A	N/A	N/A	N/A	N/A	1821 4TH ST	None	SANTA ROSA	CA	95404	3202	00	06000	38.450619	-122.69781	Sonoma County
336306	Ordering, Referring, Prescribing	N/A	1518529585	0	0	BAYS, JENNIFER D LPCC	3/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPC1922	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
336309	Ordering, Referring, Prescribing	N/A	1518540343	0	0	BUI, HOA C LCSW	5/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92780	N/A	N/A	N/A	N/A	N/A	1311 NORTH SAN FERNANDO	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
336314	Ordering, Referring, Prescribing	N/A	1518555325	0	0	BUGAY, JOEL S LMFT	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT86388	N/A	N/A	N/A	N/A	N/A	710 N. ANAHEIM BLVD	None	ANAHEIM	CA	92805	0000	00	06000	33.84246264	-117.9161609	Orange County
336321	Ordering, Referring, Prescribing	N/A	1518580372	0	0	BERNARD, BENJAMIN J MD	7/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197606	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
336352	Ordering, Referring, Prescribing	N/A	1518680925	0	0	BUCHANON, SHERICA A PA-C	8/7/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64912	N/A	N/A	N/A	N/A	N/A	3701 J ST	201	SACRAMENTO	CA	95816	5518	00	06000	38.571237	-121.4566245	Sacramento County
336374	Ordering, Referring, Prescribing	N/A	1518794965	0	0	BAZYUK, IRINA RN PHN	12/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	705524	N/A	N/A	N/A	N/A	N/A	2707 TRANSWORLD DR	None	STOCKTON	CA	95206	3948	00	06000	37.90830509	-121.2326659	San Joaquin County
336379	Ordering, Referring, Prescribing	N/A	1528014644	0	0	BAGHAI, MERCEDEH MD	2/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94732	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
336401	Ordering, Referring, Prescribing	N/A	1528114980	0	0	BEYENE, YEMISRACH A MD	4/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C168678	N/A	N/A	N/A	N/A	N/A	5442 SYCUAN RD	None	EL CAJON	CA	92019	1816	00	06000	32.78885903	-116.8320996	San Diego County
336402	Ordering, Referring, Prescribing	N/A	1528117074	0	0	BERENT, LARRY A	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW9331	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	SUITE 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
336403	Ordering, Referring, Prescribing	N/A	1528101896	0	0	BARTON, DEANNE A LMFT	8/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49164	N/A	N/A	N/A	N/A	N/A	1830 S CENTRAL ST	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
336404	Ordering, Referring, Prescribing	N/A	1528120623	0	0	BILLUPS, NATASHA L LMFT	8/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45933	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVE.	155	TORRANCE	CA	90502	1314	00	06000	33.84828383	-118.2860386	Los Angeles County
336435	Ordering, Referring, Prescribing	N/A	1528194289	0	0	BANEZ, FELIZA HELEN DDS	7/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	50569	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
336441	Ordering, Referring, Prescribing	N/A	1528205614	0	0	BLACKMON-LUCAS, LASHAWN LMFT	7/11/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147999	N/A	N/A	N/A	N/A	N/A	900 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0911	00	06000	34.1268333	-117.2670508	San Bernardino County
336442	Ordering, Referring, Prescribing	N/A	1528206752	0	0	BRADLEY, KELLY LMFT	2/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36664	N/A	N/A	N/A	N/A	N/A	815 FIRST ST	None	BRENTWOOD	CA	94513	1777	00	06000	37.93394493	-121.6960606	Contra Costa County
336493	Ordering, Referring, Prescribing	N/A	1528316759	0	0	BABAKHANIAN, ANASHEH PHARMD	1/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67482	N/A	N/A	N/A	N/A	N/A	1385 E COLORADO ST	None	GLENDALE	CA	91205	1462	00	06000	34.14276749	-118.2344085	Los Angeles County
336497	Ordering, Referring, Prescribing	N/A	1528304961	0	0	BELIZ, NICOLAS R PSYD	3/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31662	N/A	N/A	N/A	N/A	N/A	550 S. VERMONT	None	LOS ANGELES	CA	90020	1101	00	06000	34.064091	-118.2916225	Los Angeles County
336509	Ordering, Referring, Prescribing	N/A	1528319076	0	0	BRAMMER, WHITNEY A PHD	1/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30229	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD., MAILS	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
336515	Ordering, Referring, Prescribing	N/A	1528350527	0	0	BROUGHTON, BLAIR N LMFT	2/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97319	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
336544	Ordering, Referring, Prescribing	N/A	1528401486	0	0	BOYSEN, MEGAN C PSYD	5/14/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32600	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD.	STE. 155	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
336561	Ordering, Referring, Prescribing	N/A	1528431293	0	0	BUI, LANPHUONG V PHARMD	10/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	49182	N/A	N/A	N/A	N/A	N/A	1993 MCKEE RD	None	SAN JOSE	CA	95116	1406	00	06000	37.366029	-121.8533535	Santa Clara County
336563	Ordering, Referring, Prescribing	N/A	1528432085	0	0	BARAJAS, AMY J LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113755	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS DR	SUITE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
336594	Ordering, Referring, Prescribing	N/A	1528470317	0	0	BROWN, YESSICA LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81410	N/A	N/A	N/A	N/A	N/A	801 E. CHAPMAN AVE.	203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
336608	Ordering, Referring, Prescribing	N/A	1528494820	0	0	BROWNE, FREDERICK T	1/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT128871	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE.	125-D	OAKLAND	CA	94605	0000	00	06000	37.768221	-122.17608	Alameda County
336621	Ordering, Referring, Prescribing	N/A	1528527835	0	0	BUI, AMY PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79897	N/A	N/A	N/A	N/A	N/A	3001 FOOTHILL BLVD	None	LA CRESCENTA	CA	91214	2714	00	06000	34.22747229	-118.2452305	Los Angeles County
336635	Ordering, Referring, Prescribing	N/A	1528543980	0	0	BERMUDEZ, DANIELLA K LMFT	7/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120575	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
336639	Ordering, Referring, Prescribing	N/A	1528550027	0	0	BAMRAH, NAVDEEP KAUR NP	10/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009509	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVENUE	SUITE 300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
336658	Ordering, Referring, Prescribing	N/A	1528587763	0	0	BELTRAN, ADRIANA MEDINA LMFT	11/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129447	N/A	N/A	N/A	N/A	N/A	5400 E OLYMPIC BLVD	1ST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
336667	Ordering, Referring, Prescribing	N/A	1528599867	0	0	BONIFACIO, MARK GERALD M NP	5/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006060	N/A	N/A	N/A	N/A	N/A	3419 TYLER AVE	None	EL MONTE	CA	91731	3103	00	06000	34.07081311	-118.0360305	Los Angeles County
336732	Ordering, Referring, Prescribing	N/A	1528741774	0	0	BUTLER, JOHN	12/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63789	N/A	N/A	N/A	N/A	N/A	1330 LAS TABLAS RD	None	TEMPLETON	CA	93465	9758	00	06000	35.55442548	-120.723759	San Luis Obispo County
336737	Ordering, Referring, Prescribing	N/A	1528758406	0	0	BAUTISTA, RONNIE LCSW	6/1/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96824	N/A	N/A	N/A	N/A	N/A	1195 HUDSON AVE	None	SAN FRANCISCO	CA	94124	2488	00	06000	37.73275954	-122.3812862	San Francisco County
336781	Ordering, Referring, Prescribing	N/A	1538200860	0	0	BARUA, SOMA MD	8/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100376	N/A	N/A	N/A	N/A	N/A	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	00	06000	34.02383346	-118.137193	Los Angeles County
336787	Ordering, Referring, Prescribing	N/A	1538207451	0	0	BIANCHI, CHARLENE LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43635	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	None	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
336793	Ordering, Referring, Prescribing	N/A	1538214937	0	0	BEGLAU-TAYLOR, JANICE	5/1/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA10988	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
336815	Ordering, Referring, Prescribing	N/A	1538267042	0	0	BIRNBAUM, PETER S DO	4/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7133	N/A	N/A	N/A	N/A	N/A	11190 WARNER AVE	300	FOUNTAIN VALLEY	CA	92708	4045	00	06000	33.714	-117.9333585	Orange County
336839	Ordering, Referring, Prescribing	N/A	1538314943	0	0	BROOKS, MELISSA M LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105231	N/A	N/A	N/A	N/A	N/A	50 E FOOTHILL BLVD	None	ARCADIA	CA	91006	2314	00	06000	34.15096965	-118.0295442	Los Angeles County
336847	Ordering, Referring, Prescribing	N/A	1538328216	0	0	BENNETT, MICHELLE LMFT	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52416	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVE	160	TORRANCE	CA	90502	1306	00	06000	33.84828383	-118.2860386	Los Angeles County
336860	Ordering, Referring, Prescribing	N/A	1538341185	0	0	BUTERA, CHERYL L NP	7/1/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	306486	N/A	N/A	N/A	N/A	N/A	1140 WEST MISSION ROAD	None	SAN MARCOS	CA	92069	1415	00	06000	33.151851	-117.178731	San Diego County
336861	Ordering, Referring, Prescribing	N/A	1538348222	0	0	BAKER, SHELLEY T PHARMD	6/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH39611	N/A	N/A	N/A	N/A	N/A	26521 AGOURA RD	None	CALABASAS	CA	91302	1958	00	06000	34.14393164	-118.6996508	Los Angeles County
336869	Ordering, Referring, Prescribing	N/A	1538367982	0	0	BARTOLINI, SUSAN MD	12/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A98927	N/A	N/A	N/A	N/A	N/A	1835 N BROADWAY	None	SANTA MARIA	CA	93454	1404	00	06000	34.97345984	-120.4356472	Santa Barbara County
336879	Ordering, Referring, Prescribing	N/A	1538395462	0	0	BRYER-BASS, MAX LMFT	1/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124066	N/A	N/A	N/A	N/A	N/A	300 HARVEY WEST BLVD	None	SANTA CRUZ	CA	95060	1000	00	06000	36.98485698	-122.0394541	Santa Cruz County
336880	Ordering, Referring, Prescribing	N/A	1538404579	0	0	BALDERAS MARTINEZ, FABIOLA	8/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148740	N/A	N/A	N/A	N/A	N/A	120 W CHESTNUT AVE	None	LOMPOC	CA	93436	5913	00	06000	34.64219451	-120.4588223	Santa Barbara County
336912	Ordering, Referring, Prescribing	N/A	1538444104	0	0	BLODGETT, BENJAMIN	12/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59073	N/A	N/A	N/A	N/A	N/A	79795 HIGHWAY 111	None	LA QUINTA	CA	92253	4756	00	06000	33.704217	-116.2730745	Riverside County
336945	Ordering, Referring, Prescribing	N/A	1538501556	0	0	BRISCOE, AKILAH S LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116369	N/A	N/A	N/A	N/A	N/A	300 EAST LELAND	#100	PITTSBURG	CA	94565	4961	00	06000	38.01129897	-121.8878132	Contra Costa County
336961	Ordering, Referring, Prescribing	N/A	1538537303	0	0	BARMBY, TYLER S LMFT	11/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123144	N/A	N/A	N/A	N/A	N/A	212 CARMEN LANE	None	SANTA MARIA	CA	93458	7769	00	06000	34.92481416	-120.4383025	Santa Barbara County
336965	Ordering, Referring, Prescribing	N/A	1538538244	0	0	BONGARDT, CHRISTINE LMFT	9/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44422	N/A	N/A	N/A	N/A	N/A	100 E STREET	305	SANTA ROSA	CA	95404	0000	00	06000	38.441016	-122.7097035	Sonoma County
336967	Ordering, Referring, Prescribing	N/A	1538537550	0	0	BIRD, ALEXIS B LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112976	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
336975	Ordering, Referring, Prescribing	N/A	1538543384	0	0	BELL, ERICA NP	7/13/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	654919	N/A	N/A	N/A	N/A	N/A	37926 47TH ST	None	PALMDALE	CA	93552	3272	00	06000	34.57140358	-118.0449908	Los Angeles County
336990	Ordering, Referring, Prescribing	N/A	1538566997	0	0	BOZORGZADARBAB, DAMOUN LCSW	4/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70154	N/A	N/A	N/A	N/A	N/A	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
336993	Ordering, Referring, Prescribing	N/A	1538567474	0	0	BENSON, CLAYTON MD	7/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146157	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE #A	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
337037	Ordering, Referring, Prescribing	N/A	1538643903	0	0	BYRNE, MEGAN M MD	7/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180588	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
337041	Ordering, Referring, Prescribing	N/A	1538648787	0	0	BALL, KATIE LCSW	8/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85068	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	SUITE # A, B AND C	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
337046	Ordering, Referring, Prescribing	N/A	1538658281	0	0	BARRIOLA, HEYLEE LMFT	9/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122176	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
337070	Ordering, Referring, Prescribing	N/A	1538700893	0	0	BORMAN, BRITTANY L PA-C	12/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57305	N/A	N/A	N/A	N/A	N/A	905 CALLE AMANECER	115	SAN CLEMENTE	CA	92673	6274	00	06000	33.44951265	-117.6075825	Orange County
337076	Ordering, Referring, Prescribing	N/A	1538705462	0	0	BELTRAN, MANUEL F MD	5/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186121	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
337081	Ordering, Referring, Prescribing	N/A	1538715891	0	0	BARRIER, KIMBERLY A NP	10/16/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013091	N/A	N/A	N/A	N/A	N/A	16000 APPLE VALLEY RD	STE C3	APPLE VALLEY	CA	92307	7815	00	06000	34.5421391	-117.2732764	San Bernardino County
337083	Ordering, Referring, Prescribing	N/A	1538718580	0	0	BISHOP, KIMBERLY O LMFT	10/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139696	N/A	N/A	N/A	N/A	N/A	1260 N DUTTON AVE	SUITE 175	SANTA ROSA	CA	95401	4659	00	06000	38.449197	-122.7320775	Sonoma County
337097	Ordering, Referring, Prescribing	N/A	1538754643	0	0	BRESSLER, RACHEL E RN PHN	4/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	359737	N/A	N/A	N/A	N/A	N/A	1651 16TH STREET	None	SANTA MONICA	CA	90404	3891	00	06000	34.02209342	-118.4796709	Los Angeles County
337107	Ordering, Referring, Prescribing	N/A	1538796370	0	0	BEHERA, SUJATA PA-C	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA59814	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE ST	None	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
337131	Ordering, Referring, Prescribing	N/A	1538881982	0	0	BAUSBACK, KIMBERLY B PHD	8/30/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33564	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2340	00	06000	37.43949537	-122.1784133	Santa Clara County
337138	Ordering, Referring, Prescribing	N/A	1538895156	0	0	BLIDE, JUSTINE T PA	10/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61810	N/A	N/A	N/A	N/A	N/A	4212 MISSOURI FLAT RD	None	PLACERVILLE	CA	95667	6269	00	06000	38.706228	-120.834891	El Dorado County
337151	Ordering, Referring, Prescribing	N/A	1548005127	0	0	BROUSSARD, ASHLEY	4/15/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029788	N/A	N/A	N/A	N/A	N/A	220 EUCLID AVENUE	SUITE 30	SAN DIEGO	CA	92114	0000	00	06000	32.706387	-117.085098	San Diego County
337163	Ordering, Referring, Prescribing	N/A	1548037880	0	0	BURGOYNE, JENNIFER YUUMI PA-C	10/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63510	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	201	CHULA VISTA	CA	91911	2982	00	06000	32.60364599	-117.0786521	San Diego County
337183	Ordering, Referring, Prescribing	N/A	1548259401	0	0	BRAND, JONATHAN L MD	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G50045	N/A	N/A	N/A	N/A	N/A	11900 E ARTESIA BLVD	None	ARTESIA	CA	90701	4039	00	06000	33.87297352	-118.078848	Los Angeles County
337187	Ordering, Referring, Prescribing	N/A	1548238108	0	0	BYBEE, DAVID B MD	5/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G69334	N/A	N/A	N/A	N/A	N/A	4016 DALE ROAD	A	MODESTO	CA	95356	9268	00	06000	37.69723812	-121.049967	Stanislaus County
337191	Ordering, Referring, Prescribing	N/A	1548289093	0	0	BALASUBRAMANIAN, VIJAY P MD	5/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94876	N/A	N/A	N/A	N/A	N/A	1348 W HERNDON AVE STE 1	STE 101	FRESNO	CA	93711	7181	00	06000	36.83739103	-119.8137694	Fresno County
337210	Ordering, Referring, Prescribing	N/A	1548334238	0	0	BOYD, CAROL A	8/28/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D40338	N/A	N/A	N/A	N/A	N/A	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	00	06000	37.47644946	-122.2110919	San Mateo County
337218	Ordering, Referring, Prescribing	N/A	1548358310	0	0	BORDEN, ROBIN H PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH40415	N/A	N/A	N/A	N/A	N/A	11080 MAGNOLIA AVE	PHARMACY ADMINISTRATION	RIVERSIDE	CA	92505	3000	00	06000	33.90402176	-117.4750005	Riverside County
337242	Ordering, Referring, Prescribing	N/A	1548425051	0	0	BARRON, ROBERT W LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45967	N/A	N/A	N/A	N/A	N/A	43585 MONTEREY AVE	1	PALM DESERT	CA	92260	9342	00	06000	33.731946	-116.3912695	Riverside County
337245	Ordering, Referring, Prescribing	N/A	1548396146	0	0	BLOOM, RICHARD S LCSW	1/13/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26170	N/A	N/A	N/A	N/A	N/A	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	00	06000	33.9316595	-116.9468639	Riverside County
337253	Ordering, Referring, Prescribing	N/A	1548438666	0	0	BACHMAN, GARY P LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37196	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
337273	Ordering, Referring, Prescribing	N/A	1548498942	0	0	BIRATH, JOHN B PSYD	2/13/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26485	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
337313	Ordering, Referring, Prescribing	N/A	1548565542	0	0	BERNAL, JESSE LMFT	12/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84944	N/A	N/A	N/A	N/A	N/A	13130 BURBANK BLVD	None	SHERMAN OAKS, CA	CA	91401	0001	00	06000	34.17210778	-118.4192552	Los Angeles County
337328	Ordering, Referring, Prescribing	N/A	1548610934	0	0	BOSSERMAN, MARIEL CNP	1/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003971	N/A	N/A	N/A	N/A	N/A	123 F ST	F	EUREKA	CA	95501	0411	00	06000	40.80503195	-124.1666813	Humboldt County
337332	Ordering, Referring, Prescribing	N/A	1548612302	0	0	BADAM, YOGITHA N MD	6/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162990	N/A	N/A	N/A	N/A	N/A	1717 LAS VEGAS ST	None	MODESTO	CA	95358	5500	00	06000	37.6052798	-121.0027523	Stanislaus County
337377	Ordering, Referring, Prescribing	N/A	1548688856	0	0	BHALLA, ANUMEHA MD	3/6/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138876	N/A	N/A	N/A	N/A	N/A	201 S HARBOR BLVD	None	LA HABRA	CA	90631	5654	00	06000	33.93029897	-117.9331306	Orange County
337392	Ordering, Referring, Prescribing	N/A	1548719347	0	0	BERMUDEZ, ROXANA LCSW	2/4/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128491	N/A	N/A	N/A	N/A	N/A	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
337406	Ordering, Referring, Prescribing	N/A	1548740970	0	0	BECERRA-RODRIGUEZ, ANNA K LMFT	7/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134063	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 405	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
337416	Ordering, Referring, Prescribing	N/A	1548748866	0	0	BUAKAEW, PUNSIT PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67536	N/A	N/A	N/A	N/A	N/A	50040 CESAR CHAVEZ ST	None	COACHELLA	CA	92236	1426	00	06000	33.68480103	-116.1814512	Riverside County
337417	Ordering, Referring, Prescribing	N/A	1548756919	0	0	BOWDRY, CHRYSTAL LMFT	3/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131973	N/A	N/A	N/A	N/A	N/A	1486 HUNTINGTON AVE	100	SOUTH SAN FRANCIS	CA	94080	5971	00	06000	37.64441633	-122.4219331	San Mateo County
337435	Ordering, Referring, Prescribing	N/A	1548774052	0	0	BARNETT, TAWNI R LMFT	7/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120451	N/A	N/A	N/A	N/A	N/A	2855 GEER ROAD	None	TURLOCK	CA	95382	8936	00	06000	37.518318	-120.8489985	Stanislaus County
337444	Ordering, Referring, Prescribing	N/A	1548788532	0	0	BABAKHANYAN, ADRINE LCSW	9/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118014	N/A	N/A	N/A	N/A	N/A	237 N CENTRAL AVE	None	GLENDALE	CA	91203	2531	00	06000	34.14943423	-118.2579487	Los Angeles County
337459	Ordering, Referring, Prescribing	N/A	1548827074	0	0	BHULLAR, JAGDEEP S PHARMD	10/26/2020	Taxonomy not applicable	NA	n/a	000	Unknown	81724	N/A	N/A	N/A	N/A	N/A	1111 COLUMBUS ST	None	BAKERSFIELD	CA	93305	1936	00	06000	35.39744148	-118.9822815	Kern County
337463	Ordering, Referring, Prescribing	N/A	1548822349	0	0	BERNAL SUAREZ, MARA NP	8/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	95015202	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
337470	Ordering, Referring, Prescribing	N/A	1548872591	0	0	BOLLIN, EMILY A NP	10/15/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015670	N/A	N/A	N/A	N/A	N/A	1035 PLACER ST.	None	REDDING	CA	96001	1125	00	06000	40.58349378	-122.3853903	Shasta County
337493	Ordering, Referring, Prescribing	N/A	1548917602	0	0	BLUMBERG, JOSEPH PA	2/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62409	N/A	N/A	N/A	N/A	N/A	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	0001	00	06000	34.95019447	-120.4147816	Santa Barbara County
337531	Ordering, Referring, Prescribing	N/A	1558084186	0	0	BUI, PHILIP DMD	3/24/2024	Taxonomy not applicable	NA	n/a	000	Unknown	108046	N/A	N/A	N/A	N/A	N/A	17800 RENAULT ST	None	LA PUENTE	CA	91744	5333	00	06000	34.01402677	-117.913238	Los Angeles County
337567	Ordering, Referring, Prescribing	N/A	1558383059	0	0	BENJAMIN, ASHLEY B MD	5/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88287	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	250	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
337630	Ordering, Referring, Prescribing	N/A	1558548560	0	0	BUENAFE, CHITA N DDS	4/10/2024	Taxonomy not applicable	NA	n/a	000	Unknown	47234	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
337631	Ordering, Referring, Prescribing	N/A	1558561951	0	0	BOWERS, WILLIAM F LMFT	7/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46795	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	200	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
337641	Ordering, Referring, Prescribing	N/A	1558558080	0	0	BANDY, KATY L LCSW	2/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28768	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	0000	00	06000	38.24829023	-122.2745626	Napa County
337642	Ordering, Referring, Prescribing	N/A	1558601211	0	0	BANKS, CHRISTOPHER W	12/16/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013249	N/A	N/A	N/A	N/A	N/A	1846 N BROADWAY	A	SANTA MARIA	CA	93454	1447	00	06000	34.97363636	-120.4355462	Santa Barbara County
337648	Ordering, Referring, Prescribing	N/A	1558607523	0	0	BERGMAN, KAREN H LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27807	N/A	N/A	N/A	N/A	N/A	1800 NORTH GRAVENSTEIN H	None	SEBASTOPOL	CA	95472	0000	00	06000	38.42104172	-122.8461197	Sonoma County
337662	Ordering, Referring, Prescribing	N/A	1558631267	0	0	BABAKHANI, AMIR FARSHAD K	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62360	N/A	N/A	N/A	N/A	N/A	13390 POWAY RD	None	POWAY	CA	92064	4626	00	06000	32.95654343	-117.0412404	San Diego County
337674	Ordering, Referring, Prescribing	N/A	1558640573	0	0	BENIGNO, HAZEL PSYD	6/3/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30054	N/A	N/A	N/A	N/A	N/A	3450 3RD STREET	BLDG 1, UNIT 1C	SAN FRANCISCO	CA	94124	1444	00	06000	37.74535239	-122.387252	San Francisco County
337677	Ordering, Referring, Prescribing	N/A	1558657106	0	0	BATTAGLIA, CHRISTINE L DO	2/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12494	N/A	N/A	N/A	N/A	N/A	1617 MAIN ST	None	LIVINGSTON	CA	95334	1250	00	06000	37.37645459	-120.7233764	Merced County
337679	Ordering, Referring, Prescribing	N/A	1558659797	0	0	BENNETT, RACHEL Q LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76466	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	STE 100	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
337681	Ordering, Referring, Prescribing	N/A	1558657882	0	0	BOONE, MICHAEL W	4/13/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	R2061	N/A	N/A	N/A	N/A	N/A	1501 SOUTH COULTER	None	AMARILLO	TX	79106	1770	00	06000	35.200053	-101.921862	Potter County
337711	Ordering, Referring, Prescribing	N/A	1558712083	0	0	BOLLINGER, NICOLE W	7/12/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102197	N/A	N/A	N/A	N/A	N/A	3415 MARTIN LUTHER KING	JR BLVD	SACRAMENTO	CA	95817	3648	00	06000	38.54376	-121.4644095	Sacramento County
337732	Ordering, Referring, Prescribing	N/A	1558758086	0	0	BOWEN, JENNA MD	1/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171651	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HLS DR	None	ANTIOCH	CA	94509	7319	00	06000	37.97021462	-121.7841321	Contra Costa County
337753	Ordering, Referring, Prescribing	N/A	1558791194	0	0	BRAVO, SARAH E LCSW	2/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76347	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	SUITE 100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
337774	Ordering, Referring, Prescribing	N/A	1558816678	0	0	BANKS-RASKEY, LAURIE J LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90847	N/A	N/A	N/A	N/A	N/A	24275 JEFFERSON AVE	None	MURRIETA	CA	92562	7285	00	06000	33.5676365	-117.2174559	Riverside County
337779	Ordering, Referring, Prescribing	N/A	1558838078	0	0	BARCA, JASON PHARMD	8/25/2019	Taxonomy not applicable	NA	n/a	000	Unknown	72904	N/A	N/A	N/A	N/A	N/A	2110 TRUXTUN AVENUE	SUITE 400	BAKERSFIELD	CA	93301	3703	00	06000	35.37344851	-119.0261655	Kern County
337811	Ordering, Referring, Prescribing	N/A	1558876946	0	0	BROSGART, LUCIA NP	7/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031076	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
337822	Ordering, Referring, Prescribing	N/A	1558890749	0	0	BHIMAYA, SOMAYA NP	11/19/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006268	N/A	N/A	N/A	N/A	N/A	2237 W BALL RD	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
337827	Ordering, Referring, Prescribing	N/A	1558901017	0	0	BAUTISTA, JUNELYN B PHARMD	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81565	N/A	N/A	N/A	N/A	N/A	6226 E SPRING ST	SUITE 140	LONG BEACH	CA	90815	1441	00	06000	33.81040053	-118.1102715	Los Angeles County
337834	Ordering, Referring, Prescribing	N/A	1558924621	0	0	BHANDAL, MANJIT K MD	1/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL378	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	4137	00	06000	34.32450186	-118.4456317	Los Angeles County
337882	Ordering, Referring, Prescribing	N/A	1568035756	0	0	BYRD, ASHA P PA	4/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA60107	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
337883	Ordering, Referring, Prescribing	N/A	1568037984	0	0	BEHIN, PEJMAN DDS	8/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	107966	N/A	N/A	N/A	N/A	N/A	1242 E MAIN ST	None	EL CAJON	CA	92021	7205	00	06000	32.79495945	-116.938566	San Diego County
337888	Ordering, Referring, Prescribing	N/A	1568048882	0	0	BRITO, GIOVANNA LMFT	4/13/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146365	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	# 801	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
337890	Ordering, Referring, Prescribing	N/A	1568044691	0	0	BENDER STERN, JULIA MD	1/9/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192651	N/A	N/A	N/A	N/A	N/A	488 E VALLEY PKWY	411	ESCONDIDO	CA	92025	3379	00	06000	33.12523814	-117.0769715	San Diego County
337913	Ordering, Referring, Prescribing	N/A	1568122083	0	0	BROWN, TOBIAS NP	12/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95098425	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
337923	Ordering, Referring, Prescribing	N/A	1568153682	0	0	BUNYE, CHLOIE NP	7/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025060	N/A	N/A	N/A	N/A	N/A	18646 OXNARD ST	None	TARZANA	CA	91356	1411	00	06000	34.17993229	-118.5397265	Los Angeles County
337925	Ordering, Referring, Prescribing	N/A	1568133692	0	0	BUNKER, JASON D	9/21/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34982	N/A	N/A	N/A	N/A	N/A	1429 S BROADWAY	None	SANTA MARIA	CA	93454	6913	00	06000	34.93645316	-120.436196	Santa Barbara County
337928	Ordering, Referring, Prescribing	N/A	1568168698	0	0	BROTHERTON, LENY J	1/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108508	N/A	N/A	N/A	N/A	N/A	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	00	06000	33.95462085	-118.1838426	Los Angeles County
337966	Ordering, Referring, Prescribing	N/A	1568482792	0	0	BARBOUR, JACK M MD	3/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G40995	N/A	N/A	N/A	N/A	N/A	2610 INDUSTRY WAY	A	LYNWOOD	CA	90262	4028	00	06000	33.92353238	-118.2259631	Los Angeles County
337972	Ordering, Referring, Prescribing	N/A	1568491280	0	0	BAHTEN, REGINA DO	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10124	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
338009	Ordering, Referring, Prescribing	N/A	1568568921	0	0	BISHOP, BART DC	4/19/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	16267	N/A	N/A	N/A	N/A	N/A	470 N GREENFIELD AVE	STE 303	HANFORD	CA	93230	5787	00	06000	36.32996137	-119.6580167	Kings County
338043	Ordering, Referring, Prescribing	N/A	1568657633	0	0	BAUMAN, LESLIE A LMFT	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50701	N/A	N/A	N/A	N/A	N/A	500 CROWN POINT CIR	120	GRASS VALLEY	CA	95945	9561	00	06000	39.22028885	-121.0316663	Nevada County
338063	Ordering, Referring, Prescribing	N/A	1568709269	0	0	BROWN, JENNIFER LCSW	12/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29128	N/A	N/A	N/A	N/A	N/A	2313 I STREET	None	EUREKA	CA	95501	4244	00	06000	40.78679534	-124.1601037	Humboldt County
338064	Ordering, Referring, Prescribing	N/A	1568707263	0	0	BLANCHARD, SHANNON M LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105109	N/A	N/A	N/A	N/A	N/A	1798 W. BRYMAN	None	HANFORD	CA	93230	7144	00	06000	36.33869152	-119.6748755	Kings County
338067	Ordering, Referring, Prescribing	N/A	1568714772	0	0	BROKAW, ANDREA L PSYD	3/5/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28779	N/A	N/A	N/A	N/A	N/A	505 N EUCLID ST	300	ANAHEIM	CA	92801	5506	00	06000	33.8379454	-117.9416147	Orange County
338090	Ordering, Referring, Prescribing	N/A	1568744233	0	0	BOUWMEESTER, DIEDERIK-JAN F PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63614	N/A	N/A	N/A	N/A	N/A	707 N BROADWAY	None	SANTA MARIA	CA	93454	3753	00	06000	34.95981863	-120.4357596	Santa Barbara County
338121	Ordering, Referring, Prescribing	N/A	1568789022	0	0	BAIRD, STAR H LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS26292	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1293	00	06000	37.545779	-122.3213093	San Mateo County
338129	Ordering, Referring, Prescribing	N/A	1568801934	0	0	BARRAGAN, DAISY MSW LCSW	3/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78659	N/A	N/A	N/A	N/A	N/A	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1711	00	06000	34.08461594	-118.2570874	Los Angeles County
338143	Ordering, Referring, Prescribing	N/A	1568815611	0	0	BENJAMIN, JESSIKA OD	5/25/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT33415	N/A	N/A	N/A	N/A	N/A	471 N CENTRAL AVE	None	UPLAND	CA	91786	4219	00	06000	34.099308	-117.689689	San Bernardino County
338149	Ordering, Referring, Prescribing	N/A	1568826170	0	0	BAKER, COURTNEY C	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167766	N/A	N/A	N/A	N/A	N/A	201 29TH STREET	SUITE B	SACRAMENTO	CA	95816	0000	00	06000	38.581875	-121.463802	Sacramento County
338161	Ordering, Referring, Prescribing	N/A	1568841435	0	0	BURNETT, BRENDA A NP	2/9/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002453	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
338177	Ordering, Referring, Prescribing	N/A	1568862472	0	0	BUENROSTRO, FRANCISCA A LCSW	2/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91573	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
338186	Ordering, Referring, Prescribing	N/A	1568869121	0	0	BUI, HOANG V PHARMD	11/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71908	N/A	N/A	N/A	N/A	N/A	11800 DE PALMA RD	None	CORONA	CA	92883	8498	00	06000	33.74635292	-117.4536847	Riverside County
338188	Ordering, Referring, Prescribing	N/A	1568870723	0	0	BARNHART-KALINO, RACHEL L	9/11/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D63701	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 EAST	None	ROUND MOUNTAIN	CA	96084	0000	00	06000	40.80385331	-121.9397745	Shasta County
338204	Ordering, Referring, Prescribing	N/A	1568894962	0	0	BEACOM, WILLIAM W LCS	9/22/2014	Taxonomy not applicable	NA	n/a	034	MEDICARE CROSSOVER PROVIDER ONLY	17313	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
338208	Ordering, Referring, Prescribing	N/A	1568897619	0	0	BENSON, DAVID DDS	10/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	100225	N/A	N/A	N/A	N/A	N/A	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	00	06000	37.36678073	-120.576731	Merced County
338214	Ordering, Referring, Prescribing	N/A	1568899912	0	0	BUI, LOAN N	6/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127258	N/A	N/A	N/A	N/A	N/A	1530 SOUTH OLIVE ST	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
338250	Ordering, Referring, Prescribing	N/A	1568958114	0	0	BAINS, TANDEEP PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77627	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
338252	Ordering, Referring, Prescribing	N/A	1568972321	0	0	BAROVICK, JILLIAN CNM	4/22/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW236325	N/A	N/A	N/A	N/A	N/A	249 SMITH ST	#124	BROOKLYN	NY	11231	4740	00	06000	40.683276	-73.9926765	Kings County
338268	Ordering, Referring, Prescribing	N/A	1568997724	0	0	BITTEN, MICHELLE L NP	2/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006439	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BLVD	300	LAWNDALE	CA	90260	1590	00	06000	33.898572	-118.3527775	Los Angeles County
338297	Ordering, Referring, Prescribing	N/A	1578039665	0	0	BAINS, PARMVEER S PA-C	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57142	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
338302	Ordering, Referring, Prescribing	N/A	1578057576	0	0	BUENO, JOANA RUBY C NP	1/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010538	N/A	N/A	N/A	N/A	N/A	734 10TH AVE	None	SAN DIEGO	CA	92101	6502	00	06000	32.71306718	-117.1556209	San Diego County
338336	Ordering, Referring, Prescribing	N/A	1578099818	0	0	BARTON, CRAIG LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82323	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
338350	Ordering, Referring, Prescribing	N/A	1578129813	0	0	BRUCE-WASHINGTON, ASHLEY R LMFT	1/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT144665	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD	None	LONG BEACH	CA	90807	3941	00	06000	33.82086796	-118.18938	Los Angeles County
338357	Ordering, Referring, Prescribing	N/A	1578141743	0	0	BOWEN, ANNA MD	11/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192103	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
338361	Ordering, Referring, Prescribing	N/A	1578156402	0	0	BLECHA, TAMI CNP	2/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016661	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB ROAD	None	LAYTONVILLE	CA	95454	0870	00	06000	39.68781544	-123.4842982	Mendocino County
338391	Ordering, Referring, Prescribing	N/A	1578244125	0	0	BELL, ALIYAH A PA	3/26/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64298	N/A	N/A	N/A	N/A	N/A	3800 FLORIN ROAD	None	SACRAMENTO	CA	95823	1802	00	06000	38.495052	-121.463874	Sacramento County
338393	Ordering, Referring, Prescribing	N/A	1578257473	0	0	BARBIC, ELIZABETH LMFT	10/21/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150798	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	STE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
338413	Ordering, Referring, Prescribing	N/A	1578301537	0	0	BARAJAS, ANGIE NP	11/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028033	N/A	N/A	N/A	N/A	N/A	8902 WOODMAN AVE	None	ARLETA	CA	91331	8021	00	06000	34.23141203	-118.4374526	Los Angeles County
338415	Ordering, Referring, Prescribing	N/A	1578331773	0	0	BERHANE, MAAZA	10/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95027611	N/A	N/A	N/A	N/A	N/A	3605 MEDICI LANE	None	INGLEWOOD	CA	90305	0001	00	06000	33.95318649	-118.332738	Los Angeles County
338416	Ordering, Referring, Prescribing	N/A	1578310520	0	0	BONAKDAR, BIJAN DO	7/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	3674	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
338434	Ordering, Referring, Prescribing	N/A	1578579132	0	0	BOWIE, LISA A MD	12/21/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A46634	N/A	N/A	N/A	N/A	N/A	3095 YERBA BUENA RD	None	SAN JOSE	CA	95135	1513	00	06000	37.300122	-121.7627775	Santa Clara County
338435	Ordering, Referring, Prescribing	N/A	1578584223	0	0	BRADLEY, MARIA ELIZABETH B PA-C	7/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	17041	N/A	N/A	N/A	N/A	N/A	857 W CHILDS AVE	None	MERCED	CA	95341	6862	00	06000	37.2882813	-120.497688	Merced County
338446	Ordering, Referring, Prescribing	N/A	1578617692	0	0	BELLAS, VALERIE M PHD	6/7/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25034	N/A	N/A	N/A	N/A	N/A	5275 CLAREMONT AVE	None	OAKLAND	CA	94618	1032	00	06000	37.8391822	-122.260841	Alameda County
338456	Ordering, Referring, Prescribing	N/A	1578641098	0	0	BRINDERSON, CHAD D PHD	10/22/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	15106	N/A	N/A	N/A	N/A	N/A	2325 CRENSHAW BLVD	None	TORRANCE	CA	90501	0000	00	06000	33.82457516	-118.3285598	Los Angeles County
338461	Ordering, Referring, Prescribing	N/A	1578641601	0	0	BOUVIER, LUCIENNE S MD	12/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G79050	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
338462	Ordering, Referring, Prescribing	N/A	1578667077	0	0	BISHOP, MELISSA E MD	9/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C137521	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
338465	Ordering, Referring, Prescribing	N/A	1578676904	0	0	BETANCOURT, AMY L S	4/20/2017	Taxonomy not applicable	NA	n/a	000	Unknown	17978	N/A	N/A	N/A	N/A	N/A	4909 CENTENNIAL PLAZA WY	None	BAKERSFIELD	CA	93312	2011	00	06000	35.40410521	-119.0932287	Kern County
338533	Ordering, Referring, Prescribing	N/A	1578762712	0	0	BURGER, MARK F MD	7/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99988	N/A	N/A	N/A	N/A	N/A	1200 NORTH COAST HIGHWAY	None	ENCINITAS	CA	92024	1441	00	06000	33.06951378	-117.3040606	San Diego County
338549	Ordering, Referring, Prescribing	N/A	1578793923	0	0	BURCIAGA, ALEX M	9/9/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64730	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
338550	Ordering, Referring, Prescribing	N/A	1578797833	0	0	BANANI, NTANGO D MD	3/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161166	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
338564	Ordering, Referring, Prescribing	N/A	1578823746	0	0	BARRAGAN, BELEN M LMFT	7/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89068	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S	211	SAN DIEGO	CA	92108	3504	00	06000	32.76105674	-117.1609032	San Diego County
338565	Ordering, Referring, Prescribing	N/A	1578832358	0	0	BROWN, AARION M PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66738	N/A	N/A	N/A	N/A	N/A	3724 CRENSHAW BLVD	None	LOS ANGELES	CA	90016	5804	00	06000	34.01920721	-118.3350691	Los Angeles County
338581	Ordering, Referring, Prescribing	N/A	1578847331	0	0	BILLION, CASSANDRA L LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111209	N/A	N/A	N/A	N/A	N/A	23228 MADERO	None	MISSION VIEJO	CA	92691	2706	00	06000	33.62548354	-117.6804077	Orange County
338622	Ordering, Referring, Prescribing	N/A	1578904439	0	0	BARNES, LALIA G PA-C	4/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA53995	N/A	N/A	N/A	N/A	N/A	BUILDING 3100 RM 3150, H	None	SAN LUIS OBISPO	CA	93405	7889	00	06000	0	0	None
338623	Ordering, Referring, Prescribing	N/A	1578909404	0	0	BINAS, MA JASMIN F NP	9/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	22749	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
338640	Ordering, Referring, Prescribing	N/A	1578921953	0	0	BERGER, BONNIE RDH	12/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	18216	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
338677	Ordering, Referring, Prescribing	N/A	1578972543	0	0	BURSCH, LISA NP	11/19/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	472262	N/A	N/A	N/A	N/A	N/A	7777 MILLIKEM AVE	SUITE 360	RANCHO CUCAMONGA	CA	91730	6782	00	06000	34.10843256	-117.5570865	San Bernardino County
338693	Ordering, Referring, Prescribing	N/A	1578995502	0	0	BREWER, JULIA C NP	12/6/2017	Taxonomy not applicable	NA	n/a	000	Unknown	NP23281	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	STE. 300	HAWTHORNE	CA	90250	2241	00	06000	33.92825048	-118.3539285	Los Angeles County
338713	Ordering, Referring, Prescribing	N/A	1588018709	0	0	BHAKTA, MINESH PHARMD	2/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	48826	N/A	N/A	N/A	N/A	N/A	8010 2ND ST	None	PARAMOUNT	CA	90723	3404	00	06000	33.89819155	-118.159623	Los Angeles County
338717	Ordering, Referring, Prescribing	N/A	1588022636	0	0	BAO, SISI S	8/3/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65346	N/A	N/A	N/A	N/A	N/A	1661 HANOVER RD	# 103	CITY OF INDUSTRY	CA	91748	1796	00	06000	33.99109665	-117.920988	Los Angeles County
338719	Ordering, Referring, Prescribing	N/A	1588026959	0	0	BRADSHAW, JAMISON A DO	1/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19279	N/A	N/A	N/A	N/A	N/A	1735 MISSION ST	None	SAN FRANCISCO	CA	94103	2417	00	06000	37.76957692	-122.4199811	San Francisco County
338720	Ordering, Referring, Prescribing	N/A	1588030522	0	0	BEESLEY, JEFFREY W LMFT	11/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105525	N/A	N/A	N/A	N/A	N/A	1780 VERNON STREET	SUITE 1	ROSEVILLE	CA	95678	6311	00	06000	38.732967	-121.2997685	Placer County
338728	Ordering, Referring, Prescribing	N/A	1588036123	0	0	BROWN, CARLEE A	10/8/2018	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM448	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES ROAD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
338742	Ordering, Referring, Prescribing	N/A	1588054993	0	0	BOTHA, ANERIEN PSYD	7/30/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24969	N/A	N/A	N/A	N/A	N/A	5661 KEITH AVENUE	None	OAKLAND	CA	94618	1542	00	06000	37.8441646	-122.2512445	Alameda County
338751	Ordering, Referring, Prescribing	N/A	1588061337	0	0	BOYD, ASHLEY LMFT	9/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110165	N/A	N/A	N/A	N/A	N/A	421 E MORRIS AVE	None	MODESTO	CA	95354	0437	00	06000	37.651016	-120.988284	Stanislaus County
338754	Ordering, Referring, Prescribing	N/A	1588060487	0	0	BETTS, JASON LMFT	10/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128533	N/A	N/A	N/A	N/A	N/A	2933 N. EL NIDO DRIVE	None	ALTADENA	CA	91001	4529	00	06000	34.19549106	-118.1655134	Los Angeles County
338755	Ordering, Referring, Prescribing	N/A	1588063713	0	0	BOONE, KELLY NP	9/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001126	N/A	N/A	N/A	N/A	N/A	23413 LYONS AVE	None	SANTA CLARITA	CA	91355	3028	00	06000	34.37974287	-118.5428596	Los Angeles County
338761	Ordering, Referring, Prescribing	N/A	1588068027	0	0	BASI, AMANPREET S PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71783	N/A	N/A	N/A	N/A	N/A	1400 BEAUMONT AVE	None	BEAUMONT	CA	92223	4704	00	06000	33.947496	-116.977181	Riverside County
338777	Ordering, Referring, Prescribing	N/A	1588090286	0	0	BODDIE RUSSO, HEATHER J LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29058	N/A	N/A	N/A	N/A	N/A	33 ENCINA AVE	None	PALO ALTO	CA	94301	2343	00	06000	37.43913037	-122.1608344	Santa Clara County
338809	Ordering, Referring, Prescribing	N/A	1588141865	0	0	BAHRAMZI, MARIA MD	2/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173486	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
338815	Ordering, Referring, Prescribing	N/A	1588146807	0	0	BENNETT, MARY-HELEN LCSW	3/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17306	N/A	N/A	N/A	N/A	N/A	1120 W LA VETA AVE	SUITE 660	ORANGE	CA	92868	4231	00	06000	33.78029455	-117.864369	Orange County
338826	Ordering, Referring, Prescribing	N/A	1588170435	0	0	BAHENA, ROSALIE LMFT	2/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131095	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD.,	SUITE A	IRWINDALE	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
338848	Ordering, Referring, Prescribing	N/A	1588208094	0	0	BALL, OLIVIA J NP	8/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018151	N/A	N/A	N/A	N/A	N/A	855 E MADISON AVE	None	EL CAJON	CA	92020	3819	00	06000	32.80046744	-116.9522315	San Diego County
338871	Ordering, Referring, Prescribing	N/A	1588257554	0	0	BATES, KARLA P NP	3/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010843	N/A	N/A	N/A	N/A	N/A	4129 E. GAGE AVE	None	BELL	CA	90201	1128	00	06000	33.97868838	-118.1928157	Los Angeles County
338872	Ordering, Referring, Prescribing	N/A	1588256119	0	0	BACH, MYHANG PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50758	N/A	N/A	N/A	N/A	N/A	2851 S. ROSE AVE	None	OXNARD	CA	93033	1703	00	06000	34.17389279	-119.1601891	Ventura County
338879	Ordering, Referring, Prescribing	N/A	1588291702	0	0	BENYAMIN, ANDREW	8/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81130	N/A	N/A	N/A	N/A	N/A	5500 WOODRUFF AVE	None	LAKEWOOD	CA	90713	1535	00	06000	33.85687042	-118.1170346	Los Angeles County
338886	Ordering, Referring, Prescribing	N/A	1588308076	0	0	BRANDECKER, KEVIN J MD	12/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A200423	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
338896	Ordering, Referring, Prescribing	N/A	1588353973	0	0	BROWN, ALISON PSYD	5/12/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21951	N/A	N/A	N/A	N/A	N/A	16530 VENTURA BLVD.	SUITE 400	ENCINO	CA	91436	4551	00	06000	34.15766626	-118.4934057	Los Angeles County
338910	Ordering, Referring, Prescribing	N/A	1588397459	0	0	BUTTNER, GREGORY I LMFT	3/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138273	N/A	N/A	N/A	N/A	N/A	4995 CRESTVIEW DR	None	CARLSBAD	CA	92008	2600	00	06000	33.14950724	-117.3022282	San Diego County
338921	Ordering, Referring, Prescribing	N/A	1588493571	0	0	BHUIYAN, FAHRIN N DMD	6/27/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110256	N/A	N/A	N/A	N/A	N/A	2040 CAMFIELD AVE	None	COMMERCE	CA	90040	1501	00	06000	34.00861575	-118.1559052	Los Angeles County
338929	Ordering, Referring, Prescribing	N/A	1588440846	0	0	BUNSY, HONG NP	4/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95024767	N/A	N/A	N/A	N/A	N/A	4929 WEST KINGS CANYON R	None	FRESNO	CA	93727	3812	00	06000	36.73603152	-119.730573	Fresno County
338942	Ordering, Referring, Prescribing	N/A	1588678973	0	0	BLAIR, GEORGE A MD	12/27/2017	Taxonomy not applicable	NA	n/a	000	Unknown	C41463	N/A	N/A	N/A	N/A	N/A	2001 S BARRINGTON AVE	204	LOS ANGELES	CA	90025	5363	00	06000	34.03672191	-118.4500156	Los Angeles County
338945	Ordering, Referring, Prescribing	N/A	1588715155	0	0	BUNCH, KEVIN S PSYD	3/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24580	N/A	N/A	N/A	N/A	N/A	11175 SAN PABLO AVE	None	EL CERRITO	CA	94530	2157	00	06000	37.91926262	-122.31424	Contra Costa County
338983	Ordering, Referring, Prescribing	N/A	1588789218	0	0	BELL, HERMAN B MD	10/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A5193	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
338997	Ordering, Referring, Prescribing	N/A	1588808349	0	0	BERNARDO-GREGORY, ELSIE S NP	2/22/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	362664	N/A	N/A	N/A	N/A	N/A	818 PIER VIEW WAY	None	OCEANSIDE	CA	92054	2803	00	06000	33.19841599	-117.3774812	San Diego County
339003	Ordering, Referring, Prescribing	N/A	1588832976	0	0	BISHOP, RICHARD J	2/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	11959	N/A	N/A	N/A	N/A	N/A	30131 TOWN CTR DR	STE 164	LAGUNA NIGUEL	CA	92677	2086	00	06000	33.52530096	-117.7148334	Orange County
339046	Ordering, Referring, Prescribing	N/A	1588924641	0	0	BARES, ALANNA D MD	5/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128746	N/A	N/A	N/A	N/A	N/A	215 W BEAMER ST	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
339053	Ordering, Referring, Prescribing	N/A	1588937080	0	0	BESKALESS, TREASE PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56768	N/A	N/A	N/A	N/A	N/A	4520 BALFOUR RD	None	BRENTWOOD	CA	94513	1529	00	06000	37.92552452	-121.6954215	Contra Costa County
339058	Ordering, Referring, Prescribing	N/A	1588943492	0	0	BROOKS, NICOLE A LCSW	4/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100919	N/A	N/A	N/A	N/A	N/A	760 HARRISON ST	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
339115	Ordering, Referring, Prescribing	N/A	1588983498	0	0	BRAATEN, MARY ELLEN T	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53884	N/A	N/A	N/A	N/A	N/A	7003 N FIGUEROA ST	None	LOS ANGELES	CA	90041	1076	00	06000	34.12951669	-118.1880773	Los Angeles County
339125	Ordering, Referring, Prescribing	N/A	1598028714	0	0	BEEBE, ANGELA R	9/26/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0732424	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
339135	Ordering, Referring, Prescribing	N/A	1598038747	0	0	BACH, IDA M LMFT	5/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79275	N/A	N/A	N/A	N/A	N/A	40925 COUNTY CENTER DR	101	TEMECULA	CA	92591	6054	00	06000	33.52802214	-117.1605544	Riverside County
339155	Ordering, Referring, Prescribing	N/A	1598073819	0	0	BARNES, ELVA V LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99112	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
339166	Ordering, Referring, Prescribing	N/A	1598078982	0	0	BALDWIN, SARAH T LMFT	11/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122923	N/A	N/A	N/A	N/A	N/A	6070 MISSION GORGE RD	None	SAN DIEGO	CA	92120	4023	00	06000	32.78436084	-117.0978222	San Diego County
339187	Ordering, Referring, Prescribing	N/A	1598127938	0	0	BLOUNT, JACOB R MD	5/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172761	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2282	00	06000	38.555181	-121.4566785	Sacramento County
339213	Ordering, Referring, Prescribing	N/A	1598152456	0	0	BRISKY, AMY LMFT	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96019	N/A	N/A	N/A	N/A	N/A	460 KINGS COUNTY DR	SUITE 101	HANFORD	CA	93230	5953	00	06000	36.32980315	-119.668609	Kings County
339224	Ordering, Referring, Prescribing	N/A	1598152654	0	0	BRACEWELL, ANNA N MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152836	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
339240	Ordering, Referring, Prescribing	N/A	1598197121	0	0	BARNES, CARLA LCSW	7/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102802	N/A	N/A	N/A	N/A	N/A	762 WEST CYPRESS STREET	None	SAN DIMAS	CA	91773	3505	00	06000	34.09577399	-117.8223776	Los Angeles County
339242	Ordering, Referring, Prescribing	N/A	1598191660	0	0	BRISCOE, KRISTIN K PSYD	3/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101778	N/A	N/A	N/A	N/A	N/A	976 LANZEN AVENUE, 3RD F	None	SAN JOSE	CA	95126	2737	00	06000	37.33463902	-121.9121497	Santa Clara County
339267	Ordering, Referring, Prescribing	N/A	1598245979	0	0	BIM, NATHELIA P NP	11/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009620	N/A	N/A	N/A	N/A	N/A	2237 W BALL RD	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
339275	Ordering, Referring, Prescribing	N/A	1598273328	0	0	BAKSH, ASHLEY R PA-C	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56868	N/A	N/A	N/A	N/A	N/A	9460 NO NAME UNO	210	GILROY	CA	95020	3532	00	06000	37.037781	-121.570965	Santa Clara County
339281	Ordering, Referring, Prescribing	N/A	1598283525	0	0	BUI, RACHEL B	10/17/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101479	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
339298	Ordering, Referring, Prescribing	N/A	1598311490	0	0	BUI, LAURA PSYD	7/25/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35203	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
339300	Ordering, Referring, Prescribing	N/A	1598312852	0	0	BEHAN, RENEE LMFT	4/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132135	N/A	N/A	N/A	N/A	N/A	950 W JULIAN ST	None	SAN JOSE	CA	95126	2719	00	06000	37.33352455	-121.9089111	Santa Clara County
339301	Ordering, Referring, Prescribing	N/A	1598313355	0	0	BRAN, MARILYN LCSW	6/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123622	N/A	N/A	N/A	N/A	N/A	10155 COLIMA RD	None	WHITTIER	CA	90603	2042	00	06000	33.94349601	-118.0106968	Los Angeles County
339315	Ordering, Referring, Prescribing	N/A	1598331050	0	0	BORDA, NICOLE M OD	8/31/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34942	N/A	N/A	N/A	N/A	N/A	236 N MARKET ST	None	INGLEWOOD	CA	90301	1217	00	06000	33.96582518	-118.351974	Los Angeles County
339328	Ordering, Referring, Prescribing	N/A	1598368151	0	0	BATTLE, TORI NP	6/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95015933	N/A	N/A	N/A	N/A	N/A	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2605	00	06000	33.94720849	-117.399204	Riverside County
339330	Ordering, Referring, Prescribing	N/A	1598375511	0	0	BUDMAN, LAUREN PSYD	1/13/2025	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	35621	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
339332	Ordering, Referring, Prescribing	N/A	1598373243	0	0	BHARMAL, UMAIMA DMD	2/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	104962	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
339348	Ordering, Referring, Prescribing	N/A	1598390700	0	0	BALAZADEH, HALEY	11/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80994	N/A	N/A	N/A	N/A	N/A	1855 COCHRAN ST	None	SIMI VALLEY	CA	93065	0000	00	06000	34.27906738	-118.7628635	Ventura County
339354	Ordering, Referring, Prescribing	N/A	1598414872	0	0	BIJJALA, NEHA DO	9/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21486	N/A	N/A	N/A	N/A	N/A	4094 4TH AVENUE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
339362	Ordering, Referring, Prescribing	N/A	1598472409	0	0	BASU, AJA	10/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023099	N/A	N/A	N/A	N/A	N/A	5440 THORNWOOD DR	STE G	SAN JOSE	CA	95123	1217	00	06000	37.25346406	-121.8609675	Santa Clara County
339365	Ordering, Referring, Prescribing	N/A	1598484412	0	0	BANH, NAOMI N PHARMD	8/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86409	N/A	N/A	N/A	N/A	N/A	710 N ROSE DR	None	PLACENTIA	CA	92870	7520	00	06000	33.87731188	-117.8433267	Orange County
339380	Ordering, Referring, Prescribing	N/A	1598590754	0	0	BOESKIN, ERIN S NP	8/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031832	N/A	N/A	N/A	N/A	N/A	1444 E HOLT AVE	STE 301	POMONA	CA	91767	5865	00	06000	34.06297235	-117.7228495	Los Angeles County
339386	Ordering, Referring, Prescribing	N/A	1598737116	0	0	BALACUIT, DONALD DO	11/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7756	N/A	N/A	N/A	N/A	N/A	416 S MYRTLE AVE	None	MONROVIA	CA	91016	2812	00	06000	34.14746348	-118.0009385	Los Angeles County
339388	Ordering, Referring, Prescribing	N/A	1598742710	0	0	BERRY, JASON OD	2/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7047	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
339407	Ordering, Referring, Prescribing	N/A	1598805517	0	0	BAILLERGEON, ROXANN J LMFT	4/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42843	N/A	N/A	N/A	N/A	N/A	1167 E. SOUTH ST.	None	ORLAND	CA	95963	2312	00	06000	39.7400793	-122.17848	Glenn County
339411	Ordering, Referring, Prescribing	N/A	1598823742	0	0	BARNETT, MATHEW B NP	9/11/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12740	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
339414	Ordering, Referring, Prescribing	N/A	1598835142	0	0	BROMLEY, JASON	11/24/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79728	N/A	N/A	N/A	N/A	N/A	802 BREWSTER AVE	None	REDWOOD CITY	CA	94063	1510	00	06000	37.48873991	-122.2339433	San Mateo County
339424	Ordering, Referring, Prescribing	N/A	1598874422	0	0	BELCHER, GREGORY L MD	6/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G66631	N/A	N/A	N/A	N/A	N/A	14830 LOS GATOS BLVD	300	LOS GATOS	CA	95032	2053	00	06000	37.25293062	-121.9526096	Santa Clara County
339427	Ordering, Referring, Prescribing	N/A	1598881195	0	0	BYERS, DEBRA A	7/23/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	101726	N/A	N/A	N/A	N/A	N/A	6660 PEACH ST	#C12	ERIE	PA	16509	7720	00	06000	42.056685	-80.093349	Erie County
339471	Ordering, Referring, Prescribing	N/A	1598959363	0	0	BADOVSKY, LILIAN MD	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A93799	N/A	N/A	N/A	N/A	N/A	529 S.MAPLE AVE	None	LOS ANGELES	CA	90013	0000	00	06000	34.04465262	-118.2472846	Los Angeles County
339534	Ordering, Referring, Prescribing	N/A	1609119486	0	0	BANERJEE, SOMALEE MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132848	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL, STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
339535	Ordering, Referring, Prescribing	N/A	1609117704	0	0	BOUTELLE, AMY L NP	3/24/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN846559	N/A	N/A	N/A	N/A	N/A	1333 CAMINO DEL RIO S	STE 306	SAN DIEGO	CA	92108	3520	00	06000	32.76557054	-117.1516119	San Diego County
339557	Ordering, Referring, Prescribing	N/A	1609152297	0	0	BACOLOD, JIMSON	8/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56767	N/A	N/A	N/A	N/A	N/A	24325 CRENSHAW BLVD	None	TORRANCE	CA	90505	5349	00	06000	33.805287	-118.33047	Los Angeles County
339573	Ordering, Referring, Prescribing	N/A	1609168343	0	0	BAHL, ANJAM MD	4/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122035	N/A	N/A	N/A	N/A	N/A	8939 S. SEPULVEDA BLVD	SUITE 401	LOS ANGELES	CA	90045	3646	00	06000	33.95485856	-118.3962461	Los Angeles County
339593	Ordering, Referring, Prescribing	N/A	1609203900	0	0	BUMATAY, FRAGRANCE NP	7/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23118	N/A	N/A	N/A	N/A	N/A	4525 E ATHERTON STREET	None	LONG BEACH	CA	90815	3700	00	06000	33.78988246	-118.1397653	Los Angeles County
339609	Ordering, Referring, Prescribing	N/A	1609232065	0	0	BEAS, MAYRA LCSW	7/3/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW123835	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD.	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
339626	Ordering, Referring, Prescribing	N/A	1609258516	0	0	BOWEN, KRYSTAL PSYD	9/2/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32817	N/A	N/A	N/A	N/A	N/A	8300 S VERMONT AVE	None	LOS ANGELES	CA	90044	3493	00	06000	33.963021	-118.291474	Los Angeles County
339652	Ordering, Referring, Prescribing	N/A	1609301217	0	0	BEADLE, DANIEL R DC	7/3/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33863	N/A	N/A	N/A	N/A	N/A	35227 82ND ST E	None	LITTLEROCK	CA	93543	3024	00	06000	34.52196617	-117.9836979	Los Angeles County
339669	Ordering, Referring, Prescribing	N/A	1609319011	0	0	BALIAN, KAREEN S	3/9/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100325	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
339727	Ordering, Referring, Prescribing	N/A	1609419860	0	0	BENSON, MELISSA A LMFT	4/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107654	N/A	N/A	N/A	N/A	N/A	3125 MYERS STREET	None	RIVERSIDE	CA	92503	5527	00	06000	33.90932558	-117.4428095	Riverside County
339729	Ordering, Referring, Prescribing	N/A	1609422815	0	0	BECTON, ALICIA LPCC	9/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10285	N/A	N/A	N/A	N/A	N/A	1300 E SHAW AVE.	None	FRESNO	CA	93710	1300	00	06000	36.80872147	-119.765979	Fresno County
339757	Ordering, Referring, Prescribing	N/A	1609496637	0	0	BAMGBADE, BERNICE A	9/8/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106688	N/A	N/A	N/A	N/A	N/A	630 DRAKE AVE	None	SAUSALITO	CA	94965	1107	00	06000	37.87340883	-122.515085	Marin County
339780	Ordering, Referring, Prescribing	N/A	1609545458	0	0	BELDEN, ALICIA NP	5/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017281	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
339781	Ordering, Referring, Prescribing	N/A	1609543263	0	0	BINGHAM, HAYLEY E OT	10/27/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	13363	N/A	N/A	N/A	N/A	N/A	187 TANK FARM RD	220	SAN LUIS OBISPO	CA	93401	7081	00	06000	35.24678151	-120.670299	San Luis Obispo County
339787	Ordering, Referring, Prescribing	N/A	1609579341	0	0	BUENSUCESO, EVA	4/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024766	N/A	N/A	N/A	N/A	N/A	3505 LONE TREE WAY	None	ANTIOCH	CA	94509	6067	00	06000	37.98725411	-121.8065036	Contra Costa County
339880	Ordering, Referring, Prescribing	N/A	1619017779	0	0	BAKER, BRADFORD DDS	5/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	33545	N/A	N/A	N/A	N/A	N/A	50100 GOLSH ROAD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
339886	Ordering, Referring, Prescribing	N/A	1619029840	0	0	BARKER, CHRISTOPHER L MD	8/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G32194	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
339887	Ordering, Referring, Prescribing	N/A	1619025095	0	0	BARBER, TRECHANN C LCSW	10/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27179	N/A	N/A	N/A	N/A	N/A	480 E 13TH ST	None	MERCED	CA	95341	6122	00	06000	37.29194565	-120.4717887	Merced County
339894	Ordering, Referring, Prescribing	N/A	1619039559	0	0	BURKET, THOMAS J LCSW	6/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101806	N/A	N/A	N/A	N/A	N/A	4411 E KINGS CANYON RD	319	FRESNO	CA	93702	3604	00	06000	36.73594649	-119.7521955	Fresno County
339920	Ordering, Referring, Prescribing	N/A	1619106119	0	0	BAILEY, CRAIG MD	9/7/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C158468	N/A	N/A	N/A	N/A	N/A	7862 FIRESTONE BLVD.	None	DOWNEY	CA	90241	4221	00	06000	33.94382457	-118.1402202	Los Angeles County
339926	Ordering, Referring, Prescribing	N/A	1619109287	0	0	BURNETT, STEPHENYE A	4/6/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	451605	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
339927	Ordering, Referring, Prescribing	N/A	1619097714	0	0	BERNARDEZ, JORGE MD	5/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45913	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
339930	Ordering, Referring, Prescribing	N/A	1619122025	0	0	BURDICK, ADAM J MD	5/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106880	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR.	SUITE 110	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
339931	Ordering, Referring, Prescribing	N/A	1619117181	0	0	BRAR-MAGOON, MANPREET K	2/27/2018	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	4869	N/A	N/A	N/A	N/A	N/A	1200 W MAIN STREET	None	TURLOCK	CA	95380	5107	00	06000	37.4926695	-120.862917	Stanislaus County
339936	Ordering, Referring, Prescribing	N/A	1619130556	0	0	BERRY, ERIN MD	9/16/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C199079	N/A	N/A	N/A	N/A	N/A	518 GARDEN STREET	None	SANTA BARBARA	CA	93101	1606	00	06000	34.42054634	-119.6928135	Santa Barbara County
339943	Ordering, Referring, Prescribing	N/A	1619158334	0	0	BRUMBAUGH, JULIE D LMFT	5/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100351	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
339960	Ordering, Referring, Prescribing	N/A	1619158383	0	0	BAUMGARDNER, ROBERT W	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41844	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	None	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
339968	Ordering, Referring, Prescribing	N/A	1619196318	0	0	BUENAVENTURA, ESPERANZA S	4/6/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	D52717	N/A	N/A	N/A	N/A	N/A	7843 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2523	00	06000	34.213581	-118.3878055	Los Angeles County
340035	Ordering, Referring, Prescribing	N/A	1619308731	0	0	BONFANTI, CAROLINE M NP	4/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003726	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
340037	Ordering, Referring, Prescribing	N/A	1619312469	0	0	BIGGS, ARTER L MD	4/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141498	N/A	N/A	N/A	N/A	N/A	375 89TH ST	None	DALY CITY	CA	94015	1802	00	06000	37.69175212	-122.474006	San Mateo County
340065	Ordering, Referring, Prescribing	N/A	1619355773	0	0	BURNS, LAURA R PSYD	12/11/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29409	N/A	N/A	N/A	N/A	N/A	21081 S. WESTERN AVE	STE 295	TORRANCE	CA	90501	1707	00	06000	33.83886841	-118.3093605	Los Angeles County
340101	Ordering, Referring, Prescribing	N/A	1619401312	0	0	BROWN, EZEQUIEL M MD	11/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159361	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE FL 3	FL 3	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
340109	Ordering, Referring, Prescribing	N/A	1619405867	0	0	BALYAN, TARIKA S NP	11/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95005259	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
340144	Ordering, Referring, Prescribing	N/A	1619484458	0	0	BARRIO GONZALEZ, MARVELYS J NP	7/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008250	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	SUITE 302	LONG BEACH	CA	90813	3271	00	06000	33.779655	-118.1880065	Los Angeles County
340146	Ordering, Referring, Prescribing	N/A	1619480662	0	0	BOBADILLA, STEPHANIE M LCSW	9/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104267	N/A	N/A	N/A	N/A	N/A	5100 S EASTERN AVE	SUITE 110	COMMERCE	CA	90040	2950	00	06000	33.98882955	-118.1615175	Los Angeles County
340147	Ordering, Referring, Prescribing	N/A	1619496155	0	0	BREWER, RACHEL P LCSW	10/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97626	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE.	None	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
340168	Ordering, Referring, Prescribing	N/A	1619523495	0	0	BERGEZ, ELIZABETH RN BS	9/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95175386	N/A	N/A	N/A	N/A	N/A	665 WALNUT AVE	None	VALLEJO	CA	94592	1177	00	06000	38.0984383	-122.2723367	Solano County
340177	Ordering, Referring, Prescribing	N/A	1619527496	0	0	BAILEY, SHELLEY NP	12/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027557	N/A	N/A	N/A	N/A	N/A	116 S PALISADE DR	STE 200	SANTA MARIA	CA	93454	8905	00	06000	34.9523869	-120.4120717	Santa Barbara County
340186	Ordering, Referring, Prescribing	N/A	1619563848	0	0	BOCK, SARA K CNP	3/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016224	N/A	N/A	N/A	N/A	N/A	205 E. DAVIS	None	PIXLEY	CA	93256	9456	00	06000	35.96843541	-119.2923819	Tulare County
340232	Ordering, Referring, Prescribing	N/A	1619785912	0	0	BIERS, MAE PA	2/7/2025	Taxonomy not applicable	NA	n/a	000	Unknown	65912	N/A	N/A	N/A	N/A	N/A	1400 BROADWAY	None	OAKLAND	CA	94612	2004	00	06000	37.80455747	-122.2710233	Alameda County
340243	Ordering, Referring, Prescribing	N/A	1619970159	0	0	BRAZA, JEAN SUSANA F	2/29/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D46169	N/A	N/A	N/A	N/A	N/A	650 META ST	None	OXNARD	CA	93030	7182	00	06000	34.195239	-119.1759535	Ventura County
340246	Ordering, Referring, Prescribing	N/A	1619990223	0	0	BAKER, SANDEE J LMFT	2/26/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40395	N/A	N/A	N/A	N/A	N/A	19772 MCARTHUR BLVD.	SUITE 260	IRVINE	CA	92612	2412	00	06000	33.65624304	-117.8623446	Orange County
340295	Ordering, Referring, Prescribing	N/A	1629133129	0	0	BARBERENA CARRILLO, CECILIA E LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21752	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
340304	Ordering, Referring, Prescribing	N/A	1629152269	0	0	BREEDY, STEFANIE L LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21221	N/A	N/A	N/A	N/A	N/A	1701 OCEAN AVE	None	SAN FRANCISCO	CA	94112	1727	00	06000	37.72476918	-122.4604495	San Francisco County
340341	Ordering, Referring, Prescribing	N/A	1629257027	0	0	BROOKS, ANDREA L LCSW	9/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74424	N/A	N/A	N/A	N/A	N/A	966 BOSTWICK LN	None	SANTA CRUZ	CA	95062	1743	00	06000	36.98425355	-121.9874105	Santa Cruz County
340344	Ordering, Referring, Prescribing	N/A	1629258215	0	0	BUTTERFIELD, RAECHEL LCSW	12/4/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76443	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
340349	Ordering, Referring, Prescribing	N/A	1629269279	0	0	BARBEE, JACOB P MD	9/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	44414	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
340354	Ordering, Referring, Prescribing	N/A	1629281662	0	0	BALUYUT, IRENE MD	10/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87105	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
340367	Ordering, Referring, Prescribing	N/A	1629311352	0	0	BAKUNAS, CARRIE A MD	4/12/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	MD20170219	N/A	N/A	N/A	N/A	N/A	1100 CENTRAL AVE SE	None	ALBUQUERQUE	NM	87106	4930	00	06000	35.08239279	-106.6353509	Bernalillo County
340369	Ordering, Referring, Prescribing	N/A	1629311964	0	0	BLAINE, AUDREY NP	5/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP21933	N/A	N/A	N/A	N/A	N/A	751 MEDICAL CENTER COURT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
340376	Ordering, Referring, Prescribing	N/A	1629326095	0	0	BLACKSTONE, KERRI L LMFT	1/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101766	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
340412	Ordering, Referring, Prescribing	N/A	1629370903	0	0	BANGAR, PARMALA K MD FAAP	8/24/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A117429	N/A	N/A	N/A	N/A	N/A	449 S MADERA AVE	None	KERMAN	CA	93630	1537	00	06000	36.72866432	-120.0603346	Fresno County
340435	Ordering, Referring, Prescribing	N/A	1629416391	0	0	BRIKLIN, OLGA MD	9/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C198906	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	None	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
340439	Ordering, Referring, Prescribing	N/A	1629420617	0	0	BROWN, ERIC S	5/31/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	100306	N/A	N/A	N/A	N/A	N/A	11750 CHOLLA DR	STE B	DSRT HOT SPGS	CA	92240	3066	00	06000	33.96386115	-116.5144878	Riverside County
340472	Ordering, Referring, Prescribing	N/A	1629489257	0	0	BOURGETTE, RYAN B MD	2/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167450	N/A	N/A	N/A	N/A	N/A	3705 MISSION BLVD	None	SAN DIEGO	CA	92109	7104	00	06000	32.78273202	-117.2524549	San Diego County
340492	Ordering, Referring, Prescribing	N/A	1629518725	0	0	BURKETT, MEGAN CNP	7/2/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95006203	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	698	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
340506	Ordering, Referring, Prescribing	N/A	1629525597	0	0	BELL, DEVAUGHN L NP	3/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95004580	N/A	N/A	N/A	N/A	N/A	815 DR. MARTIN LUTHER KI	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
340539	Ordering, Referring, Prescribing	N/A	1629577507	0	0	BANUELOS, DAISY LMFT	8/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127270	N/A	N/A	N/A	N/A	N/A	3031 SOUTH VERMONT	None	LOS ANGELES	CA	90007	3033	00	06000	34.02666679	-118.2915608	Los Angeles County
340555	Ordering, Referring, Prescribing	N/A	1629614334	0	0	BOTELLO, ATZIN LMFT	5/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132585	N/A	N/A	N/A	N/A	N/A	5715 UTAH TRL	None	TWENTYNINE PALMS	CA	92277	6917	00	06000	34.150167	-116.036582	San Bernardino County
340575	Ordering, Referring, Prescribing	N/A	1629635263	0	0	BAINS, AMANJYOT	4/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	105512	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
340584	Ordering, Referring, Prescribing	N/A	1629652441	0	0	BENARON, MICHAEL R PA	7/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59564	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
340586	Ordering, Referring, Prescribing	N/A	1629646286	0	0	BARCARSE, VICTOR JOHN NP	2/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017351	N/A	N/A	N/A	N/A	N/A	9201 W SUNSET BLVD	SUITE 812	LOS ANGELES	CA	90069	3701	00	06000	34.09054375	-118.392295	Los Angeles County
340598	Ordering, Referring, Prescribing	N/A	1629680673	0	0	BOBB, FRANCISCA P NP	11/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016460	N/A	N/A	N/A	N/A	N/A	600 MAIN ST	None	SOLEDAD	CA	93960	2533	00	06000	36.43281182	-121.3243597	Monterey County
340612	Ordering, Referring, Prescribing	N/A	1629715917	0	0	BARCELOS, MELISSA R NP	5/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020903	N/A	N/A	N/A	N/A	N/A	600 B STREET	BUILDING A-C	LIVINGSTON	CA	95334	9593	00	06000	37.38589253	-120.734559	Merced County
340614	Ordering, Referring, Prescribing	N/A	1629717178	0	0	BAUL-HIGHFILL, ELLAIN PA	6/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61312	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
340626	Ordering, Referring, Prescribing	N/A	1629747969	0	0	BRADLEY, ALEXIS	4/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018246	N/A	N/A	N/A	N/A	N/A	1694 TULLY RD STE 40	None	SAN JOSE	CA	95122	2538	00	06000	37.32177408	-121.826526	Santa Clara County
340663	Ordering, Referring, Prescribing	N/A	1639215320	0	0	BERTELLI, ROBERT	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	41814	N/A	N/A	N/A	N/A	N/A	1428 CENTER AVE	None	DOS PALOS	CA	93620	1048	00	06000	36.986193	-120.626646	Merced County
340678	Ordering, Referring, Prescribing	N/A	1639240740	0	0	BARKER, MIKKI MD DO	10/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A5488	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
340686	Ordering, Referring, Prescribing	N/A	1639275704	0	0	BROWN, YATES R MD	2/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A103867	N/A	N/A	N/A	N/A	N/A	815 HYDE STREET	STE 100	SAN FRANCISCO	CA	94109	5998	00	06000	37.78855	-122.416917	San Francisco County
340702	Ordering, Referring, Prescribing	N/A	1639308265	0	0	BIRNBAUM, DEBORAH A DO	6/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11387	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
340736	Ordering, Referring, Prescribing	N/A	1639385404	0	0	BOTHA, CLARK A PHARMD	1/23/2019	Taxonomy not applicable	NA	n/a	000	Unknown	58078	N/A	N/A	N/A	N/A	N/A	81 S HIGHLAND SPRINGS AV	90	BEAUMONT	CA	92223	3170	00	06000	33.919204	-116.9467869	Riverside County
340755	Ordering, Referring, Prescribing	N/A	1639415276	0	0	BAIN, STEFAN	12/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21512	N/A	N/A	N/A	N/A	N/A	4212 MISSOURI FLAT RD	None	PLACERVILLE	CA	95667	6269	00	06000	38.706228	-120.834891	El Dorado County
340758	Ordering, Referring, Prescribing	N/A	1639439649	0	0	BENAVIDEZ, DAVIDIA R LMFT	12/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101244	N/A	N/A	N/A	N/A	N/A	897 GRANITE DRIVE	None	PASADENA	CA	91101	3501	00	06000	34.13703447	-118.1317905	Los Angeles County
340785	Ordering, Referring, Prescribing	N/A	1639477532	0	0	BERRY SIMON, MARJORIE LCSW	5/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115397	N/A	N/A	N/A	N/A	N/A	286 EUCLID AVE	SUITE 102	SAN DIEGO	CA	92114	3610	00	06000	32.70706919	-117.0850896	San Diego County
340794	Ordering, Referring, Prescribing	N/A	1639479561	0	0	BARLOW, NADINE R PHARMD	3/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59957	N/A	N/A	N/A	N/A	N/A	660 S. MAIN ST	None	FORT BRAGG	CA	95437	0660	00	06000	39.43345921	-123.8061586	Mendocino County
340800	Ordering, Referring, Prescribing	N/A	1639489982	0	0	BARKER, KATHLEEN C LMFT	1/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48503	N/A	N/A	N/A	N/A	N/A	6950 65TH STREET	None	SACRAMENTO	CA	95823	2316	00	06000	38.50065	-121.4357265	Sacramento County
340801	Ordering, Referring, Prescribing	N/A	1639487457	0	0	BUSTILLOS, JULIANA LCSW	12/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85663	N/A	N/A	N/A	N/A	N/A	480 E 13TH ST	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
340852	Ordering, Referring, Prescribing	N/A	1639564974	0	0	BULLEIT, ERIN E MD	9/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170205	N/A	N/A	N/A	N/A	N/A	751 LOMBARDI CT	None	SANTA ROSA	CA	95407	6798	00	06000	38.427804	-122.7493035	Sonoma County
340853	Ordering, Referring, Prescribing	N/A	1639562572	0	0	BRIDER, PAMELA R LCSW	8/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96447	N/A	N/A	N/A	N/A	N/A	1855 W KETELLA AVE	150	ANAHEIM	CA	92867	3451	00	06000	33.8061655	-117.872442	Orange County
340870	Ordering, Referring, Prescribing	N/A	1639579097	0	0	BENDIXSEN, MELISSA CCC-SLP	11/14/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	34407	N/A	N/A	N/A	N/A	N/A	1430 SCOTT ST. THIRD FLO	None	SAN FRANCISCO	CA	94115	3510	00	06000	37.7831564	-122.4376947	San Francisco County
340877	Ordering, Referring, Prescribing	N/A	1639593833	0	0	BELTRAN, NANCY M LPCC	5/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	13907	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
340881	Ordering, Referring, Prescribing	N/A	1639600901	0	0	BLANCEAGLE, GLORIA A PSYD	9/20/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28250	N/A	N/A	N/A	N/A	N/A	205 SOUTH ST	None	FORT BRAGG	CA	95437	5540	00	06000	39.43009931	-123.8032471	Mendocino County
340892	Ordering, Referring, Prescribing	N/A	1639610025	0	0	BAIRD, LAURA LMFT	10/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122364	N/A	N/A	N/A	N/A	N/A	3322 SWEETWATER SPRINGS	102	SPRING VALLEY	CA	91977	3162	00	06000	32.73879556	-116.9724522	San Diego County
340901	Ordering, Referring, Prescribing	N/A	1639629637	0	0	BUECHLER, KATLIN LMFT	8/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119368	N/A	N/A	N/A	N/A	N/A	811 GRAND AVE	None	SACRAMENTO	CA	95838	3466	00	06000	38.637621	-121.4470125	Sacramento County
340911	Ordering, Referring, Prescribing	N/A	1639647647	0	0	BERMUDEZ VERA, JOHANNA NP	10/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017611	N/A	N/A	N/A	N/A	N/A	8775 AERO DR	None	SAN DIEGO	CA	92123	1792	00	06000	32.80965551	-117.1391563	San Diego County
340942	Ordering, Referring, Prescribing	N/A	1639690845	0	0	BEHRMANN, LORENA NP	3/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95006801	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
340971	Ordering, Referring, Prescribing	N/A	1639747827	0	0	BIAKOP, GUY NP	10/12/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022515	N/A	N/A	N/A	N/A	N/A	17053 FOOTHILL BLVD	BLDG B	FONTANA	CA	92335	3574	00	06000	34.10655148	-117.432828	San Bernardino County
340984	Ordering, Referring, Prescribing	N/A	1639794670	0	0	BOZON, CARLA MARIE MD	7/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188298	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
341038	Ordering, Referring, Prescribing	N/A	1649202433	0	0	BUSTAMANTE, ADOR A MD	8/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54189	N/A	N/A	N/A	N/A	N/A	5417 YORK BLVD	None	LOS ANGELES	CA	90042	2401	00	06000	34.11987345	-118.1986245	Los Angeles County
341057	Ordering, Referring, Prescribing	N/A	1649290487	0	0	BELGUM, CYNTHIA L	12/21/1985	Taxonomy not applicable	NA	n/a	099	DENTIST	D31022	N/A	N/A	N/A	N/A	N/A	1736 PICASSO AVE	STE D	DAVIS	CA	95616	0548	00	06000	38.56413788	-121.7303182	Yolo County
341062	Ordering, Referring, Prescribing	N/A	1649302837	0	0	BOEHLE, STACI R LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36153	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
341064	Ordering, Referring, Prescribing	N/A	1649302449	0	0	BURSE, ZEENAT K LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44004	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST.	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
341092	Ordering, Referring, Prescribing	N/A	1649352121	0	0	BAIG, ERAM MD	11/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64197	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
341112	Ordering, Referring, Prescribing	N/A	1649396201	0	0	BELL, LAURIE LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49442	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DRIVE	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
341138	Ordering, Referring, Prescribing	N/A	1649465741	0	0	BELITSKI, MAYA PHD	3/21/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30848	N/A	N/A	N/A	N/A	N/A	475 BRUCE STREET	STE 200	YREKA	CA	96097	3474	00	06000	41.71860037	-122.6467317	Siskiyou County
341163	Ordering, Referring, Prescribing	N/A	1649515180	0	0	BRIGHT, MELISSA A LMFT	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80123	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
341168	Ordering, Referring, Prescribing	N/A	1649527664	0	0	BENSON, ERIC G NP	7/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13248	N/A	N/A	N/A	N/A	N/A	12700 WELCH STREET	None	WATERFORD	CA	95386	8765	00	06000	37.63957828	-120.7603281	Stanislaus County
341189	Ordering, Referring, Prescribing	N/A	1649565656	0	0	BUCKLEY, LARA PSYD	1/8/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33291	N/A	N/A	N/A	N/A	N/A	116 AGNES AVE	None	SANTA MARIA	CA	93458	2838	00	06000	34.96403742	-120.4365844	Santa Barbara County
341219	Ordering, Referring, Prescribing	N/A	1649605171	0	0	BARNES, BRIAN G LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73918	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
341223	Ordering, Referring, Prescribing	N/A	1649614827	0	0	BALL-ZONDERVAN, MONICA J MD	5/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133126	N/A	N/A	N/A	N/A	N/A	1 HOPE DRIVE	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
341229	Ordering, Referring, Prescribing	N/A	1649620063	0	0	BACH, LINDSAY M MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155391	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2315	00	06000	38.555181	-121.4566785	Sacramento County
341231	Ordering, Referring, Prescribing	N/A	1649621871	0	0	BRANDON, ANDREW T LCSW	4/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100941	N/A	N/A	N/A	N/A	N/A	1963 4TH AVE	None	SAN DIEGO	CA	92101	2394	00	06000	32.72572745	-117.1608615	San Diego County
341238	Ordering, Referring, Prescribing	N/A	1649632373	0	0	BALD, MATTHEW R MD	4/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155151	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M 160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
341251	Ordering, Referring, Prescribing	N/A	1649649237	0	0	BLANKENSHIP, CHELSEY N LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84717	N/A	N/A	N/A	N/A	N/A	1750 W WALNUT AVE	B	VISALIA	CA	93277	6233	00	06000	36.313335	-119.3114205	Tulare County
341252	Ordering, Referring, Prescribing	N/A	1649646803	0	0	BRITTON, KATRINA NP	8/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002521	N/A	N/A	N/A	N/A	N/A	1328 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
341253	Ordering, Referring, Prescribing	N/A	1649648601	0	0	BRICE, REGINALD J LCSW	7/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95586	N/A	N/A	N/A	N/A	N/A	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
341269	Ordering, Referring, Prescribing	N/A	1649676008	0	0	BILBREW, KELLIE LCSW	4/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81418	N/A	N/A	N/A	N/A	N/A	1721 E 120TH ST	None	LOS ANGELES	CA	90059	3051	00	06000	33.92464172	-118.2429544	Los Angeles County
341293	Ordering, Referring, Prescribing	N/A	1649714544	0	0	BARKER, SHANNON PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69515	N/A	N/A	N/A	N/A	N/A	7373 WEST LLANE	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
341307	Ordering, Referring, Prescribing	N/A	1649746181	0	0	BUEHLER, JO ANN RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	294397	N/A	N/A	N/A	N/A	N/A	1530 E 19TH ST	None	BAKERSFIELD	CA	93305	5406	00	06000	35.37150365	-118.9798847	Kern County
341346	Ordering, Referring, Prescribing	N/A	1649781501	0	0	BARLAM, JORDAN S LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97266	N/A	N/A	N/A	N/A	N/A	619 E 5TH STREET	None	LOS ANGELES	CA	90035	2109	00	06000	34.0432666	-118.2422934	Los Angeles County
341349	Ordering, Referring, Prescribing	N/A	1649825878	0	0	BOGDIS, MARY LMFT	12/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT140571	N/A	N/A	N/A	N/A	N/A	10832 LAUREL ST	SUITE 102	RANCHO CUCAMONGA	CA	91730	3865	00	06000	34.10486789	-117.5684863	San Bernardino County
341354	Ordering, Referring, Prescribing	N/A	1649808460	0	0	BALDERAS, RODOLFO MD	7/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188075	N/A	N/A	N/A	N/A	N/A	678 3RD	None	CHULA VISTA	CA	91910	5736	00	06000	32.62870793	-117.0750108	San Diego County
341367	Ordering, Referring, Prescribing	N/A	1649830795	0	0	BAJET, EDMUND LPCC	3/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	13497	N/A	N/A	N/A	N/A	N/A	1196 THIRD AVE	SUITE A	CHULA VISTA	CA	92111	3604	00	06000	32.61031228	-117.067833	San Diego County
341368	Ordering, Referring, Prescribing	N/A	1649850926	0	0	BASRAM, DILPREET K DDS	6/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107504	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
341377	Ordering, Referring, Prescribing	N/A	1649869868	0	0	BRENNAN, LAUREN PA-C	2/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59217	N/A	N/A	N/A	N/A	N/A	2425 ALHAMBRA BLVD	None	SACRAMENTO	CA	95817	1110	00	06000	38.55627	-121.471875	Sacramento County
341417	Ordering, Referring, Prescribing	N/A	1649997800	0	0	BOHOL, BERNADETTE A NP	8/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021749	N/A	N/A	N/A	N/A	N/A	17500 FOOTHILL BLVD	None	FONTANA	CA	92335	3736	00	06000	34.1067065	-117.4218885	San Bernardino County
341422	Ordering, Referring, Prescribing	N/A	1659002665	0	0	BYNUM, KATHRYN E NP	5/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020984	N/A	N/A	N/A	N/A	N/A	480 FIRST AVE.	None	PORTOLA	CA	96122	9406	00	06000	39.80603471	-120.463888	Plumas County
341438	Ordering, Referring, Prescribing	N/A	1659044022	0	0	BOOKER, MICHAEL P PA-C	10/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61770	N/A	N/A	N/A	N/A	N/A	10121 PINE AVENUE	None	TRUCKEE	CA	96161	0000	00	06000	39.3245308	-120.2013097	Nevada County
341456	Ordering, Referring, Prescribing	N/A	1659118529	0	0	BARTHELS, BRINNLEY M DMD	6/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110201	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
341485	Ordering, Referring, Prescribing	N/A	1659404218	0	0	BELLAMY, CHEYLA	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82399	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
341499	Ordering, Referring, Prescribing	N/A	1659426781	0	0	BROWN, LEA	5/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	10964	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3594	00	06000	37.75548534	-122.4065362	San Francisco County
341504	Ordering, Referring, Prescribing	N/A	1659444529	0	0	BENDEN, ALISON L LCSW	2/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27260	N/A	N/A	N/A	N/A	N/A	1224 VINE ST.	None	LOS ANGELES	CA	90038	0000	00	06000	34.093332	-118.326603	Los Angeles County
341511	Ordering, Referring, Prescribing	N/A	1659462653	0	0	BOYD, STEVEN M LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17792	N/A	N/A	N/A	N/A	N/A	1100 LINCOLN AVE.	108	NAPA	CA	94558	3118	00	06000	38.3085749	-122.2949243	Napa County
341518	Ordering, Referring, Prescribing	N/A	1659465557	0	0	BOYD, KATHLEEN LMFT	10/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35267	N/A	N/A	N/A	N/A	N/A	1434 THIRD ST SUITE 2D	None	NAPA	CA	94559	2860	00	06000	38.29592269	-122.2881544	Napa County
341532	Ordering, Referring, Prescribing	N/A	1659505592	0	0	BROEGE, JENNIFER LCSW	11/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23018	N/A	N/A	N/A	N/A	N/A	12510 VAN NUYS BLVD	None	PACOIMA	CA	91331	1338	00	06000	34.27814981	-118.4055414	Los Angeles County
341539	Ordering, Referring, Prescribing	N/A	1659525228	0	0	BULLEN, KEZZIA	7/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29548	N/A	N/A	N/A	N/A	N/A	900 FULTON AVE	205	SACRAMENTO	CA	95825	4517	00	06000	38.581902	-121.4007615	Sacramento County
341550	Ordering, Referring, Prescribing	N/A	1659544393	0	0	BAKER, VAUGHN L LMFT	5/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99233	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
341564	Ordering, Referring, Prescribing	N/A	1659574622	0	0	BRATT, MAYA NP	3/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16651	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
341622	Ordering, Referring, Prescribing	N/A	1659670271	0	0	BERMUDEZ, JOSEPH H LCSW	1/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74849	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
341631	Ordering, Referring, Prescribing	N/A	1659685972	0	0	BADAL, BELLA	1/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48539	N/A	N/A	N/A	N/A	N/A	2955 N TEGNER RD	None	TURLOCK	CA	95380	9401	00	06000	37.518768	-120.888963	Stanislaus County
341638	Ordering, Referring, Prescribing	N/A	1659708147	0	0	BRAVO-CHAVEZ, HUGO PA-C	11/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	23262	N/A	N/A	N/A	N/A	N/A	2801 SANTA MARIA WAY	None	SANTA MARIA	CA	93455	2118	00	06000	34.90914521	-120.4339538	Santa Barbara County
341643	Ordering, Referring, Prescribing	N/A	1659715266	0	0	BRINGAS, CHARILYN CNP	4/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024917	N/A	N/A	N/A	N/A	N/A	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	00	06000	33.8102385	-118.3441185	Los Angeles County
341665	Ordering, Referring, Prescribing	N/A	1659735405	0	0	BUSTAMANTE, DANIELA S NP	12/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021294	N/A	N/A	N/A	N/A	N/A	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1711	00	06000	34.08461594	-118.2570874	Los Angeles County
341680	Ordering, Referring, Prescribing	N/A	1659756427	0	0	BERGREEN BROWN, BRANDY L LPCC	3/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC5083	N/A	N/A	N/A	N/A	N/A	24275 JEFFERSON AVE	None	MURRIETA	CA	92562	7285	00	06000	33.5676365	-117.2174559	Riverside County
341684	Ordering, Referring, Prescribing	N/A	1659737724	0	0	BANUELOS, DENISE LCSW	12/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93252	N/A	N/A	N/A	N/A	N/A	8019 S COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
341689	Ordering, Referring, Prescribing	N/A	1659765402	0	0	BRANDY, ALEXIS E LMFT	10/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122384	N/A	N/A	N/A	N/A	N/A	2677 N MAIN ST	130	SANTA ANA	CA	92705	6623	00	06000	33.77224313	-117.8672259	Orange County
341694	Ordering, Referring, Prescribing	N/A	1659775435	0	0	BASSIRI, FARZANEH PHARMD	6/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	46194	N/A	N/A	N/A	N/A	N/A	16550 W. SOLEDAD CANYON	None	CANYON COUNTRY	CA	91387	3215	00	06000	34.42676803	-118.425457	Los Angeles County
341699	Ordering, Referring, Prescribing	N/A	1659775609	0	0	BAILEY, EMMA	10/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW111174	N/A	N/A	N/A	N/A	N/A	1727 MARTIN LUTHER KING	None	OAKLAND	CA	94612	1327	00	06000	37.80868384	-122.2744362	Alameda County
341724	Ordering, Referring, Prescribing	N/A	1659816650	0	0	BARRIENTOS, VERNA N LCSW	2/10/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106867	N/A	N/A	N/A	N/A	N/A	610 ELM ST	STE 212	SAN CARLOS	CA	94070	3070	00	06000	37.50498314	-122.2629552	San Mateo County
341734	Ordering, Referring, Prescribing	N/A	1659830610	0	0	BERNSTEIN, MEGAN	1/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	A180918	N/A	N/A	N/A	N/A	N/A	2001 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2102	00	06000	34.02891163	-118.4797466	Los Angeles County
341771	Ordering, Referring, Prescribing	N/A	1659895787	0	0	BOWIE, JILL M LMFT	9/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127945	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
341782	Ordering, Referring, Prescribing	N/A	1659926830	0	0	BALDWIN, THOMAS J LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106206	N/A	N/A	N/A	N/A	N/A	24275 JEFFERSON AVE	None	MURRIETA	CA	92562	0129	00	06000	33.5676365	-117.2174559	Riverside County
341791	Ordering, Referring, Prescribing	N/A	1659935583	0	0	BAEZ, JOANNA LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109344	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
341817	Ordering, Referring, Prescribing	N/A	1669007167	0	0	BILLIOU, KAYLA M LCSW	10/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118374	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
341818	Ordering, Referring, Prescribing	N/A	1659981330	0	0	BAJWA, KAMALJOT K NP	10/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95015081	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD S	SUITE #C	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
341837	Ordering, Referring, Prescribing	N/A	1669037271	0	0	BAUER, ERIC J MD	8/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181194	N/A	N/A	N/A	N/A	N/A	1050 N STATE ST	None	UKIAH	CA	95482	3414	00	06000	39.1623719	-123.2098216	Mendocino County
341870	Ordering, Referring, Prescribing	N/A	1669160883	0	0	BEN-ISRAEL, UZOAMAKA NP	5/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025187	N/A	N/A	N/A	N/A	N/A	5125 SKYWAY	None	PARADISE	CA	95969	5624	00	06000	39.74598961	-121.640736	Butte County
341898	Ordering, Referring, Prescribing	N/A	1669419602	0	0	BAKER, DENNIS H MD	3/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G50855	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	GOLETA	CA	93111	1646	00	06000	34.44131559	-119.8184752	Santa Barbara County
341904	Ordering, Referring, Prescribing	N/A	1669434361	0	0	BROWN, PAYTON G MD	6/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G37780	N/A	N/A	N/A	N/A	N/A	769 W BLAINE ST STE B	STE B	RIVERSIDE	CA	92507	3970	00	06000	33.98300646	-117.327555	Riverside County
341933	Ordering, Referring, Prescribing	N/A	1669536009	0	0	BRAVO, GARY MD	11/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G53626	N/A	N/A	N/A	N/A	N/A	818 CHERRY ST	None	SANTA ROSA	CA	95404	4207	00	06000	38.444382	-122.712858	Sonoma County
341937	Ordering, Referring, Prescribing	N/A	1669559415	0	0	BARSCHESKI, SABRINA LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23600	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	200	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
341943	Ordering, Referring, Prescribing	N/A	1669560793	0	0	BALUYUT, DENNIS P	11/15/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D43113	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
341958	Ordering, Referring, Prescribing	N/A	1669612388	0	0	BREVAIRE, JUDY V LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT32458	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
341970	Ordering, Referring, Prescribing	N/A	1669637757	0	0	BENNETT, KINSHASA PHD	8/27/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26517	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
341971	Ordering, Referring, Prescribing	N/A	1669633624	0	0	BLYTHE, DIANA K MD	10/13/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C128729	N/A	N/A	N/A	N/A	N/A	1700 KEYSTONE PACIFIC PK	UNIT B	PATTERSON	CA	95363	8874	00	06000	37.47600952	-121.160718	Stanislaus County
341973	Ordering, Referring, Prescribing	N/A	1669646824	0	0	BAKER-BALLANTYNE, JESSICA J	4/11/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0691172	N/A	N/A	N/A	N/A	N/A	743 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3921	00	06000	35.27698063	-120.6618385	San Luis Obispo County
341982	Ordering, Referring, Prescribing	N/A	1669673570	0	0	BRISCOE, JENNIFER G	8/5/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112522	N/A	N/A	N/A	N/A	N/A	298 BERNAL RD	None	SAN JOSE	CA	95119	1809	00	06000	37.215603	-121.7858355	Santa Clara County
341986	Ordering, Referring, Prescribing	N/A	1669682639	0	0	BEAVERS, JACQUELINE M LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53113	N/A	N/A	N/A	N/A	N/A	2057 15TH STREET	C	SAN FRANCISCO	CA	94114	1324	00	06000	37.76600154	-122.4302439	San Francisco County
341989	Ordering, Referring, Prescribing	N/A	1669701132	0	0	BARELA, ALEJANDRO	2/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81899	N/A	N/A	N/A	N/A	N/A	965 EL CAMINO AVE	None	SACRAMENTO	CA	95815	2530	00	06000	38.611638	-121.4444745	Sacramento County
342014	Ordering, Referring, Prescribing	N/A	1669752838	0	0	BRADFORD, ALMA O LCSW	10/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80125	N/A	N/A	N/A	N/A	N/A	725 LA VETA	STE 260	ORANGE	CA	92868	4403	00	06000	33.78063949	-117.8603285	Orange County
342018	Ordering, Referring, Prescribing	N/A	1669757183	0	0	BOSSMAN, EMMANUEL K PHARMD	8/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59609	N/A	N/A	N/A	N/A	N/A	15500 WASHINGTON AVE	None	SAN LEANDRO	CA	94579	1839	00	06000	37.68575579	-122.1388804	Alameda County
342049	Ordering, Referring, Prescribing	N/A	1669808358	0	0	BAKKE, GRACE A LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88102	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD	None	BALDWIN PARK	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
342070	Ordering, Referring, Prescribing	N/A	1669856217	0	0	BANAJJAR REVANASIDDAPPA, VANITHA MD	4/25/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162179	N/A	N/A	N/A	N/A	N/A	797 W CHILDS AVE	None	MERCED	CA	95341	6805	00	06000	37.2882498	-120.4963024	Merced County
342085	Ordering, Referring, Prescribing	N/A	1669866299	0	0	BARBOZA, JUAN C JR	2/22/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33209	N/A	N/A	N/A	N/A	N/A	1126 SOUTH EAST STREET	None	LONG BEACH	CA	90805	4132	00	06000	33.86008655	-118.178514	Los Angeles County
342098	Ordering, Referring, Prescribing	N/A	1669907168	0	0	BRANTING, ANDREW J MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157717	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
342100	Ordering, Referring, Prescribing	N/A	1669902656	0	0	BEACH, KATHERINE LCSW	11/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106220	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
342104	Ordering, Referring, Prescribing	N/A	1669914610	0	0	BIANCHI-TEMPLIN, TRACI D LMFT	9/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96632	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
342109	Ordering, Referring, Prescribing	N/A	1669919064	0	0	BROADHURST, EMILY LP	10/20/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34627	N/A	N/A	N/A	N/A	N/A	509 W. 10TH ST.	None	ANTIOCH	CA	94509	1653	00	06000	38.01116769	-121.8130914	Contra Costa County
342116	Ordering, Referring, Prescribing	N/A	1669920757	0	0	BERGMARK, JAMIE L OD	5/18/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33657	N/A	N/A	N/A	N/A	N/A	11717 BERNARDO PLAZA COU	105	SAN DIEGO	CA	92128	2419	00	06000	33.01929872	-117.0777714	San Diego County
342126	Ordering, Referring, Prescribing	N/A	1669964730	0	0	BHAURLA, SIMARDEEP ( LPCC	9/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14673	N/A	N/A	N/A	N/A	N/A	4139 EL CAMINO WAY	None	PALO ALTO	CA	94306	4010	00	06000	37.41340105	-122.1249131	Santa Clara County
342129	Ordering, Referring, Prescribing	N/A	1669948212	0	0	BADUE, MICAELA LMFT	6/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147592	N/A	N/A	N/A	N/A	N/A	6615 VALLEY HI DR, SACRA	None	SACRAMENTO	CA	95823	5799	00	06000	38.470986	-121.4276985	Sacramento County
342133	Ordering, Referring, Prescribing	N/A	1669975777	0	0	BALLAAO, BLYTHE A NP	3/13/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008756	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	BUILDING K	SANTA CRUZ	CA	95060	0000	00	06000	36.99276804	-122.0178271	Santa Cruz County
342143	Ordering, Referring, Prescribing	N/A	1669990115	0	0	BARRETT, MADELINE C PT	12/13/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT293636	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST.	None	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
342145	Ordering, Referring, Prescribing	N/A	1669991048	0	0	BAGHIKIAN, MANE V PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77168	N/A	N/A	N/A	N/A	N/A	4950 W SUNSET BLVD	6122	LOS ANGELES	CA	90027	5822	00	06000	34.09812092	-118.2980246	Los Angeles County
342151	Ordering, Referring, Prescribing	N/A	1669998761	0	0	BURK, STACEY LMFT	4/27/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90933	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	STE 280	SAN MATEO	CA	94403	1289	00	06000	37.54524373	-122.3205511	San Mateo County
342153	Ordering, Referring, Prescribing	N/A	1669997771	0	0	BROWN, COURTNEY A LMFT	4/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125531	N/A	N/A	N/A	N/A	N/A	485 N 1ST ST	None	SAN JOSE	CA	95112	4067	00	06000	37.34444033	-121.8968517	Santa Clara County
342252	Ordering, Referring, Prescribing	N/A	1679154207	0	0	BRAVO, ANGELINA NP	8/11/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016127	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
342267	Ordering, Referring, Prescribing	N/A	1679195143	0	0	BARLAS, TALAL MD	3/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185227	N/A	N/A	N/A	N/A	N/A	2811 H ST	None	BAKERSFIELD	CA	93301	1913	00	06000	35.38526604	-119.021172	Kern County
342299	Ordering, Referring, Prescribing	N/A	1679337646	0	0	BHAVSAR, PAYAL S NP	11/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027970	N/A	N/A	N/A	N/A	N/A	17450 MAIN ST	E	HESPERIA	CA	92345	6262	00	06000	34.41871211	-117.2821748	San Bernardino County
342311	Ordering, Referring, Prescribing	N/A	1679568711	0	0	BERGSTROM, KRISTIN C MD	3/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G168185	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE A	FORT BRAG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
342358	Ordering, Referring, Prescribing	N/A	1679669733	0	0	BROWN, TRACY R MD	1/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53733	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
342369	Ordering, Referring, Prescribing	N/A	1679708689	0	0	BELTRAN, GUSTAVO MSW LCSW	4/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82311	N/A	N/A	N/A	N/A	N/A	727 SHASTA ST	None	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
342389	Ordering, Referring, Prescribing	N/A	1679744577	0	0	BURAU, MARY L LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45378	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	110	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
342392	Ordering, Referring, Prescribing	N/A	1679758072	0	0	BENSON, JESTINA S	3/21/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100598	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
342410	Ordering, Referring, Prescribing	N/A	1679794515	0	0	BOARDMAN, ANGELA J LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46071	N/A	N/A	N/A	N/A	N/A	1470 W HERNDON AVE	300	FRESNO	CA	93711	0552	00	06000	36.83746879	-119.8186401	Fresno County
342418	Ordering, Referring, Prescribing	N/A	1679810139	0	0	BARNETT, SHANDA LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96661	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
342422	Ordering, Referring, Prescribing	N/A	1679814560	0	0	BISHOP, ANNY E LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96343	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
342423	Ordering, Referring, Prescribing	N/A	1679815765	0	0	BROCKMANN, BRENDON D MD	4/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135079	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	STE 2	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
342459	Ordering, Referring, Prescribing	N/A	1679873095	0	0	BANZUELA, KAREN	4/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	59555	N/A	N/A	N/A	N/A	N/A	7311 N FIGUEROA ST	None	LOS ANGELES	CA	90041	2512	00	06000	34.13587598	-118.1885219	Los Angeles County
342466	Ordering, Referring, Prescribing	N/A	1679908263	0	0	BERIO, KRYSTEL LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84939	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
342469	Ordering, Referring, Prescribing	N/A	1679912240	0	0	BRENES, KRISTIAN LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108617	N/A	N/A	N/A	N/A	N/A	16209 KAMANA RD	105	APPLE VALLEY	CA	92307	5244	00	06000	34.54584527	-117.2681198	San Bernardino County
342488	Ordering, Referring, Prescribing	N/A	1679943765	0	0	BURROWS, CHRISTINA M LCSW	10/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97537	N/A	N/A	N/A	N/A	N/A	455 1ST STREET	None	WOODLAND	CA	95695	4023	00	06000	38.675781	-121.773122	Yolo County
342489	Ordering, Referring, Prescribing	N/A	1679946446	0	0	BOND, DONALD C	12/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	71926	N/A	N/A	N/A	N/A	N/A	16405 HWY 116	None	GUERNEVILLE	CA	95446	0000	00	06000	38.5019157	-123.0004504	Sonoma County
342498	Ordering, Referring, Prescribing	N/A	1679959951	0	0	BROWN, KANDIE V LCSW	10/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118380	N/A	N/A	N/A	N/A	N/A	3105 WILSON RD	None	BAKERSFIELD	CA	93304	5319	00	06000	35.33217634	-119.037921	Kern County
342503	Ordering, Referring, Prescribing	N/A	1679972798	0	0	BROWN, JEFFREY PA-C	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA606	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
342513	Ordering, Referring, Prescribing	N/A	1679978787	0	0	BANNING, METAXIA PA-C	7/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53615	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
342520	Ordering, Referring, Prescribing	N/A	1679990535	0	0	BURKE, MICHAEL	11/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14398	N/A	N/A	N/A	N/A	N/A	1749 14TH STREET	100	SANTA MONICA	CA	90404	4342	00	06000	34.01877575	-118.4794554	Los Angeles County
342522	Ordering, Referring, Prescribing	N/A	1679993380	0	0	BATTAGLIA, ANDREANA LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114498	N/A	N/A	N/A	N/A	N/A	4164 BROCKTON AVE	None	RIVERSIDE	CA	92501	3400	00	06000	33.98077024	-117.3813862	Riverside County
342534	Ordering, Referring, Prescribing	N/A	1689012304	0	0	BASNET, KRISTEN	12/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C200317	N/A	N/A	N/A	N/A	N/A	444 BRUCE STREET	None	YREKA	CA	96097	3450	00	06000	41.71863548	-122.6458755	Siskiyou County
342559	Ordering, Referring, Prescribing	N/A	1689056764	0	0	BEDAIR, DALIA H DMD	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64607	N/A	N/A	N/A	N/A	N/A	9416 ROAD 238	None	TERRA BELLA	CA	93270	9416	00	06000	35.96072962	-119.0399481	Tulare County
342563	Ordering, Referring, Prescribing	N/A	1689057127	0	0	BENEDICT, DARCY E MD	1/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144542	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
342583	Ordering, Referring, Prescribing	N/A	1689092165	0	0	BROWN, MARGOT K MD	12/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137956	N/A	N/A	N/A	N/A	N/A	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
342585	Ordering, Referring, Prescribing	N/A	1689102535	0	0	BILKHU, GURTEJBIR S DO	4/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18161	N/A	N/A	N/A	N/A	N/A	1081 N. CHINA LAKE BLVD.	None	RIDGECREST	CA	93555	3198	00	06000	35.640783	-117.6698475	Kern County
342592	Ordering, Referring, Prescribing	N/A	1689115982	0	0	BALASUBRAMANIAN, SATISH Y MD	1/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160086	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
342624	Ordering, Referring, Prescribing	N/A	1689159014	0	0	BENSON, KENDRA C RN	10/30/2017	Taxonomy not applicable	NA	n/a	000	Unknown	582579	N/A	N/A	N/A	N/A	N/A	5000 CYPRESS	None	VISALIA	CA	93277	8300	00	06000	36.324207	-119.3463225	Tulare County
342637	Ordering, Referring, Prescribing	N/A	1689172447	0	0	BEEMAN, ROBERT PHARMD	7/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	45444	N/A	N/A	N/A	N/A	N/A	355 E 21ST ST	None	SAN BERNARDINO	CA	92404	4824	00	06000	34.13404548	-117.2779515	San Bernardino County
342687	Ordering, Referring, Prescribing	N/A	1689243370	0	0	BAINBRIDGE, VICTORIA M RN	6/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	95040651	N/A	N/A	N/A	N/A	N/A	1629 S CENTER ST	None	SANTA ANA	CA	92704	4111	00	06000	33.72509144	-117.8980958	Orange County
342727	Ordering, Referring, Prescribing	N/A	1689401705	0	0	BATTH, GUNJEET NP	3/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029466	N/A	N/A	N/A	N/A	N/A	2339 CLEVELAND AVE	SUITE 103	MADERA	CA	93637	8764	00	06000	36.97466548	-120.085749	Madera County
342743	Ordering, Referring, Prescribing	N/A	1689494965	0	0	BAHADOR, AMIRHOSSEIN DDS	10/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110932	N/A	N/A	N/A	N/A	N/A	200 S. WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
342814	Ordering, Referring, Prescribing	N/A	1689835324	0	0	BOELTS, KATHERINE M LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103597	N/A	N/A	N/A	N/A	N/A	2305 E BALL RD	200	ANAHEIM	CA	92806	5327	00	06000	33.81812448	-117.883548	Orange County
342819	Ordering, Referring, Prescribing	N/A	1689841629	0	0	BRYAN, KATHRYN J LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43235	N/A	N/A	N/A	N/A	N/A	22978 EL TORO RD	None	LAKE FOREST	CA	92630	4961	00	06000	33.62895849	-117.6898866	Orange County
342828	Ordering, Referring, Prescribing	N/A	1689866048	0	0	BARAJAS, CECILIA R LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50331	N/A	N/A	N/A	N/A	N/A	11060 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	00	06000	33.90401361	-117.4750239	Riverside County
342882	Ordering, Referring, Prescribing	N/A	1689960205	0	0	BASUNDHRA, SAURABH MD	12/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C172790	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
342953	Ordering, Referring, Prescribing	N/A	1699084574	0	0	BAXTER, JILIANNE R LCSW	12/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74596	N/A	N/A	N/A	N/A	N/A	11485 C AVE	None	AUBURN	CA	95603	2701	00	06000	38.93833614	-121.1048541	Placer County
342957	Ordering, Referring, Prescribing	N/A	1699098319	0	0	BERGERE, HANH PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63159	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
342988	Ordering, Referring, Prescribing	N/A	1699139105	0	0	BARSAMIAN, GEORGE R	9/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	35531	N/A	N/A	N/A	N/A	N/A	1428 CENTER AVE	None	DOS PALOS	CA	93620	2320	00	06000	36.986193	-120.626646	Merced County
342997	Ordering, Referring, Prescribing	N/A	1699159087	0	0	BANG, MI HWA	12/5/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	56982	N/A	N/A	N/A	N/A	N/A	22554 VENTURA BLVD	STE 100	WOODLAND HILLS	CA	91364	1413	00	06000	34.1675422	-118.6184028	Los Angeles County
343004	Ordering, Referring, Prescribing	N/A	1699176511	0	0	BALL, DESTINEE LCSW	5/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101465	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
343018	Ordering, Referring, Prescribing	N/A	1699200329	0	0	BAUMER, REBECCA L LCSW	2/16/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	16772	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 E	None	ROUND MOUNTAIN	CA	96084	0228	00	06000	40.80385331	-121.9397745	Shasta County
343031	Ordering, Referring, Prescribing	N/A	1699224261	0	0	BURGOS, BRIDGET S LCSW	8/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97834	N/A	N/A	N/A	N/A	N/A	1700 W CERRITOS AVE	331	ANAHEIM	CA	92804	6178	00	06000	33.80935455	-117.9437787	Orange County
343040	Ordering, Referring, Prescribing	N/A	1699242065	0	0	BENNETT, ELIZABETH E NP	11/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010098	N/A	N/A	N/A	N/A	N/A	2415 W VINE ST	100	LODI	CA	95242	3525	00	06000	38.1228953	-121.3052826	San Joaquin County
343046	Ordering, Referring, Prescribing	N/A	1699256255	0	0	BURRISS, JODY	5/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	2809	N/A	N/A	N/A	N/A	N/A	2271 W LOUISE AVE	None	MANTECA	CA	95337	8381	00	06000	37.814697	-121.255785	San Joaquin County
343067	Ordering, Referring, Prescribing	N/A	1699289629	0	0	BENCITO, NICOLE S NP	1/23/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010939	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	9A	BUENA PARK	CA	90621	4667	00	06000	33.85890953	-118.007244	Orange County
343075	Ordering, Referring, Prescribing	N/A	1699310680	0	0	BUI, ANTHONY D NP	11/5/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013181	N/A	N/A	N/A	N/A	N/A	1039 W FLORENCE AVE	None	LOS ANGELES	CA	90044	2441	00	06000	33.97463885	-118.2933327	Los Angeles County
343092	Ordering, Referring, Prescribing	N/A	1699336370	0	0	BASICAL, KYLE A MD	6/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182287	N/A	N/A	N/A	N/A	N/A	1536 E AMAR RD	None	WEST COVINA	CA	91792	1618	00	06000	34.02990474	-117.9119798	Los Angeles County
343100	Ordering, Referring, Prescribing	N/A	1699351791	0	0	BORDEN, LAURA MD	12/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8336	N/A	N/A	N/A	N/A	N/A	1201 W LA VITA AVE	None	ORANGE	CA	92868	0000	00	06000	33.78034779	-117.8655767	Orange County
343114	Ordering, Referring, Prescribing	N/A	1699392456	0	0	BURFORD, HANNAH LCSW	2/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120923	N/A	N/A	N/A	N/A	N/A	680 FLETCHER PKWY	STE 200	EL CAJON	CA	92020	2516	00	06000	32.80780847	-116.970687	San Diego County
343157	Ordering, Referring, Prescribing	N/A	1699503383	0	0	BUFFINGTON, JOLEEN NP	2/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95029273	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
343168	Ordering, Referring, Prescribing	N/A	1699700971	0	0	BRAR, HARBINDER MD	8/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40011	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
343180	Ordering, Referring, Prescribing	N/A	1699722165	0	0	BERELIANI, ARASH MD	7/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66268	N/A	N/A	N/A	N/A	N/A	1919 W 7TH ST	None	LOS ANGELES	CA	90057	4103	00	06000	34.05575686	-118.2751751	Los Angeles County
343181	Ordering, Referring, Prescribing	N/A	1699719708	0	0	BOURNS, SCOTT G DO	12/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9042	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1378	00	06000	34.29321532	-119.1597424	Ventura County
343190	Ordering, Referring, Prescribing	N/A	1699796383	0	0	BYSTRY, SUSAN O PSYD	2/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	17015	N/A	N/A	N/A	N/A	N/A	12966 EUCLID	SUITE 280	GARDEN GROVE	CA	92840	9202	00	06000	33.77455935	-117.9378298	Orange County
343203	Ordering, Referring, Prescribing	N/A	1699809145	0	0	BARCHUS, YOLANDA GUADALUPE LCSW	9/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104315	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVE.	SUITE A	SOUTH PASADENA	CA	91031	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
343230	Ordering, Referring, Prescribing	N/A	1699857268	0	0	BATTAD, LAWRENCE R CNP	3/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12648	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
343234	Ordering, Referring, Prescribing	N/A	1699869222	0	0	BOSCARELLI, ROBIN T PHD	7/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY14464	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 165	OXNARD	CA	93036	1111	00	06000	34.219566	-119.1539365	Ventura County
343240	Ordering, Referring, Prescribing	N/A	1699893602	0	0	BERGMAN, JENNIFER A LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52673	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	SUITE 200	CONCORD	CA	94520	1626	00	06000	37.98393807	-122.0466953	Contra Costa County
343253	Ordering, Referring, Prescribing	N/A	1699916296	0	0	BLANDINO, MILDRED J LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24917	N/A	N/A	N/A	N/A	N/A	1650 LAS PLUMAS AVE STE.	None	SAN JOSE	CA	95133	1657	00	06000	37.36163624	-121.8663794	Santa Clara County
343260	Ordering, Referring, Prescribing	N/A	1699927855	0	0	BONILLA, DELSIE G LMFT	1/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123935	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
343264	Ordering, Referring, Prescribing	N/A	1699938571	0	0	BARBA, CESAR L MD	7/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111855	N/A	N/A	N/A	N/A	N/A	1711 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	4901	00	06000	34.0127217	-118.466458	Los Angeles County
343268	Ordering, Referring, Prescribing	N/A	1699949727	0	0	BLAIR, AMY C LCSW	6/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28444	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
343271	Ordering, Referring, Prescribing	N/A	1699961094	0	0	BEASLEY, COREEN M LMFT	9/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128201	N/A	N/A	N/A	N/A	N/A	520 E. TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
343276	Ordering, Referring, Prescribing	N/A	1699956821	0	0	BAUTISTA, EDDIE LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115785	N/A	N/A	N/A	N/A	N/A	368 SAN JUAN GRADE RD	None	SALINAS	CA	93906	1200	00	06000	36.73674347	-121.6354761	Monterey County
343278	Ordering, Referring, Prescribing	N/A	1699978528	0	0	BLUM, DANIELLE CNM	5/4/2022	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	1436	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
343289	Ordering, Referring, Prescribing	N/A	1700031069	0	0	BRADFORD, CYNTHIA A LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112991	N/A	N/A	N/A	N/A	N/A	628 MONTEZUMA ST	None	RIO VISTA	CA	94571	1622	00	06000	38.1588479	-121.6961718	Solano County
343290	Ordering, Referring, Prescribing	N/A	1700032497	0	0	BRELIAN, DANIEL	6/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109924	N/A	N/A	N/A	N/A	N/A	711 W COLLEGE ST	SUITE 203	LOS ANGELES	CA	90012	1163	00	06000	34.06541412	-118.2414102	Los Angeles County
343294	Ordering, Referring, Prescribing	N/A	1700035003	0	0	BOYD, ERICA D LMFT	7/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126855	N/A	N/A	N/A	N/A	N/A	1968 W ADAMS BLVD	None	LOS ANGELES	CA	90018	3515	00	06000	34.03266053	-118.3081635	Los Angeles County
343295	Ordering, Referring, Prescribing	N/A	1700038478	0	0	BUTLER, KERRI M PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55776	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	None	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
343300	Ordering, Referring, Prescribing	N/A	1700050200	0	0	BROWN, LAURENCE NP	7/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17777	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
343305	Ordering, Referring, Prescribing	N/A	1700050408	0	0	BRADLEY, DEBORAH C LMFT	2/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83989	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
343353	Ordering, Referring, Prescribing	N/A	1700147659	0	0	BAKER, MEGAN E MD	5/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126428	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
343383	Ordering, Referring, Prescribing	N/A	1700181815	0	0	BALSOM, JASON	9/13/2017	Taxonomy not applicable	NA	n/a	013	HEARING AID DISPENSERS	HA7519	N/A	N/A	N/A	N/A	N/A	1106 E 17TH ST	E	SANTA ANA	CA	92701	2603	00	06000	33.75982249	-117.8556318	Orange County
343393	Ordering, Referring, Prescribing	N/A	1700195682	0	0	BRAVO, NORMA LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71259	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER STREET	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
343407	Ordering, Referring, Prescribing	N/A	1700212016	0	0	BEARD, KALISHA LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77950	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
343432	Ordering, Referring, Prescribing	N/A	1700258472	0	0	BETTERS, CARLA D NP	9/2/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	617641	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BLVD	SUITE 300	LAWNDALE	CA	90260	1581	00	06000	33.898572	-118.3527775	Los Angeles County
343467	Ordering, Referring, Prescribing	N/A	1700315231	0	0	BISHOP, MICHAEL	12/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138268	N/A	N/A	N/A	N/A	N/A	381 BAYSIDE RD	None	ARCATA	CA	95521	6497	00	06000	40.86293406	-124.0739007	Humboldt County
343502	Ordering, Referring, Prescribing	N/A	1700364775	0	0	BROWN, VANESHA LCSW	3/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121432	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
343522	Ordering, Referring, Prescribing	N/A	1700383288	0	0	BARACCHINI, CINDY M LMFT	9/22/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48641	N/A	N/A	N/A	N/A	N/A	201 W. 4TH ST.	SUITE 200	CLAREMONT	CA	91711	4710	00	06000	34.09762851	-117.7166655	Los Angeles County
343539	Ordering, Referring, Prescribing	N/A	1700428935	0	0	BJORK, KERRI L LCSW	6/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91191	N/A	N/A	N/A	N/A	N/A	720 9TH STREET	None	RAMONA	CA	92065	2348	00	06000	33.0389069	-116.8638919	San Diego County
343542	Ordering, Referring, Prescribing	N/A	1700431459	0	0	BRAVO, GERSON LMFT	9/6/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149563	N/A	N/A	N/A	N/A	N/A	1695 S SAN JACINTO AVE	SUITE A	SAN JACINTO	CA	92583	5103	00	06000	33.770961	-116.954649	Riverside County
343589	Ordering, Referring, Prescribing	N/A	1700535119	0	0	BURHANS, HALEY PHARMD	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81998	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
343595	Ordering, Referring, Prescribing	N/A	1700546132	0	0	BUCKLAND, IAN A NP	12/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018502	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
343647	Ordering, Referring, Prescribing	N/A	1700912466	0	0	BOX, ELISABETH C LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119471	N/A	N/A	N/A	N/A	N/A	1255 KENDALL RD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
343653	Ordering, Referring, Prescribing	N/A	1700917416	0	0	BURROWES, ALISON D LCSW	8/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96612	N/A	N/A	N/A	N/A	N/A	2001 28TH ST	None	BAKERSFIELD	CA	93301	1924	00	06000	35.38486605	-119.0251102	Kern County
343679	Ordering, Referring, Prescribing	N/A	1700974920	0	0	BASHIRI, NASRIN	1/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64418	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
343704	Ordering, Referring, Prescribing	N/A	1710018445	0	0	BENDIMEZ, LISA	9/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32066	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
343716	Ordering, Referring, Prescribing	N/A	1710054796	0	0	BROWNSTONE, DONNI B	7/28/2014	Taxonomy not applicable	NA	n/a	099	DENTIST	D38264	N/A	N/A	N/A	N/A	N/A	1500 21ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
343717	Ordering, Referring, Prescribing	N/A	1710050992	0	0	BAKER, SARAH C LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20909	N/A	N/A	N/A	N/A	N/A	2513 24TH STREET	None	SAN FRANCISCO	CA	94110	3556	00	06000	37.75308592	-122.4047531	San Francisco County
343741	Ordering, Referring, Prescribing	N/A	1710137955	0	0	BAZAN, MARLENE A LMFT	4/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107388	N/A	N/A	N/A	N/A	N/A	4205 W FIGARDEN DR	None	FRESNO	CA	93722	6051	00	06000	36.82930754	-119.8669532	Fresno County
343743	Ordering, Referring, Prescribing	N/A	1710128277	0	0	BROWN, HEATHER M LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108611	N/A	N/A	N/A	N/A	N/A	17800 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
343777	Ordering, Referring, Prescribing	N/A	1710215660	0	0	BRAHENY, MARY	7/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	27707	N/A	N/A	N/A	N/A	N/A	205 AVE I,	STE. 16	REDONDO BEACH	CA	90277	5619	00	06000	33.81918919	-118.3875722	Los Angeles County
343787	Ordering, Referring, Prescribing	N/A	1710233804	0	0	BALANCIO, JOLENE-FE C LCSW	2/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75254	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD.	SUITE G	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.9462235	-118.0830161	Los Angeles County
343811	Ordering, Referring, Prescribing	N/A	1710264536	0	0	BARCELON, JOHN GLENN PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66961	N/A	N/A	N/A	N/A	N/A	1538 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	00	06000	33.78779155	-117.8367795	Orange County
343814	Ordering, Referring, Prescribing	N/A	1710264262	0	0	BODELL, VICTORIA LCSW	12/4/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28776	N/A	N/A	N/A	N/A	N/A	2001 S BARRINGTON AVE	215	LOS ANGELES	CA	90025	5363	00	06000	34.03672191	-118.4500156	Los Angeles County
343824	Ordering, Referring, Prescribing	N/A	1710287537	0	0	BARNES, HEATHER A PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54933	N/A	N/A	N/A	N/A	N/A	727 N VINE ST.	None	LOS ANGELES	CA	90038	1622	00	06000	34.08422698	-118.3266837	Los Angeles County
343842	Ordering, Referring, Prescribing	N/A	1710306261	0	0	BLACK CALF, VALERIE LCSW	10/25/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW111402	N/A	N/A	N/A	N/A	N/A	3124 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2902	00	06000	37.77791438	-122.2264251	Alameda County
343856	Ordering, Referring, Prescribing	N/A	1710339684	0	0	BAILLARGEON, FANNIE T	9/19/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101673	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
343870	Ordering, Referring, Prescribing	N/A	1710355607	0	0	BRENTA, MARCIA J NP	2/4/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4622	N/A	N/A	N/A	N/A	N/A	3800 JANES ROAD	None	ARCATA	CA	95518	1115	00	06000	40.89645172	-124.0930637	Humboldt County
343881	Ordering, Referring, Prescribing	N/A	1710375225	0	0	BELL, TINA LMFT	3/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103370	N/A	N/A	N/A	N/A	N/A	7474 EL CAJON BLVD	None	LA MESA	CA	91942	7420	00	06000	32.76850004	-117.036802	San Diego County
343917	Ordering, Referring, Prescribing	N/A	1710427588	0	0	BENITEZ, ELLENY PA-C	9/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58955	N/A	N/A	N/A	N/A	N/A	347 W MISSION AVE	None	ESCONDIDO	CA	92025	1729	00	06000	33.12861918	-117.0906689	San Diego County
343939	Ordering, Referring, Prescribing	N/A	1710466073	0	0	BI, MENG LMFT	1/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT137355	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
343949	Ordering, Referring, Prescribing	N/A	1710473830	0	0	BROWNING, JANICE L LMFT	10/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135188	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
343980	Ordering, Referring, Prescribing	N/A	1710524293	0	0	BADHESHA, HARPREET K NP	10/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95013000	N/A	N/A	N/A	N/A	N/A	3554 W MT WHITNEY	None	RIVERDALE	CA	93656	0001	00	06000	36.43083157	-119.8619557	Fresno County
343993	Ordering, Referring, Prescribing	N/A	1710561279	0	0	BECERRA, MAURA MD	10/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191381	N/A	N/A	N/A	N/A	N/A	850 5TH ST	None	GONZALES	CA	93926	9491	00	06000	36.51464322	-121.4354965	Monterey County
343995	Ordering, Referring, Prescribing	N/A	1710597901	0	0	BAGRODIA, KANUPRIYA	8/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	10071	N/A	N/A	N/A	N/A	N/A	1855 LUCRETIA AVE	BUILDING M	SAN JOSE	CA	95122	3730	00	06000	37.32042717	-121.8478629	Santa Clara County
343998	Ordering, Referring, Prescribing	N/A	1710598271	0	0	BRAR, AMANDEEP KAUR DDS	4/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	105397	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
344020	Ordering, Referring, Prescribing	N/A	1710680939	0	0	BAYUDAN, EVAMAE P MD	7/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197394	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
344025	Ordering, Referring, Prescribing	N/A	1710691928	0	0	BATES, SABRINA S	12/8/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023575	N/A	N/A	N/A	N/A	N/A	939 ALTA VISTA DR	None	ALTADENA	CA	91001	1736	00	06000	34.19600718	-118.1302954	Los Angeles County
344029	Ordering, Referring, Prescribing	N/A	1710767447	0	0	BERG, BRIAN A NP	6/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95030701	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVE	None	NATIONAL CITY	CA	91950	0000	00	06000	32.68067201	-117.0804893	San Diego County
344043	Ordering, Referring, Prescribing	N/A	1710954946	0	0	BILL, MARTA B	12/30/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA0020647	N/A	N/A	N/A	N/A	N/A	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	00	06000	34.221609	-118.5360405	Los Angeles County
344050	Ordering, Referring, Prescribing	N/A	1720002314	0	0	BAUHOFER, TONYA M LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41267	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LANE	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
344059	Ordering, Referring, Prescribing	N/A	1720026495	0	0	BERLANT, JEFFREY L MD	2/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G28125	N/A	N/A	N/A	N/A	N/A	655 CANYON ROAD	None	NOVATO	CA	94947	4331	00	06000	38.09749281	-122.5813545	Marin County
344078	Ordering, Referring, Prescribing	N/A	1720106297	0	0	BROWN, RONNI E	3/21/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D39237	N/A	N/A	N/A	N/A	N/A	160 CAPP ST	None	SAN FRANCISCO	CA	94110	1210	00	06000	37.76405528	-122.4186219	San Francisco County
344079	Ordering, Referring, Prescribing	N/A	1720112741	0	0	BEST, ANDREA C MD	3/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66107	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
344080	Ordering, Referring, Prescribing	N/A	1720115090	0	0	BUNNER, SCOTT P MD	4/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83336	N/A	N/A	N/A	N/A	N/A	1250 MORENA BLVD	None	SAN DIEGO	CA	92110	3815	00	06000	32.76963745	-117.2036361	San Diego County
344081	Ordering, Referring, Prescribing	N/A	1720113061	0	0	BADDIN, PEGGY L	2/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19595	N/A	N/A	N/A	N/A	N/A	1020 S ARROYO PKWY	None	PASADENA	CA	91105	3911	00	06000	34.128351	-118.1471735	Los Angeles County
344111	Ordering, Referring, Prescribing	N/A	1720169592	0	0	BAHADUR, NEHA MD	3/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81427	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
344142	Ordering, Referring, Prescribing	N/A	1720242241	0	0	BRYANT, LATARSHA	9/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024913	N/A	N/A	N/A	N/A	N/A	475 BRUCE STREET	None	YREKA	CA	96097	3484	00	06000	41.71860037	-122.6467317	Siskiyou County
344195	Ordering, Referring, Prescribing	N/A	1720339484	0	0	BRYNER, TERESA NP	3/1/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22371	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
344196	Ordering, Referring, Prescribing	N/A	1720339708	0	0	BARTHOLOMEW, SARAH C LCSW	1/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86542	N/A	N/A	N/A	N/A	N/A	1111 W CHASE AVE	None	EL CAJON	CA	92020	5710	00	06000	32.78161035	-116.9764603	San Diego County
344224	Ordering, Referring, Prescribing	N/A	1720372774	0	0	BALICKI, DAVID S LMFT	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87584	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
344233	Ordering, Referring, Prescribing	N/A	1720397383	0	0	BURGERS, CRYSTAL D NP	10/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	NP14759	N/A	N/A	N/A	N/A	N/A	25 ALLEN ST.	None	MARTINEZ	CA	94553	9991	00	06000	38.00739608	-122.1331318	Contra Costa County
344242	Ordering, Referring, Prescribing	N/A	1720406002	0	0	BROOKS, KATHERINE M DO	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14712	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
344252	Ordering, Referring, Prescribing	N/A	1720409428	0	0	BUCHER, JOHN R LCSW	3/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74441	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
344319	Ordering, Referring, Prescribing	N/A	1720498504	0	0	BALDRIAS, ALAN J NP	3/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000314	N/A	N/A	N/A	N/A	N/A	1436 GOODRICH BLVD	105	COMMERCE	CA	90022	5111	00	06000	34.01117577	-118.1585527	Los Angeles County
344340	Ordering, Referring, Prescribing	N/A	1720524374	0	0	BANGS, SASHA S PA-C	4/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA55660	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVE	None	NATIONAL CITY	CA	91950	0000	00	06000	32.68067201	-117.0804893	San Diego County
344344	Ordering, Referring, Prescribing	N/A	1720534886	0	0	BAIERA, PARISSA N	10/3/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100781	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
344351	Ordering, Referring, Prescribing	N/A	1720535735	0	0	BUNYAPUTIKUL, STEPHANIE LEE Z LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115118	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	SUITE 200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
344353	Ordering, Referring, Prescribing	N/A	1720543986	0	0	BERNABE, TERESA J LMFT	3/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124823	N/A	N/A	N/A	N/A	N/A	14632 YORBA ST	None	TUSTIN	CA	92780	2554	00	06000	33.75056331	-117.8302319	Orange County
344354	Ordering, Referring, Prescribing	N/A	1720545197	0	0	BACULPO, REBECA C MSW LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64040	N/A	N/A	N/A	N/A	N/A	1001 SNEATH LN	307	SAN BRUNO	CA	94066	2308	00	06000	37.63462925	-122.4259247	San Mateo County
344363	Ordering, Referring, Prescribing	N/A	1720551328	0	0	BEILSTEIN, NICOLE M LMFT	5/8/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84528	N/A	N/A	N/A	N/A	N/A	161 W WILLIAMS ST	None	BANNING	CA	92220	4746	00	06000	33.9272313	-116.878477	Riverside County
344369	Ordering, Referring, Prescribing	N/A	1720567134	0	0	BANIE, SABA PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63801	N/A	N/A	N/A	N/A	N/A	199 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	4260	00	06000	37.7644964	-122.4523028	San Francisco County
344383	Ordering, Referring, Prescribing	N/A	1720587090	0	0	BRICENO RODRIGU, JESSICA G	7/11/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102169	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DSRT HOT SPGS	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
344402	Ordering, Referring, Prescribing	N/A	1720615867	0	0	BAJWA, MANDEEP S MD	5/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186551	N/A	N/A	N/A	N/A	N/A	3514 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.74247286	-117.1301067	San Diego County
344416	Ordering, Referring, Prescribing	N/A	1720640055	0	0	BRAWLEY, DUNG T	10/7/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103946	N/A	N/A	N/A	N/A	N/A	16233 KING ST	None	DELHI	CA	95315	9460	00	06000	37.43319758	-120.7809931	Merced County
344418	Ordering, Referring, Prescribing	N/A	1720643299	0	0	BATHEN-GONZALEZ, MEGAN J LMFT	10/15/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150616	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	BUILDING F	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
344435	Ordering, Referring, Prescribing	N/A	1720692098	0	0	BELL, SARAH LMFT	11/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113939	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
344451	Ordering, Referring, Prescribing	N/A	1720728637	0	0	BROWN, ANDREW MD	12/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192385	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
344454	Ordering, Referring, Prescribing	N/A	1720738131	0	0	BENINCORE ROBLEDO, ANDRES MD	12/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P4	N/A	N/A	N/A	N/A	N/A	1201 N CHERRY ST	None	TULARE	CA	93274	2233	00	06000	36.2249133	-119.336993	Tulare County
344455	Ordering, Referring, Prescribing	N/A	1720738966	0	0	BRUSSER, DANIEL M NP	7/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021573	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
344479	Ordering, Referring, Prescribing	N/A	1720866957	0	0	BRANCACCIO, AUDREANA	2/20/2025	Taxonomy not applicable	NA	n/a	000	Unknown	PA66000	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
344491	Ordering, Referring, Prescribing	N/A	1730139528	0	0	BOTTONI, THOMAS N MD	3/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G79511	N/A	N/A	N/A	N/A	N/A	2710 GATEWAY OAKS DR	None	SACRAMENTO	CA	95833	3505	00	06000	38.61612	-121.5161055	Sacramento County
344510	Ordering, Referring, Prescribing	N/A	1730202136	0	0	BLANCO, IRENE J LCSW	1/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68073	N/A	N/A	N/A	N/A	N/A	209 EAST 7TH ST.	None	MADERA	CA	93639	1288	00	06000	36.96069768	-120.0559841	Madera County
344516	Ordering, Referring, Prescribing	N/A	1730213703	0	0	BOGLE, BARRY W	11/7/2000	Taxonomy not applicable	NA	n/a	099	DENTIST	D44834	N/A	N/A	N/A	N/A	N/A	650 S ZEDIKER AVE	BLDG 3	PARLIER	CA	93648	2667	00	06000	36.60500164	-119.5210273	Fresno County
344522	Ordering, Referring, Prescribing	N/A	1730225418	0	0	BENDER, NICOLE M	1/10/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A00098184	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
344589	Ordering, Referring, Prescribing	N/A	1730377730	0	0	BOWN, RONALD E LCSW	10/15/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64390	N/A	N/A	N/A	N/A	N/A	329 W 8TH ST	None	HANFORD	CA	93230	4533	00	06000	36.32698307	-119.6503466	Kings County
344592	Ordering, Referring, Prescribing	N/A	1730381476	0	0	BOADA-DOUTT, CYNTHIA LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39678	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
344637	Ordering, Referring, Prescribing	N/A	1730469453	0	0	BAUMHEFNER, ADAM R PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63522	N/A	N/A	N/A	N/A	N/A	8005 EL CAMINO REAL	None	ATASCADERO	CA	93422	5211	00	06000	35.47712859	-120.6559822	San Luis Obispo County
344668	Ordering, Referring, Prescribing	N/A	1730513011	0	0	BENNETT, FRANCESCA PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66430	N/A	N/A	N/A	N/A	N/A	2222 COLORADO BLVD	None	LOS ANGELES	CA	90041	1143	00	06000	34.13922329	-118.2149338	Los Angeles County
344719	Ordering, Referring, Prescribing	N/A	1730611310	0	0	BEAGEN, PATRICK L MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157603	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
344725	Ordering, Referring, Prescribing	N/A	1730613811	0	0	BHUSHAN, RAGINI MD	7/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169518	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
344739	Ordering, Referring, Prescribing	N/A	1730651266	0	0	BANDA, VANESSA L LCSW	1/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93117	N/A	N/A	N/A	N/A	N/A	1095 HILLTOP DRIVE #369	None	REDDING	CA	96003	3811	00	06000	40.59126719	-122.3582225	Shasta County
344751	Ordering, Referring, Prescribing	N/A	1730665407	0	0	BALLIS, MAYA PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77435	N/A	N/A	N/A	N/A	N/A	501 J ST	None	SACRAMENTO	CA	95814	2325	00	06000	38.582118	-121.499325	Sacramento County
344752	Ordering, Referring, Prescribing	N/A	1730673450	0	0	BEVIL, KISHAN L LCSW	2/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94074	N/A	N/A	N/A	N/A	N/A	44300 LOWTREE AVENUE	102-106	LANCASTER	CA	93534	4148	00	06000	34.6882102	-118.1540483	Los Angeles County
344795	Ordering, Referring, Prescribing	N/A	1730735234	0	0	BURGIN, EMMA LMFT	11/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135719	N/A	N/A	N/A	N/A	N/A	15339 SATICOY STREET	None	VAN NUYS	CA	91406	0200	00	06000	34.2084865	-118.4678505	Los Angeles County
344812	Ordering, Referring, Prescribing	N/A	1730769100	0	0	BUSTAMANTE, STEVEN KALANI MD	1/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193132	N/A	N/A	N/A	N/A	N/A	1501 E HOLT AVENUE	None	POMONA	CA	91767	5823	00	06000	34.06321709	-117.7205804	Los Angeles County
344814	Ordering, Referring, Prescribing	N/A	1730774944	0	0	BRINCKERHOFF, KIMBERLY F CNP	8/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017002	N/A	N/A	N/A	N/A	N/A	530 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3723	00	06000	34.02866849	-118.2597481	Los Angeles County
344836	Ordering, Referring, Prescribing	N/A	1730839424	0	0	BEVERLEY, STEPHANIE J RN PHN	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95047803	N/A	N/A	N/A	N/A	N/A	1801 S POPLAR ST	None	SANTA ANA	CA	92704	4321	00	06000	33.72358134	-117.8872543	Orange County
344840	Ordering, Referring, Prescribing	N/A	1730850082	0	0	BAIDAWAR, UPASANA	6/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS106992	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
344879	Ordering, Referring, Prescribing	N/A	1740069152	0	0	BAEZA JIMENEZ, ROXANN CCC-SLP	9/26/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	35966	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
344914	Ordering, Referring, Prescribing	N/A	1740315183	0	0	BRICENO, MARCELLA LMFT	4/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43055	N/A	N/A	N/A	N/A	N/A	801 E CHAPMAN AVE	None	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
344919	Ordering, Referring, Prescribing	N/A	1740335116	0	0	BUCHEK, CARRIE M LMFT	8/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119845	N/A	N/A	N/A	N/A	N/A	2730 SALVIO STREET	None	CONCORD	CA	94519	2599	00	06000	37.98056223	-122.0282614	Contra Costa County
344922	Ordering, Referring, Prescribing	N/A	1740340231	0	0	BAUDRY, MOJDEH PHARMD	4/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43699	N/A	N/A	N/A	N/A	N/A	6640 ALTON PKWY	None	IRVINE	CA	92618	3734	00	06000	33.65911992	-117.7737909	Orange County
344961	Ordering, Referring, Prescribing	N/A	1740444777	0	0	BHANSALI, RAKESH KUMAR MD	4/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119352	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
344966	Ordering, Referring, Prescribing	N/A	1740465905	0	0	BAPTISTA, CRISTIANA A PHD	5/15/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27833	N/A	N/A	N/A	N/A	N/A	610 SANTA MONICA BLVD	223	SANTA MONICA	CA	90401	1611	00	06000	34.01816927	-118.4930051	Los Angeles County
344972	Ordering, Referring, Prescribing	N/A	1740481761	0	0	BAVARSKY, ANITA PSYD	7/10/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	22481	N/A	N/A	N/A	N/A	N/A	23123 VENTURA BLVD.	210	WOODLAND HILLS	CA	91364	1181	00	06000	34.16339045	-118.629576	Los Angeles County
344981	Ordering, Referring, Prescribing	N/A	1740511609	0	0	BURRILL, PHILLIP D LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84557	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5441	00	06000	38.425482	-122.75262	Sonoma County
344988	Ordering, Referring, Prescribing	N/A	1740529551	0	0	BUCHWITZ, BRITTANY A LMFT	7/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117136	N/A	N/A	N/A	N/A	N/A	1045 9TH AVE	None	SAN DIEGO	CA	92101	5504	00	06000	32.71607643	-117.1564968	San Diego County
345000	Ordering, Referring, Prescribing	N/A	1740543107	0	0	BRENNAN, JACK LMFT	10/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116210	N/A	N/A	N/A	N/A	N/A	1554 S SEPULVEDA BLVD	212A	LOS ANGELES	CA	90025	3359	00	06000	34.04932139	-118.4457323	Los Angeles County
345002	Ordering, Referring, Prescribing	N/A	1740560366	0	0	BLAKE, GISEL M LMFT	11/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123322	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
345033	Ordering, Referring, Prescribing	N/A	1740609361	0	0	BHALANI, KSHITIJ V MD	1/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A175174	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
345037	Ordering, Referring, Prescribing	N/A	1740614718	0	0	BUTLER, ALONIE E PSYD	8/8/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31133	N/A	N/A	N/A	N/A	N/A	4900 CALIFORNIA AVE.	SUITE 100B	BAKERSFIELD	CA	93309	7081	00	06000	35.36440586	-119.0562732	Kern County
345044	Ordering, Referring, Prescribing	N/A	1740619964	0	0	BLITZSTEIN, LEAR LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96299	N/A	N/A	N/A	N/A	N/A	2277 UNIVERSITY AVE	None	EAST PALO ALTO	CA	94303	1717	00	06000	37.46765535	-122.1415898	San Mateo County
345050	Ordering, Referring, Prescribing	N/A	1740620566	0	0	BUI, DONG V LCSW	6/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81886	N/A	N/A	N/A	N/A	N/A	333 TURK ST	None	SAN FRANCISCO	CA	94102	3703	00	06000	37.78269889	-122.4145456	San Francisco County
345060	Ordering, Referring, Prescribing	N/A	1740642719	0	0	BARNES, GEORGIA L NP	12/14/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001120	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	210	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
345068	Ordering, Referring, Prescribing	N/A	1740660307	0	0	BAKER-WILKINSON, TYLER W LMFT	3/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96824	N/A	N/A	N/A	N/A	N/A	2130 N VENTURA RD	None	OXNARD	CA	93036	2246	00	06000	34.22414993	-119.1944701	Ventura County
345075	Ordering, Referring, Prescribing	N/A	1740672153	0	0	BURCIAGA ROSALES, JOAQUIN PHD	6/14/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27016	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
345130	Ordering, Referring, Prescribing	N/A	1740747880	0	0	BAE, DAVID H	2/15/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	102263	N/A	N/A	N/A	N/A	N/A	972 GOODRICH BLVD	None	COMMERCE	CA	90022	4114	00	06000	34.01786727	-118.1546159	Los Angeles County
345158	Ordering, Referring, Prescribing	N/A	1740784669	0	0	BOOTH, BRITTANY I MD MPH	11/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166199	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
345190	Ordering, Referring, Prescribing	N/A	1740841253	0	0	BOTHA, BIANCA LCSW	11/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92674	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4113	00	06000	35.3830369	-118.9680991	Kern County
345202	Ordering, Referring, Prescribing	N/A	1740878958	0	0	BHATTACHARYYA, URMI M	3/1/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105989	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
345204	Ordering, Referring, Prescribing	N/A	1740862770	0	0	BAILEY, JAMES M NP	11/29/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013951	N/A	N/A	N/A	N/A	N/A	2813 S MAIN ST	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
345224	Ordering, Referring, Prescribing	N/A	1740915891	0	0	BAIDEN SOKOYA, EKUA A NP	8/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021190	N/A	N/A	N/A	N/A	N/A	4371 LATHAM ST	None	RIVERSIDE	CA	92501	1706	00	06000	34.00254078	-117.375234	Riverside County
345236	Ordering, Referring, Prescribing	N/A	1740965748	0	0	BAKER, KOURTNEY PA-C	9/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63261	N/A	N/A	N/A	N/A	N/A	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05128153	-119.0422344	Tulare County
345298	Ordering, Referring, Prescribing	N/A	1750395042	0	0	BUSIC, JANET R LMFT	6/4/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	32784	N/A	N/A	N/A	N/A	N/A	7248 GOLD RUN DR	None	OAKDALE	CA	95361	7877	00	06000	37.74476292	-120.9026548	Stanislaus County
345304	Ordering, Referring, Prescribing	N/A	1750410098	0	0	BECERRA, AZALEA A LMFT	11/5/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41089	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVENUE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
345309	Ordering, Referring, Prescribing	N/A	1750413365	0	0	BOWDEN, TOMIA J LMFT	5/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT81803	N/A	N/A	N/A	N/A	N/A	626 W LANCASTER BLVD	SUITE 108	LANCASTER	CA	93534	3108	00	06000	34.69792171	-118.1404554	Los Angeles County
345314	Ordering, Referring, Prescribing	N/A	1750418653	0	0	BAGNIS, KEN LMFT	10/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42155	N/A	N/A	N/A	N/A	N/A	5335 CRANER AVE	None	NORTH HOLLYWOOD	CA	91601	3313	00	06000	34.167933	-118.3691895	Los Angeles County
345318	Ordering, Referring, Prescribing	N/A	1750419230	0	0	BHARDWAJ, PRITI MD	6/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94479	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1938	00	06000	33.85486409	-118.2905603	Los Angeles County
345319	Ordering, Referring, Prescribing	N/A	1750419677	0	0	BARRERAS, BENJAMIN B MD	4/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88859	N/A	N/A	N/A	N/A	N/A	2712 MISSION STREET	None	SAN FRANCISCO,	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
345363	Ordering, Referring, Prescribing	N/A	1750531265	0	0	BARTOLOZZI, JOHN	12/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53157	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC AVE	370	LONG BEACH	CA	90806	2657	00	06000	33.805854	-118.1936805	Los Angeles County
345370	Ordering, Referring, Prescribing	N/A	1750549283	0	0	BLAISDELL, SCOTT LCSW	8/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17400	N/A	N/A	N/A	N/A	N/A	3800 KILROY AIRPORT WAY	100	LONG BEACH	CA	90806	6818	00	06000	33.80725242	-118.14497	Los Angeles County
345371	Ordering, Referring, Prescribing	N/A	1750563664	0	0	BEIZAEE, ARASH A	2/28/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D50847	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
345396	Ordering, Referring, Prescribing	N/A	1750628327	0	0	BOWMAN, ROB LMFT	11/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103821	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	STE. 200	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
345421	Ordering, Referring, Prescribing	N/A	1750674685	0	0	BLIEDEN, CARLA PHARMD	2/26/2024	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62827	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST.	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
345441	Ordering, Referring, Prescribing	N/A	1750708632	0	0	BUZZA, COLIN D MD	8/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138297	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	#7M8	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
345448	Ordering, Referring, Prescribing	N/A	1750717435	0	0	BEJAR LUA, ARACELI LCSW	4/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88712	N/A	N/A	N/A	N/A	N/A	1001 MAIN STREET	None	DELANO	CA	93215	1730	00	06000	35.76932624	-119.245737	Kern County
345459	Ordering, Referring, Prescribing	N/A	1750724738	0	0	BARAJAS, FEYGEL LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99857	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
345472	Ordering, Referring, Prescribing	N/A	1750749495	0	0	BRUTON, EMILY PT	6/22/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	43255	N/A	N/A	N/A	N/A	N/A	HWY 162 & BIGGAR LN	None	COVELO	CA	95428	0247	00	06000	39.809763	-123.2481105	Mendocino County
345484	Ordering, Referring, Prescribing	N/A	1750757886	0	0	BAILEY, DARENA A CP	6/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	4399	N/A	N/A	N/A	N/A	N/A	13778 RUETTE LE PARC	None	DEL MAR	CA	92014	3576	00	06000	32.94876672	-117.2450279	San Diego County
345487	Ordering, Referring, Prescribing	N/A	1750762423	0	0	BUGARIN, CAROLINA LCSW	6/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95067	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
345500	Ordering, Referring, Prescribing	N/A	1750782488	0	0	BOHLENDER, JERYLYN A	3/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	68362	N/A	N/A	N/A	N/A	N/A	2101 ALEXIAN DR	SUITE A	SAN JOSE	CA	95116	1901	00	06000	37.35943657	-121.848055	Santa Clara County
345522	Ordering, Referring, Prescribing	N/A	1750820965	0	0	BLUMENFELD, MARIKO E NP	1/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95006095	N/A	N/A	N/A	N/A	N/A	320 EL CERRITO PLZ	None	EL CERRITO	CA	94530	4004	00	06000	37.89921493	-122.2981973	Contra Costa County
345538	Ordering, Referring, Prescribing	N/A	1750796215	0	0	BABAYAN, ANDREW Y OD	10/23/2014	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15116	N/A	N/A	N/A	N/A	N/A	12000 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3319	00	06000	34.18665451	-118.394541	Los Angeles County
345576	Ordering, Referring, Prescribing	N/A	1750911723	0	0	BENN-TOWLE, JESSICA LMFT	10/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132819	N/A	N/A	N/A	N/A	N/A	700 FREDERICK ST	SUITE 103	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
345581	Ordering, Referring, Prescribing	N/A	1750920419	0	0	BERRY MILLETT, KATE NP	12/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013403	N/A	N/A	N/A	N/A	N/A	1104 BUCHANAN RD	#C10	ANTIOCH	CA	94509	4205	00	06000	37.99867244	-121.823243	Contra Costa County
345584	Ordering, Referring, Prescribing	N/A	1750931556	0	0	BAINS, PARVEEN K OD	9/12/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34399	N/A	N/A	N/A	N/A	N/A	3710 HWY 45	None	COLUSA	CA	95932	0000	00	06000	39.25060345	-122.0314303	Colusa County
345589	Ordering, Referring, Prescribing	N/A	1750941449	0	0	BOTROS, ANN MARIE MD	11/14/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A199965	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE, 6TH FL	None	LONG BEACH	CA	90806	2304	00	06000	33.806097	-118.151378	Los Angeles County
345592	Ordering, Referring, Prescribing	N/A	1750942553	0	0	BRINSON, ASHLEY LMFT	5/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132742	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE.	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
345627	Ordering, Referring, Prescribing	N/A	1760025332	0	0	BRADY, KEVIN M PHARMD	10/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	APH10505	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
345630	Ordering, Referring, Prescribing	N/A	1760029144	0	0	BISHOP, WEAVE C	11/21/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013332	N/A	N/A	N/A	N/A	N/A	6120 SEVILLE AVENUE	None	HUNTINGTON PARK	CA	90255	0000	00	06000	33.98438021	-118.2226279	Los Angeles County
345681	Ordering, Referring, Prescribing	N/A	1760175426	0	0	BELNAP, DAVID PA-C	7/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63091	N/A	N/A	N/A	N/A	N/A	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05128153	-119.0422344	Tulare County
345682	Ordering, Referring, Prescribing	N/A	1760181036	0	0	BUKHARI, SYEDA P NP	7/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022041	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
345683	Ordering, Referring, Prescribing	N/A	1760174486	0	0	BERNALES, ELIJAH JUSTIN LMFT	11/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131492	N/A	N/A	N/A	N/A	N/A	401 W. CIVIC CENTER DR.	700	SANTA ANA	CA	92701	4515	00	06000	33.75157353	-117.870921	Orange County
345743	Ordering, Referring, Prescribing	N/A	1760546238	0	0	BROWN, GREGORY P LMFT	7/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35923	N/A	N/A	N/A	N/A	N/A	815 HYDE ST	317	SAN FRANCISCO	CA	94109	5996	00	06000	37.78855	-122.416917	San Francisco County
345748	Ordering, Referring, Prescribing	N/A	1760556567	0	0	BROWN, KATHLEEN S LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44011	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY STREET	SUITE E500	FREMONT	CA	94537	5006	00	06000	37.55123907	-121.9828956	Alameda County
345757	Ordering, Referring, Prescribing	N/A	1760570196	0	0	BERENTSON, KARI L	8/23/2020	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	R22569	N/A	N/A	N/A	N/A	N/A	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	06000	48.23336909	-101.2951165	Ward County
345770	Ordering, Referring, Prescribing	N/A	1760624381	0	0	BESS, ALLYCE A	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52034	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
345791	Ordering, Referring, Prescribing	N/A	1760674527	0	0	BALDWIN, KISMET M MD	5/7/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111522	N/A	N/A	N/A	N/A	N/A	1601 E. HAZELTON AVE.	None	STOCKTON	CA	95205	6229	00	06000	37.9501034	-121.2684501	San Joaquin County
345807	Ordering, Referring, Prescribing	N/A	1760707400	0	0	BARRIENTOS, SANDRA I PSYD	1/26/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32353	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR SUITE	150	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
345812	Ordering, Referring, Prescribing	N/A	1760709943	0	0	BENWAY, ELI T LCSW	10/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82225	N/A	N/A	N/A	N/A	N/A	730 POLK ST	4TH FL	SAN FRANCISCO	CA	94109	7813	00	06000	37.78379532	-122.4192766	San Francisco County
345820	Ordering, Referring, Prescribing	N/A	1760730832	0	0	BALTAZAR, MARIA M LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109818	N/A	N/A	N/A	N/A	N/A	530 W BADILLO ST	None	COVINA	CA	91722	3787	00	06000	34.08625283	-117.8999625	Los Angeles County
345830	Ordering, Referring, Prescribing	N/A	1760746242	0	0	BACHOURA, GEORGINA NP	2/19/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21860	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
345841	Ordering, Referring, Prescribing	N/A	1760739221	0	0	BELTRAN, MIRNA E LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76563	N/A	N/A	N/A	N/A	N/A	8929 S. SEPULVEDA BLVD.	SUITE 201	LOS ANGELES	CA	90008	7360	00	06000	33.955164	-118.396248	Los Angeles County
345851	Ordering, Referring, Prescribing	N/A	1760775639	0	0	BALCH, AMANDA B NP	12/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20385	N/A	N/A	N/A	N/A	N/A	3904 VINALOPO DR	None	AUSTIN	TX	78738	6992	00	06000	30.31695274	-97.96275865	Travis County
345962	Ordering, Referring, Prescribing	N/A	1760933873	0	0	BIDDLE, CARINA LMFT	7/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148344	N/A	N/A	N/A	N/A	N/A	19712 MACARTHUR BLVD	110	IRVINE	CA	92612	2407	00	06000	33.65788122	-117.8626278	Orange County
345968	Ordering, Referring, Prescribing	N/A	1760911622	0	0	BUI, CHIARA L	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75815	N/A	N/A	N/A	N/A	N/A	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33578	-121.999329	Santa Clara County
345970	Ordering, Referring, Prescribing	N/A	1760942452	0	0	BADER, ELIZABETH M NP	11/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010427	N/A	N/A	N/A	N/A	N/A	1403 W. LOMITA BLVD.	100	HARBOR CITY	CA	90710	2084	00	06000	33.79785936	-118.3016552	Los Angeles County
345972	Ordering, Referring, Prescribing	N/A	1760942254	0	0	BHAKTA, SAGAR PHARMD	4/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	80347	N/A	N/A	N/A	N/A	N/A	25620 BARTON RD	None	LOMA LINDA	CA	92354	3110	00	06000	34.0485153	-117.246114	San Bernardino County
345997	Ordering, Referring, Prescribing	N/A	1760990089	0	0	BENZSCHAWEL, NICHOLAS A PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74425	N/A	N/A	N/A	N/A	N/A	13691 SAN PABLO AVE	None	SAN PABLO	CA	94806	3837	00	06000	37.95834677	-122.339696	Contra Costa County
346026	Ordering, Referring, Prescribing	N/A	1770043887	0	0	BESOYAN, AUDRIE ANNE P NP	3/31/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011170	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
346030	Ordering, Referring, Prescribing	N/A	1770057176	0	0	BROOKS, CYNTHIA A LMFT	7/19/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86672	N/A	N/A	N/A	N/A	N/A	27285 LAS RAMBLAS	232	MISSION VIEJO	CA	92691	6325	00	06000	33.56648531	-117.6686964	Orange County
346052	Ordering, Referring, Prescribing	N/A	1770090748	0	0	BOHNA, DANIELLE M LMFT	5/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126087	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
346057	Ordering, Referring, Prescribing	N/A	1770091621	0	0	BEAL, RANE N NP	12/16/2017	Taxonomy not applicable	NA	n/a	000	Unknown	95008226	N/A	N/A	N/A	N/A	N/A	201 29TH ST	STE B	SACRAMENTO	CA	95816	3288	00	06000	38.581875	-121.463802	Sacramento County
346067	Ordering, Referring, Prescribing	N/A	1770139966	0	0	BOYLE, KRISTY L	1/8/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	103305	N/A	N/A	N/A	N/A	N/A	8041 NEWMAN AVE	STE 227	HUNTINGTON BEACH	CA	92647	7034	00	06000	33.70481104	-117.9882948	Orange County
346086	Ordering, Referring, Prescribing	N/A	1770168312	0	0	BOATWRIGHT, TERESA A PHARMD	4/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	82307	N/A	N/A	N/A	N/A	N/A	7000 AUBURN BLVD	None	CITRUS HEIGHTS	CA	95621	4342	00	06000	38.689875	-121.2975585	Sacramento County
346087	Ordering, Referring, Prescribing	N/A	1770164360	0	0	BRENNER, ABIGAIL M	12/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8540	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
346116	Ordering, Referring, Prescribing	N/A	1770289043	0	0	BASLER, JULIE A NP	8/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026642	N/A	N/A	N/A	N/A	N/A	420 W. ACACIA ST.	1	STOCKTON	CA	95203	2441	00	06000	37.96135715	-121.2996632	San Joaquin County
346151	Ordering, Referring, Prescribing	N/A	1770607897	0	0	BROTT, LISA M LCSW	6/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16870	N/A	N/A	N/A	N/A	N/A	2550 W CLINTON AVE	BUILDING W	FRESNO	CA	93705	4201	00	06000	36.77202022	-119.8415276	Fresno County
346165	Ordering, Referring, Prescribing	N/A	1770629172	0	0	BOYSEN, ALEXANDRA A	4/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57059	N/A	N/A	N/A	N/A	N/A	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	0000	00	06000	38.00450116	-122.5540001	Marin County
346172	Ordering, Referring, Prescribing	N/A	1770650384	0	0	BROWN, MEHRAVAR E	8/18/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D41708	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
346208	Ordering, Referring, Prescribing	N/A	1770734550	0	0	BOOTHE, SONIA V PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61361	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	OFFICE A 1543	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
346214	Ordering, Referring, Prescribing	N/A	1770747768	0	0	BANG, MARY	4/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60125	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	#4891	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
346227	Ordering, Referring, Prescribing	N/A	1770775058	0	0	BLUHM, IVANA J CNP	10/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12012	N/A	N/A	N/A	N/A	N/A	802 W COLTON AVE	STE E	REDLANDS	CA	92374	2905	00	06000	34.06290649	-117.1918845	San Bernardino County
346231	Ordering, Referring, Prescribing	N/A	1770762429	0	0	BONNVILLE, HEATHER K	2/19/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA19271	N/A	N/A	N/A	N/A	N/A	1421 EAST 17TH ST	None	SANTA ANA	CA	92705	8505	00	06000	33.75994564	-117.847815	Orange County
346250	Ordering, Referring, Prescribing	N/A	1770834632	0	0	BLUM, VANESSA M PHD	7/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26363	N/A	N/A	N/A	N/A	N/A	3270 KERNER BLVD	SUITE 1	SAN RAFAEL	CA	94901	3270	00	06000	37.96108677	-122.5017451	Marin County
346270	Ordering, Referring, Prescribing	N/A	1770867756	0	0	BARNETT, SELINA PHD	6/21/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	22504	N/A	N/A	N/A	N/A	N/A	2333 S MOONEY BLVD	None	VISALIA	CA	93277	6228	00	06000	36.308682	-119.3154255	Tulare County
346306	Ordering, Referring, Prescribing	N/A	1770924870	0	0	BURG, TIFFANY M LCSW	4/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92359	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
346338	Ordering, Referring, Prescribing	N/A	1770968463	0	0	BALOUCH, AMIR F	9/24/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64790	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
346344	Ordering, Referring, Prescribing	N/A	1770977589	0	0	BUSICO, JENNIFER D LMFT	7/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83552	N/A	N/A	N/A	N/A	N/A	200 MICHIGAN AVE	None	VISTA	CA	92084	5424	00	06000	33.2038743	-117.2421678	San Diego County
346351	Ordering, Referring, Prescribing	N/A	1770989634	0	0	BROWN, CHLOE B LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98836	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400 SUITE 202	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
346359	Ordering, Referring, Prescribing	N/A	1770994147	0	0	BLACKBURN, JAMES A LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107839	N/A	N/A	N/A	N/A	N/A	768 PLEASANT VALLEY RD	None	DIAMOND SPRINGS	CA	95619	9260	00	06000	38.69498433	-120.8070771	El Dorado County
346379	Ordering, Referring, Prescribing	N/A	1780036798	0	0	BENNETT, NICOLE LCSW	1/14/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99624	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
346398	Ordering, Referring, Prescribing	N/A	1780063602	0	0	BURNETT, MELISSA LCSW	10/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89094	N/A	N/A	N/A	N/A	N/A	1529 EAST PALMDALE BLVD.	150	PALMDALE	CA	93550	2038	00	06000	34.57966052	-118.102275	Los Angeles County
346449	Ordering, Referring, Prescribing	N/A	1780135459	0	0	BONWELL, BRIANA LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119277	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
346461	Ordering, Referring, Prescribing	N/A	1780160978	0	0	BELLI, LYLA	6/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	3451	N/A	N/A	N/A	N/A	N/A	2255 BANCROFT AVE	None	SAN LEANDRO	CA	94577	6107	00	06000	37.7173224	-122.1428765	Alameda County
346484	Ordering, Referring, Prescribing	N/A	1780209304	0	0	BHANGU, JASMEEN K OD	8/24/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34668	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
346497	Ordering, Referring, Prescribing	N/A	1780248633	0	0	BOUMOULA, KENZA M LMFT	11/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135879	N/A	N/A	N/A	N/A	N/A	1600 W CAMPBELL AVE #201	None	CAMPBELL	CA	95008	0104	00	06000	37.28599733	-121.9780835	Santa Clara County
346531	Ordering, Referring, Prescribing	N/A	1780345561	0	0	BO, DANIELLE M NP	9/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015927	N/A	N/A	N/A	N/A	N/A	1670 E. 120 TH STREET	NSB 2 C06	LOS ANGELES	CA	90059	0000	00	06000	33.92456051	-118.2417525	Los Angeles County
346546	Ordering, Referring, Prescribing	N/A	1780374868	0	0	BARRETT, KATELYN PHARMD	5/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	87967	N/A	N/A	N/A	N/A	N/A	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	00	06000	37.70755227	-121.7149933	Alameda County
346553	Ordering, Referring, Prescribing	N/A	1780453191	0	0	BIRD, BRETT	12/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028522	N/A	N/A	N/A	N/A	N/A	12740 HESPERIA RD	A	VICTORVILLE	CA	92395	8306	00	06000	34.48256788	-117.2905361	San Bernardino County
346557	Ordering, Referring, Prescribing	N/A	1780459958	0	0	BALLOUT, REEM NP	11/17/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028078	N/A	N/A	N/A	N/A	N/A	728 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3052	00	06000	33.12769389	-117.0730873	San Diego County
346560	Ordering, Referring, Prescribing	N/A	1780603514	0	0	BHAT, BALA K MD	12/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43451	N/A	N/A	N/A	N/A	N/A	260 STATION WAY	None	ARROYO GRANDE	CA	93420	3359	00	06000	35.11996545	-120.5781386	San Luis Obispo County
346566	Ordering, Referring, Prescribing	N/A	1780456137	0	0	BHOJAK, VEDANSHI PHARMD	2/27/2024	Taxonomy not applicable	NA	n/a	000	Unknown	88857	N/A	N/A	N/A	N/A	N/A	11822 FLORAL DR WHITTIER	None	WHITTIER	CA	90601	1001	00	06000	33.99172377	-118.0495187	Los Angeles County
346584	Ordering, Referring, Prescribing	N/A	1780700443	0	0	BERG, SHARON Z PHD	10/23/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18987	N/A	N/A	N/A	N/A	N/A	849 EAST 6TH STREET	None	LOS ANGELES	CA	90021	1026	00	06000	34.03994957	-118.2414778	Los Angeles County
346586	Ordering, Referring, Prescribing	N/A	1780706770	0	0	BENNETT, STEPHANIE LMFT	3/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91182	N/A	N/A	N/A	N/A	N/A	2750 E WASHINGTON BLVD	230	PASADENA	CA	91107	1448	00	06000	34.1680038	-118.0943955	Los Angeles County
346599	Ordering, Referring, Prescribing	N/A	1780713230	0	0	BANKS, RACHEL MD	1/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C183271	N/A	N/A	N/A	N/A	N/A	1315 S ADAMS ST	None	FORT WORTH	TX	76104	4404	00	06000	32.72994159	-97.33672572	Tarrant County
346601	Ordering, Referring, Prescribing	N/A	1780736280	0	0	BETTI, ANGELA M LCSW	4/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24622	N/A	N/A	N/A	N/A	N/A	1521 UNIVERSITY AVE	None	BERKELEY	CA	94703	1422	00	06000	37.87060038	-122.2812128	Alameda County
346630	Ordering, Referring, Prescribing	N/A	1780795732	0	0	BURR, LADONNA W NMP	2/8/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0546729	N/A	N/A	N/A	N/A	N/A	8520 S BROADWAY	None	LOS ANGELES	CA	90003	3335	00	06000	33.96110579	-118.2782667	Los Angeles County
346664	Ordering, Referring, Prescribing	N/A	1780890665	0	0	BALCH, HARVEY M	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D19999	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
346712	Ordering, Referring, Prescribing	N/A	1780966234	0	0	BELCHER, PAUL	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PRH36838	N/A	N/A	N/A	N/A	N/A	100 W ONTARIO AVE	None	CORONA	CA	92882	5215	00	06000	33.85631483	-117.5699252	Riverside County
346735	Ordering, Referring, Prescribing	N/A	1790006989	0	0	BASSI, PROBHJOT PHARMD	1/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	63581	N/A	N/A	N/A	N/A	N/A	610 E NEES AVE	None	FRESNO	CA	93720	2198	00	06000	36.8520345	-119.773917	Fresno County
346748	Ordering, Referring, Prescribing	N/A	1790034726	0	0	BUCHANAN, BRITTNEY PSYD	1/14/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29152	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	None	LOS ANGELES	CA	90018	1336	00	06000	34.037415	-118.3176815	Los Angeles County
346751	Ordering, Referring, Prescribing	N/A	1790049260	0	0	BARRAGAN, MARIBEL LMFT	12/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123849	N/A	N/A	N/A	N/A	N/A	1801 PARK COURT PL	H	SANTA ANA	CA	92701	5002	00	06000	33.74986153	-117.8429355	Orange County
346765	Ordering, Referring, Prescribing	N/A	1790058352	0	0	BALLESTEROS, PATRICIA D LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108455	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
346776	Ordering, Referring, Prescribing	N/A	1790067791	0	0	BONGERS, ANNETTE M NP	9/11/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16088	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
346779	Ordering, Referring, Prescribing	N/A	1790070340	0	0	BRANSBURG, TAMARA LCSW	7/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68703	N/A	N/A	N/A	N/A	N/A	951 MADISON ST	None	ALBANY	CA	94706	2024	00	06000	37.88826153	-122.3001445	Alameda County
346784	Ordering, Referring, Prescribing	N/A	1790071033	0	0	BOTT, KENYON J RN PNP	8/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	3761704405	N/A	N/A	N/A	N/A	N/A	62 S 950 W	None	BRIGHAM CITY	UT	84302	4424	00	06000	41.50910608	-112.0312665	Box Elder County
346788	Ordering, Referring, Prescribing	N/A	1790084044	0	0	BOLDEN, PSHANA Q LCSW	7/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62906	N/A	N/A	N/A	N/A	N/A	1501 FRUITVALE AVE	None	OAKLAND	CA	94601	2322	00	06000	37.77894489	-122.2252034	Alameda County
346804	Ordering, Referring, Prescribing	N/A	1790098697	0	0	BATTERTON, AMY S LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91508	N/A	N/A	N/A	N/A	N/A	509 W 10TH ST	None	ANTIOCH	CA	94509	1653	00	06000	38.01116769	-121.8130914	Contra Costa County
346831	Ordering, Referring, Prescribing	N/A	1790153666	0	0	BATTLES, RAYVEN	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91756	N/A	N/A	N/A	N/A	N/A	10421 S FIGUEROA ST	None	LOS ANGELES	CA	90003	4423	00	06000	33.941736	-118.2826495	Los Angeles County
346835	Ordering, Referring, Prescribing	N/A	1790157915	0	0	BUCHANAN, JENNIFER L CNM	9/12/2016	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	696356	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
346854	Ordering, Referring, Prescribing	N/A	1790166866	0	0	BUI, ANN PHARMD	10/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54667	N/A	N/A	N/A	N/A	N/A	2000 E 17TH ST	None	SANTA ANA	CA	92705	8647	00	06000	33.75980651	-117.8382375	Orange County
346859	Ordering, Referring, Prescribing	N/A	1790181816	0	0	BENNETT, ERIN M NP	10/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015609	N/A	N/A	N/A	N/A	N/A	14671 OLYMPIC DRIVE	None	CLEARLAKE	CA	95422	9516	00	06000	38.9618304	-122.6382453	Lake County
346902	Ordering, Referring, Prescribing	N/A	1790245116	0	0	BOURBEAU-MEDINILLA, KATHERINE E MD	4/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178058	N/A	N/A	N/A	N/A	N/A	400 N PEPPER AVE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
346915	Ordering, Referring, Prescribing	N/A	1790262574	0	0	BUCHANAN, SHAKERA LCSW	8/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117599	N/A	N/A	N/A	N/A	N/A	5222 YGNACIO AVE	None	OAKLAND	CA	94601	5422	00	06000	37.7735641	-122.2024662	Alameda County
346925	Ordering, Referring, Prescribing	N/A	1790271252	0	0	BORDEN, DESIREE C PHARMD	3/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77402	N/A	N/A	N/A	N/A	N/A	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.8531521	-117.8160824	Orange County
346934	Ordering, Referring, Prescribing	N/A	1790284263	0	0	BROSNIHAN, MORGAN PT	1/31/2025	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT301582	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
346943	Ordering, Referring, Prescribing	N/A	1790308906	0	0	BRENNER, SARA LCSW	10/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92510	N/A	N/A	N/A	N/A	N/A	31350 RANCHO VISTA RD	None	TEMECULA	CA	92592	6200	00	06000	33.50406869	-117.1134793	Riverside County
346946	Ordering, Referring, Prescribing	N/A	1790313922	0	0	BUGARIN, MAYRA A MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183933	N/A	N/A	N/A	N/A	N/A	3420 COLLEGE AVENUE	None	SAN DIEGO	CA	92115	7134	00	06000	32.74405281	-117.0538025	San Diego County
346951	Ordering, Referring, Prescribing	N/A	1790322055	0	0	BARNES-MATTHEWS, CHRISTINA L PSYD	11/20/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35507	N/A	N/A	N/A	N/A	N/A	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	00	06000	32.75537928	-117.1416551	San Diego County
346979	Ordering, Referring, Prescribing	N/A	1790384279	0	0	BROWN, DANIELL NP	5/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95016408	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	401	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
347044	Ordering, Referring, Prescribing	N/A	1790789600	0	0	BEARDSLEY, GALE R MD	1/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G151697	N/A	N/A	N/A	N/A	N/A	560 COHASSET RD	175	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
347050	Ordering, Referring, Prescribing	N/A	1790809366	0	0	BROWN, LAURA L LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47690	N/A	N/A	N/A	N/A	N/A	6061 EAST AVE	None	ETIWANDA	CA	91739	2218	00	06000	34.14421719	-117.514554	San Bernardino County
347099	Ordering, Referring, Prescribing	N/A	1790901874	0	0	BOLIVAR, LUIS LMFT	9/25/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT21014	N/A	N/A	N/A	N/A	N/A	10329 HOLE AVE	None	RIVERSIDE	CA	92505	1747	00	06000	33.91542189	-117.4652979	Riverside County
347103	Ordering, Referring, Prescribing	N/A	1790895514	0	0	BALLARD, JEFFREY MD	1/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83822	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	0001	00	06000	34.04209386	-118.2486813	Los Angeles County
347106	Ordering, Referring, Prescribing	N/A	1790920221	0	0	BOWERS, JEANETTE L CNP	3/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	604063	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
347118	Ordering, Referring, Prescribing	N/A	1790959104	0	0	BENAVIDES, HILDA V LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99413	N/A	N/A	N/A	N/A	N/A	10 DOUGLAS DR	140	MARTINEZ	CA	94553	4077	00	06000	37.99546221	-122.1222474	Contra Costa County
347150	Ordering, Referring, Prescribing	N/A	1801011176	0	0	BODE, ILA B LMFT	9/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47139	N/A	N/A	N/A	N/A	N/A	9057 SOQUEL DR. D	STE A	APTOS	CA	95003	0000	00	06000	36.9757005	-121.890042	Santa Cruz County
347158	Ordering, Referring, Prescribing	N/A	1801019534	0	0	BEHRENDTSEN, OLE MD	2/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111247	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO S	STE B	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
347180	Ordering, Referring, Prescribing	N/A	1801055389	0	0	BUFORD-LEVELS, DOROTHEA E MSW LCSW	10/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64046	N/A	N/A	N/A	N/A	N/A	1845 BUSINESS CENTER DRI	130	SAN BERNARDINO	CA	92408	0019	00	06000	34.06865027	-117.2832038	San Bernardino County
347182	Ordering, Referring, Prescribing	N/A	1801076310	0	0	BLANTON, CRYSTAL N LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82542	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
347188	Ordering, Referring, Prescribing	N/A	1801091152	0	0	BHATNAGAR, NEERA LCSW	9/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95759	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
347190	Ordering, Referring, Prescribing	N/A	1801091772	0	0	BARNETT, CYNTHIA M LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50125	N/A	N/A	N/A	N/A	N/A	1255 KENDALL RD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
347207	Ordering, Referring, Prescribing	N/A	1801127659	0	0	BAJAJ, VIKAS	11/1/2019	Taxonomy not applicable	NA	n/a	000	Unknown	60672	N/A	N/A	N/A	N/A	N/A	4495 FIRST ST	None	LIVERMORE	CA	94551	0001	00	06000	37.69630144	-121.7443221	Alameda County
347221	Ordering, Referring, Prescribing	N/A	1801145321	0	0	BRANUM, FAYE A PA-C	6/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	52974	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
347238	Ordering, Referring, Prescribing	N/A	1801175716	0	0	BERRY, CHRISTEL S LMFT	9/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128274	N/A	N/A	N/A	N/A	N/A	3230 KERNER BLVD	None	SAN RAFAEL	CA	94901	4840	00	06000	37.96037915	-122.5019455	Marin County
347261	Ordering, Referring, Prescribing	N/A	1801194287	0	0	BENDER, DEANNE K LMFT	5/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38186	N/A	N/A	N/A	N/A	N/A	1227 E LOS ANGELES AVE.	None	SIMI VALLEY	CA	93065	2871	00	06000	34.27181352	-118.7762625	Ventura County
347264	Ordering, Referring, Prescribing	N/A	1801200613	0	0	BUCH, VISHAAL N MD	6/24/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163180	N/A	N/A	N/A	N/A	N/A	732 MOTT ST	100	SAN FERNANDO	CA	91340	4237	00	06000	34.27661761	-118.4442372	Los Angeles County
347271	Ordering, Referring, Prescribing	N/A	1801204722	0	0	BLOUNT, TAMMY M LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111907	N/A	N/A	N/A	N/A	N/A	2594 INDUSTRY WAY	None	LYNWOOD	CA	90262	0241	00	06000	33.92347498	-118.2266964	Los Angeles County
347272	Ordering, Referring, Prescribing	N/A	1801222443	0	0	BUTLER, TIFFANY M	1/13/2014	Taxonomy not applicable	NA	n/a	000	Unknown	PA22996	N/A	N/A	N/A	N/A	N/A	2185 PACHECO STREET	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
347275	Ordering, Referring, Prescribing	N/A	1801210745	0	0	BARHOMA, CHRISTINE PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67099	N/A	N/A	N/A	N/A	N/A	9830 LONG BEACH BLVD	None	SOUTH GATE	CA	90280	0001	00	06000	33.94602965	-118.21634	Los Angeles County
347299	Ordering, Referring, Prescribing	N/A	1801263348	0	0	BECK, SARAH PSYD	12/7/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34728	N/A	N/A	N/A	N/A	N/A	4401 CRENSHAW BLVD	300	LOS ANGELES	CA	90043	1227	00	06000	34.00339495	-118.3318951	Los Angeles County
347311	Ordering, Referring, Prescribing	N/A	1801274139	0	0	BICKART, KEVIN MD	7/11/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A148941	N/A	N/A	N/A	N/A	N/A	300 STEIN PLZ	SUITE 420	LOS ANGELES	CA	90095	0000	00	06000	34.06482846	-118.4443432	Los Angeles County
347312	Ordering, Referring, Prescribing	N/A	1801273198	0	0	BROWN, KETIA	6/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153229	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
347316	Ordering, Referring, Prescribing	N/A	1801276431	0	0	BILICK, MOLLY LCSW	5/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85974	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
347330	Ordering, Referring, Prescribing	N/A	1801295290	0	0	BYRUM, LORI LCSW	9/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88786	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
347346	Ordering, Referring, Prescribing	N/A	1801317854	0	0	BRASSAW, ROBERT C	6/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101751	N/A	N/A	N/A	N/A	N/A	401 W CIVIC CENTER DR	SUITE 800	SANTA ANA	CA	92701	4515	00	06000	33.75157353	-117.870921	Orange County
347360	Ordering, Referring, Prescribing	N/A	1801333893	0	0	BROH, ELEANOR H LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94097	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
347374	Ordering, Referring, Prescribing	N/A	1801361639	0	0	BAIESC, FLAVIUS L PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78928	N/A	N/A	N/A	N/A	N/A	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
347376	Ordering, Referring, Prescribing	N/A	1801365374	0	0	BARGHI, KATAYOUN PHARMD	11/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79374	N/A	N/A	N/A	N/A	N/A	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
347389	Ordering, Referring, Prescribing	N/A	1801379870	0	0	BAKHSHI, NICOLE PA-C	8/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55853	N/A	N/A	N/A	N/A	N/A	648 E 21ST ST	None	LOS ANGELES	CA	90011	1146	00	06000	34.02604371	-118.2589922	Los Angeles County
347393	Ordering, Referring, Prescribing	N/A	1801406426	0	0	BYRD, SHANTELL S LCSW	8/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124790	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD	2ND FLOOR	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
347402	Ordering, Referring, Prescribing	N/A	1801423728	0	0	BLANKERS, RANDALL MD	2/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184556	N/A	N/A	N/A	N/A	N/A	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
347407	Ordering, Referring, Prescribing	N/A	1801432547	0	0	BOWMAN, CYNTHIA K LPCC	4/6/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6910	N/A	N/A	N/A	N/A	N/A	560 WALL ST	None	AUBURN	CA	95603	3931	00	06000	38.90941996	-121.0753971	Placer County
347416	Ordering, Referring, Prescribing	N/A	1801447172	0	0	BRAIN, COURTNEY LMFT	5/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114283	N/A	N/A	N/A	N/A	N/A	2420 MARTIN RD	STE 200	FAIRFIELD	CA	94534	8651	00	06000	38.27452806	-122.0511683	Solano County
347421	Ordering, Referring, Prescribing	N/A	1801450267	0	0	BESAS, KATHLEEN STEPHANIE J NP	12/24/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009404	N/A	N/A	N/A	N/A	N/A	18111 NORTHRIDGE STREET	None	NORTHRIDGE	CA	91330	8270	00	06000	37.90402754	-122.1126321	Contra Costa County
347433	Ordering, Referring, Prescribing	N/A	1801492442	0	0	BOUWSMA, LAURA K PA	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59298	N/A	N/A	N/A	N/A	N/A	250 LOCUST ST	None	SANTA CRUZ	CA	95060	3813	00	06000	36.97493323	-122.028799	Santa Cruz County
347435	Ordering, Referring, Prescribing	N/A	1801493424	0	0	BREKKE, CARLEIGH J NP	7/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014998	N/A	N/A	N/A	N/A	N/A	10175 LEVON AVE	None	TRUCKEE	CA	96161	4821	00	06000	39.32449955	-120.1999296	Nevada County
347445	Ordering, Referring, Prescribing	N/A	1801525944	0	0	BROWN, EMILY NP	8/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022342	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
347446	Ordering, Referring, Prescribing	N/A	1801522859	0	0	BLAND, JACELIS NP	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022752	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
347451	Ordering, Referring, Prescribing	N/A	1801533658	0	0	BIESANZ, KATHRYN L OT	5/22/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT23682	N/A	N/A	N/A	N/A	N/A	434 7TH ST	None	EUREKA	CA	95501	1803	00	06000	40.80022571	-124.1658967	Humboldt County
347466	Ordering, Referring, Prescribing	N/A	1801634704	0	0	BOYLE, PATRICIA NP	8/12/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031625	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
347473	Ordering, Referring, Prescribing	N/A	1801810049	0	0	BRUNOLLI, JOHN M PT	12/1/2019	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT19605	N/A	N/A	N/A	N/A	N/A	1311 SANGUINETTI RD	STE C	SONORA	CA	95370	6210	00	06000	37.97447385	-120.3613052	Tuolumne County
347491	Ordering, Referring, Prescribing	N/A	1801906193	0	0	BATTY, BRENT J LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT82008	N/A	N/A	N/A	N/A	N/A	1119 E MONTE VISTA AVE	None	VACAVILLE	CA	95688	3009	00	06000	38.36024633	-121.9763983	Solano County
347496	Ordering, Referring, Prescribing	N/A	1801906649	0	0	BOHAN, DENNIS P LMFT	11/13/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	12115	N/A	N/A	N/A	N/A	N/A	870 MARKET ST	SUITE 862	SAN FRANCISCO	CA	93230	8823	00	06000	37.7848184	-122.4070488	San Francisco County
347502	Ordering, Referring, Prescribing	N/A	1801926043	0	0	BLANCHARD, ANNA LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23483	N/A	N/A	N/A	N/A	N/A	615 W CIVIC CENTER DR	200	SANTA ANA	CA	92701	4006	00	06000	33.75157048	-117.8744355	Orange County
347527	Ordering, Referring, Prescribing	N/A	1801979729	0	0	BORJORQUEZ, ANN M LMFT	7/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37890	N/A	N/A	N/A	N/A	N/A	401 THE CITY DR S	None	ORANGE	CA	92868	3303	00	06000	33.78395385	-117.8887742	Orange County
347545	Ordering, Referring, Prescribing	N/A	1811023187	0	0	BRUTON, NOELLE C LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39841	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
347548	Ordering, Referring, Prescribing	N/A	1811028806	0	0	BENNETT, MARGARET LMFT	12/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40373	N/A	N/A	N/A	N/A	N/A	11429 VALLEY BLVD	None	EL MONTE	CA	91731	3229	00	06000	34.06953065	-118.0288485	Los Angeles County
347567	Ordering, Referring, Prescribing	N/A	1811061336	0	0	BUI, LINDSEY PHARMD	4/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57540	N/A	N/A	N/A	N/A	N/A	7373 WEST LN	None	STOCKTON	CA	95210	0000	00	06000	38.017701	-121.297869	San Joaquin County
347582	Ordering, Referring, Prescribing	N/A	1811084106	0	0	BENNETT, HENRY E	5/23/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D20816	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
347585	Ordering, Referring, Prescribing	N/A	1811089717	0	0	BERTOLLI, THOMAS A MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A38824	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	00	06000	39.68781544	-123.4842982	Mendocino County
347602	Ordering, Referring, Prescribing	N/A	1811142383	0	0	BERMAN, DEBORAH LCSW	6/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116002	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
347613	Ordering, Referring, Prescribing	N/A	1811188303	0	0	BABAYANS, KATHERINE LMFT	2/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51245	N/A	N/A	N/A	N/A	N/A	206 4TH STREET	None	YREKA	CA	96097	2951	00	06000	41.73086136	-122.6377395	Siskiyou County
347616	Ordering, Referring, Prescribing	N/A	1811194178	0	0	BURRELL, KEITH A LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34129	N/A	N/A	N/A	N/A	N/A	11175 SAN PABLO AVE	None	EL CERRITO	CA	94530	2157	00	06000	37.91926262	-122.31424	Contra Costa County
347643	Ordering, Referring, Prescribing	N/A	1811231145	0	0	BURRAGE SHEETZ, HEATHER A LMFT	7/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88522	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
347694	Ordering, Referring, Prescribing	N/A	1811314271	0	0	BARRIENTOS, KYRA LMFT	2/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96883	N/A	N/A	N/A	N/A	N/A	600 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92401	1164	00	06000	34.110486	-117.2896755	San Bernardino County
347749	Ordering, Referring, Prescribing	N/A	1811403603	0	0	BOULOM, HIEU T PHARMD	10/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77146	N/A	N/A	N/A	N/A	N/A	750 S BASCOM AVE	None	SAN JOSE	CA	95128	2603	00	06000	37.314261	-121.931793	Santa Clara County
347755	Ordering, Referring, Prescribing	N/A	1811406168	0	0	BANKHEAD, EBONY N NP	5/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008775	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
347768	Ordering, Referring, Prescribing	N/A	1811423619	0	0	BLUE, SARAH E MD	8/31/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181679	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	475	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
347793	Ordering, Referring, Prescribing	N/A	1811469349	0	0	BLOOMBERG, LAURA A	12/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130210	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE., SUITE 1	None	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
347798	Ordering, Referring, Prescribing	N/A	1811474513	0	0	BAZYAR, MEHRZAD LMFT	10/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108725	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	500	THOUSAND OAKS	CA	91360	4402	00	06000	34.17854676	-118.8805015	Ventura County
347804	Ordering, Referring, Prescribing	N/A	1811478662	0	0	BOWREY, JOHNNY PHARMD	9/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77147	N/A	N/A	N/A	N/A	N/A	3500 COFFEE RD	None	MODESTO	CA	95355	1305	00	06000	37.690002	-120.976061	Stanislaus County
347813	Ordering, Referring, Prescribing	N/A	1811493430	0	0	BADDIGAM, VINDHYA MD	4/17/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195605	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
347816	Ordering, Referring, Prescribing	N/A	1811491749	0	0	BORTNER, ADAM C MD	4/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164879	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
347822	Ordering, Referring, Prescribing	N/A	1811504749	0	0	BURTCH, MAGGIE M RN CNM	11/13/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	236160	N/A	N/A	N/A	N/A	N/A	1104 BUCHANAN RD	C10	ANTIOCH	CA	94509	4205	00	06000	37.99867244	-121.823243	Contra Costa County
347825	Ordering, Referring, Prescribing	N/A	1811511744	0	0	BRADLEY, KRISTIN M NP	1/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014035	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
347859	Ordering, Referring, Prescribing	N/A	1811602071	0	0	BOYNAGIRYAN, VAHRAM PHARMD	12/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87533	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD #155	None	GLENDALE	CA	91203	2324	00	06000	34.15116156	-118.2549512	Los Angeles County
347891	Ordering, Referring, Prescribing	N/A	1811700669	0	0	BRESHEARS, ASHLEY D NP	1/27/2025	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95033712	N/A	N/A	N/A	N/A	N/A	2929 K ST	None	SACRAMENTO	CA	95816	7187	00	06000	38.572245	-121.4672175	Sacramento County
347901	Ordering, Referring, Prescribing	N/A	1811765944	0	0	BELTRE ESPINOSA, KATHERINE PA-C	4/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64375	N/A	N/A	N/A	N/A	N/A	437 N EUCLID AVE	None	ONTARIO	CA	91762	3456	00	06000	34.067988	-117.6521805	San Bernardino County
347912	Ordering, Referring, Prescribing	N/A	1811970072	0	0	BENJAMIN, LLOYD MD	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44478	N/A	N/A	N/A	N/A	N/A	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	00	06000	38.642832	-121.3649325	Sacramento County
347917	Ordering, Referring, Prescribing	N/A	1811948235	0	0	BARNETT, ANNE PA	1/16/2025	Taxonomy not applicable	NA	n/a	000	Unknown	65707	N/A	N/A	N/A	N/A	N/A	1325 E CHURCH ST	STE 202	SANTA MARIA	CA	93454	5915	00	06000	34.95209265	-120.4147348	Santa Barbara County
347966	Ordering, Referring, Prescribing	N/A	1821148040	0	0	BORDEN, ERLENE K LMFT	1/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45974	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
347969	Ordering, Referring, Prescribing	N/A	1821148941	0	0	BHUVA, RAJIV H MD	9/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73890	N/A	N/A	N/A	N/A	N/A	677 E TANGERINE ST	None	AZUSA	CA	91702	6868	00	06000	34.14108743	-117.896971	Los Angeles County
347973	Ordering, Referring, Prescribing	N/A	1821154402	0	0	BRANNON, MICHELLE LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53785	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	300	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
347976	Ordering, Referring, Prescribing	N/A	1821157835	0	0	BIRD-MARINUCCI, MEREDITH LCSW	12/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25522	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
347994	Ordering, Referring, Prescribing	N/A	1821169392	0	0	BORDEAUX, CHRISTOPHER T LPCC	2/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	725	N/A	N/A	N/A	N/A	N/A	1980 ALLSTON WAY	None	BERKELEY	CA	94704	1463	00	06000	37.86896156	-122.2709173	Alameda County
348007	Ordering, Referring, Prescribing	N/A	1821213547	0	0	BOTELLO, AMBER C LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44414	N/A	N/A	N/A	N/A	N/A	1830 S. CENTRAL STREET	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
348014	Ordering, Referring, Prescribing	N/A	1821237678	0	0	BERNARDO, RACHELLE PA-C	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	17718	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
348017	Ordering, Referring, Prescribing	N/A	1821245952	0	0	BAURMANN, AMELIA G	5/23/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0706664	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
348020	Ordering, Referring, Prescribing	N/A	1821209560	0	0	BROOKS, ANN D	2/19/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0298238	N/A	N/A	N/A	N/A	N/A	11722 S WILMINGTON AVE	None	LOS ANGELES	CA	90059	2543	00	06000	33.9267675	-118.2390104	Los Angeles County
348023	Ordering, Referring, Prescribing	N/A	1821255944	0	0	BROWN, LOUMESHIA LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86995	N/A	N/A	N/A	N/A	N/A	1887 MONTEREY RD, STE 20	None	SAN JOSE	CA	95112	6192	00	06000	37.308636	-121.8664102	Santa Clara County
348025	Ordering, Referring, Prescribing	N/A	1821260878	0	0	BALES, ALICIA L MD	11/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110948	N/A	N/A	N/A	N/A	N/A	14600 SHERMAN WAY	100D	VAN NUYS	CA	91405	5869	00	06000	34.20025916	-118.4500763	Los Angeles County
348028	Ordering, Referring, Prescribing	N/A	1821286071	0	0	BERRY, FERNALD Z LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT81719	N/A	N/A	N/A	N/A	N/A	1950 MARKET ST	None	RIVERSIDE	CA	92501	1720	00	06000	34.00316496	-117.3767967	Riverside County
348038	Ordering, Referring, Prescribing	N/A	1821298753	0	0	BORILLO, CARMENCITA GISELLE B LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53691	N/A	N/A	N/A	N/A	N/A	1212 N. CALIFORNIA ST.	None	STOCKTON	CA	95202	0000	00	06000	37.96681769	-121.2881382	San Joaquin County
348043	Ordering, Referring, Prescribing	N/A	1821305277	0	0	BOUZAGLOU, LISA R LCSW	12/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70108	N/A	N/A	N/A	N/A	N/A	4344 LATHAM ST	110	RIVERSIDE	CA	92501	0400	00	06000	34.00198519	-117.3739252	Riverside County
348057	Ordering, Referring, Prescribing	N/A	1821335241	0	0	BRADLEY, MEGAN M LMFT	7/19/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82933	N/A	N/A	N/A	N/A	N/A	160 B GUTHRIE LN	STE 1	BRENTWOOD	CA	94513	4060	00	06000	37.924074	-121.682652	Contra Costa County
348067	Ordering, Referring, Prescribing	N/A	1821349622	0	0	BISSELL, MARY B MD	12/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132363	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
348070	Ordering, Referring, Prescribing	N/A	1821359027	0	0	BRAVO, ENRIQUE M LMFT	4/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95753	N/A	N/A	N/A	N/A	N/A	1172 S MAIN ST	125	SALINAS	CA	93901	2204	00	06000	36.6581389	-121.659298	Monterey County
348081	Ordering, Referring, Prescribing	N/A	1821374810	0	0	BUI, HIEN V PHARMD	7/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55418	N/A	N/A	N/A	N/A	N/A	600 LONG BEACH BLVD	None	LONG BEACH	CA	90802	1321	00	06000	33.774372	-118.189284	Los Angeles County
348094	Ordering, Referring, Prescribing	N/A	1821401787	0	0	BOGHOSIAN, BRANDIE PSYD	10/11/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30570	N/A	N/A	N/A	N/A	N/A	30200 AGOURA RD	SUITE 190	AGOURA HILLS	CA	91301	5434	00	06000	34.14513267	-118.7821377	Los Angeles County
348096	Ordering, Referring, Prescribing	N/A	1821403361	0	0	BHARADWAJ, TINA PHARMD	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	66788	N/A	N/A	N/A	N/A	N/A	7400 ELK GROVE BLVD	None	ELK GROVE	CA	95757	6299	00	06000	38.405799	-121.4134875	Sacramento County
348105	Ordering, Referring, Prescribing	N/A	1821420498	0	0	BROWN, SHAWN LMFT	10/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT105721	N/A	N/A	N/A	N/A	N/A	1483 ALVA ST.	None	CARPINTERIA	CA	93013	1501	00	06000	34.40325505	-119.509423	Santa Barbara County
348116	Ordering, Referring, Prescribing	N/A	1821437138	0	0	BATHKE, GRACE S	12/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51794	N/A	N/A	N/A	N/A	N/A	1546 N MAIN ST	None	SALINAS	CA	93906	5101	00	06000	36.71242425	-121.6543238	Monterey County
348118	Ordering, Referring, Prescribing	N/A	1821437567	0	0	BALDONADO, ESTHER N NP	8/29/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	735795	N/A	N/A	N/A	N/A	N/A	2700 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5353	00	06000	37.33899611	-121.9746975	Santa Clara County
348131	Ordering, Referring, Prescribing	N/A	1821459769	0	0	BORELLI, JESSICA LMFT	9/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149669	N/A	N/A	N/A	N/A	N/A	1620 CUMMINS	None	MODESTO	CA	95358	0000	00	06000	37.658709	-121.036333	Stanislaus County
348161	Ordering, Referring, Prescribing	N/A	1821506866	0	0	BEAL, MADISON J CNM	12/19/2017	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	235938	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	STE A-D	SACRAMENTO	CA	95820	4717	00	06000	38.526282	-121.471398	Sacramento County
348219	Ordering, Referring, Prescribing	N/A	1821584301	0	0	BESSERMIN, CRAIG	7/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120120	N/A	N/A	N/A	N/A	N/A	1483 ALVA ST	None	CARPINTERIA	CA	93013	1501	00	06000	34.40325505	-119.509423	Santa Barbara County
348229	Ordering, Referring, Prescribing	N/A	1821606971	0	0	BOTTARINI, ANGELA M PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82576	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
348234	Ordering, Referring, Prescribing	N/A	1821616103	0	0	BAISLEY, CHRYSTAL R LMFT	1/19/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137292	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
348252	Ordering, Referring, Prescribing	N/A	1821653783	0	0	BELAY, ADRIANA I CNP	7/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012094	N/A	N/A	N/A	N/A	N/A	1145 GAYLEY AVE	SUITE 301	LOS ANGELES	CA	90024	3423	00	06000	34.0597492	-118.4461093	Los Angeles County
348264	Ordering, Referring, Prescribing	N/A	1821677584	0	0	BAIN, NATALIE N MD	12/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183464	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
348274	Ordering, Referring, Prescribing	N/A	1821719659	0	0	BRANNON, BROOKE E DDS	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107997	N/A	N/A	N/A	N/A	N/A	630 DRAKE AVE	None	SAUSALITO	CA	94965	1107	00	06000	37.87340883	-122.515085	Marin County
348280	Ordering, Referring, Prescribing	N/A	1821728627	0	0	BADWAL, GAGANDEEP NP	6/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021256	N/A	N/A	N/A	N/A	N/A	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	00	06000	38.475585	-121.4285265	Sacramento County
348288	Ordering, Referring, Prescribing	N/A	1821764564	0	0	BROOKS, ALEXIS	7/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110302	N/A	N/A	N/A	N/A	N/A	1031 WATERLOO RD	None	STOCKTON	CA	95205	4256	00	06000	37.96732496	-121.2723543	San Joaquin County
348294	Ordering, Referring, Prescribing	N/A	1821815069	0	0	BACH, MELLANY DMD	9/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110819	N/A	N/A	N/A	N/A	N/A	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	00	06000	34.084557	-118.123042	Los Angeles County
348296	Ordering, Referring, Prescribing	N/A	1821767617	0	0	BOYLAND, KRISTYN J PA	5/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	59334	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
348298	Ordering, Referring, Prescribing	N/A	1821830670	0	0	BARRAZA, ADRIENNE M CNP	5/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95030291	N/A	N/A	N/A	N/A	N/A	12294 CHARLTON RD	None	MADERA	CA	93636	8552	00	06000	36.92728716	-119.8912115	Madera County
348330	Ordering, Referring, Prescribing	N/A	1831216639	0	0	BRINSON, SUZANNE D LCSW	1/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28031	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DRIVE	200	VALENCIA	CA	91355	5430	00	06000	34.42039699	-118.5463513	Los Angeles County
348336	Ordering, Referring, Prescribing	N/A	1831218643	0	0	BOGHOSSIAN, NANCY A LCSW	3/22/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25118	N/A	N/A	N/A	N/A	N/A	333 S. BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
348358	Ordering, Referring, Prescribing	N/A	1831267970	0	0	BEALS, MELISSA LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44106	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	STE 100	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
348412	Ordering, Referring, Prescribing	N/A	1831399740	0	0	BALDRIAS, PERCIVAL J NP	6/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP16510	N/A	N/A	N/A	N/A	N/A	831 E. ARROW HIGHWAY	None	POMONA	CA	91767	2535	00	06000	34.09030767	-117.7353578	Los Angeles County
348413	Ordering, Referring, Prescribing	N/A	1831395425	0	0	BONNER, KENNETH DDS	7/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	33215	N/A	N/A	N/A	N/A	N/A	1919 W 7TH ST	None	LOS ANGELES	CA	90057	4103	00	06000	34.05575686	-118.2751751	Los Angeles County
348417	Ordering, Referring, Prescribing	N/A	1831398395	0	0	BUSSEL, NATALYA MD	1/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85087	N/A	N/A	N/A	N/A	N/A	905 EAST 8TH ST.	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
348422	Ordering, Referring, Prescribing	N/A	1831433184	0	0	BRISENO, JAZMIN LCSW	10/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97960	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2451	00	06000	33.99703164	-118.1499826	Los Angeles County
348432	Ordering, Referring, Prescribing	N/A	1831442532	0	0	BERGSTRESSER, HENRYETTA H LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW90746	N/A	N/A	N/A	N/A	N/A	720 WOOD STREET	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
348463	Ordering, Referring, Prescribing	N/A	1831502780	0	0	BRITTON, ANTHONY G DC	6/8/2019	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	32953	N/A	N/A	N/A	N/A	N/A	9674 LAS TUNAS DR	None	TEMPLE CITY	CA	91780	2139	00	06000	34.1070156	-118.0583645	Los Angeles County
348558	Ordering, Referring, Prescribing	N/A	1831637198	0	0	BUSTILLO, CAMILLE J	1/20/2017	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	15920	N/A	N/A	N/A	N/A	N/A	24422 AVENIDA DE LA CARL	STE 100	LAGUNA HILLS	CA	92653	3648	00	06000	33.56726005	-117.705397	Orange County
348603	Ordering, Referring, Prescribing	N/A	1831693902	0	0	BAGGETT, MICHAEL J MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165472	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
348613	Ordering, Referring, Prescribing	N/A	1831709773	0	0	BROWN, CARROLL T NP	8/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95018200	N/A	N/A	N/A	N/A	N/A	652 PETALUMA AVE.	None	SEBASTOPOL	CA	95472	4256	00	06000	38.39662494	-122.8201368	Sonoma County
348622	Ordering, Referring, Prescribing	N/A	1831714047	0	0	BRUCKI, JESSIE LMFT	8/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141007	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD	None	LONG BEACH	CA	90807	3941	00	06000	33.82086796	-118.18938	Los Angeles County
348636	Ordering, Referring, Prescribing	N/A	1831748920	0	0	BORGESON, JENNIFER LCSW	3/3/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	358074	N/A	N/A	N/A	N/A	N/A	29632 E HIGHWAY 299	None	ROUND MOUNTAIN	CA	96084	8000	00	06000	40.80385331	-121.9397745	Shasta County
348639	Ordering, Referring, Prescribing	N/A	1831750306	0	0	BASTOLA, PRASANNA MD	4/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177433	N/A	N/A	N/A	N/A	N/A	1023 E FLORIDA AVE	None	HEMET	CA	92543	4510	00	06000	33.74750847	-116.961147	Riverside County
348675	Ordering, Referring, Prescribing	N/A	1831845718	0	0	BLOOM, LINDSAY NP	2/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029056	N/A	N/A	N/A	N/A	N/A	1560 MARKET ST	None	REDDING	CA	96001	1023	00	06000	40.58346871	-122.390608	Shasta County
348677	Ordering, Referring, Prescribing	N/A	1831868967	0	0	BOYLES, KALYNNE R NP	12/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018272	N/A	N/A	N/A	N/A	N/A	4151 MEXICALI DR	None	BAKERSFIELD	CA	93313	2065	00	06000	35.317233	-119.081649	Kern County
348693	Ordering, Referring, Prescribing	N/A	1831935881	0	0	BEETS, KALMIA NP	6/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030698	N/A	N/A	N/A	N/A	N/A	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	00	06000	33.20904502	-117.2286439	San Diego County
348742	Ordering, Referring, Prescribing	N/A	1841310240	0	0	BOIADJIEVA, EUGENIE LCSW	1/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21744	N/A	N/A	N/A	N/A	N/A	200 PINE AVE.	400	LONG BEACH	CA	90802	3041	00	06000	33.76962	-118.1923435	Los Angeles County
348743	Ordering, Referring, Prescribing	N/A	1841313418	0	0	BUCK, GARY L PHD	11/19/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27298	N/A	N/A	N/A	N/A	N/A	921 TRANSPORT WAY	33	PETALUMA	CA	94954	1464	00	06000	38.2557496	-122.6400016	Sonoma County
348780	Ordering, Referring, Prescribing	N/A	1841378247	0	0	BURGETT, JOSHUA M NP	8/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16637	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
348783	Ordering, Referring, Prescribing	N/A	1841382785	0	0	BROWN, BONNIE W PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48068	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PARKWAY	625	SAN JOSE	CA	95119	1101	00	06000	37.23951066	-121.8013511	Santa Clara County
348807	Ordering, Referring, Prescribing	N/A	1841436284	0	0	BECKER, BRANDON S LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104822	N/A	N/A	N/A	N/A	N/A	1968 W. ADAMS BLVD	None	LOS ANGELES	CA	90018	3515	00	06000	34.03266053	-118.3081635	Los Angeles County
348821	Ordering, Referring, Prescribing	N/A	1841451820	0	0	BHAKTA, RUSHABH C	4/28/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57796	N/A	N/A	N/A	N/A	N/A	72780 COUNTRY CLUB DRIVE	403	RANCHO MIRAGE	CA	92270	4149	00	06000	33.75795596	-116.392246	Riverside County
348841	Ordering, Referring, Prescribing	N/A	1841501640	0	0	BLAIR, CLYDE A LMFT	12/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47961	N/A	N/A	N/A	N/A	N/A	790 E SANTA CLARA ST	STE 106	VENTURA	CA	93001	2957	00	06000	34.27950947	-119.2888755	Ventura County
348849	Ordering, Referring, Prescribing	N/A	1841509353	0	0	BRATILOVEANU, ANDREEA	9/23/2013	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT014081	N/A	N/A	N/A	N/A	N/A	2050 W REDLANDS BLVD	None	REDLANDS	CA	92374	6228	00	06000	34.06509	-117.2228535	San Bernardino County
348861	Ordering, Referring, Prescribing	N/A	1841539632	0	0	BABICH, VIOLETTA LMFT	8/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111442	N/A	N/A	N/A	N/A	N/A	401 ROLAND WAY	SUITE 150	OAKLAND	CA	94621	2034	00	06000	37.74106765	-122.2051051	Alameda County
348874	Ordering, Referring, Prescribing	N/A	1841549383	0	0	BOTRUS, ANTHONY B LMFT	10/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97019	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
348876	Ordering, Referring, Prescribing	N/A	1841548948	0	0	BALDRIDGE, DEREK J LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79801	N/A	N/A	N/A	N/A	N/A	3530 ATLANITC AVE	210	LONG BEACH	CA	90807	4569	00	06000	33.820875	-118.1850035	Los Angeles County
348899	Ordering, Referring, Prescribing	N/A	1841576501	0	0	BHAKTA, BABITA PHARMD	8/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45205	N/A	N/A	N/A	N/A	N/A	2801 ADELINE STREET	None	BERKELEY	CA	94703	2204	00	06000	37.85820135	-122.2676316	Alameda County
348901	Ordering, Referring, Prescribing	N/A	1841577863	0	0	BELLOMY, AMY PA-C	1/2/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA21997	N/A	N/A	N/A	N/A	N/A	925 MAIDU AVE	None	NEVADA CITY	CA	95959	8600	00	06000	39.26930172	-121.0261274	Nevada County
348928	Ordering, Referring, Prescribing	N/A	1841622768	0	0	BRAZINSKY JONES, JENNIFER LCSW	11/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18466	N/A	N/A	N/A	N/A	N/A	47 6TH STREET	STE 205	PETALUMA	CA	94952	3034	00	06000	38.23069878	-122.6401504	Sonoma County
348932	Ordering, Referring, Prescribing	N/A	1841636321	0	0	BROWN, JEFFREY A MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159363	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2307	00	06000	38.555181	-121.4566785	Sacramento County
348933	Ordering, Referring, Prescribing	N/A	1841627981	0	0	BOSWELL, JULIE	11/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53840	N/A	N/A	N/A	N/A	N/A	1905 NOTRE DAME BLVD	220	CHICO	CA	95928	7796	00	06000	39.73299712	-121.7950678	Butte County
348939	Ordering, Referring, Prescribing	N/A	1841638681	0	0	BROWN, ASHLEY M PSYD	3/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31506	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
348957	Ordering, Referring, Prescribing	N/A	1841668498	0	0	BELGARDE, MCKENNA C LCSW	7/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102600	N/A	N/A	N/A	N/A	N/A	1125 WEST 6TH STREET	103	LOS ANGELES	CA	90017	1896	00	06000	34.05441139	-118.2628642	Los Angeles County
348968	Ordering, Referring, Prescribing	N/A	1841691599	0	0	BEATTY, MARTHA L LCSW	10/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110977	N/A	N/A	N/A	N/A	N/A	1940 E DEERE AVE	135	SANTA ANA	CA	92705	5718	00	06000	33.70430421	-117.8482556	Orange County
348983	Ordering, Referring, Prescribing	N/A	1841713823	0	0	BUFORD, BRETT T OT	5/7/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	19563	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
349010	Ordering, Referring, Prescribing	N/A	1841753258	0	0	BELL, SHINA LMFT	1/24/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT152838	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
349019	Ordering, Referring, Prescribing	N/A	1841757598	0	0	BEBERO, MA MILDRED NP	1/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010918	N/A	N/A	N/A	N/A	N/A	315 E 13TH ST	None	MERCED	CA	95341	6212	00	06000	37.29248035	-120.4730619	Merced County
349033	Ordering, Referring, Prescribing	N/A	1841774668	0	0	BLOM, JACOB B	8/19/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103246	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento
349039	Ordering, Referring, Prescribing	N/A	1841787991	0	0	BANDOOKWALA, MARIA A NP	6/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016458	N/A	N/A	N/A	N/A	N/A	2760 3RD STREET	None	CERES	CA	95307	3220	00	06000	37.591929	-120.9545125	Stanislaus County
349046	Ordering, Referring, Prescribing	N/A	1841800380	0	0	BROWN, PATRICIA V NP	12/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014968	N/A	N/A	N/A	N/A	N/A	1001 2ND ST	SUITE 225	NAPA	CA	94559	3099	00	06000	38.29837488	-122.2851912	Napa County
349068	Ordering, Referring, Prescribing	N/A	1841857661	0	0	BIGHAM, KYLE PHARMD	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	82452	N/A	N/A	N/A	N/A	N/A	1006 W WABASH AVE	None	EUREKA	CA	95501	2121	00	06000	40.79158228	-124.1830134	Humboldt County
349073	Ordering, Referring, Prescribing	N/A	1841866027	0	0	BARROS, JOSE L PA-C	4/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	59696	N/A	N/A	N/A	N/A	N/A	5036 PASSONS BLVD	SUITE 2	PICO RIVERA	CA	90660	0000	00	06000	33.99766599	-118.0784216	Los Angeles County
349078	Ordering, Referring, Prescribing	N/A	1841881588	0	0	BUNNY, LIZA PHARMD	1/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84043	N/A	N/A	N/A	N/A	N/A	5688 TELEPHONE RD	None	VENTURA	CA	93003	5326	00	06000	34.26489851	-119.2152357	Ventura County
349091	Ordering, Referring, Prescribing	N/A	1841931003	0	0	BREAU, NATALIE OD	10/30/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT35181TLG	N/A	N/A	N/A	N/A	N/A	5460 E LA PALMA AVE	None	ANAHEIM	CA	92807	2023	00	06000	33.85983003	-117.7966383	Orange County
349095	Ordering, Referring, Prescribing	N/A	1841946803	0	0	BARBEAU, ALEXANDRA M PA-C	6/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61180	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
349098	Ordering, Referring, Prescribing	N/A	1841955051	0	0	BAK, PATRYCJA NP	11/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019019	N/A	N/A	N/A	N/A	N/A	940 E WILLIAMS ST	STE 102	BANNING	CA	92220	5848	00	06000	33.92715416	-116.8662911	Riverside County
349108	Ordering, Referring, Prescribing	N/A	1841986593	0	0	BARTHELMASS, MICHAELA MD	10/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	12355	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	N26	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
349110	Ordering, Referring, Prescribing	N/A	1841990603	0	0	BRANDT, KATHLEEN	7/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024536	N/A	N/A	N/A	N/A	N/A	475 BRUCE STREET	None	YREKA	CA	96097	3484	00	06000	41.71860037	-122.6467317	Siskiyou County
349115	Ordering, Referring, Prescribing	N/A	1851000491	0	0	BATRA, NEHA DDS	11/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108391	N/A	N/A	N/A	N/A	N/A	65 S HOCKETT ST	None	PORTERVILLE	CA	93257	4728	00	06000	36.06415362	-119.0171608	Tulare County
349119	Ordering, Referring, Prescribing	N/A	1851017305	0	0	BILBAO, SOPHIA PA	2/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62300	N/A	N/A	N/A	N/A	N/A	905 CALLE AMANECER	SUITE 115	SAN CLEMENTE	CA	92673	6226	00	06000	33.44951265	-117.6075825	Orange County
349120	Ordering, Referring, Prescribing	N/A	1851009724	0	0	BOSCH, JAN-MATTHEW NP	11/8/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023295	N/A	N/A	N/A	N/A	N/A	190 S OAK AVE	BLDG. 2/STE 1	OAKDALE	CA	95361	3528	00	06000	37.75958945	-120.8613916	Stanislaus County
349128	Ordering, Referring, Prescribing	N/A	1851028948	0	0	BARRAGAN, EDUARDO LCSW	8/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82415	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY SUITE	None	SANTA ROSA	CA	95407	5486	00	06000	38.425266	-122.749875	Sonoma County
349163	Ordering, Referring, Prescribing	N/A	1851339501	0	0	BAUM, SHONA Q LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20092	N/A	N/A	N/A	N/A	N/A	2620 26TH AVE.	None	OAKLAND	CA	94601	1907	00	06000	37.79088756	-122.2231716	Alameda County
349166	Ordering, Referring, Prescribing	N/A	1851403299	0	0	BOZART, KIM LCSW	9/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25300	N/A	N/A	N/A	N/A	N/A	5193 FINO DRIVE	None	SAN DIEGO	CA	92124	4711	00	06000	32.82659778	-117.102697	San Diego County
349169	Ordering, Referring, Prescribing	N/A	1851408090	0	0	BIYO, EULE T N MD	6/22/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A95948	N/A	N/A	N/A	N/A	N/A	740 OAK AVE PKWY	STE 145	FOLSOM	CA	95630	6815	00	06000	38.665917	-121.1367735	Sacramento County
349172	Ordering, Referring, Prescribing	N/A	1851417950	0	0	BROWN, KASEY PHILLIPS LCSW	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21037	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
349184	Ordering, Referring, Prescribing	N/A	1851423651	0	0	BUELL, JEFFREY L LCSW	1/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60938	N/A	N/A	N/A	N/A	N/A	2640 MARTIN LUTHER KING	None	BERKELEY	CA	94704	3238	00	06000	37.85995514	-122.2717612	Alameda County
349191	Ordering, Referring, Prescribing	N/A	1851431589	0	0	BRODNICK, CHESTER LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	9181	N/A	N/A	N/A	N/A	N/A	2457 ENDICOTT ST	None	LOS ANGELES	CA	90032	3047	00	06000	34.0756087	-118.1731005	Los Angeles County
349195	Ordering, Referring, Prescribing	N/A	1851437578	0	0	BOYEA, JENNIFER M LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50099	N/A	N/A	N/A	N/A	N/A	5650 MOUNT ACKERLY DR	None	SAN DIEGO	CA	92111	4016	00	06000	32.80910151	-117.1793115	San Diego County
349204	Ordering, Referring, Prescribing	N/A	1851449177	0	0	BARBASTE, JORGE O LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38822	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	00	06000	37.97021462	-121.7841321	Contra Costa County
349238	Ordering, Referring, Prescribing	N/A	1851527691	0	0	BOHON, MICHAEL R LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100174	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
349240	Ordering, Referring, Prescribing	N/A	1851536247	0	0	BRADBERRY, SERENA P LMFT	1/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97772	N/A	N/A	N/A	N/A	N/A	23311 DRACAEA AVE	None	MORENO VALLEY	CA	92553	3201	00	06000	33.92807348	-117.258489	Riverside County
349254	Ordering, Referring, Prescribing	N/A	1851567820	0	0	BROWNELL, MARILYNNE M RN PNP	3/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4028	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	0629	00	06000	34.42887662	-119.7237878	Santa Barbara County
349295	Ordering, Referring, Prescribing	N/A	1851645642	0	0	BLOCK, LINDSEY L NP	5/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	22310	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
349299	Ordering, Referring, Prescribing	N/A	1851649495	0	0	BHAKTA, PARIN PHARMD	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68897	N/A	N/A	N/A	N/A	N/A	1237 CRANBROOK PL	None	FULLERTON	CA	92833	1406	00	06000	33.88377254	-117.9752064	Orange County
349316	Ordering, Referring, Prescribing	N/A	1851673966	0	0	BONILLA-HAENN, BRYCE C LPCC	2/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6905	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	None	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
349324	Ordering, Referring, Prescribing	N/A	1851691729	0	0	BARBARA, PETER A PHARMD	3/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH41615	N/A	N/A	N/A	N/A	N/A	1201 AVOCADO AVE	None	EL CAJON	CA	92020	7704	00	06000	32.778864	-116.9579805	San Diego County
349362	Ordering, Referring, Prescribing	N/A	1851732622	0	0	BASEL, SAYED M MD	6/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120406	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
349418	Ordering, Referring, Prescribing	N/A	1851820567	0	0	BHATHELA, NEIL A MD	8/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19037	N/A	N/A	N/A	N/A	N/A	300 STEIN PLZ	SUITE 420	LOS ANGELES	CA	90095	6901	00	06000	34.06482846	-118.4443432	Los Angeles County
349429	Ordering, Referring, Prescribing	N/A	1851832208	0	0	BRYANT, CODY A MD	11/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172311	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
349448	Ordering, Referring, Prescribing	N/A	1851860829	0	0	BEARD, CORY LMFT	11/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126382	N/A	N/A	N/A	N/A	N/A	1170 INDUSTRIAL	None	REDDING	CA	96002	0734	00	06000	40.57474549	-122.3503065	Shasta County
349457	Ordering, Referring, Prescribing	N/A	1851875215	0	0	BURCHFIELD, JENNA M PA	9/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56044	N/A	N/A	N/A	N/A	N/A	250 WEST 5TH ST	None	HANFORD	CA	93230	4533	00	06000	36.32439821	-119.6472235	Kings County
349462	Ordering, Referring, Prescribing	N/A	1851883748	0	0	BURGER, NATALIE LMFT	9/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128093	N/A	N/A	N/A	N/A	N/A	2601 MAY RD	None	EL SOBRANTE	CA	94803	3130	00	06000	37.96697591	-122.2969952	Contra Costa County
349470	Ordering, Referring, Prescribing	N/A	1851910194	0	0	BISHOP, ANDREA A LPCC	6/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC7989	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
349486	Ordering, Referring, Prescribing	N/A	1851934814	0	0	BARBIERI, ANGELICA P LMFT	4/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132513	N/A	N/A	N/A	N/A	N/A	290 I.O.O.F. AVENUE	None	GILROY	CA	95020	5204	00	06000	37.0137857	-121.5686472	Santa Clara County
349501	Ordering, Referring, Prescribing	N/A	1851958052	0	0	BARATI, PARVANE DO	1/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19320	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
349504	Ordering, Referring, Prescribing	N/A	1851958680	0	0	BRONSTEIN, SUSAN J	9/4/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RN347882	N/A	N/A	N/A	N/A	N/A	1651 16TH STREET	None	SANTA MONICA	CA	90404	3801	00	06000	34.02209342	-118.4796709	Los Angeles County
349508	Ordering, Referring, Prescribing	N/A	1851981716	0	0	BEHESHTI, BANAFSHEH DC	7/21/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	34995	N/A	N/A	N/A	N/A	N/A	8825 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2657	00	06000	34.00181371	-118.0847275	Los Angeles County
349533	Ordering, Referring, Prescribing	N/A	1861042798	0	0	BLAND, SANDRIA D LMFT	8/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134278	N/A	N/A	N/A	N/A	N/A	10549 JEFFERSON BLVD	SUITE 600	CULVER CITY	CA	90232	3513	00	06000	34.00659325	-118.3923586	Los Angeles County
349564	Ordering, Referring, Prescribing	N/A	1861117863	0	0	BALL, SARAH M NP	11/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023310	N/A	N/A	N/A	N/A	N/A	2970 HILLTOP MALL ROAD	307	RICHMOND	CA	94806	5274	00	06000	37.97819764	-122.329244	Contra Costa County
349582	Ordering, Referring, Prescribing	N/A	1861243271	0	0	BECKMAN, KARI	3/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121629	N/A	N/A	N/A	N/A	N/A	1002 E GRAND AVE	None	ESCONDIDO	CA	92025	4605	00	06000	33.12639838	-117.0682191	San Diego County
349597	Ordering, Referring, Prescribing	N/A	1861426827	0	0	BEGINO, RUBEN H	2/10/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D48787	N/A	N/A	N/A	N/A	N/A	8401 NE HALSEY ST	STE 102	SANTA ANA	CA	92704	5727	00	06000	0	0	None
349600	Ordering, Referring, Prescribing	N/A	1861472060	0	0	BLACK, JANET L LCSW	12/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19200	N/A	N/A	N/A	N/A	N/A	13975 MONO WAY	H	SONORA	CA	95370	0000	00	06000	37.97831488	-120.3396851	Tuolumne County
349602	Ordering, Referring, Prescribing	N/A	1861479941	0	0	BORDERS, JEFFREY S MD	6/22/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C139941	N/A	N/A	N/A	N/A	N/A	450 FOURTH AVE	401	CHULA VISTA	CA	91910	4426	00	06000	32.63513513	-117.0820663	San Diego County
349611	Ordering, Referring, Prescribing	N/A	1861517815	0	0	BISHOP, HOLLY LCSW	5/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62909	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	SUITE 150	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
349616	Ordering, Referring, Prescribing	N/A	1861522658	0	0	BUCKLEY, SUZANNE D LMFT	12/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC35659	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
349665	Ordering, Referring, Prescribing	N/A	1861637654	0	0	BOYD, CHRISTINE H LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51445	N/A	N/A	N/A	N/A	N/A	8755 AERO DR	230	SAN DIEGO	CA	92123	1776	00	06000	32.80965252	-117.139383	San Diego County
349676	Ordering, Referring, Prescribing	N/A	1861676462	0	0	BEER, JEANETTE L NP	10/31/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	638882	N/A	N/A	N/A	N/A	N/A	4555 PRECISSI LN	None	STOCKTON	CA	95207	6239	00	06000	37.98919284	-121.3152121	San Joaquin County
349687	Ordering, Referring, Prescribing	N/A	1861694952	0	0	BUHL, REBECCA L LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51262	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	GOLETA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
349691	Ordering, Referring, Prescribing	N/A	1861702730	0	0	BASS, BRIAN J LCSW	3/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78872	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
349697	Ordering, Referring, Prescribing	N/A	1861716185	0	0	BERBERABE, JOSEPH D	3/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95024593	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
349720	Ordering, Referring, Prescribing	N/A	1861746687	0	0	BOYAJIAN, SYLVIE A LMFT	4/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90463	N/A	N/A	N/A	N/A	N/A	225 W BROADWAY	None	GLENDALE	CA	91204	1331	00	06000	34.14673469	-118.257145	Los Angeles County
349755	Ordering, Referring, Prescribing	N/A	1861801359	0	0	BIRNBERG, JOELLE S MD	7/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138930	N/A	N/A	N/A	N/A	N/A	6801 COLDWATER CANYON AV	None	NORTH HOLLYWOOD	CA	91605	5162	00	06000	34.194447	-118.4138285	Los Angeles County
349756	Ordering, Referring, Prescribing	N/A	1861804247	0	0	BURGESS, DANIEL DO	4/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18163	N/A	N/A	N/A	N/A	N/A	28078 BAXTER RD	530	MURRIETA	CA	92563	1402	00	06000	33.615	-117.1670265	Riverside County
349787	Ordering, Referring, Prescribing	N/A	1861847758	0	0	BAINS, NAVNEET	3/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157671	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
349795	Ordering, Referring, Prescribing	N/A	1861855330	0	0	BOREK-ROBINSON, LEANN LMFT	3/13/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145786	N/A	N/A	N/A	N/A	N/A	17800 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
349829	Ordering, Referring, Prescribing	N/A	1861918104	0	0	BECK, RICA M NP	6/14/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006764	N/A	N/A	N/A	N/A	N/A	16127 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	00	06000	34.10650281	-117.4531156	San Bernardino County
349855	Ordering, Referring, Prescribing	N/A	1861951352	0	0	BAQUIR, EMILIANO D NP	7/1/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	745172	N/A	N/A	N/A	N/A	N/A	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	00	06000	34.43847322	-118.5729968	Los Angeles County
349870	Ordering, Referring, Prescribing	N/A	1861974875	0	0	BELL, JASMINE LMFT	8/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121230	N/A	N/A	N/A	N/A	N/A	1328 W MANCHESTER AVE	None	LOS ANGELES	CA	90044	2240	00	06000	33.95998503	-118.2992802	Los Angeles County
349907	Ordering, Referring, Prescribing	N/A	1871030288	0	0	BLACKHAM, ALLISON H CNM	3/9/2021	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM479	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
349922	Ordering, Referring, Prescribing	N/A	1871047555	0	0	BASS, KATHERINE E PHARMD	12/12/2017	Taxonomy not applicable	NA	n/a	000	Unknown	72196	N/A	N/A	N/A	N/A	N/A	9215 E HWY 140	None	PLANADA	CA	95365	0001	00	06000	37.2954507	-120.3209234	Merced County
349925	Ordering, Referring, Prescribing	N/A	1871049304	0	0	BOMAN, JAIMEE L LMFT	8/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127340	N/A	N/A	N/A	N/A	N/A	3725 TAYLOR ROAD	SUITE 1	LOOMIS	CA	95650	9283	00	06000	38.81963826	-121.1950015	Placer County
349927	Ordering, Referring, Prescribing	N/A	1871058636	0	0	BLAYTON, ASHLEY M NP	7/13/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011028	N/A	N/A	N/A	N/A	N/A	2299 MOWRY AVE	3B	FREMONT	CA	94538	1621	00	06000	37.55671415	-121.9817758	Alameda County
349952	Ordering, Referring, Prescribing	N/A	1871090324	0	0	BHATT, APURVA P MD	8/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174272	N/A	N/A	N/A	N/A	N/A	1500 DOM WAY	None	SACRAMENTO	CA	95864	2705	00	06000	38.593134	-121.3887825	Sacramento County
349987	Ordering, Referring, Prescribing	N/A	1871154526	0	0	BAE, JINYI NP	11/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95012980	N/A	N/A	N/A	N/A	N/A	619 CROUCH ST	SUITE 100	OCEANSIDE	CA	92054	4460	00	06000	33.19572979	-117.3536776	San Diego County
350017	Ordering, Referring, Prescribing	N/A	1871225730	0	0	BOBIE, JOHN LMFT	2/12/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153168	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	None	COVINA	CA	91723	3100	00	06000	34.079904	-117.8863235	Los Angeles County
350030	Ordering, Referring, Prescribing	N/A	1871284711	0	0	BRUNK, ANDIE LMFT	1/9/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT152566	N/A	N/A	N/A	N/A	N/A	9713 SANTA MONICA BLVD.	SUITE 201	BEVERLY HILLS	CA	90210	4236	00	06000	34.06835061	-118.4076858	Los Angeles County
350031	Ordering, Referring, Prescribing	N/A	1871260661	0	0	BUELTEL, KAYLA L	2/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LEP4106	N/A	N/A	N/A	N/A	N/A	2553 OLD FARM RD	None	BAKERSFIELD	CA	93312	3531	00	06000	35.38321439	-119.1367185	Kern County
350033	Ordering, Referring, Prescribing	N/A	1871295493	0	0	BELTRON, KIMBERLY M NP	5/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020497	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
350034	Ordering, Referring, Prescribing	N/A	1871286013	0	0	BARGHOUTH, NATALIA	5/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108820	N/A	N/A	N/A	N/A	N/A	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	00	06000	37.36514449	-121.8292446	Santa Clara County
350048	Ordering, Referring, Prescribing	N/A	1871374264	0	0	BIDI, RETA PA-C	12/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63780	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
350061	Ordering, Referring, Prescribing	N/A	1871568899	0	0	BENNETT, BERNARD L MD	3/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C42114	N/A	N/A	N/A	N/A	N/A	39022 PRESIDIO WAY	None	FREMONT	CA	94538	1221	00	06000	37.54421269	-121.9910888	Alameda County
350063	Ordering, Referring, Prescribing	N/A	1871543397	0	0	BRIGANTI, REINA A NP	5/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	507758	N/A	N/A	N/A	N/A	N/A	570 S MT VERNON AVE	STE G	SAN BERNARDINO	CA	92410	2737	00	06000	34.090776	-117.3138565	San Bernardino County
350069	Ordering, Referring, Prescribing	N/A	1871601609	0	0	BALAND, MATTHEW LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47416	N/A	N/A	N/A	N/A	N/A	6615 VALLEY HI DRIVE	None	SACRAMENTO	CA	95823	7076	00	06000	38.470986	-121.4276985	Sacramento County
350095	Ordering, Referring, Prescribing	N/A	1871638007	0	0	BOGAR, SUSAN E CNM	12/8/2020	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	MW727	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	210	INGLEWOOD	CA	90301	4502	00	06000	33.966333	-118.3439975	Los Angeles County
350118	Ordering, Referring, Prescribing	N/A	1871680868	0	0	BAMBERGER, DEBBIE	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0482460	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
350143	Ordering, Referring, Prescribing	N/A	1871741561	0	0	BONILLA, ERICKA LCSW	6/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68430	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE.	None	LOS ANGELES	CA	90033	0001	00	06000	34.06300636	-118.2054784	Los Angeles County
350162	Ordering, Referring, Prescribing	N/A	1871775627	0	0	BORAH, DEBORAH	7/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA14055	N/A	N/A	N/A	N/A	N/A	648 E. 21ST STREET	None	LOS ANGELES	CA	90011	1146	00	06000	34.02604371	-118.2589922	Los Angeles County
350170	Ordering, Referring, Prescribing	N/A	1871801803	0	0	BLALACK, CARLY S LCSW	6/18/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29364	N/A	N/A	N/A	N/A	N/A	12835 POINTE DEL MAR WAY	1	DEL MAR	CA	92014	3846	00	06000	32.93216216	-117.2433492	San Diego County
350180	Ordering, Referring, Prescribing	N/A	1871812537	0	0	BEAS, VIRGINIA LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105369	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BOULEVARD MS	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
350184	Ordering, Referring, Prescribing	N/A	1871814483	0	0	BANDARIZADEH, RASHEL PHARMD	10/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53677	N/A	N/A	N/A	N/A	N/A	2101 N.ROSE AVE	None	OXNARD	CA	93030	9628	00	06000	34.221969	-119.1618045	Ventura County
350199	Ordering, Referring, Prescribing	N/A	1871840009	0	0	BOLANOS, LIZA L	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94583	N/A	N/A	N/A	N/A	N/A	1051 PICADOR BLVD	None	SAN DIEGO	CA	92154	3548	00	06000	32.57614401	-117.0562098	San Diego County
350205	Ordering, Referring, Prescribing	N/A	1871846196	0	0	BONNELL, ANTONIETA M LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102773	N/A	N/A	N/A	N/A	N/A	9829 CARMENITA ROAD	H	WHITTTIER	CA	90605	3262	00	06000	33.9479708	-118.0466386	Los Angeles County
350220	Ordering, Referring, Prescribing	N/A	1871872606	0	0	BALLARD, BRIANNE E LMFT	8/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114778	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	None	MISSION VIEJO	CA	92691	6441	00	06000	33.56536541	-117.670334	Orange County
350241	Ordering, Referring, Prescribing	N/A	1871893776	0	0	BERK, KACIE	3/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	64578	N/A	N/A	N/A	N/A	N/A	645 SAN ANTONIO RD	None	MOUNTAIN VIEW	CA	94040	1303	00	06000	37.40220238	-122.1130454	Santa Clara County
350258	Ordering, Referring, Prescribing	N/A	1871922567	0	0	BERROCAL, AGUSTINA LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99445	N/A	N/A	N/A	N/A	N/A	6333 TELEGRAPH AVE	102	OAKLAND	CA	94609	0000	00	06000	37.84914135	-122.260702	Alameda County
350259	Ordering, Referring, Prescribing	N/A	1871925222	0	0	BOYD, ROSCHELLE R	8/23/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0802709	N/A	N/A	N/A	N/A	N/A	5068 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3128	00	06000	34.02101146	-118.1603463	Los Angeles County
350264	Ordering, Referring, Prescribing	N/A	1871926527	0	0	BERLIN, KALEY MSW LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75045	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET	None	SAN FRANCISCO	CA	94116	0661	00	06000	37.7388459	-122.4861544	San Francisco County
350277	Ordering, Referring, Prescribing	N/A	1871947770	0	0	BEATTY, ZACHARY L DC	5/9/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33549	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
350300	Ordering, Referring, Prescribing	N/A	1871980706	0	0	BROOKS, BRENDA F LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104813	N/A	N/A	N/A	N/A	N/A	5740 RALSTON STREET	SUITE 201	OXNARD	CA	93003	0001	00	06000	34.26070802	-119.213699	Ventura County
350341	Ordering, Referring, Prescribing	N/A	1881039642	0	0	BRAVO, ELIZABETH S LCSW	8/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102944	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
350368	Ordering, Referring, Prescribing	N/A	1881071454	0	0	BAL, JAGRUP S	4/5/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	100860	N/A	N/A	N/A	N/A	N/A	847 W CHILDS AVE	None	MERCED	CA	95341	6862	00	06000	37.28825369	-120.4963159	Merced County
350397	Ordering, Referring, Prescribing	N/A	1881115798	0	0	BARRINO, BRIANA O LCSW	8/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117004	N/A	N/A	N/A	N/A	N/A	29775 HAUN RD	None	MENIFEE	CA	92586	6540	00	06000	33.68839122	-117.1750902	Riverside County
350431	Ordering, Referring, Prescribing	N/A	1881171387	0	0	BONURA, JANELLE A LCSW	4/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101203	N/A	N/A	N/A	N/A	N/A	855 N EUCLID AVE	None	ONTARIO	CA	91762	2729	00	06000	34.074063	-117.6514785	San Bernardino County
350474	Ordering, Referring, Prescribing	N/A	1881242782	0	0	BALAYAN, SHAINA-JILL S NP	12/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95016143	N/A	N/A	N/A	N/A	N/A	3505 LONE TREE DR	1	ANTIOCH	CA	94509	6067	00	06000	37.98725411	-121.8065036	Contra Costa County
350485	Ordering, Referring, Prescribing	N/A	1881268159	0	0	BHATTACHARYA, ARKA MD	9/23/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A199166	N/A	N/A	N/A	N/A	N/A	1275 THARP RD	None	YUBA CITY	CA	95993	2645	00	06000	39.14572609	-121.6484225	Sutter County
350500	Ordering, Referring, Prescribing	N/A	1881288546	0	0	BORAIE, BASEM PHARMD	10/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84110	N/A	N/A	N/A	N/A	N/A	775 TUCKER RD	None	TEHACHAPI	CA	93561	2502	00	06000	35.125704	-118.4678675	Kern County
350503	Ordering, Referring, Prescribing	N/A	1881300192	0	0	BENKO, ELIZABETH NP	1/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024055	N/A	N/A	N/A	N/A	N/A	40 PRADO RD	None	SAN LUIS OBISPO	CA	93401	7313	00	06000	35.25596696	-120.6723865	San Luis Obispo County
350510	Ordering, Referring, Prescribing	N/A	1881343788	0	0	BECERRA-ALMENDAREZ, ALEXA MD	9/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189997	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
350522	Ordering, Referring, Prescribing	N/A	1881385870	0	0	BELCHER, SONNI CNP	4/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024824	N/A	N/A	N/A	N/A	N/A	2344 6TH ST	None	BERKELEY	CA	94710	2412	00	06000	37.86198466	-122.295766	Alameda County
350550	Ordering, Referring, Prescribing	N/A	1881654812	0	0	BROWN, NANCY G NP	4/10/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	344536	N/A	N/A	N/A	N/A	N/A	5000 ROCKLIN ROAD	None	ROCKLIN	CA	95677	3337	00	06000	38.790729	-121.2153525	Placer County
350581	Ordering, Referring, Prescribing	N/A	1881749158	0	0	BENNETT, CATHLEEN LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT24810	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE	SUITE 200	CONCORD	CA	94520	4817	00	06000	37.98393807	-122.0466953	Contra Costa County
350582	Ordering, Referring, Prescribing	N/A	1881753200	0	0	BOLEN, DEWEY L	4/26/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18863	N/A	N/A	N/A	N/A	N/A	2469 OLD EUREKA WAY	None	REDDING	CA	96001	0336	00	06000	40.58589079	-122.4073788	Shasta County
350594	Ordering, Referring, Prescribing	N/A	1881768380	0	0	BRUNO, SUSAN M LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43738	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	None	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
350597	Ordering, Referring, Prescribing	N/A	1881772606	0	0	BROWN, STEPHANIE K MD	7/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G78022	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
350610	Ordering, Referring, Prescribing	N/A	1881790418	0	0	BHUPATHY, ANAND DO	4/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A6177	N/A	N/A	N/A	N/A	N/A	25815 BARTON RD	STE 101	LOMA LINDA	CA	92354	3857	00	06000	34.04825519	-117.2408344	San Bernardino County
350614	Ordering, Referring, Prescribing	N/A	1881817112	0	0	BERKOWITZ, BERNICE LMFT	9/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46843	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	475	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
350619	Ordering, Referring, Prescribing	N/A	1881841575	0	0	BAJWA, RANJEET S OD FAAO	1/12/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT13492	N/A	N/A	N/A	N/A	N/A	833 SEQUOIA AVE	None	LINDSAY	CA	93247	1424	00	06000	36.212967	-119.0961185	Tulare County
350639	Ordering, Referring, Prescribing	N/A	1881887404	0	0	BRAVO, WENDY Z LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51470	N/A	N/A	N/A	N/A	N/A	1650 LAS PLUMAS AVE	K	SAN JOSE	CA	95133	1657	00	06000	37.36163624	-121.8663794	Santa Clara County
350669	Ordering, Referring, Prescribing	N/A	1881954188	0	0	BACHMAN, LIZBETH LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103967	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
350675	Ordering, Referring, Prescribing	N/A	1881961886	0	0	BAINS, HARJIT PHARMD	8/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50270	N/A	N/A	N/A	N/A	N/A	1615 MERIDIAN AVE	None	SAN JOSE	CA	95125	5532	00	06000	37.293957	-121.9135775	Santa Clara County
350716	Ordering, Referring, Prescribing	N/A	1891033254	0	0	BHARADWAJ, REENA PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67770	N/A	N/A	N/A	N/A	N/A	4495 MACK RD	None	SACRAMENTO	CA	95823	4545	00	06000	38.474874	-121.451292	Sacramento County
350790	Ordering, Referring, Prescribing	N/A	1891146817	0	0	BOBO, KIANA LMFT	6/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121493	N/A	N/A	N/A	N/A	N/A	3870 CRENSHAW BLVD	SUITE 207	LOS ANGELES	CA	90008	1815	00	06000	34.0152336	-118.3348463	Los Angeles County
350816	Ordering, Referring, Prescribing	N/A	1891177630	0	0	BODINI, CHANCE DDS	4/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	64610	N/A	N/A	N/A	N/A	N/A	50100 GOLSH ROAD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
350820	Ordering, Referring, Prescribing	N/A	1891182093	0	0	BARLOW, STEWART H MD	7/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163354	N/A	N/A	N/A	N/A	N/A	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
350823	Ordering, Referring, Prescribing	N/A	1891182119	0	0	BEST, KAITLIN R DO	6/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16722	N/A	N/A	N/A	N/A	N/A	204 E.BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
350847	Ordering, Referring, Prescribing	N/A	1891230439	0	0	BRADLEY, BLANCA LCSW	1/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93353	N/A	N/A	N/A	N/A	N/A	237 N CENTRAL AVE	None	GLENDALE	CA	91203	3526	00	06000	34.14943423	-118.2579487	Los Angeles County
350855	Ordering, Referring, Prescribing	N/A	1891249926	0	0	BALBI, MIRANDA J LMFT	12/22/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	213026	N/A	N/A	N/A	N/A	N/A	2821 H STREET	None	BAKERSFIELD	CA	93301	1913	00	06000	35.38560771	-119.0211608	Kern County
350857	Ordering, Referring, Prescribing	N/A	1891248787	0	0	BAKKIE, CAYLAN I LMFT	7/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128578	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	STE 280	SAN MATEO	CA	94403	1289	00	06000	37.54524373	-122.3205511	San Mateo County
350874	Ordering, Referring, Prescribing	N/A	1891281689	0	0	BARBARI, NATASHA LCSW	7/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115414	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	350	INGLEWOOD	CA	90301	4501	00	06000	33.966333	-118.3439975	Los Angeles County
350885	Ordering, Referring, Prescribing	N/A	1891309654	0	0	BURCHFIEL, NANCY A CNP	3/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014999	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
350889	Ordering, Referring, Prescribing	N/A	1891319455	0	0	BARON, MARIA S NP	8/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022197	N/A	N/A	N/A	N/A	N/A	16387 FIRST STREET	None	GUERNEVILLE	CA	95446	0226	00	06000	38.50111158	-122.9999868	Sonoma County
350893	Ordering, Referring, Prescribing	N/A	1891323739	0	0	BECHELLI, MATTHEW MD	12/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL5120	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
350921	Ordering, Referring, Prescribing	N/A	1891377271	0	0	BARATZ, ASHLEY PHD	4/2/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32498	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
350924	Ordering, Referring, Prescribing	N/A	1891407953	0	0	BABAIAN, ALISSA PA-C	2/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62311	N/A	N/A	N/A	N/A	N/A	1311 N. SAN FERNANDO BLV	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
350943	Ordering, Referring, Prescribing	N/A	1891448544	0	0	BUCHHOLD, LOUIS LMFT	2/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40266	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
350945	Ordering, Referring, Prescribing	N/A	1891436630	0	0	BARBOZA, GEORGE NP	4/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95020563	N/A	N/A	N/A	N/A	N/A	39755 MURRIETA HOT SPRIN	None	MURRIETA	CA	92563	9151	00	06000	33.55575954	-117.1627899	Riverside County
350975	Ordering, Referring, Prescribing	N/A	1891727533	0	0	BURNS, PETER B MD	6/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G145142	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
350993	Ordering, Referring, Prescribing	N/A	1891816880	0	0	BACHMAN, JOHN A PHD	5/17/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	6894	N/A	N/A	N/A	N/A	N/A	4212 MISSOURI FLAT ROAD	None	PLACERVILLE	CA	95667	6269	00	06000	38.706228	-120.834891	El Dorado County
350996	Ordering, Referring, Prescribing	N/A	1891819249	0	0	BENACERRAF, TANIA LCSW	11/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18997	N/A	N/A	N/A	N/A	N/A	1400 SOUTH GRAND AVENUE	SUITE 600	LOS ANGELES	CA	90015	2881	00	06000	34.03692236	-118.2655238	Los Angeles County
351069	Ordering, Referring, Prescribing	N/A	1891975702	0	0	BUI, PHONG F MD	2/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106596	N/A	N/A	N/A	N/A	N/A	7561 CENTER AVE	32	HUNTINGTON BEACH	CA	92647	3037	00	06000	33.73398651	-117.997398	Orange County
351100	Ordering, Referring, Prescribing	N/A	1902055395	0	0	BANOONI, AZITA B	4/17/2019	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	22280	N/A	N/A	N/A	N/A	N/A	6120 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	2911	00	06000	33.98438021	-118.2226279	Los Angeles County
351116	Ordering, Referring, Prescribing	N/A	1902091473	0	0	BHARIER, SARAH PSYD	3/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26083	N/A	N/A	N/A	N/A	N/A	2325 CLEMENT AVE	A	ALAMEDA	CA	94501	7061	00	06000	37.77017367	-122.2389726	Alameda County
351120	Ordering, Referring, Prescribing	N/A	1902093743	0	0	BEDDINGFIELD, GRETCHEN R LMFT	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49520	N/A	N/A	N/A	N/A	N/A	1870 N. MAIN STREET	None	SALINAS	CA	93906	2042	00	06000	36.71784314	-121.6554107	Monterey County
351146	Ordering, Referring, Prescribing	N/A	1902146756	0	0	BANTIMBA, JULIA B OT	6/4/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT13267	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
351154	Ordering, Referring, Prescribing	N/A	1902154420	0	0	BURKE, HAYDEN MD	5/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150361	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
351185	Ordering, Referring, Prescribing	N/A	1902189160	0	0	BANGA, RUPINDERJEET K PHARMD	8/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44996	N/A	N/A	N/A	N/A	N/A	1781 COLUSA HWY	None	YUBA CITY	CA	95993	9096	00	06000	39.14166118	-121.6480966	Sutter County
351202	Ordering, Referring, Prescribing	N/A	1902217219	0	0	BELL, MARY LMFT	12/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102986	N/A	N/A	N/A	N/A	N/A	2150 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1337	00	06000	38.557287	-121.461444	Sacramento County
351214	Ordering, Referring, Prescribing	N/A	1902234651	0	0	BELLO, BRIAN S MD	11/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127497	N/A	N/A	N/A	N/A	N/A	4525 E ATHERTON ST	None	LONG BEACH	CA	90815	3700	00	06000	33.78988246	-118.1397653	Los Angeles County
351217	Ordering, Referring, Prescribing	N/A	1902239957	0	0	BAJWA, JASHANJOT S	6/2/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100948	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
351222	Ordering, Referring, Prescribing	N/A	1902239726	0	0	BENWAY, JESSICA N LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102052	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
351223	Ordering, Referring, Prescribing	N/A	1902272537	0	0	BUTLER, MOLLY E LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102651	N/A	N/A	N/A	N/A	N/A	1105 E FLORIDA AVE	None	HEMET	CA	92543	4512	00	06000	33.74750951	-116.960463	Riverside County
351248	Ordering, Referring, Prescribing	N/A	1902291925	0	0	BARROSO PEREZ, ARLENIS MD	8/4/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152756	N/A	N/A	N/A	N/A	N/A	625 34TH ST	STE 100 & 200	BAKERSFIELD	CA	93301	2307	00	06000	35.39046051	-119.0092725	Kern County
351250	Ordering, Referring, Prescribing	N/A	1902301880	0	0	BAZAZI, ALEXANDER R MD	6/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164265	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
351276	Ordering, Referring, Prescribing	N/A	1902340334	0	0	BROWN, ASHLEY M CNP	1/22/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95005465	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	STE 201	CHULA VISTA	CA	91911	2975	00	06000	32.60364599	-117.0786521	San Diego County
351280	Ordering, Referring, Prescribing	N/A	1902339021	0	0	BURNIER, ANDRE M MD	6/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157069	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
351289	Ordering, Referring, Prescribing	N/A	1902359607	0	0	BRADLEY, LAURA PA	3/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53585	N/A	N/A	N/A	N/A	N/A	220 EUCLID AVE	30	SAN DIEGO	CA	92114	3644	00	06000	32.706387	-117.085098	San Diego County
351317	Ordering, Referring, Prescribing	N/A	1902433063	0	0	BEASLEY, ADAM MD FAAP	7/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184791	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	SUITE 320	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
351339	Ordering, Referring, Prescribing	N/A	1902520158	0	0	BONILLA, ADRIANA LCSW	10/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94714	N/A	N/A	N/A	N/A	N/A	302 N MIDWAY DR	None	ESCONDIDO	CA	92027	2708	00	06000	33.13619959	-117.0509061	San Diego County
351341	Ordering, Referring, Prescribing	N/A	1902535792	0	0	BURRELL, CHRISTOPHER PHARMD	5/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	66173	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	BLDG 5, 1ST FLOOR, 1M	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
351346	Ordering, Referring, Prescribing	N/A	1902555675	0	0	BILLINGS, ANDREW A NP	7/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021535	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
351347	Ordering, Referring, Prescribing	N/A	1902557226	0	0	BRADBURY, ALEC CNP	1/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019763	N/A	N/A	N/A	N/A	N/A	16 RITTER ST	None	SAN RAFAEL	CA	94901	3323	00	06000	37.97151013	-122.5251246	Marin County
351353	Ordering, Referring, Prescribing	N/A	1902570120	0	0	BRADLEY, MALLORY K NP	8/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022414	N/A	N/A	N/A	N/A	N/A	1014 1/2 N VERMONT AVENU	None	LOS ANGELES	CA	90029	0000	00	06000	34.0900257	-118.2916693	Los Angeles County
351356	Ordering, Referring, Prescribing	N/A	1902577430	0	0	BAREKAT, AYEH PHARMD	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84978	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
351369	Ordering, Referring, Prescribing	N/A	1902831878	0	0	BELL, WILLIAM LMFT	1/15/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38966	N/A	N/A	N/A	N/A	N/A	327 N SAN MATEO DR	10	SAN MATEO	CA	94401	2543	00	06000	37.57156972	-122.3318678	San Mateo County
351375	Ordering, Referring, Prescribing	N/A	1902805831	0	0	BRITTON, JOSEPH C MD	6/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G71840	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
351388	Ordering, Referring, Prescribing	N/A	1902905664	0	0	BILLIPS, MAVIS W MD MPH	11/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A51005	N/A	N/A	N/A	N/A	N/A	11099 N TORREY PINES RD	290	LA JOLLA	CA	92037	1029	00	06000	32.908302	-117.2409075	San Diego County
351426	Ordering, Referring, Prescribing	N/A	1902949910	0	0	BROWN, DONNA R LMFT	8/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141254	N/A	N/A	N/A	N/A	N/A	809 PLUMAS ST	None	YUBA CITY	CA	95991	9998	00	06000	39.13989097	-121.6173645	Sutter County
351427	Ordering, Referring, Prescribing	N/A	1902949621	0	0	BARBER, MACEO	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	78375	N/A	N/A	N/A	N/A	N/A	755 S VAN NESS AVE	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
351435	Ordering, Referring, Prescribing	N/A	1902964588	0	0	BENESHAN, ROBERT M DDS	4/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS20815	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
351453	Ordering, Referring, Prescribing	N/A	1912020389	0	0	BERBER, MARTHA E LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98767	N/A	N/A	N/A	N/A	N/A	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
351464	Ordering, Referring, Prescribing	N/A	1912039785	0	0	BOGAN, LINDSEY R LMFT	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47528	N/A	N/A	N/A	N/A	N/A	851 N OAKLAND AVE	None	PASADENA	CA	91104	4343	00	06000	34.16031813	-118.1403347	Los Angeles County
351474	Ordering, Referring, Prescribing	N/A	1912050014	0	0	BARSTEN PASCUALY, JULIE	5/1/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA12879	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
351484	Ordering, Referring, Prescribing	N/A	1912068735	0	0	BENNETT, LONNA A LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22633	N/A	N/A	N/A	N/A	N/A	330 E LIVE OAK AVE	None	ARCADIA	CA	91006	5617	00	06000	34.10850998	-118.0219204	Los Angeles County
351488	Ordering, Referring, Prescribing	N/A	1912084591	0	0	BENNETT, LARRY D DC	1/30/2015	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	291190	N/A	N/A	N/A	N/A	N/A	590 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3257	00	06000	36.06962449	-119.030337	Tulare County
351523	Ordering, Referring, Prescribing	N/A	1912157413	0	0	BARNES, CHRISTY LCSW	2/19/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81114	N/A	N/A	N/A	N/A	N/A	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	00	06000	34.098921	-118.287374	Los Angeles County
351527	Ordering, Referring, Prescribing	N/A	1912166406	0	0	BENATTI ATWOOD, DAVID W MD	6/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137214	N/A	N/A	N/A	N/A	N/A	11444 W WASHINGTON BLVD	None	LOS ANGELES	CA	90066	6024	00	06000	34.00195228	-118.4158524	Los Angeles County
351542	Ordering, Referring, Prescribing	N/A	1912208828	0	0	BAER, HILARY D	4/23/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0841009	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC AVE	STE 370	LONG BEACH	CA	90806	2661	00	06000	33.805854	-118.1936805	Los Angeles County
351548	Ordering, Referring, Prescribing	N/A	1912217654	0	0	BRYANT, GIMONE LCSW	7/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95786	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	125-A	OAKLAND	CA	94605	2457	00	06000	37.768221	-122.17608	Alameda County
351563	Ordering, Referring, Prescribing	N/A	1912256660	0	0	BANIQUED, JONATHAN R	2/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	67825	N/A	N/A	N/A	N/A	N/A	7400 ELK GROVE BLVD	None	ELK GROVE	CA	95757	6299	00	06000	38.405799	-121.4134875	Sacramento County
351604	Ordering, Referring, Prescribing	N/A	1912302662	0	0	BOWMAN, DAVID H LMFT	9/27/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97657	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
351608	Ordering, Referring, Prescribing	N/A	1912309154	0	0	BARBER, DEBORAH M LMFT	10/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102185	N/A	N/A	N/A	N/A	N/A	3060 VALENCIA AVE	7	APTOS	CA	95003	4165	00	06000	36.97678922	-121.8865479	Santa Cruz County
351611	Ordering, Referring, Prescribing	N/A	1912308974	0	0	BAIRIAN, CRYSTAL	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71222	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
351619	Ordering, Referring, Prescribing	N/A	1912314766	0	0	BENYOUNG, LINDA	5/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86748	N/A	N/A	N/A	N/A	N/A	1911 WILLLIAMS DRIVE	210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
351623	Ordering, Referring, Prescribing	N/A	1912323338	0	0	BOWLES, HELEN M LCSW	3/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121642	N/A	N/A	N/A	N/A	N/A	2919 MISSION STREET	None	SAN FRANCISCO	CA	94110	3917	00	06000	37.75028364	-122.418239	San Francisco County
351631	Ordering, Referring, Prescribing	N/A	1912332743	0	0	BYUN, ANNA L PHARMD	4/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69487	N/A	N/A	N/A	N/A	N/A	12642 PICRUST ST	None	SAN DIEGO	CA	92120	4121	00	06000	32.94713332	-117.1414488	San Diego County
351656	Ordering, Referring, Prescribing	N/A	1912374851	0	0	BARISH, BETH E LMFT	2/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79621	N/A	N/A	N/A	N/A	N/A	18600 MAIN ST	295	HUNTINGTON BEACH	CA	92648	1729	00	06000	33.69235011	-117.9909361	Orange County
351697	Ordering, Referring, Prescribing	N/A	1912432469	0	0	BURNS, JACOB R MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158263	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2282	00	06000	38.555181	-121.4566785	Sacramento County
351704	Ordering, Referring, Prescribing	N/A	1912447624	0	0	BRAGG, KELCIE P RN CPNP	3/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006241	N/A	N/A	N/A	N/A	N/A	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
351728	Ordering, Referring, Prescribing	N/A	1912481284	0	0	BERNELIS, AMBER PA-C	5/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57031	N/A	N/A	N/A	N/A	N/A	475 BRUCE ST	None	YREKA	CA	96097	6474	00	06000	41.71860037	-122.6467317	Siskiyou County
351764	Ordering, Referring, Prescribing	N/A	1912534553	0	0	BRIGANTI, DAVID N DO	5/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21086	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
351766	Ordering, Referring, Prescribing	N/A	1912539966	0	0	BOYKIN, KEYONA NP	2/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011446	N/A	N/A	N/A	N/A	N/A	9925 INTERNATIONAL BLVD	SUITE 5	OAKLAND	CA	94603	2558	00	06000	37.74332565	-122.1698542	Alameda County
351768	Ordering, Referring, Prescribing	N/A	1912548942	0	0	BOURAS, LAUREN M RDH	2/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RDH31863	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
351805	Ordering, Referring, Prescribing	N/A	1912658220	0	0	BROWN, VANESSA LCSW	1/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21227	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	180	DAVIS	CA	95605	2394	00	06000	38.58811316	-121.5270471	Yolo County
351825	Ordering, Referring, Prescribing	N/A	1912747809	0	0	BECKER, CARY L RDH	7/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RDH19955	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
351827	Ordering, Referring, Prescribing	N/A	1912745852	0	0	BARNETT, GARRETT DDS	7/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110323	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
351831	Ordering, Referring, Prescribing	N/A	1912786401	0	0	BRADLEY, JOSEPH NP	12/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028253	N/A	N/A	N/A	N/A	N/A	339 PAJARO ST	None	SALINAS	CA	93901	3400	00	06000	36.6725294	-121.6522021	Monterey County
351839	Ordering, Referring, Prescribing	N/A	1912965575	0	0	BRADWELL, JAMES M MD	9/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	48615	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
351858	Ordering, Referring, Prescribing	N/A	1922102243	0	0	BALME, ERIC LMFT	4/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34860	N/A	N/A	N/A	N/A	N/A	4250 FOWLER LN	SUITE 204	DIAMOND SPRINGS	CA	95619	9781	00	06000	38.69331583	-120.8130299	El Dorado County
351872	Ordering, Referring, Prescribing	N/A	1922138528	0	0	BELL, SONIA D MD	7/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85402	N/A	N/A	N/A	N/A	N/A	555 FRONT STREET	None	SAN FRANCISCO	CA	94111	1911	00	06000	37.79691743	-122.399497	San Francisco County
351949	Ordering, Referring, Prescribing	N/A	1922315332	0	0	BURKLE, MARGARET F LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108930	N/A	N/A	N/A	N/A	N/A	165 8TH ST.	None	SAN FRANCISCO	CA	94103	2726	00	06000	37.77674401	-122.4121297	San Francisco County
351966	Ordering, Referring, Prescribing	N/A	1922355742	0	0	BACH, ALBERT T PHARMD	4/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67326	N/A	N/A	N/A	N/A	N/A	9501 JERONIMO RD	None	IRVINE	CA	92618	2018	00	06000	33.64938161	-117.7173612	Orange County
351971	Ordering, Referring, Prescribing	N/A	1922357417	0	0	BONYADIAN, MARYAM LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87042	N/A	N/A	N/A	N/A	N/A	237 N CENTRAL AVE SUITE	None	GLENDALE	CA	91203	3526	00	06000	34.14943423	-118.2579487	Los Angeles County
351985	Ordering, Referring, Prescribing	N/A	1922385061	0	0	BOJNOWSKI, DONALD K DC	6/30/2020	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	15527	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
351988	Ordering, Referring, Prescribing	N/A	1922385285	0	0	BICERA, ELEANOR Q PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49653	N/A	N/A	N/A	N/A	N/A	795 E. FOOTHILL BLVD	None	POMONA	CA	91767	1223	00	06000	34.10721485	-117.7372912	Los Angeles County
352010	Ordering, Referring, Prescribing	N/A	1922418003	0	0	BERUMEN, JANETT LCSW	8/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103108	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
352013	Ordering, Referring, Prescribing	N/A	1922420819	0	0	BLASY, DAVID LMFT	8/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120764	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
352036	Ordering, Referring, Prescribing	N/A	1922461839	0	0	BEACH, KOURTNEY LCSW	9/6/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82303	N/A	N/A	N/A	N/A	N/A	912 FREMONT STREET	None	DELANO	CA	93215	4827	00	06000	35.76763031	-119.2498143	Kern County
352052	Ordering, Referring, Prescribing	N/A	1922481324	0	0	BUI, CINDY	1/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192832	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
352069	Ordering, Referring, Prescribing	N/A	1922494145	0	0	BROWN, BETTY LMFT	7/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133781	N/A	N/A	N/A	N/A	N/A	555 SCHOOL ST.	None	PITTSBURG	CA	94565	0001	00	06000	38.01980655	-121.8792708	Contra Costa County
352076	Ordering, Referring, Prescribing	N/A	1922502954	0	0	BOYD, KEVIN LCSW	11/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66628	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER STREET	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
352098	Ordering, Referring, Prescribing	N/A	1922539758	0	0	BERRY, AMBER D LPCC	12/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC8964	N/A	N/A	N/A	N/A	N/A	3491 KURTZ STREET	None	SAN DIEGO	CA	92110	1330	00	06000	32.7557948	-117.209639	San Diego County
352100	Ordering, Referring, Prescribing	N/A	1922541499	0	0	BAINS, SANDEEP	7/27/2019	Taxonomy not applicable	NA	n/a	000	Unknown	55019	N/A	N/A	N/A	N/A	N/A	7140 W PERSHING CT	None	VISALIA	CA	93291	7941	00	06000	36.339669	-119.370834	Tulare County
352132	Ordering, Referring, Prescribing	N/A	1922586072	0	0	BOLANOS, JERALYN LCSW	10/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW118720	N/A	N/A	N/A	N/A	N/A	11050 ARTESIA BLVD.	None	CERRITOS	CA	90703	2543	00	06000	33.8728535	-118.097847	Los Angeles County
352143	Ordering, Referring, Prescribing	N/A	1922612720	0	0	BRADSHAW, BIANCA PHARMD	5/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56022	N/A	N/A	N/A	N/A	N/A	401 WALNUT ST	None	RED BLUFF	CA	96080	8945	00	06000	40.17779587	-122.2368802	Tehama County
352148	Ordering, Referring, Prescribing	N/A	1922629864	0	0	BLOSSER, JOSHUA A DO	1/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20582	N/A	N/A	N/A	N/A	N/A	31720 TEMECULA PKWY	200	TEMECULA	CA	92592	5802	00	06000	33.4799323	-117.1033702	Riverside County
352171	Ordering, Referring, Prescribing	N/A	1922699008	0	0	BOURAKI, KYRIAKI J	2/18/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	107301	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
352227	Ordering, Referring, Prescribing	N/A	1932153970	0	0	BAZAK, ILAN DPM	1/31/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E3741	N/A	N/A	N/A	N/A	N/A	1121 N FAIRFAX AVE	None	LOS ANGELES	CA	90046	5306	00	06000	34.091451	-118.3615195	Los Angeles County
352234	Ordering, Referring, Prescribing	N/A	1932221140	0	0	BRUNO, AMY E	3/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015777	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
352235	Ordering, Referring, Prescribing	N/A	1932213543	0	0	BERCI, LIGIA MD	2/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A77726	N/A	N/A	N/A	N/A	N/A	9837 FOLSOM BLVD	F	SACRAMNETO	CA	95827	1327	00	06000	38.575764	-121.330647	Sacramento
352257	Ordering, Referring, Prescribing	N/A	1932240611	0	0	BROWN, MONIQUE AMBER	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27381	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	0920	00	06000	34.10679449	-117.3542535	San Bernardino County
352261	Ordering, Referring, Prescribing	N/A	1932253440	0	0	BRYAN, JOHN B LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44869	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	107	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
352266	Ordering, Referring, Prescribing	N/A	1932263860	0	0	BARAN, JOAN PHD	4/30/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	14679	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
352267	Ordering, Referring, Prescribing	N/A	1932235264	0	0	BARTH-ROGERS, YOHANNA MD	10/15/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132712	N/A	N/A	N/A	N/A	N/A	7821 S AVALON BLVD	None	LOS ANGELES	CA	90003	2358	00	06000	33.969393	-118.265197	Los Angeles County
352273	Ordering, Referring, Prescribing	N/A	1932280021	0	0	BUENO, ROBIN LCSW	6/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73395	N/A	N/A	N/A	N/A	N/A	6330 RUGBY AVE	None	HUNTINGTON PARK	CA	90255	4064	00	06000	33.98277323	-118.2265373	Los Angeles County
352279	Ordering, Referring, Prescribing	N/A	1932301322	0	0	BECKHAM, KIMBERLY A	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40626	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVE	None	HAYWARD	CA	94544	2923	00	06000	37.64800936	-122.0758633	Alameda County
352280	Ordering, Referring, Prescribing	N/A	1932297280	0	0	BEFORT, MARK M	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20807	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
352285	Ordering, Referring, Prescribing	N/A	1932308400	0	0	BETANCOURT, INES T LCSW	1/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16348	N/A	N/A	N/A	N/A	N/A	100 BLANKEN AVE	None	SAN FRANCISCO	CA	94134	2407	00	06000	37.7119479	-122.4006456	San Francisco County
352316	Ordering, Referring, Prescribing	N/A	1932400710	0	0	BORKENHAGEN, QUYNH PHARMD	4/29/2019	Taxonomy not applicable	NA	n/a	000	Unknown	68687	N/A	N/A	N/A	N/A	N/A	12602-12604 VENTURA BLVD	None	STUDIO CITY	CA	91604	2414	00	06000	34.14358415	-118.4078173	Los Angeles County
352319	Ordering, Referring, Prescribing	N/A	1932409711	0	0	BARRETO, CAMILA LMFT	5/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90005	N/A	N/A	N/A	N/A	N/A	548 MILLS WAY	None	GOLETA	CA	93117	4021	00	06000	34.42196627	-119.8753858	Santa Barbara County
352337	Ordering, Referring, Prescribing	N/A	1932436144	0	0	BRYAN, LAUREN M LMFT	4/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84454	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	None	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
352352	Ordering, Referring, Prescribing	N/A	1932477742	0	0	BACON, HIROMI K LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72144	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
352363	Ordering, Referring, Prescribing	N/A	1932488871	0	0	BASARAN, ISMAIL E	2/5/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D44827	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
352369	Ordering, Referring, Prescribing	N/A	1932497542	0	0	BABB, ELIZABETH K PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65538	N/A	N/A	N/A	N/A	N/A	8010 PARKWAY DR	AREA 5	LA MESA	CA	91942	2104	00	06000	32.7749024	-117.0246371	San Diego County
352383	Ordering, Referring, Prescribing	N/A	1932514957	0	0	BALL SEPULVEDA, JAVIER F PHD	7/21/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31938	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	SUITE 600	LOS ANGELES	CA	90015	2881	00	06000	34.03692236	-118.2655238	Los Angeles County
352384	Ordering, Referring, Prescribing	N/A	1932527892	0	0	BUENROSTRO, ANDREA L MD	3/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149470	N/A	N/A	N/A	N/A	N/A	1501 E HOLT AVE	A	POMONA	CA	91767	5823	00	06000	34.06321709	-117.7205804	Los Angeles County
352389	Ordering, Referring, Prescribing	N/A	1932530342	0	0	BUI, MATTHEW PHARMD	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70288	N/A	N/A	N/A	N/A	N/A	3110 BALFOUR RD	None	BRENTWOOD	CA	94513	5500	00	06000	37.92525934	-121.7220343	Contra Costa County
352401	Ordering, Referring, Prescribing	N/A	1932541257	0	0	BAYS, DEREK J MD	10/18/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149095	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
352451	Ordering, Referring, Prescribing	N/A	1932614104	0	0	BAEZ, BIRIDIANA LMFT	10/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122441	N/A	N/A	N/A	N/A	N/A	5628 E SLAUSON AVE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
352460	Ordering, Referring, Prescribing	N/A	1932622206	0	0	BRAR, JASLEEN K MD	7/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169476	N/A	N/A	N/A	N/A	N/A	517 S MADERA AVE	None	KERMAN	CA	93630	1523	00	06000	36.72710606	-120.060325	Fresno County
352487	Ordering, Referring, Prescribing	N/A	1932677960	0	0	BARSTEIN, JAMIE PHD	3/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31705	N/A	N/A	N/A	N/A	N/A	13130 BURBANK BLVD	None	SHERMAN OAKS	CA	91401	1401	00	06000	34.17210778	-118.4192552	Los Angeles County
352488	Ordering, Referring, Prescribing	N/A	1932678323	0	0	BIBRIESCA, JONATHAN LCSW	3/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107147	N/A	N/A	N/A	N/A	N/A	11100 ARTESIA BOULEVARD	SUITE A	CERRITOS	CA	90703	2547	00	06000	33.87288108	-118.097253	Los Angeles County
352508	Ordering, Referring, Prescribing	N/A	1932712544	0	0	BULLARD, KAYLA RN BS	10/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	95053841	N/A	N/A	N/A	N/A	N/A	800 NIBLICK RD	None	PASO ROBLES	CA	93446	4858	00	06000	35.61575355	-120.672279	San Luis Obispo County
352512	Ordering, Referring, Prescribing	N/A	1932715851	0	0	BENOWITZ, SARA M LCSW	2/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113865	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST FL 2	FL 2	PASADENA	CA	91105	4026	00	06000	34.12993251	-118.1516625	Los Angeles County
352600	Ordering, Referring, Prescribing	N/A	1932964970	0	0	BOYNAGIRYAN, SERZH NP	2/5/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028967	N/A	N/A	N/A	N/A	N/A	1241 S GLENDALE AVE	201	GLENDALE	CA	91205	3385	00	06000	34.13065269	-118.2524619	Los Angeles County
352609	Ordering, Referring, Prescribing	N/A	1942210893	0	0	BURIAN, PAMELA PA	1/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	12734	N/A	N/A	N/A	N/A	N/A	4905 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90027	6101	00	06000	34.10180109	-118.2963991	Los Angeles County
352622	Ordering, Referring, Prescribing	N/A	1942315320	0	0	BRAMBILA-BRAGA, NATASHA E	10/7/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D52830	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
352633	Ordering, Referring, Prescribing	N/A	1942330550	0	0	BERKE, JASMINE D	2/5/2018	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC4357	N/A	N/A	N/A	N/A	N/A	21507 E CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
352637	Ordering, Referring, Prescribing	N/A	1942338355	0	0	BIERMAN, REBECCA DO	6/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	2OA7569	N/A	N/A	N/A	N/A	N/A	1691 GRAMERCY AVE	None	TORRANCE	CA	90501	3236	00	06000	33.83161459	-118.3165672	Los Angeles County
352661	Ordering, Referring, Prescribing	N/A	1942374251	0	0	BORNSTEIN, HAROLD S MD	2/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G34048	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	SUITE 2100	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
352677	Ordering, Referring, Prescribing	N/A	1942430020	0	0	BORCSA, ESTERA M LCSW	5/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70017	N/A	N/A	N/A	N/A	N/A	801 E CHAPMAN AVE	203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
352684	Ordering, Referring, Prescribing	N/A	1942446380	0	0	BREITBART, JENNIFER MD	11/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138338	N/A	N/A	N/A	N/A	N/A	5901 GREEN VALLEY CIR	405	CULVER CITY	CA	90230	6938	00	06000	33.98409358	-118.3923715	Los Angeles County
352710	Ordering, Referring, Prescribing	N/A	1942493937	0	0	BURNS, ISAAC L LMFT	8/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44245	N/A	N/A	N/A	N/A	N/A	3700 DELTA FAIR BLVD	STE. 206	ANTIOCH	CA	94509	4019	00	06000	38.0038852	-121.8448833	Contra Costa County
352755	Ordering, Referring, Prescribing	N/A	1942589767	0	0	BREEN, JENNIFER LMFT	6/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50461	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
352767	Ordering, Referring, Prescribing	N/A	1942610142	0	0	BEARDSLEY, MEGAN L LPCC	1/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC9165	N/A	N/A	N/A	N/A	N/A	1350 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2422	00	06000	35.12076617	-120.6044977	San Luis Obispo County
352776	Ordering, Referring, Prescribing	N/A	1942625017	0	0	BARAHONA, FREDDIE LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98509	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVE	None	HAYWARD	CA	94544	2923	00	06000	37.64800936	-122.0758633	Alameda County
352784	Ordering, Referring, Prescribing	N/A	1942633490	0	0	BERNABE, NARAE L LMFT	2/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95046	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
352789	Ordering, Referring, Prescribing	N/A	1942635305	0	0	BRAMBILA, LISSETTE LCSW	7/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95551	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
352796	Ordering, Referring, Prescribing	N/A	1942647904	0	0	BRYAN, PAUL S LCSW	9/6/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72904	N/A	N/A	N/A	N/A	N/A	210 N. CHESTER AVE	None	BAKERSFIELD	CA	93308	4048	00	06000	35.407179	-119.0208925	Kern County
352798	Ordering, Referring, Prescribing	N/A	1942648811	0	0	BROWN, SPENCER PHARMD	9/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	67970	N/A	N/A	N/A	N/A	N/A	1018 CASITAS PASS RD	None	CARPINTERIA	CA	93013	2109	00	06000	34.395972	-119.5130879	Santa Barbara County
352801	Ordering, Referring, Prescribing	N/A	1942635255	0	0	BALTAZAR RUEZGA, MIRIAM LCSW	1/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88673	N/A	N/A	N/A	N/A	N/A	5110 W GOLDLEAF CIR	2ND FLOOR	LOS ANGELES	CA	90056	1282	00	06000	33.98790164	-118.367233	Los Angeles County
352820	Ordering, Referring, Prescribing	N/A	1942684790	0	0	BECHTHOLD, DARIN PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53031	N/A	N/A	N/A	N/A	N/A	1141 W AVENUE L	None	LANCASTER	CA	93534	7077	00	06000	34.66039349	-118.1514285	Los Angeles County
352823	Ordering, Referring, Prescribing	N/A	1942687496	0	0	BOTELLO, ENRIQUE LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115120	N/A	N/A	N/A	N/A	N/A	275 S MADERA AVE	404	KERMAN	CA	93630	1403	00	06000	36.73165922	-120.0602617	Fresno County
352842	Ordering, Referring, Prescribing	N/A	1942717343	0	0	BAKRAMIAN, JILBERT R	6/7/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102233	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DSRT HOT SPGS	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
352845	Ordering, Referring, Prescribing	N/A	1942719125	0	0	BONGURALA, ARCHANA-REDDY MD	11/15/2019	Taxonomy not applicable	NA	n/a	000	Unknown	A166699	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4841	00	06000	35.407179	-119.0208925	Kern County
352856	Ordering, Referring, Prescribing	N/A	1942730627	0	0	BARNES, CASEE PHARMD	1/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75746	N/A	N/A	N/A	N/A	N/A	1929 W SAN MARCOS	None	SAN MARCOS	CA	92078	3903	00	06000	33.13230673	-117.2107325	San Diego County
352871	Ordering, Referring, Prescribing	N/A	1942759691	0	0	BAINS, SHEENA NP	12/15/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016243	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
352886	Ordering, Referring, Prescribing	N/A	1942783014	0	0	BOJORQUEZ, MARITZA LCSW	2/25/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80936	N/A	N/A	N/A	N/A	N/A	69175 RAMON RD	BLDG A	CATHEDRAL CITY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
352903	Ordering, Referring, Prescribing	N/A	1942817846	0	0	BARUCH, TALIA R NP	7/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017817	N/A	N/A	N/A	N/A	N/A	2100 N BROADWAY	None	SANTA ANA	CA	92706	2624	00	06000	33.76425305	-117.8695929	Orange County
352922	Ordering, Referring, Prescribing	N/A	1942864327	0	0	BEYER, CAROLINE W MD	9/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182134	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
352950	Ordering, Referring, Prescribing	N/A	1942937727	0	0	BUI, DANQUYNH C PHARMD	10/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85354	N/A	N/A	N/A	N/A	N/A	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	00	06000	37.55399458	-121.9756047	Alameda County
352954	Ordering, Referring, Prescribing	N/A	1942961297	0	0	BLUMENTHAL, ELISE G LMFT	1/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	22763	N/A	N/A	N/A	N/A	N/A	4124 ODIE LN	None	SANTA MARIA	CA	93455	3109	00	06000	34.88243442	-120.433739	Santa Barbara County
352996	Ordering, Referring, Prescribing	N/A	1952109050	0	0	BENREY, NURIT PHD	1/2/2025	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	35604	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	SUITE 500	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
353000	Ordering, Referring, Prescribing	N/A	1952122681	0	0	BASSETT, AMANDA P PA-C	12/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65606	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
353001	Ordering, Referring, Prescribing	N/A	1952145955	0	0	BENINCOSA, MATTHEW	6/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95030709	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
353025	Ordering, Referring, Prescribing	N/A	1952408601	0	0	BETTENCOURT, SHANNON C LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42581	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	None	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
353048	Ordering, Referring, Prescribing	N/A	1952441537	0	0	BERMUDEZ, VIVIAN E LMFT	6/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41050	N/A	N/A	N/A	N/A	N/A	850 E. FOOTHILL BLVD.	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
353111	Ordering, Referring, Prescribing	N/A	1952587834	0	0	BARRETO, DELIA LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28625	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
353145	Ordering, Referring, Prescribing	N/A	1952640591	0	0	BARRIENTOS, WENDY LCSW	8/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96538	N/A	N/A	N/A	N/A	N/A	17053 E FOOTHILL BLVD.	None	FONTANA	CA	92335	3574	00	06000	34.10655148	-117.432828	San Bernardino County
353147	Ordering, Referring, Prescribing	N/A	1952668519	0	0	BADYAL, HARDEEP K	11/14/2017	Taxonomy not applicable	NA	n/a	000	Unknown	21840	N/A	N/A	N/A	N/A	N/A	1530 MANNING AVE	None	REEDLEY	CA	93654	2346	00	06000	36.60413846	-119.4316515	Fresno County
353159	Ordering, Referring, Prescribing	N/A	1952686958	0	0	BHULLAR, SARBJIT S MD	1/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118741	N/A	N/A	N/A	N/A	N/A	4378 AUBURN BLVD	None	SACRAMENTO	CA	95841	4175	00	06000	38.645082	-121.3614315	Sacramento County
353162	Ordering, Referring, Prescribing	N/A	1952691354	0	0	BROWN, DAVID M MD	6/6/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	MD60637692	N/A	N/A	N/A	N/A	N/A	217 W CATALDO AVE.	None	SPOKANE	WA	99201	2217	00	06000	47.665782	-117.4152105	Spokane County
353201	Ordering, Referring, Prescribing	N/A	1952755191	0	0	BARDESSONO, LESLIE C DO	4/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20848	N/A	N/A	N/A	N/A	N/A	31764 CASINO DR	SUITE 300	LAKE ELSINORE	CA	92530	2312	00	06000	33.65724839	-117.29582	Riverside County
353206	Ordering, Referring, Prescribing	N/A	1952754822	0	0	BRENNER, TINA PA	5/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA53554	N/A	N/A	N/A	N/A	N/A	3834 S WESTERN AVE	None	LOS ANGELES	CA	90062	1104	00	06000	34.016157	-118.3088825	Los Angeles County
353220	Ordering, Referring, Prescribing	N/A	1952789422	0	0	BRUETT, LINDSEY D PHD	5/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29422	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	BLDG 5 SUITE 6B	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
353231	Ordering, Referring, Prescribing	N/A	1952805582	0	0	BALTONADO, JULET O DO	4/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17798	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
353234	Ordering, Referring, Prescribing	N/A	1952819120	0	0	BOATWRIGHT, SIERRA A	4/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121641	N/A	N/A	N/A	N/A	N/A	2981 CALLE NOGUERA	None	SANTA BARBARA	CA	93105	2847	00	06000	34.44138148	-119.7278726	Santa Barbara County
353237	Ordering, Referring, Prescribing	N/A	1952816233	0	0	BUNIAG, ALVIN N	1/11/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102092	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
353250	Ordering, Referring, Prescribing	N/A	1952828717	0	0	BUCK, JASMINE L LMFT	3/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124817	N/A	N/A	N/A	N/A	N/A	260 COHASSET RD	120	CHICO	CA	95926	2282	00	06000	39.754035	-121.851117	Butte County
353259	Ordering, Referring, Prescribing	N/A	1952845364	0	0	BRANDT, DAVID M NP	12/16/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95005441	N/A	N/A	N/A	N/A	N/A	5549 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	2068	00	06000	33.939216	-117.453893	Riverside County
353264	Ordering, Referring, Prescribing	N/A	1952852808	0	0	BLAIS, BRITTNEY R NP	10/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95014574	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVE	None	SAN DIEGO	CA	92115	4011	00	06000	32.76023438	-117.0667611	San Diego County
353271	Ordering, Referring, Prescribing	N/A	1952861304	0	0	BENNETT-HORNE, CHRISTINA A LMFT	6/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147632	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
353286	Ordering, Referring, Prescribing	N/A	1952877391	0	0	BONDEROV, JULIE A RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	318598	N/A	N/A	N/A	N/A	N/A	1300 BAKER ST	None	BAKERSFIELD	CA	93305	4326	00	06000	35.38256022	-118.990868	Kern County
353293	Ordering, Referring, Prescribing	N/A	1952889727	0	0	BERNAL, ASHLEY C LMFT	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94658	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
353341	Ordering, Referring, Prescribing	N/A	1952999187	0	0	BUNAG, CHARLES NP	12/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016275	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
353346	Ordering, Referring, Prescribing	N/A	1962009324	0	0	BLACK, ELLIE C NP	7/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014901	N/A	N/A	N/A	N/A	N/A	925 N LAKE BLVD	102B	TAHOE CITY	CA	96145	2307	00	06000	39.17441644	-120.1374812	Placer County
353373	Ordering, Referring, Prescribing	N/A	1962058941	0	0	BATTLE, ASHLEY LCSW	7/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109219	N/A	N/A	N/A	N/A	N/A	440 EXCHANGE	250	IRVINE	CA	92602	1390	00	06000	33.71504086	-117.7849539	Orange County
353385	Ordering, Referring, Prescribing	N/A	1962087114	0	0	BETHEL, JONATHAN R LCSW	4/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107684	N/A	N/A	N/A	N/A	N/A	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
353390	Ordering, Referring, Prescribing	N/A	1962107276	0	0	BATHAN, KAREN F MD	2/4/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A200992	N/A	N/A	N/A	N/A	N/A	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33578	-121.999329	Santa Clara County
353391	Ordering, Referring, Prescribing	N/A	1962105510	0	0	BIALOSTOZKY, NATALIE MD	7/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197401	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
353393	Ordering, Referring, Prescribing	N/A	1962109256	0	0	BELL, DEARA LCSW	9/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126412	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS ROAD	None	OAKLAND	CA	94605	0000	00	06000	37.76047483	-122.157608	Alameda County
353400	Ordering, Referring, Prescribing	N/A	1962127183	0	0	BREIWISH, RAZAN LCSW	10/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126557	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
353411	Ordering, Referring, Prescribing	N/A	1962190272	0	0	BACHA, AARON O DMD	7/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108934	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
353414	Ordering, Referring, Prescribing	N/A	1962197640	0	0	BOJORQUEZ, WENDY LCSW	12/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110931	N/A	N/A	N/A	N/A	N/A	1666 PRECISION PARK LN	None	SAN YSIDRO	CA	92173	1346	00	06000	32.5659146	-117.059667	San Diego County
353440	Ordering, Referring, Prescribing	N/A	1962469148	0	0	BASSANELLI, ANTHONY G MD	10/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G55820	N/A	N/A	N/A	N/A	N/A	1751 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3408	00	06000	33.84576	-116.528208	Riverside County
353442	Ordering, Referring, Prescribing	N/A	1962473983	0	0	BURGOS, GENY B MD	4/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53610	N/A	N/A	N/A	N/A	N/A	1801 E. MARCH LN	C340	STOCKTON	CA	95210	6676	00	06000	38.00315652	-121.2868715	San Joaquin County
353450	Ordering, Referring, Prescribing	N/A	1962517367	0	0	BRIONES-COLMAN, FELICIA R MD	2/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80153	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
353454	Ordering, Referring, Prescribing	N/A	1962523522	0	0	BELLOTTI, ROXANNE L LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24897	N/A	N/A	N/A	N/A	N/A	1450 CIVIC COURT	SUITE 200	CONCORD, CA	CA	94520	7955	00	06000	37.9718675	-122.0496338	Contra Costa County
353455	Ordering, Referring, Prescribing	N/A	1962515759	0	0	BAUTISTA, PAOLA A LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46976	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
353461	Ordering, Referring, Prescribing	N/A	1962532028	0	0	BAUTISTA, CHARLOTTE LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49467	N/A	N/A	N/A	N/A	N/A	1891 EFFIE. ST.	None	LOS ANGELES	CA	90026	1711	00	06000	34.08461594	-118.2570874	Los Angeles County
353467	Ordering, Referring, Prescribing	N/A	1962554121	0	0	BLANKENSHIP, HEATHER LMFT	8/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80616	N/A	N/A	N/A	N/A	N/A	515 E WASHINGTON BLV	515	CRESCENT CITY	CA	95531	8342	00	06000	41.77269652	-124.199019	Del Norte County
353493	Ordering, Referring, Prescribing	N/A	1962607838	0	0	BENAVIDES, DENISE	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94676	N/A	N/A	N/A	N/A	N/A	1055 W. HENDERSON AVE	2	PORTERVILLE	CA	93257	0905	00	06000	36.08036906	-119.0410926	Tulare County
353505	Ordering, Referring, Prescribing	N/A	1962628719	0	0	BRONSON, CARLY A	10/2/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	819882	N/A	N/A	N/A	N/A	N/A	41820 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	00	06000	34.24651473	-116.8897879	San Bernardino County
353507	Ordering, Referring, Prescribing	N/A	1962634840	0	0	BEAL, JEFFREY LCSW	4/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92582	N/A	N/A	N/A	N/A	N/A	6333 TELEGRAPH AVE	102	OAKLAND	CA	94609	1359	00	06000	37.84914135	-122.260702	Alameda County
353512	Ordering, Referring, Prescribing	N/A	1962641050	0	0	BROWN, MONIQUE R LMFT	1/17/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46467	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST.	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
353546	Ordering, Referring, Prescribing	N/A	1962702381	0	0	BARAKAT, CLAUDE PHARMD	1/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	39018	N/A	N/A	N/A	N/A	N/A	7789 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2195	00	06000	34.25856597	-118.3021164	Los Angeles County
353564	Ordering, Referring, Prescribing	N/A	1962743971	0	0	BRANDON, NICHOLE A LCSW	6/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95066	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
353591	Ordering, Referring, Prescribing	N/A	1962777441	0	0	BUCHER, SUSAN PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH41247	N/A	N/A	N/A	N/A	N/A	4805 BECHELLI LN	None	REDDING	CA	96002	3556	00	06000	40.54014957	-122.3548634	Shasta County
353613	Ordering, Referring, Prescribing	N/A	1962797787	0	0	BELETSIS, LISA NP	12/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19238	N/A	N/A	N/A	N/A	N/A	2990 ORO DAM BLVD E	A	OROVILLE	CA	95966	5190	00	06000	39.51099741	-121.5417288	Butte County
353625	Ordering, Referring, Prescribing	N/A	1962818922	0	0	BROWN, MAECHELLE LCSW	1/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92691	N/A	N/A	N/A	N/A	N/A	1 CIVIC PLAZA DR	3RD FLOOR SPACE 141	CARSON	CA	90745	2243	00	06000	33.8328256	-118.2592958	Los Angeles County
353644	Ordering, Referring, Prescribing	N/A	1962837088	0	0	BRENNER, DANIEL J LCSW	7/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124022	N/A	N/A	N/A	N/A	N/A	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	00	06000	33.844239	-116.5282075	Riverside County
353660	Ordering, Referring, Prescribing	N/A	1962860866	0	0	BAY, DEANNA LPCC	5/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC5914	N/A	N/A	N/A	N/A	N/A	720 WOOD STREET	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
353664	Ordering, Referring, Prescribing	N/A	1962864710	0	0	BEDOLLA ROCHA, ELISABETH MD	7/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150730	N/A	N/A	N/A	N/A	N/A	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
353695	Ordering, Referring, Prescribing	N/A	1962911610	0	0	BARADARIAN, KATRIN LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111548	N/A	N/A	N/A	N/A	N/A	12821 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3012	00	06000	34.18670951	-118.41246	Los Angeles County
353778	Ordering, Referring, Prescribing	N/A	1972047645	0	0	BONILLA LOPEZ, JUDITH A LCSW	9/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96727	N/A	N/A	N/A	N/A	N/A	17053 EAST FOOTHILL BLVD	BLDG. B	FONTANA	CA	92335	3574	00	06000	34.10655148	-117.432828	San Bernardino County
353781	Ordering, Referring, Prescribing	N/A	1972061216	0	0	BARAJAS, REBECCA NP	2/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011086	N/A	N/A	N/A	N/A	N/A	781 N SEQUOIA AVE	STE 3	LINDSAY	CA	93247	1448	00	06000	36.21240571	-119.0961081	Tulare County
353787	Ordering, Referring, Prescribing	N/A	1972075257	0	0	BLANDFORD, SHAWNA LMFT	7/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134464	N/A	N/A	N/A	N/A	N/A	9837 FOLSOM BLVD	SUITE F	SACRAMENTO	CA	95827	1356	00	06000	38.575764	-121.330647	Sacramento County
353791	Ordering, Referring, Prescribing	N/A	1972084382	0	0	BIGGS, JAMIE L	5/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81990	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
353793	Ordering, Referring, Prescribing	N/A	1972085801	0	0	BAXTER, CARLA G PT	6/29/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	295131	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
353800	Ordering, Referring, Prescribing	N/A	1972089902	0	0	BUNTING, MEGAN D LCSW	4/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107779	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
353803	Ordering, Referring, Prescribing	N/A	1972098143	0	0	BRYAN, MADISON LCSW	9/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104051	N/A	N/A	N/A	N/A	N/A	10155 COLIMA ROAD	None	WHITTIER	CA	90603	2042	00	06000	33.94349601	-118.0106968	Los Angeles County
353825	Ordering, Referring, Prescribing	N/A	1972149425	0	0	BUNETI, SUDHA	10/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57997	N/A	N/A	N/A	N/A	N/A	3110 BALFOUR RD	None	BRENTWOOD	CA	94513	5500	00	06000	37.92525934	-121.7220343	Contra Costa County
353836	Ordering, Referring, Prescribing	N/A	1972165660	0	0	BANUELOS, JOSE NP	9/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013880	N/A	N/A	N/A	N/A	N/A	191 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	5201	00	06000	33.82405622	-116.5282664	Riverside County
353860	Ordering, Referring, Prescribing	N/A	1972240950	0	0	BROWN, DANIELLE NP	12/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020668	N/A	N/A	N/A	N/A	N/A	1330 LAS TABLAS RD	None	TEMPLETON	CA	93465	9758	00	06000	35.55442548	-120.723759	San Luis Obispo County
353869	Ordering, Referring, Prescribing	N/A	1972267714	0	0	BARRAGAN, PERLA LCSW	8/5/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117112	N/A	N/A	N/A	N/A	N/A	2201 MISSION AVE	100	SAN DIEGO	CA	92116	2839	00	06000	32.76012926	-117.1411896	San Diego County
353939	Ordering, Referring, Prescribing	N/A	1972663631	0	0	BAUTISTA, JENNIGRACE PHARMD	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55747	N/A	N/A	N/A	N/A	N/A	1800 HARRISON STREET	13 FLOOR	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
353947	Ordering, Referring, Prescribing	N/A	1972681039	0	0	BRONSTEIN, IRINA MD	10/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81647	N/A	N/A	N/A	N/A	N/A	266 N JACKSON AVE	SUITE 4	SAN JOSE	CA	95116	1606	00	06000	37.36445516	-121.8492308	Santa Clara County
353950	Ordering, Referring, Prescribing	N/A	1972685865	0	0	BRADY, SILVIA PHARMD	3/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45069	N/A	N/A	N/A	N/A	N/A	820 LAS GALLINAS AVE	None	SAN RAFAEL	CA	94903	3410	00	06000	38.00702954	-122.5471567	Marin County
353971	Ordering, Referring, Prescribing	N/A	1972727865	0	0	BINNING, DEBORAH A NP	11/14/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8116	N/A	N/A	N/A	N/A	N/A	12865 MAIN ST	STE 105	GARDEN GROVE	CA	92840	8205	00	06000	33.7757526	-117.9410457	Orange County
353974	Ordering, Referring, Prescribing	N/A	1972744878	0	0	BOLAND, DARYA R	2/1/2016	Taxonomy not applicable	NA	n/a	000	Unknown	177	N/A	N/A	N/A	N/A	N/A	1020 PINE STREET	None	PASO ROBLES	CA	93446	2520	00	06000	35.62509992	-120.6886853	San Luis Obispo County
353990	Ordering, Referring, Prescribing	N/A	1972764660	0	0	BARNETT, KEITH J LCSW	10/11/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70624	N/A	N/A	N/A	N/A	N/A	2042 MARKET ST	None	REDDING	CA	96001	1926	00	06000	40.57913792	-122.3886718	Shasta County
354003	Ordering, Referring, Prescribing	N/A	1972795789	0	0	BALUMBU-BENNETT, ZULU K	1/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29504	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
354020	Ordering, Referring, Prescribing	N/A	1972830438	0	0	BUSTILLOS, VICTORIA	5/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69203	N/A	N/A	N/A	N/A	N/A	1051 PICADOR BLVD	None	SAN DIEGO	CA	92154	3548	00	06000	32.57614401	-117.0562098	San Diego County
354021	Ordering, Referring, Prescribing	N/A	1972819118	0	0	BENJAMIN-BULLOCK, AMARA D LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93729	N/A	N/A	N/A	N/A	N/A	3301 EAST 12TH STREET	STE 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
354047	Ordering, Referring, Prescribing	N/A	1972855823	0	0	BERNABE, SANDRA L LCSW	10/29/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92729	N/A	N/A	N/A	N/A	N/A	4816 E 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
354049	Ordering, Referring, Prescribing	N/A	1972880235	0	0	BARKHORDARI, NOOSHIN Y PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66380	N/A	N/A	N/A	N/A	N/A	11000 VENTURA BLVD	None	STUDIO CITY	CA	91604	4224	00	06000	34.14047342	-118.3703398	Los Angeles County
354055	Ordering, Referring, Prescribing	N/A	1972883577	0	0	BENEDICT-MONTGOMERY, MARGARET PHD	3/12/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28824	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH ST	259	OAKLAND	CA	94601	3424	00	06000	37.77617499	-122.2247899	Alameda County
354065	Ordering, Referring, Prescribing	N/A	1972895779	0	0	BECKER, SHANNON C	10/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A121997	N/A	N/A	N/A	N/A	N/A	1221 SOUTH AVENUE	WEST CAMPUS	SACRAMENTO	CA	95838	4464	00	06000	38.633418	-121.437189	Sacramento County
354076	Ordering, Referring, Prescribing	N/A	1972907681	0	0	BRAVO, DANIELA LCSW	12/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88751	N/A	N/A	N/A	N/A	N/A	1800 GRAVENSTEIN HWY N	None	SEBASTOPOL	CA	95472	2607	00	06000	38.42104172	-122.8461197	Sonoma County
354086	Ordering, Referring, Prescribing	N/A	1972917748	0	0	BABARIA, VIVEK DO	1/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16665	N/A	N/A	N/A	N/A	N/A	2888 LONG BEACH BLVD STE	210	LONG BEACH	CA	90262	0000	00	06000	33.809706	-118.189343	Los Angeles County
354119	Ordering, Referring, Prescribing	N/A	1972960805	0	0	BOBROSKY, HANNAH LMFT	10/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135036	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
354128	Ordering, Referring, Prescribing	N/A	1972970986	0	0	BOGORAD, YULIYA PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73030	N/A	N/A	N/A	N/A	N/A	329 PIKES COURT	None	MARTINEZ	CA	94553	6220	00	06000	37.9555281	-122.1014048	Contra Costa County
354142	Ordering, Referring, Prescribing	N/A	1972982353	0	0	BRIZENDINE, YOLANDE M LCSW	2/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66388	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
354150	Ordering, Referring, Prescribing	N/A	1982005427	0	0	BARCENAS, VERONICA LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118533	N/A	N/A	N/A	N/A	N/A	5628 E SLAUSON AVE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
354159	Ordering, Referring, Prescribing	N/A	1982013975	0	0	BHANDARI, STUTI MD	3/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144972	N/A	N/A	N/A	N/A	N/A	7750 N. FRESNO STREET	104	FRESNO	CA	93720	2410	00	06000	36.85139259	-119.7836202	Fresno County
354176	Ordering, Referring, Prescribing	N/A	1982044640	0	0	BLUTH, DOUGLAS M DPM	5/29/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5254	N/A	N/A	N/A	N/A	N/A	11899 SHAW PL	None	HANFORD	CA	93230	6644	00	06000	36.30003132	-119.6312291	Kings County
354192	Ordering, Referring, Prescribing	N/A	1982070850	0	0	BACH, CYNTHIA PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72911	N/A	N/A	N/A	N/A	N/A	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3118	00	06000	37.78096053	-122.4637512	San Francisco County
354268	Ordering, Referring, Prescribing	N/A	1982188645	0	0	BUI, DIANA PHARMD	3/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78983	N/A	N/A	N/A	N/A	N/A	27220 HEATHER RIDGE RD	None	LAGUNA NIGUEL	CA	92677	3418	00	06000	33.56677119	-117.7120863	Orange County
354272	Ordering, Referring, Prescribing	N/A	1982197554	0	0	BERNARDO, CHRISTIAN HENRY S MD	8/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166871	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
354279	Ordering, Referring, Prescribing	N/A	1982211546	0	0	BARRETTO, LAUREN LMFT	10/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140537	N/A	N/A	N/A	N/A	N/A	340 LORTON AVE	205	BURLINGAME	CA	94010	4151	00	06000	37.57990909	-122.3467938	San Mateo County
354307	Ordering, Referring, Prescribing	N/A	1982261756	0	0	BOYT, CHRISTOPHER MSW LCSW	4/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114864	N/A	N/A	N/A	N/A	N/A	375 DOVER PKWY	None	DELANO	CA	93215	3438	00	06000	35.76117904	-119.2523551	Kern County
354335	Ordering, Referring, Prescribing	N/A	1982372181	0	0	BATH, PARAMJOT K PHARMD	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84979	N/A	N/A	N/A	N/A	N/A	10331 W GOSHEN AVE	SUIT B	VISALIA	CA	93291	9328	00	06000	36.341388	-119.40633	Tulare County
354347	Ordering, Referring, Prescribing	N/A	1982448577	0	0	BHULLAR, RAVINDER K NP	6/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030465	N/A	N/A	N/A	N/A	N/A	1093 11TH ST	None	REEDLEY	CA	93654	2950	00	06000	36.60074456	-119.4445203	Fresno County
354348	Ordering, Referring, Prescribing	N/A	1982444733	0	0	BUTLER, MORGAN	5/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	726856	N/A	N/A	N/A	N/A	N/A	2390 BASS LAKE ROAD	None	RESCUE	CA	95672	9571	00	06000	38.69608287	-121.0078389	El Dorado County
354360	Ordering, Referring, Prescribing	N/A	1982638623	0	0	BRAVO, JULIAN A MD	6/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C169856	N/A	N/A	N/A	N/A	N/A	1501 WEST IMPERIAL AVENU	None	CALEXICO	CA	92231	1851	00	06000	32.68255505	-115.4993712	Imperial County
354373	Ordering, Referring, Prescribing	N/A	1982708921	0	0	BHATIA, NARENDER N MD	8/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A33956	N/A	N/A	N/A	N/A	N/A	11735 FIRESTONE BLVD	306	NORWALK	CA	90650	2808	00	06000	33.91353706	-118.0831749	Los Angeles County
354379	Ordering, Referring, Prescribing	N/A	1982722310	0	0	BORCHART, ANGELIQUE P LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96160	N/A	N/A	N/A	N/A	N/A	500 AIRPORT WAY	None	CAMARILLO	CA	93010	8500	00	06000	34.2075752	-119.0762641	Ventura County
354384	Ordering, Referring, Prescribing	N/A	1982728093	0	0	BARROSO, ANALIA PHD	11/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24389	N/A	N/A	N/A	N/A	N/A	12440 FIRESTONE BLVD	3025	NORWALK	CA	90650	4328	00	06000	33.90523023	-118.0681168	Los Angeles County
354387	Ordering, Referring, Prescribing	N/A	1982727095	0	0	BERSUDSKY, SHANA E LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45302	N/A	N/A	N/A	N/A	N/A	760 W. MOUNTAIN VIEW ST.	None	ALTADENA	CA	91001	4996	00	06000	34.19178664	-118.1657029	Los Angeles County
354396	Ordering, Referring, Prescribing	N/A	1982738654	0	0	BERNATH, MICHAEL S PHD	12/10/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16049	N/A	N/A	N/A	N/A	N/A	1521 UNIVERSITY AVE	None	BERKELEY	CA	94703	1422	00	06000	37.87060038	-122.2812128	Alameda County
354399	Ordering, Referring, Prescribing	N/A	1982738175	0	0	BROWN, MICHELLE NP	2/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16996	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
354400	Ordering, Referring, Prescribing	N/A	1982746749	0	0	BIMBELA, ALFREDO NP	6/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	15951	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
354410	Ordering, Referring, Prescribing	N/A	1982767844	0	0	BRASWELL, SYLVIA P LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW9345	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
354430	Ordering, Referring, Prescribing	N/A	1982820486	0	0	BLUMENTHAL, LORRAINE B LCSW	6/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60586	N/A	N/A	N/A	N/A	N/A	399 DRAKE AVE.	None	MONTEREY	CA	93940	7504	00	06000	36.6110925	-121.9005527	Monterey County
354446	Ordering, Referring, Prescribing	N/A	1982843579	0	0	BUROFF, KAREN LCSW	12/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112737	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	SUITE 201	EL CAJON	CA	92021	7417	00	06000	32.80772549	-116.94771	San Diego County
354461	Ordering, Referring, Prescribing	N/A	1982870010	0	0	BRICKER, TERRA	4/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51050	N/A	N/A	N/A	N/A	N/A	490 S FARRELL DR	SUITE C 208	PALM SPRINGS	CA	92262	7944	00	06000	33.81651	-116.5180015	Riverside County
354477	Ordering, Referring, Prescribing	N/A	1982910485	0	0	BALDOR, DENINE A NP	5/26/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005536	N/A	N/A	N/A	N/A	N/A	1212 BROADWAY	1200	OAKLAND	CA	94612	1814	00	06000	37.80315112	-122.2718722	Alameda County
354482	Ordering, Referring, Prescribing	N/A	1982900783	0	0	BALLARD, MICHELLE L	5/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75676	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	93707	0000	00	06000	34.54007429	-117.2744761	San Bernardino County
354483	Ordering, Referring, Prescribing	N/A	1982923918	0	0	BRATTON, STEPHEN P PHD	4/14/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	20537	N/A	N/A	N/A	N/A	N/A	2240 OLD RIVER ROAD	None	UKIAH	CA	95482	6103	00	06000	39.1293897	-123.1645436	Mendocino County
354487	Ordering, Referring, Prescribing	N/A	1982927505	0	0	BLANCO, MARIA J LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93082	N/A	N/A	N/A	N/A	N/A	2919 MISSION ST	None	SAN FRANCISCO	CA	94110	3917	00	06000	37.75028364	-122.418239	San Francisco County
354488	Ordering, Referring, Prescribing	N/A	1982938189	0	0	BURGOS, JOSE L LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64083	N/A	N/A	N/A	N/A	N/A	330 EAST LIVE OAK AVENUE	None	ARCADIA	CA	91006	5617	00	06000	34.10850998	-118.0219204	Los Angeles County
354492	Ordering, Referring, Prescribing	N/A	1982941647	0	0	BLACKMON, JOHNNY L LMFT	1/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85029	N/A	N/A	N/A	N/A	N/A	201 N K ST	None	TULARE	CA	93274	4005	00	06000	36.20957262	-119.3464875	Tulare County
354494	Ordering, Referring, Prescribing	N/A	1982947628	0	0	BEBAWY, MADGY A OD	6/5/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14579	N/A	N/A	N/A	N/A	N/A	5632 PHILADELPHIA ST	104	CHINO	CA	91710	8702	00	06000	34.0337373	-117.6827801	San Bernardino County
354501	Ordering, Referring, Prescribing	N/A	1982965760	0	0	BRYANT, NAIMA M LMFT	8/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115434	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
354506	Ordering, Referring, Prescribing	N/A	1982967196	0	0	BHALODIA, ANIL C PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50778	N/A	N/A	N/A	N/A	N/A	3378 S BRISTOL ST	None	SANTA ANA	CA	92704	8203	00	06000	33.70209286	-117.8856779	Orange County
354514	Ordering, Referring, Prescribing	N/A	1982978839	0	0	BOYER, GINA M LMFT	1/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93515	N/A	N/A	N/A	N/A	N/A	6145 IMPERIAL AVE	None	SAN DIEGO	CA	92114	4213	00	06000	32.70948583	-117.0658797	San Diego County
354558	Ordering, Referring, Prescribing	N/A	1992041768	0	0	BUENROSTRO, ELSA Q LCSW	5/5/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83137	N/A	N/A	N/A	N/A	N/A	4141 STATE ST	None	SANTA BARBARA	CA	93110	1814	00	06000	34.4404695	-119.7612045	Santa Barbara County
354577	Ordering, Referring, Prescribing	N/A	1992075923	0	0	BUCHANAN, JANELLE LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108269	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	600	THOUSAND OAKS	CA	91360	4463	00	06000	34.17854676	-118.8805015	Ventura County
354583	Ordering, Referring, Prescribing	N/A	1992084503	0	0	BOHANNON, IAN Y	3/29/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75211	N/A	N/A	N/A	N/A	N/A	871 ENBORG CT.	None	SAN JOSE	CA	95128	2645	00	06000	37.311489	-121.933817	Santa Clara County
354587	Ordering, Referring, Prescribing	N/A	1992085443	0	0	BERNSTEIN, JENNIFER PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62602	N/A	N/A	N/A	N/A	N/A	1001 W CARSON ST STE K	STE K	CARSON	CA	90810	1409	00	06000	33.83183499	-118.2071846	Los Angeles County
354595	Ordering, Referring, Prescribing	N/A	1992103170	0	0	BEASLEY, RANDOLPH M LMFT	10/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120092	N/A	N/A	N/A	N/A	N/A	1430 TRUXTUN AVE	STE 400	BAKERSFIELD	CA	93301	5220	00	06000	35.37345768	-119.0173312	Kern County
354615	Ordering, Referring, Prescribing	N/A	1992123962	0	0	BECKERMAN, JESSICA L MD	7/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141692	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
354649	Ordering, Referring, Prescribing	N/A	1992175822	0	0	BLACKMAN, BRANDI A LMFT	1/5/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113670	N/A	N/A	N/A	N/A	N/A	900 FULTON AVE	205	SACRAMENTO	CA	95825	4517	00	06000	38.581902	-121.4007615	Sacramento County
354656	Ordering, Referring, Prescribing	N/A	1992193726	0	0	BODMAN, RONA DDS	3/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64113	N/A	N/A	N/A	N/A	N/A	1201 INDUSTRIAL ST	None	REDDING	CA	96002	0757	00	06000	40.57469253	-122.349645	Shasta County
354710	Ordering, Referring, Prescribing	N/A	1992298988	0	0	BRESLOW, PATRICE RN BS	4/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	334325	N/A	N/A	N/A	N/A	N/A	4100 NORMAL ST	None	SAN DIEGO	CA	92103	2653	00	06000	32.75524466	-117.1465638	San Diego County
354724	Ordering, Referring, Prescribing	N/A	1992332845	0	0	BAILEY, JENNIFER MD	7/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180443	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
354737	Ordering, Referring, Prescribing	N/A	1992350821	0	0	BEAT, JENNIFER C LMFT	11/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122905	N/A	N/A	N/A	N/A	N/A	222 E MAIN ST	None	BARSTOW	CA	92311	2361	00	06000	34.89870403	-117.025149	San Bernardino County
354739	Ordering, Referring, Prescribing	N/A	1992348239	0	0	BEREDO, LEONORA B NP	1/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013642	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
354746	Ordering, Referring, Prescribing	N/A	1992369409	0	0	BERMEO, WILLIAM L MD	11/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183494	N/A	N/A	N/A	N/A	N/A	3401 AERO JET AVE	None	EL MONTE	CA	91731	2801	00	06000	34.070031	-118.068778	Los Angeles County
354768	Ordering, Referring, Prescribing	N/A	1992421317	0	0	BAILEY, MARTIN S PHARMD	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86925	N/A	N/A	N/A	N/A	N/A	1755 HACIENDA DR	None	VISTA	CA	92081	4546	00	06000	33.18744941	-117.2759225	San Diego County
354806	Ordering, Referring, Prescribing	N/A	1992740518	0	0	BENNETT, IAN M MD	12/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C192310	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DRIVE	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
354808	Ordering, Referring, Prescribing	N/A	1992741755	0	0	BUTLER, MARVIN PA-C	4/1/2016	Taxonomy not applicable	NA	n/a	000	Unknown	PA53193	N/A	N/A	N/A	N/A	N/A	1850 WALNUT ST	None	RED BLUFF	CA	96080	3611	00	06000	40.16904822	-122.2542817	Tehama County
354819	Ordering, Referring, Prescribing	N/A	1992785703	0	0	BONNER, ERNEST L MD	9/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A30477	N/A	N/A	N/A	N/A	N/A	2929 EL CAMINO AVENUE	A	SACRAMENTO	CA	95821	6012	00	06000	38.610846	-121.3945875	Sacramento County
354822	Ordering, Referring, Prescribing	N/A	1992773956	0	0	BULLUM, ANTHONY J OD	11/16/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	8412	N/A	N/A	N/A	N/A	N/A	1328 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
354836	Ordering, Referring, Prescribing	N/A	1992828545	0	0	BECK, MICHAEL V PHD	6/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23034	N/A	N/A	N/A	N/A	N/A	1000 S MAIN ST	#210-B	MONTEREY	CA	93901	2352	00	06000	36.66226091	-121.6578913	Monterey
354838	Ordering, Referring, Prescribing	N/A	1992835797	0	0	BERJIS, SHIVA LMFT	12/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34043	N/A	N/A	N/A	N/A	N/A	15305 RAYEN ST	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
354840	Ordering, Referring, Prescribing	N/A	1992836829	0	0	BADER, CHRISTIAN A	5/27/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D44652	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
354867	Ordering, Referring, Prescribing	N/A	1992874341	0	0	BLANCHFIELD, KELLI LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17218	N/A	N/A	N/A	N/A	N/A	10953 RAMONA BLVD	1298A	EL MONTE	CA	91731	2629	00	06000	34.07205148	-118.0372365	Los Angeles County
354877	Ordering, Referring, Prescribing	N/A	1992890222	0	0	BURT, ANGELA M MD	5/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A93897	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
354887	Ordering, Referring, Prescribing	N/A	1992906796	0	0	BEIL, ANDREA D LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41059	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	SUITE 125-C	OAKLAND	CA	94605	2408	00	06000	37.768221	-122.17608	Alameda County
354899	Ordering, Referring, Prescribing	N/A	1992931174	0	0	BAULDRY, CIARA LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86800	N/A	N/A	N/A	N/A	N/A	354 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3876	00	06000	35.1136354	-120.5916435	San Luis Obispo County
354908	Ordering, Referring, Prescribing	N/A	1992960462	0	0	BOYER, DARREN M MD	6/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111784	N/A	N/A	N/A	N/A	N/A	2001 SANTA MONICA BLVD	490W	SANTA MONICA	CA	90404	2102	00	06000	34.02891163	-118.4797466	Los Angeles County